Coupling and propagation of normal and dysrhythmic gastric slow waves during acute hyperglycaemia in healthy humans

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72187/1/j.1365-2982.2008.01235.x.pd

Relating gastric scintigraphy and symptoms to motility capsule transit and pressure findings in suspected gastroparesis

BackgroundWireless motility capsule (WMC) findings are incompletely defined in suspected gastroparesis. We aimed to characterize regional WMC transit and contractility in relation to scintigraphy, etiology, and symptoms in patients undergoing gastric emptying testing.MethodsA total of 209 patients with gastroparesis symptoms at NIDDK Gastroparesis Consortium centers underwent gastric scintigraphy and WMCs on separate days to measure regional transit and contractility. Validated questionnaires quantified symptoms.Key ResultsSolid scintigraphy and liquid scintigraphy were delayed in 68.8% and 34.8% of patients; WMC gastric emptying times (GET) were delayed in 40.3% and showed 52.8% agreement with scintigraphy; 15.5% and 33.5% had delayed small bowel (SBTT) and colon transit (CTT) times. Transit was delayed in ⠥2 regions in 23.3%. Rapid transit was rarely observed. Diabetics had slower GET but more rapid SBTT versus idiopathics (P ⠤ .02). GET delays related to greater scintigraphic retention, slower SBTT, and fewer gastric contractions (P ⠤ .04). Overall gastroparesis symptoms and nausea/vomiting, early satiety/fullness, bloating/distention, and upper abdominal pain subscores showed no relation to WMC transit. Upper and lower abdominal pain scores (P ⠤ .03) were greater with increased colon contractions. Constipation correlated with slower CTT and higher colon contractions (P = .03). Diarrhea scores were higher with delayed SBTT and CTT (P ⠤ .04).Conclusions & InferencesWireless motility capsules define gastric emptying delays similar but not identical to scintigraphy that are more severe in diabetics and relate to reduced gastric contractility. Extragastric transit delays occur in >40% with suspected gastroparesis. Gastroparesis symptoms show little association with WMC profiles, although lower symptoms relate to small bowel or colon abnormalities.Wireless motility capsule (WMC) findings in suspected gastroparesis and relations to symptoms have been poorly defined. Evaluation of patients with gastroparesis symptoms revealed gastric emptying delays with WMCs that were similar to scintigraphy, were related to reduced contractility, and were often associated with extragastric or generalized transit delays; symptoms correlated poorly with WMC profiles. These findings provide insight into motor abnormalities in gastroparesis pathogenesis and form a basis for future investigations studying the impact of WMC testing on clinical care.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141493/1/nmo13196.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/141493/2/nmo13196_am.pd

Modulation of Intestinal Gas Dynamics in Healthy Human Volunteers by the 5-HT 4 Receptor Agonist Tegaserod

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75277/1/j.1572-0241.2006.00708.x.pd

Inhibitory actions of a high fibre diet on intestinal gas transit in healthy volunteers

Background: Fibre treatment often produces gaseous symptoms which have been attributed to fermentation by colonic bacteria with increased gas production. Effects of fibre ingestion on intestinal gas flow are unexplored. Aims: We aimed to test the hypothesis that consumption of a high fibre diet retards gas transit. Subjects: Ten healthy volunteers participated. Methods: To investigate the effects of fibre on gas dynamics, physiological gas mixtures were jejunally perfused at 12 ml/min×2 hours after a standard diet for seven days with and without psyllium 30 g/day in a crossover fashion. Gas was collected from an intrarectal catheter to bypass the anus and evacuation was quantified in real time using a barostat. Results: On initiating gas perfusion under control conditions, an initial lag phase with no gas expulsion was observed (1129 (274) seconds). Thereafter, gas evacuation from the rectum proceeded with cumulative volumes of 1429 (108) ml by the end of the second hour. Evacuation was pulsatile with passage of 20.9 (2.5) boluses, with mean volumes of 68.2 (5.0) ml. Fibre prolonged the lag time (2265 (304) seconds; p<0.05) and reduced cumulative gas evacuation volumes (1022 (80) ml; p<0.05). Decreased gas evacuation resulted from reductions in the numbers of bolus passages (14.2 (1.1); p<0.05) but not bolus volumes (70.7 (3.4) ml; p = 0.66). Conclusions: Consumption of a high fibre diet retards intestinal gas transit by decreasing bolus propulsion to the rectum. Thus, in addition to increasing gas production by colonic flora, fibre ingestion may elicit gaseous symptoms by promoting gas retention