Measurement Of Gastric Emptying Research Articles

A 25-Year Longitudinal Evaluation of Gastric Emptying in Diabetes

OBJECTIVETo evaluate the natural history of gastric emptying in diabetes.RESEARCH DESIGN AND METHODSThirteen patients with diabetes (12, type 1; 1, type 2) had measurements of gastric emptying, blood glucose levels, glycated hemoglobin, upper gastrointestinal symptoms, and autonomic nerve function at baseline and after 24.7 ± 1.5 years.RESULTSThere was no change in gastric emptying of either solids (% retention at 100 min) (baseline 58.5 ± 5% vs. follow-up 51.9 ± 8%; P = 0.35) or liquids (50% emptying time) (baseline 29.8 ± 3 min vs. follow-up 34.3 ± 6 min; P = 0.37). Gastric emptying of solid at follow-up was related to emptying at baseline (r = 0.56, P < 0.05). At follow-up, blood glucose concentrations were lower (P = 0.006), autonomic function deteriorated (P = 0.03), and gastrointestinal symptoms remained unchanged (P = 0.17).CONCLUSIONSIn unselected patients with diabetes, gastric emptying appears remarkably stable over 25 years.

Performance characteristics of scintigraphic measurement of gastric emptying of solids in healthy participants

Gastric emptying (GE) is measured in pharmacodynamic and diagnostic studies. Our aim was to assess inter- and intra-subject coefficients of variation (COV) of scintigraphic GE measurements in healthy subjects, and associations of GE with gender and body mass index (BMI). Data from participants with scintigraphic measurements of gastric emptying of solids were analyzed. Primary endpoints were gastric emptying T(1/2) (GE T(1/2) ) and GE at 1, 2, 3, and 4 h. The patient cohort consisted of 105 males and 214 females; at least two studies were performed in 47 subjects [16 males (M), 32 females (F)]. Inter-subject COV (COV(inter) ) for GE T(1/2) were similar in M and F: overall 24.5% (M 26.0%, F 22.5%); COV are predictably lowest for GE at 4 h (COV(inter) 9.6%). COV(intra) for T(1/2) and GE at 4 h were overall 23.8% and 12.6%, and were similar to COV(inter) values. Gender (but not age or BMI) was significantly associated with GE T1/2 [P < 0.001, F 127.6 ± 28.7 (SD) min; M 109.9 ± 28.6 min] and with GE at 1 h and 2 h. Repeat GE T(1/2) values in 47 participants were significantly correlated (r = 0.459, P < 0.001) with median difference of -6 min (mean -1.6, range -56 to 72 min). Bland-Altman plots showed Δ GE T(1/2) similarly distributed across mean GE T(1/2) 100-155 min, and across studies conducted 90-600 days apart. Inter-subject variations in scintigraphic GE results are only slightly higher than the intra-subject measurements, which are also reproducible over time in healthy volunteers. Gender, but not BMI, is significantly associated with GE results.

The effects of fasting duration on gastric emptying in man, an exploration of the role of the endocannabinoid system and inter‐individual responsiveness

In animal studies, gut vagal afferent neurons express cannabinoid (CB1) receptors, whose expression is increased by fasting. We aimed to explore the possibility that similar effects might be relevant in man in controlling gastric emptying. Fourteen healthy volunteers underwent measurements of gastric emptying using the (13) C acetate breath test, after either a nutrient (skimmed milk) or non-nutrient (water) meal following both a 12 and 24 h fast. Further gastric emptying studies were performed with and without the CB1 receptor antagonist Rimonabant (20 mg or 80 mg). Because of the inter-individual variations observed, two subjects underwent additional studies with and without Rimonabant to determine intra-individual consistency. Gastric emptying was evaluated as cumulative C13 : C12 ratio values, measured at 5 min intervals for 30 min. In the group as a whole, fasting duration slowed gastric emptying for both the nutrient [120 ± 30 (mean ± SD) vs 101 ± 34, P < 0.05] and non-nutrient [226 ± 62 vs 177 ± 47, P < 0.05] meals, but there was no effect of Rimonabant. However, there was consistent inter individual variation; thus while 12 subjects showed a slowing, two (14%) exhibited accelerated gastric emptying for both the nutrient and the non-nutrient meal after 24 h fasting and in one of whom, Rimonabant consistently reversed the fasting effect on the non-nutrient meal. Extended fasting alters the gastric emptying of liquid meals but there are consistent differences between individuals. Where there is an accelerated response to fasting, Rimonabant appears to reverse the effect.

Gastric emptying and symptoms of bulimia nervosa: Effect of a prokinetic agent

ObjectivePrevious studies have suggested that delayed gastric emptying and abnormal postprandial release of hormones that influence satiation, particularly cholecystokinin (CCK), may play an important role in the pathophysiology of bulimia nervosa (BN). This study was designed to test these hypotheses as well as the efficacy of the prokinetic agent erythromycin in patients with BN. MethodThirty-two normal-weight women with BN and 24 control participants consumed a large liquid test meal. Gastric emptying and pre- and postprandial release of CCK, peptide YY (PYY), and ghrelin were determined. Participants with BN were then recruited for double-blind treatment with erythromycin up to 500mg three times daily vs. placebo for 6 weeks, following which they consumed a repeat test meal with gastric emptying and appetitive hormone measurements. ResultsCCK release at 15 min following the meal was marginally lower (p=0.1) in BN than in control participants. Rate of gastric emptying and postprandial hormone release were similar in BN and controls. BN patients assigned to erythromycin compared to those assigned to placebo had more rapid gastric emptying following treatment, but there were no differences in release of CCK, PYY, or ghrelin following the post-treatment test meal. Moreover, treatment with erythromycin was not associated with clinical response. DiscussionThe current study does not support the clinical utility of moderate dose erythromycin in treating BN. Furthermore, the findings suggest that a modest increase in gastric emptying rate is associated neither with altered postprandial hormonal release nor with clinical benefit in these patients. While providing no evidence for the effectiveness of prokinetic agents in this setting, our findings do not preclude the possibility that a greater increase in gastric emptying rate might prove beneficial.

Simultaneous measurement of gastric emptying and gastrocecal transit times in conscious rats using a breath test after ingestion of [1-&lt;sup&gt;13&lt;/sup&gt;C] acetic acid and lactose-[&lt;sup&gt;13&lt;/sup&gt;C] ureide

This study reports a method for the evaluation of both gastric emptying and gastrocecal transit times in rats simultaneously by using the same breath testing system measuring equipment. Male rats were used after fasting. Gastric emptying and gastrocecal transit time were evaluated by using [1-13C] acetic acid (8 mg/kg) and lactose-[13C] ureide (60 mg/kg), respectively. A mixture of both 13C-labelled compounds dissolved in Racol (liquid nutrient formula) was administered orally. The level of 13CO2 in the expired air was measured using an infrared spectrometer at appropriate intervals for a period of 420 min. The level of 13CO2 in the expired air from [1-13C] acetic acid increased with time and peaked at about 30 min before decreasing, while that from lactose-[13C] ureide increased after about 180 min. The time taken to reach the maximum value of gastric emptying (Tmax) was 27.5±0.9 min. Gastrocecal transit time was 180±11.5 min, which was calculated as the time before the 13CO2 value increased again. These results accorded with the results of gastric emptying and gastrocecal transit time evaluated by using each 13C-labelled compound separately. These results demonstrate that this method is useful for the simultaneous evaluation of gastric emptying and gastrocecal transit times in rats.

Peripheral Effects of Rimonabant on Upper Gastrointestinal Motility

Background: Rimonabant (SR 141716A) is an antagonist-inverse agonist of cannabinoid receptor 1 (CB1), which was developed for the obesity treatment. The aim of this study was to investigate effects of rimonabant on gastric emptying, gastric tone, accommodation and compliance, antral contractions and small intestinal contractions in dogs. Materials and Methods: Six dogs were equipped with a duodenal cannula for the measurements of gastricemptying, small bowel contractions and small bowel slow waves. Another six dogs were equipped with a gastric cannula for the measurements of gastric tone, accommodation and compliance, antral contractions and gastric slow waves. Each of the measurements was obtained in one control and two rimonabant sessions (different doses). Results: 1) Rimonabant accelerated gastric emptying of liquids and the effect was more potent at a dose of 1 mg/kg than 0.5 mg/kg; 2) Rimonabant increased gastric tone and reduced gastric compliance and accommodation with the 1.0 mg/kg dose being more potent; 3) Rimonabant inhibited antral contractions; 4) Rimonabant increased small intestinal contractions. The small intestinal contraction index was 9.60 ± 2.44 in the control session and increased to 12.35 ± 1.45 with rimonabant 0.5mg/kg (p=0.018 vs. control) and 14.75 ± 2.46 with rimonabant 1 mg/kg (p=0.008 vs. control). Conclusions: Rimonabant reduces gastric compliance and accommodation, inhibits antral contractions but increases intestinal motility. These findings suggest the peripheral mechanisms of rimonabant in reducing food intake and body weight.

Effect of jatrorrhizine on delayed gastrointestinal transit in rat postoperative ileus

Postoperative ileus is major cause of postoperative complication and prolonged hospitalization. Jatrorrhizine, which is a protoberberine alkaloid isolated from the medicinal plants Berberis aristata and Coptis chinensis, has been found to increase contractility of gastric antral and ileum smooth muscles of rat gastrointestinal tract. We have investigated whether jatrorrhizine could offset gastrointestinal transit in rat with postoperative ileus. Postoperative ileus was induced by laparotomy with intestinal manipulation under anaesthesia. Gastrointestinal transit was evaluated by measurement of gastric emptying, geometric centre and the migration of Evans blue. Postoperative ileus significantly delayed gastric emptying and intestinal transit. Jatrorrhizine dose-dependently (0.1, 0.3 and 1 mg/kg) offset delayed gastric emptying and intestinal transit (geometric centre and the migration of Evans blue) in postoperative ileus. Pretreatment of animals with atropine inhibited the action of jatrorrhizine on gastric emptying and intestinal transit, but pretreatment of animals with SB204070 did not influence the effect of jatrorrhizine on gastric emptying and intestinal transit in postoperative ileus. Jatrorrhizine offset postoperative ileus-induced delayed gastric emptying and intestinal transit in rats, an action mediated via the cholinergic pathway, but not involving activation of 5-HT(4) receptors.

Application of the lactose13C‐ureide breath test for measurement of equine orocaecal transit time

Application of the lactose (13) C-ureide breath test (LUBT) for measurement of equine orocaecal transit time (OCTT) has not been reported previously. The ability to assess OCTT noninvasively, and to investigate its relationship to gastric emptying rate and small intestinal transit, would be of both clinical and research value. 1) Assessment of the LUBT in healthy horses, with comparison of induced versus noninduced test protocols. 2) Application of a new dual stable isotope breath test (lactose (13) C-ureide and (13) C-octanoic acid) for gastrointestinal transit measurement. The LUBT will allow quantification of equine OCTT, and test efficacy will be enhanced by prior administration of lactose (12) C-ureide as shown in vitro. The dual tracer breath test will permit simultaneous measurement of gastric emptying, OCTT and small bowel transit times. Induced and noninduced LUBTs were performed in 3 healthy mature horses in randomised order using a standard test meal and protocol. Combined LUBT and (13) C-octanoic acid breath tests ((13) C-OABT) were performed in 4 individuals on 4 occasions at weekly intervals. Expiratory isotopic recovery was modelled to allow generation of gastric emptying data, small bowel transit times and caecal transit parameters. The induction protocol for the LUBT increased the rate and magnitude of expiratory (13) CO(2) significantly. Mean ± s.d. values for OCTT, caecal lag phase (t(lag) ) and caecal t(1/2) using the induced LUBT were 3.24 ± 0.65 h, 5.62 ± 1.22 h and 6.31 ± 1.21 h, respectively. Dual stable isotope tests resulted in the production of 2 discrete peaks in expiratory (13) CO(2) in 15/16 tests from which gastric t(1/2), OCTT and small bowel transit (SBT) parameters could be calculated. The induced LUBT provides a reliable noninvasive measure of equine OCTT and can be paired with the (13) C-OABT to provide further information about small intestinal motility.

Inter‐observer reproducibility and analysis of gastric volume measurements and gastric emptying assessed with magnetic resonance imaging

Magnetic resonance (MR) imaging provides direct, non-invasive measurements of gastric function and emptying. The inter-observer variability (IOV) of MR volume measurements and the most appropriate analysis of MR data have not been established. To assess IOV of total gastric volume (TGV) and gastric content volume (GCV) measurements from MR images and the ability of standard power exponential (PowExp), and a novel linear exponential (LinExp) model to describe MR data. Ten healthy volunteers received three different volumes of a liquid nutrient test meal (200-800 mL) on 3 days in a randomized order. Magnetic resonance scans were acquired using a 1.5T system every 1-5 min for 60 min. Total gastric volume and GCV were measured independently by three observers. Volume data were fitted by PowExp and LinExp models to assess postprandial volume change and gastric emptying half time (T(50) ). An initial rise in GCV and TGV was often observed after meal ingestion, thereafter GCV and TGV decreased in an approximately linear fashion. Inter-observer variability decreased with greater volumes from 12% at 200 mL to 6% at 600 and 800 mL. Inter-observer variability for T(50) was <5%. PowExp and LinExp models provided comparable estimates of T(50) ; however, only LinExp described dynamic volume change in the early postprandial period. Gastric MR provides quantitative measurements of postprandial volume change with low IOV, unless the stomach is nearly empty. The novel LinExp model describes the dynamic volume changes in the early postprandial period more accurately than the PowExp model used in existing gastric emptying studies.

HLA-DQ genotype is associated with accelerated small bowel transit in patients with diarrhea-predominant irritable bowel syndrome

Colonic transit (CT) is accelerated in 46% of patients with diarrhea-predominant irritable bowel syndrome (IBS-D). Improvement in IBS-D with gluten withdrawal is associated with human leukocyte antigen (HLA)-DQ2 positivity; the mechanism of improvement is unclear. To determine if HLA-DQ2-positive or HLA-DQ8-positive patients with IBS-D have faster small bowel (SB) or CT than HLA-DQ2-negative and HLA-DQ8-negative patients. Among 94 patients with IBS-D, who previously provided DNA samples, 64 had undergone validated measurements of CT [geometric center at 24 h (GC24)]; 50 of the patients also had measurement of gastric emptying (GE) and 54 of SB transit (colonic filling at 6 h). HLA-DQ status was determined by tag single nucleotide polymorphism approach. Associations of colonic filling at 6 h and GC24 with HLA-DQ2 and HLA-DQ8 status were assessed using analysis of covariance, adjusting for BMI. Mean age was 40.8±1.6 years; 98.5% were females. In 60 of the 64 patients, celiac disease was excluded by serology or histology. There were no significant differences in age or BMI among the different HLA-DQ groups. Independently, patients positive for HLA-DQ2 had numerically greater colonic filling at 6 h compared with HLA-DQ2-negative (P=0.065), and those positive for HLA-DQ8 had greater colonic filling at 6 h compared with HLA-DQ8-negative patients (P=0.021). Gastric emptying was not associated with HLA-DQ2 and HLA-DQ8 status. Patients positive for both HLA-DQ2 and HLA-DQ8 had greater colonic filling at 6 h (P=0.013) and numerically higher, but not significant, GC24 (P=0.38) compared with HLA-DQ2-negative and HLA-DQ8-negative patients. Patients with IBS-D positive for HLA-DQ8 or for both HLA-DQ2 and HLA-DQ8 have faster SB transit. The mechanism of the accelerated SB transit and the effect of gluten withdrawal on SB function in IBS-D deserve further investigation.

National Survey of Physicians' Perception of the Cause, Complications, and Management of Gastroparesis

Manifestations of gastroparesis are heterogeneous and clinical complications are poorly defined. Misconceptions of gastroparesis may be common. The objective was to determine physicians' perception of gastroparesis and identify areas that need further research and education. A physician survey was prospectively developed and tested. The survey included questions on the etiology, symptoms, management and perceived complications of gastroparesis. Physicians' feedback included rated responses by Likert scale and ranked responses by priority. A total of 3658 surveys were mailed to gastroenterologists and general practitioners using an online physician directory and a local medical society directory. Analysis of variance and t test were utilized. A total of 397 surveys were returned. 85.9% of responses were from the national survey and 14.1% were local. Physicians ranked diabetes (70%) as the most common cause of gastroparesis, followed by idiopathic (21%) and postsurgical (9%). Postprandial epigastric pain (61%) was ranked as the most frequent symptom of gastroparesis, followed by retching/vomiting (20%) and heartburn/regurgitation (19%). 60% believed scintigraphy t1/2 is an accurate measurement of gastric emptying. Only one-third believed gastric electrical stimulation was effective as treatment of gastroparesis. Physicians rated abdominal pain as the most clinically significant complication of gastroparesis surpassing weight loss, hospitalization for dehydration, and malnutrition (P < 0.01). There were small but statistically significant differences between gastroenterologists versus general practitioners and private versus academic physicians. More physician awareness and education is needed on gastroparesis and the standardized four-hour gastric scintigraphy method, as well to clarify the management strategy for this condition.

Effect of Gastric Secretion on Measurement of Liquid Gastric Emptying by 13C-Acetate Breath Test in Humans – A Combined Magnetic Resonance Imaging (MRI) and 13C Breath Test Study

Effect of Gastric Secretion on Measurement of Liquid Gastric Emptying by 13C-Acetate Breath Test in Humans – A Combined Magnetic Resonance Imaging (MRI) and 13C Breath Test Study

Simultaneous measurement of gastric emptying of the soluble and insoluble components of a formulation using a dual isotope, gamma scintigraphic technique.

The gastric emptying of a soluble and an insoluble component of a capsule formulation has been monitored by gamma scintigraphy using a dual isotope technique. There was no significant difference between the emptying rates for the two components or between fasting and non-fasting conditions (P greater than 0.01).

Clinical diagnoses reached in patients undergoing combined ambulatory ph and impedance monitoring for symptoms suspected to be secondary to reflux disease refractory to acid suppression

IntroductionSince August 2007 we have employed combined ambulatory pH and impedance monitoring in the investigation of patients with symptoms thought attributable to gastro-oesophageal reflux refractory to acid suppression. The aim...

Effect of heavy exercise on gastrointestinal transit in endurance athletes

Background and aims. Disturbances in transit of the gastrointestinal (GI) tract have been proposed to be involved in the etiology of the GI symptoms in heavy exercise. However, the results are conflicting. In the present study, we investigated the effect of heavy exercise on GI transit in well-trained athletes. Methods. Fifteen healthy well-trained athletes underwent measurement of gastric emptying, small bowel transit and colonic transit with radiopaque markers during a resting week and during a week with heavy training. GI symptoms, bowel habits, food intake and exercise performed were registered. Results. Small bowel transit was accelerated during the training period compared with the resting period (3.7 (2.6–12.3) h vs. 6.9 (4.2–17.2) h, p = 0.04). Segmental colonic transit in the descending colon was significantly accelerated during exercise compared with rest (0.1 (0–0.4) h vs. 0.4 (0.1–0.7) h, p = 0.03). Gastric emptying did not change during exercise compared with resting (2.4 (0.7–4.6) h vs. 1.8 (0.9–3.3) h, p = 0.16). Stool frequency increased significantly during the week with heavy exercise compared with the week without training (1.5 (1.2–1.8) stools/day vs. 1.3 (1.0–1.7) stools/day, p = 0.02). Stool consistency according to Bristol Stool Form Scale tended to be looser during the training period compared with the resting period (4.2 (3.7–4.5) vs. 3.9 (3.0–4.3), p = 0.08). Conclusion. Heavy exercise affects transit in the GI tract, which might be involved in the generation of GI symptoms and altered stool frequency/consistency in endurance athletes.

Structural identifiability analysis of pharmacokinetic models using DAISY: semi-mechanistic gastric emptying models for 13C-octanoic acid

Structural identifiability analysis is necessary for efficient parameter estimation and it is concerned with determination of whether the parameters in a model can be identified from specified experiments with perfect input-output data. Structural identifiability analysis is very important in mathematical modelling of biological and biomedical experiments and should be considered at the design stage of these experiments. There are three possible outcomes from a structural identifiability analysis; globally/uniquely identifiable, locally/non-uniquely identifiable or non-identifiable/unidentifiable. An ideal outcome is a globally/uniquely identifiable model, however a locally/non-uniquely identifiable outcome can help to identify areas of the model or experiment that need improvement. Despite the importance of structural identifiability analysis, it is still not widely used due to the heavy computational burden involved and the lack of software. A new software package, DAISY, that implemented differential algebra for identifiability analysis was recently released. DAISY is freely available, easy to use and does not require any high-level programming skill. The (13)C-octanoic acid breath test is now widely used for assessing the rate of gastric emptying in patients. Unlike scintigraphy, which is the gold standard and is a direct measure of the rate of gastric emptying, the (13)C-octanoic acid breath test is an indirect method for assessing the rate of gastric emptying. However the (13)C-octanoic acid breath test is cheaper, safer and easy to perform. Because the rate of excretion of (13)CO(2) in breath does not only reflect the rate of gastric emptying but other processes involved between the ingestion of (13)C-octanoic acid and elimination of (13)CO(2) in breath, the parameters commonly derived from the excretion data are not direct measures of gastric emptying. The aim of this paper was to propose a new semi-mechanistic model for the analysis of (13)C-octanoic acid breath excretion data and demonstrate the use of DAISY to assess the identifiability of the model. One- and two-compartment disposition models were linked to a model which has separate compartments for the stomach, intestine and breath. To obtain a globally identifiable model, a repeated (13)C-octanoic breath test in the same individual experimental design was also investigated and this adds a separate stomach compartment to the model. Finally the gastric emptying rate constant from the first (13)C-octanoic breath test was constrained to be the same as the absorption rate constant from the intestine. From the structural identifiability analysis carried out in DAISY, the model based on two experiments (baseline and treatment) and a constraint is globally identifiable. In summary, the present work describes a new semi-mechanistic model that will allow efficient and reliable assessment of the rate of gastric emptying from the (13)C-octanoic breath test.

Proximal and Overall Gastric Emptying of Solids in Patients with Reduced Gastric Volume Accommodation Compared to Matched Controls

Interventions such as gastric surgery and erythromycin result in displacement of solids to the distal stomach and acceleration of overall and proximal gastric emptying. The effect of non-surgical impairment of gastric accommodation on gastric emptying is unclear. Non-surgical impairment of gastric accommodation is associated with accelerated gastric emptying. To compare measurements of proximal and overall gastric emptying in patients with reduced postprandial gastric volume accommodation with the emptying rates in age- and gender-matched controls with normal postprandial gastric volume accommodation. We evaluated overall and proximal gastric emptying in nine patients with impaired gastric accommodation and age-equivalent and gender-matched controls. Gastric volumes and emptying were measured using validated SPECT and dual gamma camera scintigraphy, respectively. We compared group differences in overall and proximal gastric emptying t (1/2) by t test. Patients with impaired postprandial gastric volume accommodation had greater fasting gastric volume. The proportion of food emptied from the proximal stomach immediately after meal ingestion was lower and t (1/2) of proximal gastric emptying correspondingly longer in the group with reduced postprandial gastric accommodation. In contrast, differences were not detected in overall gastric emptying in the two groups, and the ratio of overall to proximal gastric emptying t (1/2) was greater in the group with impaired volume accommodation. Proximal stomach emptying is reduced in patients with impaired postprandial volume accommodation; this difference occurs predominantly during the time of meal ingestion. Compensatory mechanisms that result in normal overall gastric emptying require further elucidation.

Prebiotic potential and gastrointestinal effects of immature wheat grain (IWG) biscuits

In this study the effects of immature wheat grains (IWG), a natural source of fructo-oligosaccharides (FOS), on intestinal microbiota and gastrointestinal function were evaluated. Ileal effluents from three ileostomates were collected for 8h after IWG-enriched or Control biscuit administration, and then fermented in vitro with human faecal inoculum. On fermentation broths, microbial counts and SCFA were measured. Moreover, we investigated the effect of IWG biscuits on gastric emptying. Twelve healthy volunteers underwent ultrasound measurement of gastric emptying of a standard meal consumed 5h after a breakfast composed by lactose-free milk and IWG or Control biscuits; hunger and satiety sensations were also evaluated in this period. Bifidobacteria and lactic acid bacteria counts were higher (P<0.05) in IWG than in Control cultures, supporting the prebiotic effects of IWG, probably linked to its FOS content; moreover IWG fermentation produced more acetate. In vivo IWG biscuits delayed gastric emptying of the next meal (P<0.05), decreased hunger (P<0.001) and increased satiety (P<0.005). Therefore in vitro results substantiate the potential of IWG as a prebiotic ingredient and in vivo data suggest an effect of IWG on gastric emptying and on persistent satiety. These preliminary data tend to support the use of IWG in formulating functional prebiotic products suitable to promote satiety.

胃電図の衛生学への応用にむけて

In general, gastrointestinal motility tests cause pain; therefore, the establishment of noninvasive methods is desired. Noninvasive methods facilitate the measurement of motility close to the normal physiological state, can provide new findings, and may contribute to the development of associated fields. Electrogastrography (EGG) is a gastrointestinal motility test in which gastrointestinal electric activity is measured. Compared with other gastrointestinal motility measurement methods such as the gastric emptying and internal pressure measurement methods, EGG is noninvasive and allows measurement under minimum restriction; therefore, measurement for a long time is also possible. In addition, since gastrointestinal electric activity, which cannot be quantified using other methods, can be measured, EGG is applicable to the evaluation of the state of the body and pathological conditions, and may provide new findings such as those useful for the prevention of gastrointestinal dysfunction associated with various disorders. EGG is also useful for preventing disorders associated with abnormal gastrointestinal activity such as functional dyspepsia, which has been more frequently observed in recent years, and constipation, which is an extremely frequent complaint in the elderly. Thus, EGG is of marked importance in public health. However, the range of EGG utilizations and applications is still limited at present. Therefore, we outlined the measurement/analysis methods, the advantages and problems of EGG and electrogastroenterography (EGEG), described their clinical importance, and also commented on forefront studies on EGG and evaluated its prospects.

Measurement of gastric emptying of a high-nutrient liquid by 3D ultrasonography in diabetic gastroparesis

Gastric emptying (GE) is delayed in 30-50% of patients with longstanding diabetes. Scintigraphy represents the 'gold standard' for measurement of GE, but is associated with a radiation burden. Three-dimensional (3D) ultrasonography has recently been demonstrated to provide a valid measure of liquid GE in healthy subjects; however, the technique has not been validated in patients with gastroparesis. The primary aim of this study was to compare measurements of GE of a high-nutrient glucose drink by 3D ultrasonography and scintigraphy in diabetic gastroparesis. Ten patients (eight type 1, two type 2, 6M, 4F, aged 46.1 ± 4.5 years, BMI 29.1 ± 1.6 kg m(-2), duration 19.6 ± 3.3 years) with diabetic gastroparesis [defined as retention at 100 min of solid (100 g minced beef) ≥ 61% and/or 50% emptying time (T50) of liquid (150 mL 10% dextrose) ≥ 31 min], were studied. Concurrent measurements of GE by scintigraphy and 3D ultrasonography were performed following ingestion of 75 g glucose in 300 mL water labeled with 20 MBq (99m) Tc-sulfur colloid. There was no significant difference in GE between the two techniques (T50s: scintigraphy - 103.3 ± 10.0 min VS 3D ultrasonography - 98.8 ± 10.4 min; P = 0.60). There was a significant correlation between scintigraphic and ultrasonographic T50s (r = 0.67, P = 0.03). The limits of agreement for the T50s were -57.22 min and +48.22 min (mean difference -4.5 min). Blood glucose after the drink was greater when GE was relatively more rapid (e.g. at t = 60 min; scintigraphy: r = -0.65, P = 0.04; 3D ultrasonography: r = -0.78, P = 0.008). Three-dimensional ultrasonography appears to provide a valid, and non-invasive, measure of GE of high-nutrient liquids in diabetic gastroparesis.