Frequency Of Antral Contractions Research Articles

Physiological characterization of gastric emptying using high-resolution antropyloroduodenal manometry.

Delayed gastric emptying (GE) has been associated with antral and pyloric dysmotility. We aimed to characterize differences in the antral, duodenal, and pyloric motility profiles associated with delayed GE, using high-resolution antropyloroduodenal manometry (HR-ADM). Patients referred for HR-ADM for dyspeptic symptoms performed a concurrent GE breath test (NCT01519180 and NCT04918329). HR-ADM involved 36 sensors 1 cm apart, placed across the pylorus. Interdigestive and postprandial periods were identified. Antral, pyloric, and duodenal motor profiles were analyzed recording the frequency, amplitude, and propagative nature of contractions for each period. Plots of patients with normal and delayed GE were compared. Sixty patients underwent both HR-ADM and GE tests. Twenty-five and 35 patients had delayed and normal GE, respectively. Antral and duodenal motor profiles were not different between the two groups during the interdigestive period. During the postprandial period, a lower frequency of antral contractions was associated with delayed GE (2.22 vs. 1.39 contractions/min; P = 0.002), but no difference in mean contraction amplitude was observed. The pyloric region was identified in all the patients and pylorospasms, defined as 3 min of repeated isolated pyloric contractions, were more frequent in patients with delayed GE (32.0% vs. 5.7%; P = 0.02) during the postprandial period. No difference in duodenal contraction profiles was observed. Manometric profile alterations were observed in 72% of the patients with delayed GE, with 56% having a low frequency of antral contractions. Using HR-ADM, patients with delayed GE displayed different postprandial antropyloric motility as compared with patients with normal GE.NEW & NOTEWORTHY High-resolution antropyloroduodenal manometry (HR-ADM) allows precise characterization of antral, pyloric, and duodenal motility, although its association with gastric emptying (GE) has been poorly investigated. Concurrent HR-ADM with GE measurement showed a lower frequency of antral postprandial contractions and an increased frequency of postprandial pylorospasms in patients with delayed GE. HR-ADM could, therefore, be useful in the future to better select patients for treatments targeting the pylorus.

Fourier Phase Analysis of Dynamic Antral Contraction Scintigraphy: New Software, Reference Values, and Comparisons to Conventional Gastric Emptying.

Dynamic antral contraction scintigraphy (DACS) has been used to evaluate for gastric dysmotility by measuring antral contraction frequency and ejection fraction (EF). Fourier phase image analysis has the potential to assess gastric antral contractions for dyssynchrony as has been used for analyzing nuclear cardiology ventriculography (multigated acquisition studies) for cardiac dyssynchrony. The aims of this study were to determine whether Fourier phase analysis helps to characterize antral motility physiology, whether Fourier phase analysis correlates with conventional gastric emptying scintigraphy (GES), and which DACS parameters may aid in diagnosing gastric dysmotility, particularly delayed gastric emptying (GE). Methods: DACS and GES of healthy volunteers (n = 22) were compared with patients (n = 99) with symptoms of gastroparesis. New DACS Fourier phase analysis software was developed. Results: GE was delayed (n = 53) or normal (n = 46) in patients. There was a linear correlation between the time for the stomach to empty 50% of the meal and the percentage total proximal and distal in-phase antral pixels at 30 min (r = 0.37, P = 0.0001) and 60 min (r = 0.26, P = 0.007). In healthy volunteers, the mean proximal-to-distal ratio of in-phase antral pixels increased from 1.67 (30 min) to 2.65 (120 min) (P = 0.035), and EF increased from 23% (30 min) to 32% (120 min) (P = 0.022). Multivariable regressions of percentage total proximal and distal in-phase antral pixels (30 min) and EF (60 min) were the best predictors of abnormal GE (adjusted odds ratio, 3.30 [95% CI, 1.21-9.00] and 2.97 [95% CI, 1.08-8.21], respectively). Conclusion: This study used Fourier phase analysis to analyze DACS in healthy volunteers and patients with symptoms of gastroparesis. In addition to establishing reference values, new physiologic information on antral motility was obtained. In healthy volunteers, there was an increasing proximal-to-distal ratio of in-phase antral pixels and antral EF over time after meal ingestion. The percentage total proximal and distal in-phase antral pixels at both 30 and 60 min correlated well with GE values for the time for the stomach to empty 50% of the meal. For symptomatic patients, the percentage total proximal and distal in-phase antral pixels at 30 min and the EF at 60 min after meal ingestion correlated with delayed GE on conventional GES. Thus, Fourier phase analysis of DACS appears to have potential to further aid in diagnosing gastric dysmotility in GES.

Comprehensive characterization of antral and pyloric contractions by high resolution manometry: applied physiology in suspected gastroparesis.

Delayed gastric emptying may result from diverse pathophysiological mechanisms including antral hypomotility and pylorospasm. With increasing use of gastric peroral endoscopic myotomy and preliminary evidence of efficacy, our aim was to assess the motor functions of the distal antrum and pylorus in patients with symptoms of gastroparesis using high-resolution antropyloroduodenal manometry (HR-ADM). Sixteen patients with symptoms suggestive of gastroparesis underwent HR-ADM with 13 sensors, 1 cm apart, placed across the antropyloroduodenal (APD) junction and 2 sensors, 10 cm apart, in descending and distal duodenum. The 1-h postprandial motility was quantitated as contraction frequency/minute, average amplitude, and motility index (MI). Six healthy volunteers served as controls. In the patient group, the HR-ADM identified postprandial antral hypomotility, isolated pyloric pressure waves, and tonic elevation of baseline pressure in pylorus. Patients had significantly reduced frequency of the full-hour postprandial antral contractions/minute compared with healthy volunteers [1.52 (0.97, 1.67) vs. 2.04 (1.70, 2.67), P = 0.005], as well as reduced MI [9.65 (8.29, 10.31) vs. 11.04 (10.65, 11.63), P = 0.002]. The average contraction amplitude was numerically, but not significantly reduced [51.9 (21.9, 74.9) vs. 73.0 (59.8, 82.7), P = 0.14]. Bland-Altman plots showed similar distribution of antral contraction frequency and MI during the first and second postprandial 30-min periods for both patients and controls. High-resolution ADM can characterize a variety of postprandial antral contractile and pyloric motility dysfunctions. This technique shows promise to provide guidance for the selection of optimal treatment of patients with gastroparesis.NEW & NOTEWORTHY Current selection of different treatments for patients with gastroparesis is empiric or based on trial and error, though pyloric distensibility and diameter may predict response to pyloric interventions. High-resolution antropyloroduodenal manometry (HR-ADM) can characterize a variety of postprandial antral contractile and pyloric motility dysfunctions in patients with suspected gastroparesis. HR-ADM shows promise to provide guidance for selection and individualization of treatments such as prokinetic agents or pyloric interventions for patients with gastroparesis based on documented pathophysiology.

Antral contractility following Asian-style meal in healthy volunteers: effect of genders, menstruation, smoking status and age

Objective(s):The normal range of the frequency of antral contractions, similar to other gastric motility parameters, are different depending on the population and the test meal. We, therefore, conducted the analysis to establish the normal ranges for the frequency of antral contractions derived from dynamic antral scintigraphy (DAS) following an Asian-styled solid meal in Thai healthy volunteers.Methods:We retrospectively analyzed the data from the study on normal gastric emptying values. The dynamic scintigraphic images had been obtained in a 45 degree left anterior oblique view during the first 32 minutes following the ingestion of a 267-kcal steamed rice, a technetium-99m-labeled microwaved egg and 100 mL of water. A polynomial normalization model was used to analyze and to calculate the frequency of antral contractions. The data analysis was repeated by the same operator 1 month apart to assess reproducibility.Results:Data of 18 volunteers (10 males and 8 females) were eligible for analysis. The mean±SD of the frequencies of the antral contractions were 3.06±1.08 cycles/min on the first and 3.04±1.10 cycles/min on the second analysis. Comparison of the two analyses revealed a moderate agreement (ICC=0.632, 95% CI 0.329-0.818) without significant difference (p-value=0.942). No significant effect of gender, menstruation status, smoking or age was demonstrated in this study.Conclusion:DAS is a non-invasive technique that can measure the frequency of antral contractions. The technique is reproducible and consistent. Future study may be required to assess the effect of gender, menstruation status, smoking and age.

Effect of acupuncture at Zusanli\xa0(ST36) point on antral contraction function under ultrasound guidance: study protocol of a randomized controlled trial

BackgroundAlthough the relationship between deqi sensations and curative effect has always been controversial, deqi sensations has been regarded as the key indicator of clinical efficacy of acupuncture therapy. There is little evidence for standardization or visualization of the mechanism of acupuncture’s therapeutic effect. This trial aims to evaluate the effect of needling at Zusanli (ST36) on antral contraction function as visualized by ultrasound.MethodsThis is a two-arm, single-blind, randomized, controlled trial. A total of 116 acupuncture-naïve healthy subjects will be randomly allocated to the acupuncture group or sham acupuncture group in a 1:1 ratio. Participants in the acupuncture group will receive manual acupuncture at Zusanli (ST36) with the needling depth at crural interosseous membrane. Those in the sham acupuncture group will be given penetrating needling depth at the superficial fascia layer. The primary outcome will be the changes in antral contraction frequency (ACF) before and after acupuncture. The secondary outcomes will be the changes in the thermal infrared spectrum of gastric area skin, the antral contraction amplitude (ACA), the antral movement index (AMI), and the scores on the Chinese version of Massachusetts General Hospital Acupuncture Sensation Scale (C-MASS). The adverse events will be evaluated and recorded in detail.DiscussionThis study may provide visual and objective evidence regarding the safety and efficacy of manual acupuncture at Zusanli (ST36). In addition, the results of this study will help to identify the role of Zusanli (ST36)in the inducing deqi.Trial registrationChinese Clinical Trial Registry ChiCTR2000040686. Registered on 8 December 2020

A hierarchical model of abdominal configuration changes extracted from golden angle radial magnetic resonance imaging

Abdominal organs are subject to a variety of physiological forces that superimpose their effects to influence local motion and configuration. These forces not only include breathing, but can also arise from cyclic antral contractions and a range of slow configuration changes. To elucidate each individual motion pattern as well as their combined effects, a hierarchical motion model was built for characterization of these 3 motion modes (characterized as deformation maps between states) using golden angle radial MR signals. Breathing motions are characterized first. Antral contraction states are then reconstructed after breathing motion-induced deformation are corrected; slow configuration change states are further extracted from breathing motion-corrected image reconstructions. The hierarchical model is established based on these multimodal states, which can be either individually shown or combined to demonstrate any arbitrary composited motion patterns. The model was evaluated using 20 MR scans acquired from 9 subjects. Poor reproducibility of breathing motions both within as well as between scan sessions was observed, with an average intra-subject difference of 1.6 cycles min−1 for average breathing frequencies of 12.0 cycles min−1. Antral contraction frequency distributions were more stable than breathing, but also presented poor reproducibility between scans with an average difference of 0.3 cycles min−1 for average frequencies of 3.2 cycles min−1. The magnitudes of motions beyond breathing were found to be significant, with 14.4 and 33.8 mm maximal motions measured from antral contraction and slow configuration changes, respectively. Hierarchical motion models have potential in multiple applications in radiotherapy, including improving the accuracy of dose delivery estimation, providing guidance for margin creation, and supporting advanced decisions and strategies for immobilization, treatment monitoring and gating.

SPARC: Simultaneous Assessment of Gastric Emptying and Motility with Contrast Enhanced Magnetic Resonance Imaging in Humans

PurposeMagnetic resonance imaging (MRI) of the gastrointestinal (GI) tract is an emerging technique for non‐invasive assessment of gastric emptying and motility in animals and humans. However, addition of MRI contrast agents to the test meal is often required to produce high luminal contrast to facilitate image analysis. Here, we reported a recipe of a test meal that is all natural (e.g. gadolinium‐free) and safe for humans. The ingredients of the test meal all contain relatively high concentration of manganese, which allow the lumen of the GI tract to be visible inside MRI. To capture gastric emptying and motility simultaneously, we have developed a dynamic 3D imaging protocol with high spatial and temporal resolution and an image segmentation and analysis algorithm.MethodSix healthy volunteers (3 woman; age 24–31) participated in this study. All subjects were asked to fast for 12 hours. Subjects were scanned using a 3T Siemens Prisma MRI scanner using an 18‐channel body coil and a 32‐channel spine coil. Prior to meal consumption, pre‐prandial gastric volume was quantified using a 3D true fast imaging (TRUFI) with steady‐state free precession sequence under free breathing. Then the subjects were instructed to ingest 350 ml of a semi‐solid test meal (263kcal) that contains blended natural foods (i.e. pineapple, banana, blueberry, firm tofu) with a relatively high concentration of manganese. Post‐meal MRI scans were performed using a 3D Spoiled Gradient Echo Variant (VIBE) sequence under gentle breaths over a 90‐minute time course. Post‐prandial gastric volumes, as well as antral contraction frequency and amplitude of the peristaltic wave, were quantified from the dynamic 3D MRI images using a custom‐built image processing pipeline.ResultsPre‐prandial gastric volume was measured prior to test meal consumption (30.98±12.29 mL). After the subjects consumed the test meal, the presence of manganese in the meal enhanced the contrast of the gastric lumen (Fig. 1). The imaging protocol collected fast real‐time MRI scans of the stomach processing and emptying of a meal and the algorithms quantified gastric motility and emptying rate. The stomach volume decreased at a rate of 1.58±0.50 mL/min, mainly attributed to volume decrease in the fundus and the corpus (1.31±0.53 mL/min) than in the antrum (0.28±0.15 mL/min). The frequency of gastric contractions was 2.79±0.17 cycles/min, which was in line with the frequency of gastric slow wave in humans. The displacement of the luminal wall (i.e. contraction amplitude) was greater at the antrum (7.42±1.39 mm) than at the fundus and the corpus (4.52±0.25 mm), as illustrated in Fig. 2.ConclusionHere, we developed a contrast‐enhanced gastric MRI protocol to non‐invasively monitor gastric emptying and motility in humans. Such experimental protocol was further empowered by advanced image analysis to enable comprehensive assessment of gastric functions and physiology. In summary, the proposed method may become a reliable standard to guide diagnosis and treatment of gastric disorders in humans.Support or Funding InformationNIH SPARC OT2OD023847Example gastric MRI images of the stomach distended with the test meal. The contrast of the gastric lumen was significantly enhanced due to the presence of manganese in the meal.Figure 1Mapping amplitude of gastric contractions on the luminal wall. The displacement of the luminal wall was greatest at the antrum, followed by the corpus, and smallest at the fundus.Figure 2

Dynamic changes in early gastric cantrum motility in craniocerebral injury patients

To investigate the dynamic changes in early gastric antrum contraction in patients with craniocerebral injury. The patients with craniocerebral injury admitted to neurosurgery intensive care unit (ICU) of the First Affiliated Hospital of Sun Yat-sen University from July to November in 2018 were enrolled. The changes in antral contraction frequency (ACF), antral contraction amplitude (ACA) and antral motility index (MI) were dynamically observed at 1-6 days after injury by ultrasonography. According to Glasgow coma score (GCS), the patients were divided into moderate to severe craniocerebral (GCS ≤ 11) and mild craniocerebral injury groups (GCS > 11). The differences in ACF, ACA and MI between the two groups were compared to observe the effect of craniocerebral injury on gastric antral motility. The patients were divided into simple supratentorial and supratentorial combined infratentorial lesion groups according to the lesion location of craniocerebral injury. The differences in ACF, ACA and MI between the two groups were compared to analyze the influence of lesion location on gastric antrum activity. A total of 68 patients with craniocerebral injury were screened during the study period, 50 patients were in accorded with the admission criteria, 17 patients were withdrawn from the observation because they could not tolerate the ultrasonography of gastric antrum or discharged from ICU. Finally, 33 patients were enrolled in the analysis. (1) The ACF, ACA and MI at 1 day after injury were lower [ACF (times/min): 1.67 (0.00, 2.00), ACA: 42.06 (0.00, 44.45)%, MI: 0.70 (0.00, 0.87)], and then gradually increased, till 6 days after injury, ACF was 1.83 (1.25, 2.79) times/min, ACA was 56.80 (33.25, 60.77)%, and MI was 0.89 (0.50, 1.70), which showed no differences among all time points (all P > 0.05). (2) The contractile function of gastric antrum in two groups of patients with different degrees of craniocerebral injury was decreased, especially ACA in patients with moderate to severe craniocerebral injury (n = 22), which showed significant differences at 3 days and 5 days after injury as compared with mild craniocerebral injury [n = 11; 3 days: 35.05 (0.00, 53.69)% vs. 58.51 (49.90, 65.45)%, 5 days: 39.88 (0.00, 77.01)% vs. 56.94 (41.71, 66.66)%, both P < 0.05], indicating that the degree of craniocerebral injury affected the contractive function of gastric antrum. However, there was no significant difference in ACF or MI between the two groups at different time points after injury. (3) The contractile function of gastric antrum was decreased after craniocerebral injury in both groups of patients with different lesion locations of craniocerebral injury. The ACF, ACA, and MI at 3-4 days in patients with supratentorial combined infratentorial lesion (n = 12) were slightly lower than those in patients with simple supratentorial lesion [n = 21; 3 days: ACF (times/min) was 0.83 (0.00, 2.00) vs. 2.25 (0.00, 3.00), ACA was 35.05 (0.00, 53.60)% vs. 49.93 (0.00, 63.44)%, MI was 0.29 (0.00, 1.07) vs. 1.23 (0.00, 1.61); 4 days: ACF (times/min) was 1.42 (0.50, 2.63) vs. 2.00 (1.63, 2.63), ACA was 30.45 (21.69, 60.61)% vs. 43.29 (38.41, 53.35)%, MI was 0.50 (0.15, 1.45) vs. 0.97 (0.66, 1.28)] without statistical differences (all P > 0.05), indicating that the lesion location might not affect the contractive function of gastric antrum. In the early stage of craniocerebral injury, the contractile function of gastric antrum was decreased, and the more severe the craniocerebral injury, the worse contractive function of gastric antrum.

Autonomic functions and gastric motility in children with functional abdominal pain disorders.

BACKGROUNDAbdominal pain-predominant functional gastrointestinal disorders (AP-FGIDs) are the most common cause of recurrent abdominal pain in children. Despite its high prevalence, the underlying pathophysiology of this condition is poorly understood.AIMTo assess the role of gastric dysmotility and autonomic nervous system dysfunction in the pathophysiology of AP-FGIDs.METHODSOne hundred children, fulfilling Rome III criteria for AP-FGIDs, and 50 healthy controls, aged 5 to 12 years, were recruited after obtaining parental consent. All patients were investigated for underlying organic disorders. Gastric motility and cardiovascular autonomic functions were assessed using validated non-invasive techniques.RESULTSThe main gastric motility parameters assessed (gastric emptying rate [45.7 vs 59.6 in controls], amplitude [48.7 vs 58.2], frequency of antral contractions [8.3 vs 9.4], and antral motility index [4.1 vs 6.4]) were significantly lower in children with AP-FGIDs (P < 0.05). The post-prandial antral dilatation at 1 min after the test meal significantly correlated with the severity of abdominal pain (P < 0.05). Assessment of autonomic functions in AP-FGID patients showed neither a significant difference compared to the control group, nor a correlation with gastric motility abnormalities (P > 0.05). The duration of pain episodes negatively correlated with the parasympathetic tone (maladaptive parasympathetic tone) (P < 0.05).CONCLUSIONChildren with AP-FGIDs have abnormal gastric motility but normal cardiovascular autonomic functions. There is no relationship between abnormal gastric motility and autonomic functions. The pathogenesis of AP-FGIDs is not related to cardiovascular autonomic dysfunction.

Tolerable pain reduces gastric fundal accommodation and gastric motility in healthy subjects: a crossover ultrasonographic study

BackgroundObstacles to pain management include patients’ reluctance to inform healthcare provides about their pain, and differences in the pain management aims between patients and healthcare providers. The objective of this study was to evaluate whether tolerable pain influences gastric fundal accommodation and gastric motility in healthy subjects.MethodsWe undertook a crossover comparison study to evaluate gastric fundal accommodation and gastric motility in 74 healthy subjects in the presence or absence of tolerable pain. The intensity of tolerable pain was defined as the upper limit of pain compatible with comfortable daily life. Pain was generated by clipping a clothes pin to the ear lobe, and the intensity of pain was adjusted by inserting the gauze between the ear lobe and the pin. Gastric fundal accommodation and gastric motility were assessed by external ultrasonography. The cross-sectional area of the proximal stomach was measured after subjects had taken 100 mL-liquid meals four times, then the amplitude and frequency of antral contractions were measured.ResultsThe median numerical rating scale of tolerable pain was 3 (interquartile rang 2–4). Gastric fundal accommodation, gastric motility and gastric emptying were all significantly impaired by tolerable pain (P < 0.001 for all comparisons).ConclusionsEven tolerable pain can reduce gastric fundal accommodation and gastric motility, which could result in anorexia or decreased quality of life. Our findings provide important insights into pain management education for patients tolerating pain and healthcare providers encouraging patients to tolerate pain. This study was registered retrospectively.

Abdominal migraine in children: association between gastric motility parameters and clinical characteristics.

BackgroundApproximately 0.2–1 % of children suffers from abdominal migraine (AM). Pathophysiology of AM has not been adequately studied. This study evaluated gastric motility in children with AM.MethodsSeventeen children (6 boys), within an age range of 4–15 years, referred to a tertiary care paediatric unit, North Colombo Teaching Hospital Ragama, Sri Lanka, from 2007 to 2012, were screened. Those fulfilling Rome III criteria for AM were recruited after obtaining parental consent. None had clinical or laboratory evidence of organic disorders. Twenty healthy children (8 boys), with an age range of 4–14 years, were recruited as controls. Liquid gastric emptying rate (GE) and antral motility parameters were assessed using an ultrasound method.ResultsAverage GE (41.6 % vs. 66.2 %, in controls), amplitude of antral contractions (A) (57.9 % vs. 89.0 %) and antral motility index (MI) (5.0 vs. 8.3) were lower and fasting antral area (1.8 cm2 vs. 0.6 cm2) was higher in children with AM (p < 0.01). No significant difference in the frequency of antral contractions (F) (8.8/3 min vs. 9.3/3 min, p = 0.08) was found between the two groups. Scores obtained for severity of abdominal pain had a negative correlation with A (r = −0.55, p = 0.03). Average duration of abdominal pain episodes correlated with GE (r = −0.58, p = 0.02). Negative correlations were observed between duration of AM and A (r = −0.55), F (r = −0.52), and MI (r = −0.57) (p < 0.05).ConclusionsGE and antral motility parameters were significantly lower in children with AM. A significant correlation was found between symptoms and gastric motility. These findings suggest a possible role of abnormal gastric motility in the pathogenesis of AM.

Modulation of vagal tone enhances gastroduodenal motility and reduces somatic pain sensitivity

The parasympathetic nervous system, whose main neural substrate is the vagus nerve, exerts a fundamental antinociceptive role and influences gastrointestinal sensori-motor function. Our research question was to whether combined electrical and physiological modulation of vagal tone, using transcutaneous electrical vagal nerve stimulation (t-VNS) and deep slow breathing (DSB) respectively, could increase musculoskeletal pain thresholds and enhance gastroduodenal motility in healthy subjects. Eighteen healthy subjects were randomized to a subject-blinded, sham-controlled, cross-over study with an active protocol including stimulation of auricular branch of the vagus nerve, and breathing at full inspiratory capacity and forced full expiration. Recording of cardiac derived parameters including cardiac vagal tone, moderate pain thresholds to muscle, and bone pressure algometry, conditioned pain modulation using a cold pressor test and a liquid meal ultrasonographic gastroduodenal motility test were performed. Cardiac vagal tone increased during active treatment with t-VNS and DSB compared to sham (p=0.009). In comparison to sham, thresholds to bone pain increased (p=0.001), frequency of antral contractions increased (p=0.004) and gastroduodenal motility index increased (p=0.016) with active treatment. However, no effect on muscle pain thresholds and conditioned pain modulation was seen. This experimental study suggests that this noninvasive approach with combined electrical and physiological modulation of vagal tone enhances gastroduodenal motility and reduces somatic pain sensitivity. These findings warrant further investigation in patients with disorders characterized with chronic pain and gastrointestinal dysmotility such as functional dyspepsia and irritable bowel syndrome.

PP‐14 EFFECTS OF BODY MASS INDEX ON GASTRIC MOTILITY IN CHILDREN WITH ABDOMINAL PAIN‐PREDOMINANT FUNCTIONAL GASTROINTESTINAL DISORDERS

Introduction:There is evidence that overweight children have a higher prevalence of functional gastrointestinal disorders (FGIDs) than normal‐weight children. Objective of this study was to assess the effects of body mass index (BMI) on gastric motility abnormalities in children with abdominal pain‐predominant FGIDs (AP‐FGIDs).Methods:Gastric motility parameters of 100 children with AP‐FGIDs (61(61%) girls, mean age 8.0 years [SD 2.1years] and 50 healthy controls (30 (30%) boys, mean age 8.6 years [SD 1.9 years]) were assessed at the Gastroenterology Research Laboratory of Faculty of Medicine, University of Kelaniya, Sri Lanka, using a previously validated ultrasound method. AP‐FGIDs were diagnosed using Rome III criteria. Fifty‐four had functional abdominal pain, 23 had irritable bowel syndromes, 9 had functional dyspepsia, 8 had abdominal migraine and 6 had more than one AP‐FGID.Results:Patients with AP‐FGIDs had significantly lower gastric emptying rate (44.9% vs. 59.5% in controls, p &lt; 0.0001), frequency of antral contractions (8.29 vs. 9.44, p &lt; 0.0001), amplitude of antral contraction (48.6% vs. 58.1%, p &lt; 0.0001) and antral motility index (4.0 vs. 6.4, p = 0.001). Fasting antral size (FA) and antral area at 1minute (AA1) and antral area at 15 minutes (AA15) after ingestion of the liquid test meal were not significantly different. BMI of children with AP‐FGIDs and controls were respectively 15.2 and 15.6 (p = 0.42). The correlations between BMI and AA1 (r = 0.29, p = 0.007), AA15 (r = 0.32, p = 0.003) and MI (r = 0.22, p = 0.038) in children with AP‐FGIDs were significant. Patients with BMI &lt;15Kg/m2 had a lower FA (1.5cm2 vs. 2.1cm2, p = 0.03), AA1 (8.9 cm2 vs. 10.7 cm2, p = 0.003) and AA15 (4.6 cm2 vs. 5.8 cm2, p = 0.01) than patients with BMI &gt;15Kg/m2.Conclusions:BMI has an impact on certain gastric motility parameters in children with AP‐FGIDs. However, it does not contribute to abnormalities seen in main gastric motility parameters such as gastric emptying.

Gastric Motility Following Ingestion of a Solid Meal in a Cohort of Adult Asthmatics

Background/AimsAsthmatics have abnormal esophageal motility and increased prevalence of gastroesophageal reflux disease (GERD). The contribution of gastric motility is less studied. We studied gastric myoelectrical activity, gastric emptying (GE) and their association with GERD symptoms and vagal function in adult asthmatics.MethodsThirty mild, stable asthmatics and 30 healthy controls underwent real-time ultrasonography and 1 hour pre- and post-prandial cutaneous electrogastrography, following a test meal (480 kcal, 60% carbohydrate, 20% protein, 20% fat and 200 mL water). The percentage of normal slow waves and arrhythmias, dominant frequency and power, frequency of antral contractions, gastric emptying rate (GER) and antral motility index (MI) was calculated. Twenty-seven asthmatics underwent gastroscopy and in all subjects GERD symptoms were assessed by a validated questionnaire. Vagal function parameters were correlated with gastric motility parameters.ResultsThe asthmatics (37% male; 34.8 ± 8.4 years) and controls (50% male; 30.9 ± 7.7 years) were comparable. None had endoscopic gastric pathological changes. Twenty asthmatics described GERD symptoms. Twenty-two (73.3%) asthmatics showed a hypervagal response. Compared to controls, asthmatics had delayed GER and lower MI, lower percentage of normal gastric slow waves, more gastric dysrythmias and failed to increase the post-prandial dominant power. There was no correlation of GE and cutaneous electrogastrography parameters with presence of GERD symptoms or with vagal function.ConclusionsAsthmatics showed abnormal gastric myoelectrical activity, delayed GE and antral hypomotility in response to a solid meal compared to controls. There was no association with vagal function or GERD symptom status.

Gastric emptying and antral motility parameters in children with functional dyspepsia: Association with symptom severity

Functional dyspepsia (FD) is an important gastrointestinal problem with obscure etiology. Abnormal gastric motility is suggested as a possible pathophysiological mechanism for symptoms. The main objective of this study was to assess gastric motility in Sri Lankan children with FD. Forty-one children (19 [46.3%] males, age 4-14 years, mean 7.5 years, SD 2.6 years) referred to the Gastroenterology Research Laboratory, Faculty of Medicine, University of Kelaniya, from January 2007 to December 2011, were screened. Those fulfilling Rome III criteria for FD were recruited. None had clinical or laboratory evidence of organic disorders. Twenty healthy children were recruited as controls (eight [40%] males, age 4-14 years, mean 8.4 years, SD 3.0 years). Liquid gastric emptying rate (GE) and antral motility parameters were assessed using an ultrasound-based method. Average GE (45.6% vs 66.2% in controls), amplitude of antral contractions (58.2% vs 89.0%) and antral motility index (5.1 vs 8.3) were lower and fasting antral area (1.5 cm(2) vs 0.6 cm(2)) was higher in patients with FD (P < 0.01). Frequency of antral contractions (8.8 vs 9.3) did not show a significant difference (P = 0.07). Scores obtained for severity of abdominal pain negatively correlated with GE (r = -0.35, P = 0.025). Children with FD, exposed to stressful events had higher fasting antral area (1.9 cm(2)) than those not exposed to stress (1.0 cm(2)) (P = 0.02). GE and antral motility parameters were significantly impaired in children with FD compared with controls. GE negatively correlated with severity of symptoms. This study points to disturbances in gastric motility as an etiological factor for FD.

Ultrasonographic Assessment of Liquid Gastric Emptying and Antral Motility According to the Subtypes of Irritable Bowel Syndrome in Children

Gastric motor abnormalities have been reported in adults with irritable bowel syndrome (IBS), commonly in constipation-predominant IBS (IBS-C); however, such studies are uncommon in children. Furthermore, differences of gastric motility have not been studied in children with different IBS subtypes. Seventy-six children (33 [43%] boys, age 4-14 years, mean 7.9 years, SD 3.0 years) fulfilling Rome III criteria for IBS and 20 healthy controls (8 [40%] boys, age 4-14 years, mean 8.4 years, SD 3.0 years) were recruited (diarrhea-predominant IBS=21, IBS-C=31, mixed IBS=19, and unsubtyped IBS=5). Liquid gastric emptying rate (GER) and antral motility were assessed using an ultrasound method. Average GER (43.8% vs 66.2% in controls), amplitude of antral contractions (56.4% vs 89%), and antral motility index (5.1 vs 8.3) were lower and fasting antral area (1.6 vs 0.6) was higher in patients with IBS (P<0.0001). Frequency of antral contractions F (8.9 vs 9.3) did not show a significant difference. Patients exposed to stressful events had a significantly lower GER, compared to those not exposed to such events (P=0.03). Gastric motility parameters had no correlation with severity of symptoms. GER (42.6%, 46.3%, 39.6%), fasting antral area (1.4 cm², 1.8 cm², 1.8 cm²), amplitude of antral contractions (53%, 58.9%, 51.8%), frequency of antral contractions (8.7, 8.9, 9.2), and antral motility index (4.7, 5.3, 4.8) were not different among diarrhea-predominant IBS, IBS-C, and mixed IBS (P>0.05). GER and antral motility parameters were significantly impaired in children with IBS compared with controls. GER and antral motility parameters were not different between IBS subtypes.

Ultrasonographic study of antral motility in patients with Barrett's oesophagus and erosive oesophagitis

Background: Antral contractility and antroduodenal motility are major physiologic determinants of gastric emptying (GE). Delayed GE has been demonstrated in patients with reflux disease. In our previous study, using ultrasonography, we have investigated the role of the proximal stomach in the GE of patients with erosive oesophagitis (EO) or with Barrett's oesophagus (BO). The aim of the present study was the assessment of the antral contractility and its role in GE in these two subsets of patients with reflux disease. Patients and methods: Twenty-one patients BO, 17 patients with moderate EO (10 LA-A; 7 LA-B), and 19 control persons (CP) without history of reflux symptoms or dyspepsia were enrolled into the study. After an overnight fast the subjects ingested 500ml of a low calorie content semisolid test meal. The GE was characterized by the reduction of the residual gastric content calculated from the change of cross-sectional areas determined at predefined time points over a period of 240min after ingestion of the test meal. The frequency of antral contractions was counted for 3min at each time point. The amplitude of contractions was calculated from the maximal reduction of the antral area for each contraction. The motility index (MI) was expressed as the multiplication of the mean amplitude and frequency of the contractions. Results: GE was significantly slower in patients with BO and EO than in CP. In patients with BO a significant decrease of the MI was observed in the first 90 minutes of the study, whereas significant reduction of MI occurred only in the first 45 minutes in patients with EO. A negative correlation was observed between the GE and MI in the first 45min of the study in both groups of patients with reflux disease. Conclusions: Impaired antral motility and delayed GE are demonstrated in patients with BO and EO. Antral dysmotility was more pronounced in patients with BO. A possible role of increased biliary reflux in patients with BO warrants further investigation.

Delayed gastric emptying rates and impaired antral motility in children fulfilling Rome III criteria for functional abdominal pain

Gastric sensorymotor dysfunctions have been implicated in the pathophysiology of some functional gastrointestinal disorders, such as functional dyspepsia and irritable bowel syndrome. Therefore, we hypothesized that abnormal gastric emptying and impaired antral motility are possible underlying mechanisms of symptoms in children with functional abdominal pain (FAP). Hundred and two children [37 (36.3%) males, 4-14 years, mean 7.8 years, SD 2.7 years] fulfilling Rome III criteria for FAP were recruited for this study. An age and sex compatible group of healthy children (n = 20) were selected as controls [8 (40%) males, 4-14 years, mean 8.4 years, SD 3.0 years]. Liquid gastric emptying rate (GER) and antral motility parameters (amplitude of antral contractions, frequency of antral contractions and antral motility index) were assessed using a previously reported ultrasound method. Average GER (42.1% vs 66.2% in controls), amplitude of antral contractions (56.5% vs 89%), frequency of contractions per 3 min (8.5 vs 9.3), and antral motility index (4.9 vs 8.3) were significantly lower in patients with FAP compared with controls (P < 0.01). Fasting antral area was higher in patients (1.4 vs 0.6, P < 0.0001). GER negatively correlated with the scores obtained for severity of abdominal pain (r = -0.29, P = 0.004). Gastric emptying rate and antral motility parameters were significantly impaired in patients with FAP and GER negatively correlated with symptom severity. These findings highlight the possible role of gastrointestinal motility abnormalities in the pathophysiology of childhood FAP.

Effect of ginger on gastric motility and symptoms of functional dyspepsia.

To evaluate the effects of ginger on gastric motility and emptying, abdominal symptoms, and hormones that influence motility in dyspepsia. Eleven patients with functional dyspepsia were studied twice in a randomized double-blind manner. After an 8-h fast, the patients ingested three capsules that contained ginger (total 1.2 g) or placebo, followed after 1 h by 500 mL low-nutrient soup. Antral area, fundus area and diameter, and the frequency of antral contractions were measured using ultrasound at frequent intervals, and the gastric half-emptying time was calculated from the change in antral area. Gastrointestinal sensations and appetite were scored using visual analog questionnaires, and blood was taken for measurement of plasma glucagon-like peptide-1 (GLP-1), motilin and ghrelin concentrations, at intervals throughout the study. Gastric emptying was more rapid after ginger than placebo [median (range) half-emptying time 12.3 (8.5-17.0) min after ginger, 16.1 (8.3-22.6) min after placebo, P≤0.05]. There was a trend for more antral contractions (P=0.06), but fundus dimensions and gastrointestinal symptoms did not differ, nor did serum concentrations of GLP-1, motilin and ghrelin. Ginger stimulated gastric emptying and antral contractions in patients with functional dyspepsia, but had no impact on gastrointestinal symptoms or gut peptides.

Re: Myocardial Infarction Associated with Adderall XR and Alcohol Use in a Young Man

<i>Background</i>—Animal studies have shown that motilin affects gall bladder motility. In humans, no effect has been shown, but erythromycin, a motilin receptor agonist, induces gall bladder emptying. <i>Aims</i>—To explore the effect of increasing doses of exogenous motilin on gall bladder volume and antral contractility in the fasted state in humans. <i>Methods</i>—After an overnight fast, eight healthy men received increasing intravenous doses of Leu¹³-motilin (KW-5139) or 0.9% NaCl in a double blind, randomised fashion. Gall bladder volume and antral contraction frequency were determined by ultrasonography. <i>Results</i>—Infusion of motilin increased plasma motilin levels. Motilin induced a reduction in gall bladder volume of 8.0 (5.0)%, 17.1 (5.0)%, 18.5 (4.7)%, and 16.1 (4.9)% of baseline volume at the end of infusion of 2, 4, ,8 and 16 pmol/kg/min respectively, compared with mean stable gall bladder volumes during placebo infusion (p&lt;0.05). Antral contraction frequency increased during motilin infusion, but not during placebo infusion (p&lt;0.05). <i>Conclusions</i>—Exogenous motilin reducted fasting gall bladder volume and increased antral contractions. After reaching maximal reduction, the gall bladder volume did not decrease further during continuous motilin infusion at higher doses and stayed at the same reduced volume. The degree of gall bladder volume reduction during motilin infusion mimicked gall bladder emptying preceding antral phase III activity of the migrating motor complex in humans. This study indicates that motilin may play a physiological role in the regulation of gall bladder emptying in the fasted state.