Gastric Emptying Test Research Articles

Gastric sensory and motor dysfunction in adolescents with functional dyspepsia

Validated, noninvasive studies were used to compare sensation and motor function of the upper gastrointestinal tract in adolescents with functional dyspepsia (FD) and in control subjects. Fifteen adolescents with FD and 15 healthy participants underwent standardized symptom assessment, a satiation nutrient drink test, and 13 C-Spirulina platensis breath test for gastric emptying of solids. Adolescents with FD also underwent measurements of fasting and postprandial gastric volume by means of single-photon emission computed tomography, and their results were compared with those from 15 healthy volunteers (age, 18 to 25 years). Compared with control subjects, adolescents with FD had significantly higher postprandial symptoms 30 minutes after reaching maximum satiation with the nutrient drink test and significant delay in the T 1/2 for gastric emptying of solids. Compared with healthy 18- to 25-year-old adults, adolescents had a diminished postprandial gastric volume response. By means of single-photon emission computed tomography, frequent baseline dyspeptic symptoms were associated with prolonged T 1/2 for gastric emptying and higher postprandial aggregate symptom score. A baseline increased severity of dyspepsia symptoms was associated with prolonged T 1/2 for gastric emptying. Adolescents with FD demonstrate increased postprandial symptoms after challenge, delayed gastric emptying, and a reduced gastric volume response to feeding.

Is Pylorospasm a Cause of Delayed Gastric Emptying After Pylorus-Preserving Pancreaticoduodenectomy?

Delayed gastric emptying (DGE) occurs in 14% to 61% of patients after pylorus-preserving pancreaticoduodenectomy, but its pathogenesis is unclear. We hypothesized that DGE may be due to pylorospasm secondary to vagal injuries at operation and may be preventable by the addition of pyloromyotomy. Patients operated on consecutively between April 2000 and August 2003 were studied. Pyloromyotomy was of the Fredet-Ramstedt type combined with antroplasty. DGE-free recovery was defined as tolerance of a diet for three successive days by postoperative day 8. The symptom of nausea was used as a basis for nasogastric tube removal and diet resumption. A gastric emptying test (GET) with solid food was obtained. Patients with difficulty swallowing were fed via a feeding tube. There were 47 patients. Two patients were excluded because of death (n = 1) and ileus with pancreatic fistula (n = 1). Diagnoses were pancreatic cancer (n = 23), chronic pancreatitis (n = 11), ampullary cancer (n = 5), mucinous cystic neoplasm (n = 5), and duodenal villous adenoma (n = 3). Median times to nasogastric tube removal, start of liquid diet, and start of solid diet were postoperative days 2, 3, and 5, respectively. Two patients had tube feedings. Preoperative GET was abnormal in 51%, and postoperative GET was abnormal in 37%. The average length of stay was 9.5 days (median, 7 days). DGE occurred in only one patient (2.2%). There were no late complications during a 6-month follow-up. The addition of pyloromyotomy to pylorus-preserving pancreaticoduodenectomy is effective in preventing DGE. Results are supportive of the hypothesis that DGE may be caused by operative injuries of the vagus innervating the pyloric region.

Temporary gastric electrical stimulation with orally or PEG-placed electrodes in patients with drug refractory gastroparesis

Gastric electrical stimulation (GES) has been shown to be efficacious for drug refractory gastroparesis, but GES requires surgery. Placement of temporary GES electrodes endoscopically (ENDOstim) or via a PEG (PEGstim) is feasible, thereby allowing rapid assessment and comparison of temporary use (TEMP) with permanent (PERM) implantation. Twenty consecutive patients with gastroparesis had TEMP electrodes placed (6 ENDOstim, 14 PEGstim). TEMP alone and TEMP vs. PERM placement of GES devices in 13 of 20 patients were compared via the following: average vomiting frequency score (VFS), total symptom score, days to symptom improvement, electrode impedance, and gastric emptying test. For patients receiving TEMP, GES demonstrated a rapid, significant, and sustained improvement in VFS, results similar to those for PERM. Both ENDO and PEG placement of GES electrodes are safe and effective in patients with gastroparesis, with outcomes that correspond to those achieved with permanent GES implantation.

Gastroparesis and electrical stimulation: can we afford the power bill?

Gastroparesis and electrical stimulation: can we afford the power bill?

Lack of gastrointestinal symptoms in a 60-year-old patient with MNGIE

Mitochondrial neurogastrointestinal encephalopathy (MNGIE) is an autosomal recessive multisystem disorder caused by mutations in the thymidine phosphorylase gene ( TP ).1 The disease is characterized by onset between the first and fifth decades of life, ptosis, progressive external ophthalmoparesis, peripheral neuropathy, and leukoencephalopathy.1,2⇓ Gastrointestinal (GI) involvement is a major hallmark of the disease, and all reported patients have GI dysmotility.2-4⇓⇓ We report a 60-year-old woman born after a normal pregnancy. She had bilateral ptosis since childhood and tremor affecting hands and head since age 2 years. She was 145 cm tall and weighed 41 kg at age 60 years. Neurologic examination at age 60 years showed bilateral ptosis with bilateral external ophthalmoplegia. Optic fundi were normal without retinitis. Strength was normal, but she had areflexia. She also had action and rest tremor. Her maternal grandfather and her daughter had tremor. Echocardiography revealed a mild thickening in the septum heart muscle. She had no GI symptoms. A radionuclide gastric emptying test showed mild gastroparesis. Laboratory data showed elevated venous lactate at rest (4.1 mmol/L; normal, 0.9 to 2.7). Brain MRI revealed diffuse hyperintense signal affecting the white matter of the cerebral hemispheres, midbrain, and pons. Abundant cytochrome c oxidase (COX)-negative ragged-red fibers and lipid droplets were found in biceps muscle biopsy (figure). The patient’s sister had short stature, and the patient’s …

Long-term follow-up of gastric stimulation for obesity: the Mestre 8-year experience.

10 years experience with gastric stimulation demonstrates promise, in particular because weight loss is achieved and maintained without drugs or side-effects. We report on a total of 65 patients who have received an Implantable Gastric Stimulator (IGS(R)) since 1995. 65 patients have received an IGS and were monitored for weight loss as well as co-morbidities. Gastroesophageal Reflux Disease (GERD) was assessed by endoscopy and symptoms were evaluated. An acute Holter study was performed on 4 patients pre-implant, post-implant, and post-activation of the IGS. Oral glucose tolerance test (OGTT) using a 76-g bolus of oral dextrose was done before device implantation and after-activation. Gastric emptying was tested on 19 of the patients using Tc99, both pre-implant and 6 months post-implant. Resting Energy Expenditure (REE) was studied in 15 patients using indirect calorimetry at 3 different points in time: pre-activation, 6 months post-implant, and 12 months post-implant. Blood pressure was measured using an electronic wrist device to overcome potential artifacts due to arm fat. IGS patients lost significant weight with no side-effects and experienced significant and rapid improvements in blood pressure. Almost all of the GERD patients reported symptomatic relief during gastric pacing. OGTT demonstrated improved response to insulin at 7 months post-stimulation. The gastric emptying and REE tests were less conclusive, to a great extent because of the small sub-population of patients. While the exact mechanisms of gastric stimulation remain incompletely understood, it appears that the implantation of an IGS is associated with weight loss, an improvement (decrease) in blood pressure in hypertensive patients, and a reduction or elimination of symptoms in those who had GERD. This promising weight loss therapy warrants further study, in particular because of its intriguing results with co-morbidities.

Antroduodenal motility in neurologically handicapped children with feeding intolerance.

BackgroundDysphagia and feeding intolerance are common in neurologically handicapped children. The aim is to determine the etiologies of feeding intolerance in neurologically handicapped children who are intolerant of tube feedings.MethodsEighteen neurologically handicapped children, followed in the Tube Feeding Clinic at the Children's Hospital of Wisconsin who were intolerant of gastrostomy feedings. The charts of these 18 patients were reviewed. Past medical history, diagnoses, history of fundoplication and results of various tests of gastrointestinal function including barium contrast radiography, endoscopy and antroduodenal manometry were documented.ResultsFive of 11 children had abnormal barium upper gastrointestinal series. Seven of 14 had abnormal liquid phase gastric emptying tests. Two of 16 had esophagitis on endoscopy. All 18 children had abnormal antroduodenal motility.ConclusionsIn neurologically handicapped children foregut dysmotility may be more common than is generally recognized and can explain many of the upper gastrointestinal symptoms in neurologically handicapped children.

Gastric emptying in patients with restricting and binge/purging subtypes of anorexia nervosa.

Gastrointestinal symptoms are common in anorexia and in bulimia nervosa, but their relationship with gastric dysmotility and their possible improvement with refeeding are still debated. Twenty-three anorexic patients (12 with the binge/purging and 11 with the restricting subtypes) were studied using an ultrasonographic gastric-emptying test, psychopathological questionnaires, and bowel symptom questionnaires, before and after 4 and 22 wk rehabilitation. Gastric symptom scores were markedly higher in patients than in controls and improved significantly with treatment. On entry, compared to controls, gastric emptying was significantly delayed in restricters and purgers (357 +/- 25.3 and 360 +/- 13.0 min, respectively, mean +/- SEM; controls 207 +/- 9.1). After 4 and 22 wk of treatment, it improved in restricters (315 +/- 20.1 and 296 +/- 17.2 min, respectively), but not in purgers (337 +/- 14.3 and 335 +/- 15.9 min). No relationship was found between entry values of symptoms of gastric emptying and of psychopathological tests or between their variations over time. Gastric emptying derangement and dyspeptic symptoms are present in both subtypes of anorexia nervosa patients. Long-term rehabilitation improves gastrointestinal symptoms, gastric emptying, and psychopathological distress in an independent manner, whereas short-term refeeding does not.

O0117 REPRODUCIBILITY OF THE 13 C OCTANOIC ACID BREATH TEST FOR THE MEASUREMENT OF GASTRIC EMPTYING OF SOLIDS IN CHILDREN

Introduction: The “gold standard” for measuring gastric emptying is scintigraphy. The 13 C octanoic acid breath test is an interesting alternative to measure the gastric emptying of solids, as it is non radioactive. The 13 C octanoic acid breath test using mass spectrometry has been validated against scintigraphy in adults (Ghoos, Gastroenterology 1993;104:1640–7) and has a physiological day-to-day variability in adults (mean coefficient of variation: 26.71 % for gastric half emptying time, 44.93 % for gastric lag phase, 10.82 for gastric emptying coefficient )(Ghoos, Gastroenterology 1993;104:1640–7) as well as in premature infants (mean coefficient of variation: 23.9 % for gastric half emptying time, 12.2 % for gastric emptying coefficient) (Barnett, JPGN 1999; 29: 26–30). There are no data in the literature concerning the use of Non Dispersive InfraRed Spectrometry (NDIRS) in the evaluation of gastric emptying of solids with octanoic acid in children. This study was performed to assess the reproducibility of the 13 C octanoic acid breath test for gastric emptying of solids in children using NDIRS. Methods: Gastric emptying for solids was tested in 19 healthy children (6 girls, 13 boys). After an overnight fasting, a solid test meal consisting of a pancake with a caloric content of 230 kcal, and labelled with 50 microliter 13 C octanoic acid, was given. Breath samples were taken before feeding and at 15 minutes interval after feeding for 4 hours. Samples were analyzed using NDIRS (Wagner Analysen Technik, Worpswede, Germany), and 13 C recovery was used to calculate values for gastric half emptying time (t1/2), time of peak 13 C exhalation or gastric lag phase (tlag) and gastric emptying coefficient (GEC). The 13 C octanoic acid breath test was then repeated 2 or more times 2 to 7 days apart (2 patients 4 times, 7 patients 3 times, 10 patients 2 times). Intra-individual variability and reproducibility of the parameters t1/2, tlag and GEC were expressed as coefficient of variation (CV). Results: The median age was 12.83 years (range 6.75 –17.08), the median CV of t1/2 was 12.9 % (range 2.5 – 29.6) for a t1/2 with a range between 89 and 220 minutes, the median CV of tlag was 12.4 % (range 0.8 – 27.8) for a tlag with a range between 61 and 163 minutes, the median CV of GEC was 10.9 % (range 3.4 – 30.2) for a GEC with a range between 1.82 and 4.20. The CV’s of t1/2, tlag and GEC were independent of the values of t1/2, tlag and GEC. Conclusion: The 13 C octanoic acid breath test using NDIRS is an easy and non-radioactive procedure with very good reproducibility for measuring the gastric emptying of solids in children.

Treatment of Diabetic Gastroparesis by High-Frequency Gastric Electrical Stimulation

To investigate the long-term efficacy of high-frequency gastric electrical stimulation (GES) for treating diabetic gastroparesis. This is a retrospective review of 48 adult diabetic patients with refractory gastroparesis who had a GES system implanted surgically and had follow-up evaluations at 6 and 12 months. The outcome measures were total symptom score (TSS), derived from six upper gastrointestinal (GI) symptom subscores; health-related quality of life (HQOL), including physical composite score (PCS) and mental composite score (MCS) assessed by SF-36 questionnaire, radionuclide gastric emptying test, nutritional status, HbA1c, and adverse events. In comparison with baseline, TSS, all six upper GI symptom subscores, PCS, and MCS were significantly improved at 6 months, with the improvement sustained at 12 months. Of 13 patients receiving nutritional support at baseline by tube feeding, only 5 required supplemental enteral feeding at 12 months, and none of the 9 on total parenteral nutrition continued this support. The mean number of hospitalization days during the year after GES was significantly reduced by 52 days compared with the prior year. HbA1c levels were significantly reduced at 12 months. Gastric emptying was only minimally and not significantly faster. Because of infections at the pulse generator pocket site, four patients had their GES systems removed 3-17 months postsurgery. In diabetic patients with refractory gastroparesis, high-frequency GES by a permanently implanted system significantly improved upper GI symptoms, HQOL, nutritional status, glucose control, and hospitalizations with an acceptably low complication rate.

Effect of Percutaneous Endoscopic Gastrostomy on Gastro-esophageal Reflux and Gastric Emptying

BACKGROUNDS: Percutaneous endoscopic gastrostomy (PEG) has gained broad acceptance as an effective method for achieving enteral access in patients who need chronic nutritional support. It was reported that gastro-esophageal reflux (GER) was less observed with PEG feeding as compared with naso-gastric tube feeding, and that the posture under feeding may affect GER. However, real change in GER before and after the PEG placement remains unknown. AIMS: We investigated GER using ambulatory pH monitoring, and gastric emptying before and after the PEG. The effect of posture while feeding on the GER was also evaluated. METHODS: Twenty patients (8 men and 12 women; mean age, 79.4 years) who need continuous nutritional support due to various diseases such as a stroke, were registered. Under the written informed consent from patients or their families, ambulatory 24-h esophago-gastric pH monitoring, and the gastric emptying test were performed before (with naso-gastric tube feeding) and 1 month after the PEG placement. Seventy-two hours before the monitoring, drugs which affect gastric acid secretion and/or gastric motility were stopped. The content and pattern of feeding through the tube were fixed. Gastric emptying time was determined by the paracetamol method in which serum acetaminophen level was measured 45 min after drinking the semi-liquid test meal (200 mL, 200 kcal) with acetaminophen (20 mg/kg). Some patients after PEG were fed at Fowler position on the first day and at supine position on the second day with 48-h pH monitoring. RESULTS: The mean of intra-esophageal pH was increased after PEG placement (before: 5.59±0.16, after: 6.05±0.21). The time ratio of intra-esophageal pH less than 4 was significantly decreased (before: 9.5±3.1%, after: 5.8±2.5%), suggesting that GER was less observed with PEG feeding. Gastric acidity evaluated by the mean intra-gastric pH and holding time ratio of intra-gastric pH more than 3, was not varied with PEG placement. Gastric emptying was delayed in patients as compared with those in healthy volunteers, but PEG did not modify gastric emptying. The posture under feeding did not affect GER, gastric acidity, and gastric emptying. CONCLUSIONS: GER was less observed with PEG feeding as compared with naso-gastric tube feeding, suggesting the advantage of PEG feeding in regardless the posture while feeding.

Effect of high-frequency gastric electrical stimulation on gastric myoelectric activity in gastroparetic patients.

The aim of this study was to investigate the effect of gastric electrical stimulation (GES) on gastric myoelectric activity (GMA) and to identify possible mechanisms that could help explain how high-frequency GES is effective in treating nausea and vomiting associated with gastroparesis. Fifteen gastroparetic patients who received high-frequency GES were enrolled. Two pairs of temporary pacing wires were implanted on the serosa of the stomach along the greater curvature during surgery for placement of the permanent stimulation device. Two-channel serosal recordings of GMA before and during GES were measured. A gastric emptying test and severity of nausea and vomiting were assessed at baseline and at 3 months of GES. Power spectral and cross correlation analyses revealed that impaired propagation of slow waves (50%), tachygastria (30%) and abnormal myoelectric responses to a meal (50%) were the main abnormalities observed at baseline. GES with a high frequency significantly enhanced the slow wave amplitude and propagation velocity, and resulted in a significant improvement in nausea and vomiting but did not entrain the gastric slow wave or improve gastric emptying after 3 months of GES.

Gastric emptying and intragastric distribution of a solid meal in functional dyspepsia: influence of gender and anxiety.

Gastric dysmotility and psychological factors have been implicated in the pathophysiology of functional dyspepsia. To investigate the influence of gender and anxiety on gastric emptying and intragastric food distribution in patients with functional dyspepsia. A standard gastric emptying test was used to study total and compartmental gastric emptying of a solid meal in 22 patients with functional dyspepsia (16 women). Comparisons of the data for dyspeptic men and women were made with 2 respective subgroups of controls (9 men; 9 women). The presence of anxiety and depression was assessed by the Hospital Anxiety and Depression scale. Delayed gastric emptying was observed in 32% of patients with functional dyspepsia. As a group, dyspeptic women had a significantly longer half-emptying time as compared with dyspeptic men ( 19 +/- 41 min vs. 78 +/- 22 min) and to female controls (96 +/- 17 min). There was no difference in half-emptying times between male patients and controls. The initial activity in the proximal stomach was significantly lower for both men and women with functional dyspepsia in comparison with their respective controls. In addition, meal retention in the distal stomach of dyspeptic women was significantly greater than that in female controls. Sixteen (72%) functional dyspepsia patients had anxiety when evaluated by the Hospital Anxiety and Depression scale. Those patients who scored for anxiety showed significantly greater antral meal retention than patients without anxiety. Our study confirmed that prolonged gastric emptying in patients with functional dyspepsia is related to the female sex, while the abnormalities of the meal intragastric distribution appear to occur in dyspeptic males and females. Anxiety is frequent in functional dyspepsia and seems to be related to abnormal antral retention of food in these patients.

Reliability of the [13C]‐acetate breath test in the measurement of gastric emptying of ethanol solutions: a methodological study

Background: The [13C]‐acetate breath test is a clinically well‐established test for measuring gastric emptying of liquids and correlates significantly with scintigraphy. However, no studies have been undertaken to examine the relationship between gastric emptying measured by the [13C]‐acetate breath test and ultrasonography. Furthermore, it is not known how ethanol may affect gastric emptying as measured by the [13C]‐acetate breath test. This is particularly important because of the additional steps of absorption, metabolism and exhalation of the tracer involved in the [13C]‐acetate breath test compared to the simple measurement of gastric emptying by ultrasonography. The aim of the present study was to examine the relationship between the gastric half emptying times measured by the [13C]‐acetate breath test and by ultrasonography and to determine the effect of ethanol on the comparability between both methods. Methods: On separate days, 10 healthy, fasted randomly selected subjects received the following solutions by gastric tube: 500 mL water, 4% and 10% (v/v) ethanol, 5.5% and 11.4 % (w/v) glucose. Gastric half emptying times of the test solutions were simultaneously determined using the [13C]‐acetate breath test and ultrasonography of the fundus and the antrum. Results: The gastric emptying rates determined by ultrasonography of the fundus correlated significantly with the results obtained using the [13C]‐acetate breath test for all test solutions (r = 0.64–0.92, P < 0.05 for all), whereas ultrasonography of the antrum correlated significantly with the breath test only when water (r = 0.94, P = 0.001) was used. The difference between the mean half‐emptying times obtained using the [13C]‐acetate breath test and ultrasonography of the fundus was 55 ± 1.8 min. This difference was significantly longer when 4% and 10% (v/v) ethanol solutions were given (61.2 ± 3.3 and 71.2 ± 2.9 min) compared to water (P < 0.05). Conclusions: A good correlation was found between gastric emptying as measured by the [13C]‐acetate breath test and ultrasonography of the fundus. Measurements that were obtained using the [13C]‐acetate breath test demonstrate a longer gastric half emptying time compared with those obtained using ultrasonography. This difference is even more marked when ethanol solutions are used. Presumably, this is because ethanol affects the absorption and/or the hepatic metabolism of the tracer. The [13C]‐acetate breath test is therefore not a reliable gastric emptying test for comparison of different solutions, especially when ethanol‐containing liquids are used.

Prevalence of delayed gastric emptying in diabetic patients and relationship to dyspeptic symptoms: a prospective study in unselected diabetic patients.

Data on the prevalence of abnormal gastric emptying in diabetic patients are still lacking. The relation between gastric emptying and dyspeptic symptoms assessed during gastric emptying measurement has not yet been investigated. The aim was to investigate the prevalence of delayed gastric emptying in a large cohort of unselected diabetic patients and to investigate the relation between gastric emptying and gastrointestinal sensations experienced in the 2 weeks before and during the test meal, prospectively. Gastric emptying was evaluated in 186 patients (106 with type 1 diabetes, mean duration of diabetes 11.6 +/- 11.3 years) using 100 mg (13)C-enriched octanoic acid added to a solid meal. Gastric emptying was significantly slower in the diabetic subjects than in the healthy volunteers (T(50): 99.5 +/- 35.4 vs. 76.8 +/- 21.4 min, P < 0.003; Ret(120 min): 30.6 +/- 17.2 vs. 20.4 +/- 9.7%, P < 0.006). Delayed gastric emptying was observed in 51 (28%) diabetic subjects. The sensations experienced in the 2 weeks before the test were weakly correlated with the sensation scored during the gastric emptying test. Sensations assessed during the gastric emptying test did predict gastric emptying to some extent (r = 0.46, P < 0.0001), whereas sensations experienced in the previous 2 weeks did not. This prospective study shows that delayed gastric emptying can be observed in 28% of unselected patients with diabetes. Upper gastrointestinal sensations scored during the gastric emptying tests do predict the rate of gastric emptying to some extent and sensation experienced during daily life does not.

Effect of mosapride on glycemic control and gastric emptying in type 2 diabetes mellitus patients with gastropathy

Delay of gastric emptying is one of the factors responsible for unfavorable glycemic control. We investigated the possible effects of mosapride, a digestive tract prokinetic agent, on glycemic control in diabetic patients complicated with gastropathy. Enrolled were 36 type II diabetic patients presenting with mild digestive tract symptoms. They were given mosapride 15 mg per day for 6 months. Seventeen cases were subjected to gastric emptying test according to marker method (administration of a capsule containing 20 pieces of radiopaque marker during breakfast, followed by abdominal X-ray imaging 3 and 5 h later). In 18 cases, HbA 1C was improved by more than 0.3% for 6 months, whereby these 18 cases were defined as the improvement group. The remaining 18 cases were defined as the non-improvement group. In the gastric emptying study, basal number of the residual markers before administration of mosapride was determined 3 and 5 h later to show 18.3±1.8 and 7.6±5.1, respectively, in the improvement group while after administration, they were reduced down to 11.2±5.1 and 1.4±2.5, respectively. In sharp contrast, the basal counterparts in the non-improvement group were 19.1±1.5, and 16.4±3.4, respectively, whereas administration failed to reduce the number of the residual markers and they remained to be as high as 19.0±1.4 and 11.1±6.4, respectively. Gastric motility in the improvement group was much more improved by mosapride administration relative to those in the non-improvement group. Mosapride might elicit improvement in the glycemic control in the patients with diabetic gastropathy.

Clinical features of malignant syndrome in Parkinson's disease and related neurological disorders

Introduction. We elucidated the cause and clinical characteristics of malignant syndrome (MS) in patients with Parkinson's disease (PD), early-onset parkinsonism (EOP), and other neurological disorders. Materials and methods. Subjects were 260 patients with PD or EOP, and three patients with other neurological disorders associated with MS. We studied clinical symptoms before and after the onset of MS, and evaluated autonomic function particularly before the onset of MS. Results. The overall incidence of MS accompanying PD and EOP in our department was eight of 260 patients (3.1%). The incidence of MS in EOP was significantly higher than that in PD. All patients with MS showed comparatively longer duration of illness and advanced stage of PD and EOP. Factors triggering MS included reduced dosage or discontinuation of anti-parkinsonian drugs, reduction of oral intake, dehydration, infectious disease, postoperative state, and treatment with major tranquilizers. Although patients demonstrated marked autonomic symptoms at the onset of MS, in many cases autonomic dysfunction developed before the onset of MS. Even EOP patients, who usually demonstrated milder autonomic dysfunction, showed abnormalities in the correlation between circadian rhythm of blood pressure and pulse rate, and/or abnormal gastric emptying test, suggesting that autonomic dysfunction plays an important role in the cause of MS. Cooling the body, fluid replacement, resumption or increasing the dosage of anti-parkinsonian drugs and administration of dantrolene sodium overcame MS in all cases. Conclusion. Autonomic dysfunction is related to the cause and clinical features of MS in PD, EOP and some other neurological disorders.

Function of the proximal stomach after partial versus complete laparoscopic fundoplication

Objectives After antireflux surgery, more than 30% of patients develop dyspeptic symptoms such as fullness and early satiety. We have previously shown that these symptoms are related to fundoplication-induced changes in proximal gastric motor and sensory function, especially impaired postprandial relaxation. We hypothesize that impaired fundus relaxation may be more pronounced after complete versus partial fundoplication. Methods Fasting and postprandial proximal gastric motor and sensory function were measured with an electronic barostat in patients after laparoscopic partial (n = 14) and complete (n = 14) fundoplication, in gastroesophageal reflux disease (GERD) patients (n = 12), and in healthy control subjects (n = 15). Gastric emptying and vagus nerve function tests were performed in all patients. Results Minimal distending pressure (MDP) and proximal gastric compliance were not significantly different among patients after antireflux surgery, GERD patients, and healthy controls. Maximal postprandial fundus relaxation was significantly ( p < 0.01) reduced in patients after partial (267 ± 32 ml) and complete (294 ± 34 ml) fundoplication compared with GERD patients (448 ± 30 ml) and healthy controls (409 ± 25 ml). Sensations of fullness were not significantly different between patients with partial and complete fundoplication. There was a significant positive correlation between the postoperative duration and the degree of postprandial fundus relaxation ( r = 0.67; p < 0.001). Conclusions Both after complete and after partial fundoplication, proximal gastric motor function is affected, with impaired postprandial relaxation and increased sensation of fullness. These alterations are not related to the type of fundoplication but correlate significantly with the duration of the postoperative period.

Function of the proximal stomach after partial versus complete laparoscopic fundoplication.

After antireflux surgery, more than 30% of patients develop dyspeptic symptoms such as fullness and early satiety. We have previously shown that these symptoms are related to fundoplication-induced changes in proximal gastric motor and sensory function, especially impaired postprandial relaxation. We hypothesize that impaired fundus relaxation may be more pronounced after complete versus partial fundoplication. Fasting and postprandial proximal gastric motor and sensory function were measured with an electronic barostat in patients after laparoscopic partial (n = 14) and complete (n = 14) fundoplication, in gastroesophageal reflux disease (GERD) patients (n = 12), and in healthy control subjects (n = 15). Gastric emptying and vagus nerve function tests were performed in all patients. Minimal distending pressure (MDP) and proximal gastric compliance were not significantly different among patients after antireflux surgery, GERD patients, and healthy controls. Maximal postprandial fundus relaxation was significantly (p < 0.01) reduced in patients after partial (267 +/- 32 ml) and complete (294 +/- 34 ml) fundoplication compared with GERD patients (448 +/- 30 ml) and healthy controls (409 +/- 25 ml). Sensations of fullness were not significantly different between patients with partial and complete fundoplication. There was a significant positive correlation between the postoperative duration and the degree of postprandial fundus relaxation (r = 0.67; p < 0.001). Both after complete and after partial fundoplication, proximal gastric motor function is affected, with impaired postprandial relaxation and increased sensation of fullness. These alterations are not related to the type of fundoplication but correlate significantly with the duration of the postoperative period.

Different gastric emptying of solid and liquid meals after pylorus-preserving pancreatoduodenectomy.

Transient gastric stasis immediately after pylorus-preserving pancreatoduodenectomy (PPPD) is a common complication, but the cause remains unknown. Changes in gastric emptying were investigated in patients undergoing PPPD for periampullary malignancy. In 14 patients undergoing PPPD, liquid- and solid-phase gastric emptying were evaluated before and after operation (mean 38 (range 27-53) days after operation). Two pharmacological gastric-emptying tests were used: the acetaminophen test for liquid-phase emptying and the sulphamethizole capsule food test for solid-phase gastric emptying. All patients exhibited delayed solid emptying but fairly good liquid emptying. Gastric function in the early postoperative period after PPPD is characterized by delayed solid-phase but good liquid-phase emptying.