Water Load Test Research Articles

The effect of visceral reception activation (water load test) on autonomic activity and gastric myoelectric activity in gastrointestinal malignancies.

The aim of this study was to analyze the effect of water load test (WLT) on heart rate variability (HRV), blood pressure variability (BPV), hemodynamic parameters and gastric myoelectric activity in gastrointestinal (GI) cancer patients. WLT activates gastrointestinal mechanoreception and osmoreception, and hence, can indirectly modulate autonomic activity. Eighty patients (mean age 61.2 years) were enrolled, along with the group of healthy controls. HRV, BPV and electrogastrography (EGG) were recorded at rest (in a fasted state) and after water uptake at 100 ml/min. WLT contributed to an increase in the percentages of normogastria time, from 37.3 % to 50.0 % (p=0.02) and from 42.3 % to 47.7 % (p=0.01), respectively in colon and rectal cancer. Cancer patients presented lower values of HRV indices determined on linear analysis at rest and after WLT. A slight predominance of the sympathetic component was observed in response to WLT, which was reflected by changes in hemodynamic parameters. The response to WLT is a consequence of GI mechanoreception and osmoreception activation and resultant pressure reaction. This effect was disrupted by the neoplastic process within the GI tract, especially in gastric and colon malignancies, but not in rectal cancer (Tab. 2, Fig. 12, Ref. 40). Text in PDF www.elis.sk Keywords: autonomic nervous system, gastric myoelectric activity, water uptake, heart rate variability, blood pressure variability, gastrointestinal cancer.

Risk of Glove Perforations with Simulated Arthroscopic Knot Tying: a Randomized Biomechanical Study

Surgical knot tying has been known to create cuts and calluses on the fingertips of surgeons. Glove damage puts the surgeon at risk for transmittable diseases and places the patient at risk for infection. The goal of this study was to determine if the incidence of glove perforations increases with the number of arthroscopic knots tied using non-latex gloves. An in vitro controlled, randomized biomechanical study was completed where double gloved surgeons would perform two, four, six, or eight knots on a custom knot tying station. Each knot consisted of a sliding knot and three half hitches and tension was measured to ensure reproducibility between surgeons. Twenty-five double gloved pairs were allocated for each group in addition to twenty control gloves for a total of 420 gloves tested. Visual inspection, the FDA standard 1 L water load test and electroconductivity testing was performed to evaluate for perforations. 6/400 (1.5%) gloves involved in knot tying were found to have perforations while 1/20 (5%) of the control gloves had a detectable perforation. There were no holes identified in any of the gloves used to tie two knots by either load test or electroconductivity testing. There were two perforated gloves in the groups with four, six and eight knots. The difference was not statistically significant. The number of knots tied during a surgery is not independently associated with glove perforations. Other mechanical stresses, imbibition, and time of wear during surgery may play a role but were not evaluated. Given the low but demonstrative rate of perforations, double gloving is recommended.

Water Load Test in the Diagnosis of Syndrome of Inappropriate Antidiuresis (SIAD): Results from the Waterline Study

Water Load Test in the Diagnosis of Syndrome of Inappropriate Antidiuresis (SIAD): Results from the Waterline Study

The water load test in school children and adolescents with functional gastrointestinal disorders.

We hypothesize that patients with functional gastrointestinal disorders(FGID) drink less water volume than healthy subjectsduring water load test. We evaluated and compared the water load test in students with and without FGIDusing the Rome III questionnaire. We performed the water load test in 142 students from two schools in Colombia. Students were diagnosed using the Spanish version of the Rome III questionnaire. Students drank water ad libitum for 3min or until pain, satiety, or vomiting occurred. We correlated anthropometric variables with water volumes drunk. We recorded symptoms like pain and nausea, before and after the water load test. We evaluated 142 students, with a mean age of 12.1 ± 0.2years and 59.9% girls. Mean water volume drunk was 459 ± 22mL. There was no significant difference between water volume drunk by students with and without FGID(466 ± 36 vs. 453 ± 27mL, p = 0.108). We found a significant correlation between water volume drunk and gender, age, weight, height, and body mass index. Students with and without FGIDingest similar volumes of water. Test adverse effects are minimal, and the test is safe to perform and well tolerated.

Where is an emotion? Using targeted visceroception as a method of improving emotion regulation in healthy participants to inform suicide prevention initiatives: a randomised controlled trial

BackgroundWilliam James’ 1884 paper “What is an emotion?” has generated much recent interest in affective science regarding somatic contributions to emotion. Studies of interoception (“sensing the physiological condition of the body”) suggest that sensing specific parts of the body contributes to the production of emotion, namely when sensing the viscera (i.e. “visceroception” of the heart, gut or lungs). Improved visceroception has, for instance, been linked to increased emotional intensity, suggesting a role for interoception in emotion regulation that may pertain specifically to visceral bodily locations. Thus, in addition to asking James’ question, “What is an emotion?”, we ask, “Where is an emotion?”. Further, there is an evidence base pointing to the connections between emotion regulation and suicide, and between interoception and suicide. This is a preliminary trial investigating whether targeted interoception/visceroception improves emotion regulation. Ultimately, the overall project aims to inform suicide prevention efforts.MethodsThe trial utilises a pre-test/post-test control group design, with two experimental groups undergoing visceroceptive interventions (focussing on areas pertaining to the gut or heart) and a control group. The interventions will run for 8 weeks. A spatial cueing task will measure reaction times to bodily changes relating to lower abdomen or chest focus. A stop/signal task will measure emotional inhibition, which is hypothesised to obscure awareness of active bodily locations. Visceroceptive ability will be tracked using a heartbeat estimation task, a water load test, and by self-report questionnaire. The sample will consist of healthcare professionals and healthcare students. Despite these being groups that represent a relatively high suicide risk among professional and student groups, all participants will be healthy, given the preliminary nature of this trial.DiscussionTo our knowledge, this will be the first project to address whether emotional feeling presents as a localised bodily phenomenon and whether trained awareness of emotional localisation can improve emotion regulation. It will also be the first to investigate relationships between interoception and emotional inhibition (i.e. whether a sustained interoceptive practice leads to the disinhibition of bodily emotional sensations, which can positively contribute to emotion regulation). These empirical findings on emotion regulation from a healthy sample will be used to inform a desk-based enquiry into the role of embodied emotion in suicide prevention, which may make a significant contribution to a growing evidence base on interoception and suicide.Trial registrationACTRN12619000324112. Registered on 4 March 2019. Universal Trial Number (UTN): U1111-1221-0201.

Gastric interoception and gastric myoelectrical activity in bulimia nervosa and binge-eating disorder.

ObjectiveIdentifying factors that control food intake is crucial to the understanding and treatment of eating disorders characterized by binge eating. In healthy individuals, stomach distension plays an important role in the development of satiation, but gastric sensations might be overridden in binge eating. The present study investigated the perception of gastric signals (i.e., gastric interoception) and gastric motility in patients experiencing binge‐eating episodes, that is, bulimia nervosa (BN) and binge‐eating disorder (BED).MethodTwenty‐nine patients with BN or BED (ED group) and 32 age‐, sex‐, and BMI‐matched healthy controls (HC group) participated in the study. The onset of satiation and stomach fullness were assessed using a novel 2‐step water load test (WLT‐II). Gastric myoelectrical activity (GMA) was measured by electrogastrography (EGG) before and after ingestion of noncaloric water.ResultsIndividuals in the ED group drank significantly more water until reporting satiation during the WLT‐II. The percentage of normal gastric myoelectrical power was significantly smaller in the ED group compared to HC, and negatively related to the number of objective binge‐eating episodes per week in patients with BN or BED. Power in the bradygastria range was greater in ED than in HC participants.DiscussionPatients with EDs have a delayed response to satiation compared to HC participants, together with abnormal GMA. Repeated binge‐eating episodes may induce disturbances to gastric motor function.

Glucocorticoids Reverse Diluted Hyponatremia Through Inhibiting Arginine Vasopressin Pathway in Heart Failure Rats.

BackgroundArginine vasopressin dependent antidiuresis plays a key role in water‐sodium retention in heart failure. In recent years, the role of glucocorticoids in the control of body fluid homeostasis has been extensively investigated. Glucocorticoid deficiency can activate V2R (vasopressin receptor 2), increase aquaporins expression, and result in hyponatremia, all of which can be reversed by glucocorticoid supplement.Methods and ResultsHeart failure was induced by coronary artery ligation for 8 weeks. A total of 32 rats were randomly assigned to 4 groups (n=8/group): sham surgery group, congestive heart failure group, dexamethasone group, and dexamethasone in combination with glucocorticoid receptor antagonist RU486 group. An acute water loading test was administered 6 hours after drug administration. Left ventricular function was measured by a pressure‐volume catheter. Protein expressions were determined by immunohistochemistry and immunoblotting. The pressure‐volume loop analysis showed that dexamethasone improves cardiac function in rats with heart failure. Western blotting confirmed that dexamethasone remarkably reduces the expressions of V2R, aquaporin 2, and aquaporin 3 in the renal‐collecting ducts. As a result of V2R downregulation, the expressions of glucocorticoid regulated kinase 1, apical epithelial sodium channels, and the furosemide‐sensitive Na‐K‐2Cl cotransporter were also downregulated. These favorable effects induced by dexamethasone were mostly abolished by the glucocorticoid receptor inhibitor RU486, indicating that the aforementioned effects are glucocorticoid receptor mediated.ConclusionsGlucocorticoids can reverse diluted hyponatremia via inhibiting the vasopressin receptor pathway in rats with heart failure.

Osmoregulation in children with cystic fibrosis.

Hyponatremia is not rare in cystic fibrosis and might be due to several mechanisms. An endocrine and renal imbalance in water and salt homeostasis was suggested. To address this hypothesis, we assessed the urinary concentrating and diluting ability in 12 cystic fibrosis patients (6 females, 6 males) and in two control groups: 14 children with pneumonia (9 females, 5 males) and in 13 healthy children (9 females, 4 males). Renal concentrating ability was evaluated following overnight water deprivation. Urine osmolality was not significantly different between groups. Renal diluting ability was assessed by means of a water-load test. This provoked a decrease in urine osmolality, as well as an increase in diuresis and solute-free water excretion. These changes were comparable among groups.Conclusion: Children with cystic fibrosis show a preserved renal concentrating and diluting capacity. A generalized endocrine and renal imbalance in water and salt homeostasis therefore appears unlikely.What is Known:•Hyponatremia sometimes occurs in cystic fibrosis.What is New:•Osmoregulation is normal in cystic fibrosis.

Significance of lipid peroxidation processes in renal excretory dysfunction in cases of acute blood loss complicated by limb ischemia-reperfusion and its correction

Introduction. Activation of lipid peroxidation processes, which are exacerbated in cases of limb ischemia-reperfusion associated with temporary application of a tourniquetis a key mechanism of acute blood loss. However, its significance in the pathogenesis of renal dysfunction is understudied. The information on the effectiveness of carbacetam administration under these conditions, which has an antioxidant effect, is lacking.Objective. The aim of the research was to investigate the significance of lipid peroxidation processes in renal excretory dysfunction in cases of acute blood loss complicated by limb ischemia-reperfusion, and to evaluate the effectiveness of carbacetam for correction of these disorders.Materials and methods. The experiments were performed on 108 nonlinear male rats weighing 160-180 g. All animals were divided into five groups: a control group and four experimental groups (6 rats in each).The first experimental group comprised the animals anesthetized with thiopental sodium, in which a two-hour limb ischemia was simulated with further reperfusion. In the second experimental group the acute blood loss in the amount of 20-22% of a circulating blood volume was simulated to the anesthetized animals by femoral vein dissection. In the third experimental group these injuries were combined. In the fourth experimental group the animals with acute blood loss complicated by limb ischemia-reperfusion were administered with carbacetam intraperitoneally at a dose of 5 mg per kilogram of animal weight for correction. In the control group, the animals were anesthetized with equivalent dose of thiopental sodium; a tourniquet was applied for 2 hours without stopping the blood flow, and subsequently studied in 1 hour.In 1 and 2 hours, as well as in 1, 7and 14 days, the renal function was assessed in the experimental animals by means of the water loading test. Urine was collected for 2 hours and diures is was determined. After urine collection, the rats were anesthetized with thiopental sodium andtakenout of the experiment by total bloodletting from the heart. Concentrations of sodium in the urine and serum, as well as protein in the urine were determined. According to these data, sodium and protein excretion wasassessed. Additionally, the content of reagents with regard to thiobarbituric acid –TBA-active products of lipid peroxidation, was determined in the renal medulla.Results and discussion. In cases of limb ischemia-reperfusion, acute blood loss and their combination, the content of TBA-active products of lipid peroxidation in the renal medulla increased the most in 1 day. Up to the 14thday, the index decreased, but did not reach the level of the control group and was significantly higher in the group of animals with acute blood loss complicated by limb ischemia-reperfusion. In cases of the simulated injuries, increased sodium and protein excretion was evidenced compareto the control group.The highest increase in these parameters corresponded to the maximum activation of lipid peroxidation in the renal medulla in relation to the terms, and according to the amplitude increased from the group with limb ischemia-reperfusion to the group with acute blood loss and then to the group with combination of these disorders. This pattern was manifested the most significantly in 7-14 days of the reperfusion period. In case of carbacetam administration, the content of TBA-active products of lipid peroxidation and sodium excretionin the renal medulla significantly decreased in 7-14 days, compare to the animals without correction.Protein excretion decreased in 14 days of carbacetam administration. Taking into account the pronounced antioxidant properties of carbacetam, the attained result proved the significance of activation of lipid peroxidation processes in cases of kidney damage after limb ischemia-reperfusion, acute blood loss and their combination.Conclusions. With underlying limb ischemia-reperfusion, acute blood loss, and their combination, the sodium and protein excretion increase compare to the control group. The highest increase of these parameterstakes placein 1 day of the reperfusion period thatcorresponds to the maximal accumulation of TBA-active products of lipid peroxidation in the renal medulla in relation to the terms.The amplitude of changes in the studied parameters increases from the group of animals with limb ischemia-reperfusion to that with acute blood loss, and then to the group with their combination that is the most pronounced in 7-14 days of the reperfusion period.The carbacetam administration (at a dose of 5 mg per kilogram of animal body weight) causes a significant nephroprotective effect and up to the 14th day leads to a significant decrease in the content of TBA-active products of lipid peroxidation, reduced sodium and protein excretion in the renal medulla.

Nissen fundoplication and dyspeptic symptoms: is the water load test useful?

The water load test is a simple, cheap and standardized method to evaluate gastric distension and gastric motility responses. We have previously shown that in patients with mild erosive or non-erosive esophagitis this test is frequently abnormal, suggesting an altered gastric function. The aim was to evaluate the water load test score before and after Nissen fundoplication in reflux patients. Thirty-one patients (16 men, 15 women, mean age 46.5 y) were studied before and 3 months after Nissen fundoplication by stationary esophageal manometry, wireless Bravo pH system monitoring (48 hours), and water load test. A dyspepsia symptom questionnaire was also completed before and after surgery. Data were compared with those of 35 controls. All patients had pH-monitoring positive for pathological acid exposure and/or related-reflux symptoms in the absence of motility disorders. Basal symptoms scores were higher in patients compared to controls and improved after surgery, except than postprandial fullness, early satiation, and bloating, that were significantly increased. At baseline, all patients ingested significantly lower water volumes than controls, with a tendency to early onset of fullness and nausea, respectively. After surgery, the water volumes were significantly lower than presurgery. In patients with reflux-related symptoms, with or without esophagitis, the water load test is frequently abnormal, suggesting an altered gastric function. Nissen fundoplication is associated with a relatively higher incidence of bloating, epigastric pain and fullness. These preliminary data could explain the incomplete resolution of symptoms after surgery in some patients, and suggest the use of additional studies to explore the gastric function in presurgical evaluation.

Thermal investigations on self-aspirating type radial flow burners with induced swirl

Multi-port gas burners find applications in various industrial and domestic heating appliances. The multiple flame jets of the burners provide higher rate of heat transfer with uniform heat flux over a large area of the target surface. An extensive contribution to the design and development of energy efficient and clean combustion gas burners is reported by the scientific community. The involvement of combustion apart from the heat transfer makes the physical understanding more complex as compared to other heating methods. One of the most interesting things is that the combustion and the heat transfer phenomenon are associated with one another and the independent characterization of each will be unproductive. Present study investigates the thermal characterization of self-aspirating radial-type domestic gas stove burners. The heat transfer characteristics are studied for varied inner port swirl angles. An alternate methodology is suggested to evaluate the thermal performance of burners which gives more technical insights in comparison with conventional water loading test. The thermal efficiency from the conventional water loading method and the presented alternate method matches within ±2%. Among all swirl angles of burner ports, the inner port swirl angle of 10° produced higher Nusselt number and thermal efficiency. The efficiency is found to be increased by 7% by a simultaneous reduction in the loading height by 10 mm and by providing an inner swirl angle of 10°.

Osmoregulation Performance and Kidney Transplant Outcome.

Kidney transplant recipients have an impaired ability to dilute urine but seldom develop baseline hyponatremia before ESRD. Although hyponatremia is a risk factor for adverse events in CKD and in kidney transplant recipients, it remains unclear whether subtler alterations in osmoregulation performance are associated with outcome. We studied a single-center prospective cohort of 1258 kidney transplant recipients who underwent a water-loading test 3 months after transplant to determine osmoregulation performance. Measured GFR (mGFR) was performed at the same visit. A group of 164 healthy candidates for kidney donation served as controls. We further evaluated the association of osmoregulation performance with transplantation outcomes and subsequent kidney function. Unlike controls, most kidney transplant recipients failed to maintain plasma sodium during water loading (plasma sodium slope of -0.6±0.4 mmol/L per hour in transplant recipients versus -0.12±0.3 mmol/L per hour in controls; P<0.001). Steeper plasma sodium reduction during the test independently associated with the composite outcome of all-cause mortality and allograft loss (hazard ratio [HR], 1.73 per 1 mmol/L per hour decrease in plasma sodium; 95% confidence interval [95% CI], 1.23 to 2.45; P=0.002) and allograft loss alone (HR, 2.04 per 1 mmol/L per hour decrease in plasma sodium; 95% CI, 1.19 to 3.51; P=0.01). The association remained significant in a prespecified sensitivity analysis excluding patients with hyperglycemia. In addition, a steeper plasma sodium slope 3 months after transplantation independently correlated with lower mGFR at 12 months (β=1.93; 95% CI, 0.46 to 3.41; P=0.01). Reduced osmoregulation performance occurs frequently in kidney transplant recipients and is an independent predictor of renal outcome.

Effects of Water Loading on Observed and Predicted Plasma Sodium, and Fluid and Urine Cation Excretion in Healthy Individuals

The discovery of sodium storage without concurrent water retention suggests the presence of an additional compartment for sodium distribution in the body. The osmoregulatory role of this compartment under hypotonic conditions is not known. Experimental interventional study. Single-center study of 12 apparently healthy men. To investigate whether sodium can be released from its nonosmotic stores after a hypotonic fluid load, a water-loading test (20mL water/kg in 20 minutes) was performed. During a 240-minute follow-up, we compared the observed plasma sodium concentration ([Na+]) and fluid and urine cation excretion with values predicted by the Barsoum-Levine and Nguyen-Kurtz formulas. These formulas are used for guidance of fluid therapy during dysnatremia, but do not account for nonosmotic sodium stores. 30 minutes after water loading, mean plasma [Na+] decreased 3.2±1.6 (SD) mmol/L, after which plasma [Na+] increased gradually. 120 minutes after water loading, plasma [Na+] was significantly underestimated by the Barsoum-Levine (-1.3±1.4mmol/L; P=0.05) and Nguyen-Kurtz (-1.5±1.5mmol/L; P=0.03) formulas. In addition, the Barsoum-Levine and Nguyen-Kurtz formulas overestimated urine volume, while cation excretion was significantly underestimated, with a cation gap of 57±62 (P=0.009) and 63±63mmol (P=0.005), respectively. After 240 minutes, this gap was 28±59 (P=0.2) and 34±60mmol (P=0.08), respectively. The compartment from which the mobilized sodium originated was not identified, and heterogeneity in responses to water loading was observed across participants. These data suggest that healthy individuals are able to mobilize osmotically inactivated sodium after an acute hypotonic fluid load. Further research is needed to expand knowledge about the compartment of osmotically inactivated sodium and its role in osmoregulation and therapy for dysnatremias. This investigator-initiated study was partly supported by a grant from Unilever Research and Development Vlaardingen, The Netherlands B.V. (MA-2014-01914).

Abdominal Pain in Patients with Gastroparesis: Associations with Gastroparesis Symptoms, Etiology of Gastroparesis, Gastric Emptying, Somatization, and Quality of Life.

(1) To describe characteristics of abdominal pain in Gp; (2) describe Gp patients reporting abdominal pain. Patients with idiopathic gastroparesis (IG) and diabetic gastroparesis (DG) were studied with gastric emptying scintigraphy, water load test, wireless motility capsule, and questionnaires assessing symptoms [Patient Assessment of Upper GI Symptoms (PAGI-SYM) including Gastroparesis Cardinal Symptom Index (GCSI)], quality of life (PAGI-QOL, SF-36), psychological state [Beck Depression Inventory (BDI), State-Trait Anxiety Index (STAI), PHQ-15 somatization scale]. In total, 346 Gp patients included 212 IG and 134 DG. Ninety percentage of Gp patients reported abdominal pain (89% DG and 91% IG). Pain was primarily in upper or central midline abdomen, described as cramping or sickening. Upper abdominal pain was severe or very severe on PAGI-SYM by 116/346 (34%) patients, more often by females than by males, but similarly in IG and DG. Increased upper abdominal pain severity was associated with increased severity of the nine GCSI symptoms, depression on BDI, anxiety on STAI, somatization on PHQ-15, the use of opiate medications, decreased SF-36 physical component, and PAGI-QOL, but not related to severity of delayed gastric emptying or water load ingestion. Using logistic regression, severe/very severe upper abdominal pain associated with increased GCSI scores, opiate medication use, and PHQ-15 somatic symptom scores. Abdominal pain is common in patients with Gp, both IG and DG. Severe/very severe upper abdominal pain occurred in 34% of Gp patients and associated with other Gp symptoms, somatization, and opiate medication use. ClinicalTrials.gov Identifier: NCT01696747.

Do body-related sensations make feel us better? Subjective well-being is associated only with the subjective aspect of interoception.

According to the proposition of several theoretical accounts, the perception of the bodily cues, interoceptive accuracy and interoceptive sensibility, has a significant positive impact on subjective well-being. Others assume a negative association; however, empirical evidence is scarce. In this study, 142 young adults completed questionnaires assessing subjective well-being, interoceptive sensibility, and subjective somatic symptoms and participated in measurements of proprioceptive accuracy (reproduction of the angle of the elbow joint), gastric sensitivity (water load test), and heartbeat tracking ability (Schandry task). Subjective well-being showed weak to medium positive associations with interoceptive sensibility and weak negative associations with symptom reports. No associations with measures of interoceptive accuracy were found. Gastric sensitivity as opposed to heartbeat perception and proprioceptive accuracy moderated the association between interoceptive sensibility and well-being. Thus, subjective well-being is associated only with the self-reported (perceived) aspect of interoception but not related to the sensory measures of interoceptive accuracy.

Multichannel Investigation of Interoception: Sensitivity Is Not a Generalizable Feature.

Objective: The term interoception refers to the perception of bodily cues. In empirical studies, it is assessed using heartbeat detection or tracking tasks, often with the implicit assumption that cardioception reflects general interoceptive ability. Studies that applied a multichannel approach measured only a limited number of modalities. In the current study, six modalities were assessed to gain a deeper understanding of the relationship between the different sensory channels of interoception.Methods: For 118 university students (53% male) gastric perception (water load test), heartbeat perception (Schandry task), proprioception (elbow joint), ischemic pain (tourniquet technique), balancing ability (one leg stand), and perception of bitter taste were measured. Pair-wise correlation analysis and exploratory factor analyses (principal component analysis (PCA) and maximum likelihood (ML) extraction with oblimin rotation) were then carried out with a three-factor solution to investigate the underlying associations.Results: Correlation analysis only revealed significant associations between variables belonging to the same sensory modality (gastric perception, pain, bitter taste). Similarly, the three factors that consistently emerged in the factor analyses represented the three aforementioned modalities.Discussion: Interoceptive sensitivity assessed by using one channel only cannot be generalized. Interoceptive modalities carrying crucial information for survival are not integrated with other channels.

Impaired Gastric Myoelectrical Reactivity in Children and Adolescents with Obesity Compared to Normal-Weight Controls.

Obesity often has its onset in childhood and can be accompanied by various comorbidities such as functional gastrointestinal disorders and altered gastric myoelectrical activity (GMA). This study investigates whether obesity in childhood and adolescence is already associated with altered GMA, and whether an inpatient weight loss program affects GMA. Sixty children with obesity (OBE) and 27 normal-weight children (NW) (12.9 ± 1.7 years; 51% female) were compared for their GMA at rest, after a stress test, and after a drink-to-full water load test. A continuous electrogastrogram (EGG) was recorded and analyzed with respect to gastric slow waves and tachygastric activity. OBE were examined upon admission (T1) and before discharge (T2) following an inpatient weight loss program; NW served as control group. Compared to NW, children with obesity showed flattened GMA as indicated by lower tachygastric reactivity after stress and water load test at T1. Data of OBE did not differ between T1 and T2. EGG parameters were associated neither with sex, age, and BMI nor with subjective stress and food intake. Children with obesity show impaired gastric myoelectrical reactivity in response to a stress and water load test compared to normal-weight controls, which does not change during an inpatient weight loss program.

Regional Brain Activity During Rest and Gastric Water Load in Subtypes of Functional Dyspepsia: A Preliminary Brain Functional Magnetic Resonance Imaging Study.

Background/AimsFunctional dyspepsia (FD) remains a great clinical challenge since the FD subtypes, defined by Rome III classification, still have heterogeneous pathogenesis. Previous studies have shown notable differences in visceral sensation processing in the CNS in FD compared to healthy subjects (HS). However, the role of CNS in the pathogenesis of each FD subtype has not been recognized.MethodsTwenty-eight FD patients, including 10 epigastric pain syndrome (EPS), 9 postprandial distress syndrome (PDS), and 9 mixed-type, and 10 HS, were enrolled. All subjects underwent a proximal gastric perfusion water load test and the regional brain activities during resting state and water load test were investigated by functional magnetic resonance imaging.ResultsFor regional brain activities during the resting state and water load test, each FD subtype was significantly different from HS (P < 0.05). Focusing on EPS and PDS, the regional brain activities of EPS were stronger than PDS in the left paracentral lobule, right inferior frontal gyrus pars opercularis, postcentral gyrus, precuneus, insula, parahippocampal gyrus, caudate nucleus, and bilateral cingulate cortices at the resting state (P < 0.05), and stronger than PDS in the left inferior temporal and fusiform gyri during the water load test (P < 0.05).ConclusionsCompared to HS, FD subtypes had different regional brain activities at rest and during water load test, whereby the differences displayed distinct manifestations for each subtype. Compared to PDS, EPS presented more significant differences from HS at rest, suggesting that the abnormality of central visceral pain processing could be one of the main pathogenesis mechanisms for EPS.

Adult female with symptomatic AVPR2-related nephrogenic syndrome of inappropriate antidiuresis (NSIAD).

SummaryActivating mutations in AVPR2 are associated with nephrogenic syndrome of inappropriate antidiuresis (NSIAD). NSIAD causes hyponatremia, decreased serum osmolality and clinical symptoms, which may present from birth or in infancy and include hypotonia, irritability, vomiting and/or seizures. Symptoms in later life are often less specific and include malaise, dizziness, confusion, tiredness and headache. NSIAD is a rare X-linked condition, which is associated with a variable phenotype in males, of whom some present in infancy but others do not become symptomatic until adulthood, or occasionally, never. Female carriers may present with episodes of hyponatremia, usually found incidentally. Literature in this field is limited; namely, two clinical reports describing a female proband, both diagnosed in infancy. We describe, for the first time, the case of an adult female proband with NSIAD, who had longstanding associated symptoms of tiredness, headache, temporary memory loss and mood changes as well as hyponatremia and decreased serum osmolality. A water load test demonstrated an inability to dilute urine and gene sequencing confirmed a recurrent activating mutation in AVPR2. The variant was inherited from the proband’s mother who had had longstanding episodes of transient asymptomatic hyponatremia. This is the third report of a female proband with NSIAD and is the first female reported who sought medical treatment for chronic symptoms from adulthood. This case acts as a reminder of the importance of considering NSIAD as a diagnosis in females of all ages with unexplained hyponatremia.Learning points:Activating mutations in the AVPR2 gene are associated with the rare X-linked condition nephrogenic syndrome of inappropriate antidiuresis.NSIAD is associated with hyponatremia, decreased serum osmolality and inappropriately increased urinary osmolality. Early clinical symptoms in infancy include hypotonia, irritability, vomiting and/or seizures. Symptoms in later life include malaise, dizziness, confusion, tiredness and headache.NSIAD should be considered in female, as well as male, patients who present with unexplained hyponatremia and decreased serum osmolality. Family history may reveal relevant symptoms or biochemical features in other family members. However, family history may not always be informative due to the variable nature of the condition or if the proband has a de novo pathogenic variant.A water load test with measurement of AVP may be informative in distinguishing NSIAD from SIADH. Measurement of co-peptin levels may be considered, in substitution for direct measurement of AVP.Patients with NSIAD should be counseled about appropriate daily fluid volume intake. Potential episodes of fluid overload should be avoided.

Intragastric Meal Distribution During Gastric Emptying Scintigraphy for Assessment of Fundic Accommodation: Correlation with Symptoms of Gastroparesis.

Impaired fundic accommodation (FA) limits fundic relaxation and the ability to act as a reservoir for food. Assessing intragastric meal distribution (IMD) during gastric emptying scintigraphy (GES) allows for a simple measure of FA. The 3 goals of this study were to evaluate trained readers' (nuclear medicine and radiology physicians) visual assessments of FA from solid-meal GES; develop software to quantify GES IMD; and correlate symptoms of gastroparesis with IMD and gastric emptying. Methods: After training to achieve a consensus interpretation of GES FA, 4 readers interpreted FA in 148 GES studies from normal volunteers and patients. Mixture distribution and κ-agreement analyses were used to assess reader consistency and agreement of scoring of FA. Semiautomated software was used to quantify IMD (ratio of gastric counts in the proximal stomach to those in the total stomach) at 0, 1, 2, 3, and 4 h after ingestion of a meal. Receiver-operating-characteristic analysis was performed to optimize the diagnosis of abnormal IMD at 0 min (IMD0) with impaired FA. IMD0, GES, water load testing, and symptoms were then compared in 177 patients with symptoms of gastroparesis. Results: Reader pairwise weighted κ-values for the visual assessment of FA averaged 0.43 (moderate agreement) for normal FA versus impaired FA. Readers achieved 84.0% consensus and 85.8% reproducibility in assessing impaired FA. IMD0 based on the division of the stomach into proximal and distal halves averaged 0.809 (SD, 0.083) for normal FA and 0.447 (SD, 0.132) (P < 0.01) for impaired FA. On the basis of receiver-operating-characteristic analysis, the optimal cutoff for IMD0 discrimination of normal FA from impaired FA was 0.568 (sensitivity, 86.7%; specificity, 91.7%). Of 177 patients with symptoms of gastroparesis, 129 (72.9%) had delayed gastric emptying; 25 (14.1%) had abnormal IMD0 Low IMD0 (impaired FA) was associated with increased early satiety (P = 0.02). Conclusion: FA can be assessed visually during routine GES with moderate agreement and high reader consistency. Visual and quantitative assessments of FA during GES can yield additional information on gastric motility to help explain patients' symptoms.