The gastrointestinal motility laboratory.

Abnormalities of gastrointestinal (GI) motor function contribute directly or indirectly to a number of common clinical problems and account for significant health care-related expenditure. Proper evaluation of patients who have suspected GI motility disorders is important to ensure a correct diagnosis and to embark on an appropriate plan of treatment. The GI motility laboratory serves as an important area for patient evaluation in gastroenterology and is an essential element in any comprehensive digestive disease program.

Assessment of gastric emptying and small-bowel motility: scintigraphy, breath tests, manometry, and SmartPill.

Gastric and small-bowel dysfunction can include gastroparesis, functional dyspepsia, and even irritable bowel syndrome. Patients with symptoms suggesting these disorders are commonly encountered by a variety of physicians, especially gastroenterologists. In most patients, the physical examination and upper endoscopy are normal, and thus symptoms are suggested to be from a motility disorder or a functional gastrointestinal disorder.

Symptoms of gastroparesis: use of the gastroparesis cardinal symptom index in symptomatic patients referred for gastric emptying scintigraphy.

Background/aim: The Gastroparesis Cardinal Symptom Index (GCSI) was developed to assess symptoms of gastroparesis. The aim of this study was to correlate symptoms using the GCSI with delayed gastric emptying (DGE) in symptomatic patients referred for gastric emptying scintigraphy (GES).

Methods: A total of 226 consecutive symptomatic patients referred for GES completed the 9-question GCSI.

Lack of interaction between metoclopramide and morphine in vitro and in mice.

1. This study examined interactions via common metabolism or via common pharmacodynamic pathways between frequently co-prescribed metoclopramide (a prokinetic) and morphine (an opioid analgesic). 2.

Differences in intragastric pH in diabetic vs. idiopathic gastroparesis: relation to degree of gastric retention.

Evidence suggests that distinct mechanisms underlie diabetic and idiopathic gastroparesis. Differences in gastric acid in gastroparesis of different etiologies and varying degrees of gastric stasis are uninvestigated. We tested the hypotheses that 1) gastric pH profiles show differential alteration in diabetic vs.

Transsphincteric pH profile at the gastroesophageal junction.

Background & Aims: Esophageal acid exposure conventionally is measured 5 cm above the lower esophageal sphincter (LES). The aim of this study was to compare pH profiles at sites within the LES, the distal esophagus, and the proximal stomach.

Methods: Ten normal subjects underwent esophageal manometry followed by 24-hour esophagogastric pH monitoring using an 8-channel pH probe recording at 5 and 1.

Cyclic vomiting syndrome in adults.

Cyclic vomiting syndrome (CVS) was initially described in children but can occur in all age groups. Cyclic vomiting syndrome is increasingly recognized in adults. However, the lack of awareness of CVS in adults has led to small numbers of diagnosed patients and a paucity of published data on the causes, diagnosis and management of CVS in adults.

Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine.

This consensus statement from the members of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine recommends a standardized method for measuring gastric emptying (GE) by scintigraphy. A low-fat, egg-white meal with imaging at 0, 1, 2, and 4 h after meal ingestion, as described by a published multicenter protocol, provides standardized information about normal and delayed GE. Adoption of this standardized protocol will resolve the lack of uniformity of testing, add reliability and credibility to the results, and improve the clinical utility of the GE test.

Tonic and phasic pyloric activity in response to CCK-octapeptide.

Background: The purpose of this study was to determine whether a high-resolution solid-state catheter system could detect regional pressure changes within the antrum and pylorus in response to CCK-octapeptide.

Methods: Subjects received a 30 min infusion of CCK-octapeptide at either 0.02 or 0.

Gastric emptying of a non-digestible solid: assessment with simultaneous SmartPill pH and pressure capsule, antroduodenal manometry, gastric emptying scintigraphy.

Gastric emptying of digestible solids occurs after trituration of food particles. Non-digestible solids are thought to empty with phase III of the migrating motor complex (MMC). The aim of this study was to determine if a non-digestible capsule given with a meal empties from the stomach with return of the fasting phase III MMC or during the fed pattern with the solid meal.

Predictive factors for clinical improvement with Enterra gastric electric stimulation treatment for refractory gastroparesis.

Unlabelled: The objectives of this study were to determine the clinical response to Enterra gastric electric stimulation (GES) in patients with refractory gastroparesis and to determine factors associated with a favorable response.

Methods: This study was conducted in patients undergoing Enterra GES for refractory gastroparesis. Symptoms were scored before and after GES implantation using the Gastroparesis Cardinal Symptom Index (GCSI) with additional questions about abdominal pain and global clinical response.

Botulinum toxin A for the treatment of delayed gastric emptying.

Background: Observational data suggest that intrapyloric injection of botulinum toxin A (BoTN/A) reduces symptoms and accelerates gastric emptying in idiopathic and diabetic gastroparesis. Our purpose was to determine whether botulinum toxin improves symptoms to a significantly greater extent than placebo. An additional objective was to determine whether there is an acceleration of gastric emptying after injection.

Gastroparesis-related hospitalizations in the United States: trends, characteristics, and outcomes, 1995-2004.

Objectives: Gastroparesis is an increasingly recognized disorder. Its prevalence in the United States is unknown. We examined the trends, characteristics, and outcomes of gastroparesis-related hospitalizations during 1995-2004.

Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine.

This consensus statement from the members of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine recommends a standardized method for measuring gastric emptying (GE) by scintigraphy. A low-fat, egg-white meal with imaging at 0, 1, 2, and 4 h after meal ingestion, as described by a published multicenter protocol, provides standardized information about normal and delayed GE. Adoption of this standardized protocol will resolve the lack of uniformity of testing, add reliability and credibility to the results, and improve the clinical utility of the GE test.

Comparison of gastric emptying of a nondigestible capsule to a radio-labelled meal in healthy and gastroparetic subjects.

Background: Gastric emptying scintigraphy (GES) using a radio-labelled meal is used to measure gastric emptying. A nondigestible capsule, SmartPill, records luminal pH, temperature, and pressure during gastrointestinal transit providing a measure of gastric emptying time (GET).

Aims: To compare gastric emptying time and GES by assessing their correlation, and to compare GET and GES for discriminating healthy subjects from gastroparetics.

The gastrointestinal motility laboratory.

Abnormalities of gastrointestinal (GI) motor function contribute directly or indirectly to a number of common clinical problems and account for significant health care-related expenditure. Proper evaluation of patients who have suspected GI motility disorders is important to ensure a correct diagnosis and to embark on an appropriate plan of treatment. The GI motility laboratory serves as an important area for patient evaluation in gastroenterology and is an essential element in any comprehensive digestive disease program.

Egg labeling methods for gastric emptying scintigraphy are not equivalent in producing a stable solid meal.

Unlabelled: A wide range of radiolabeled test meals have been used for gastric emptying scintigraphy. The purpose of this study was to test whether (99m)Tc-sulfur colloid-labeled liquid egg white is as stable as 2 fresh whole eggs labeled with (99m)Tc-sulfur colloid and whether the cooking method is important.

Methods: Whole eggs and liquid egg white were mixed with (99m)Tc-sulfur colloid and cooked by either microwaving or frying on a griddle.

Gastric electric stimulation for the treatment of gastroparesis.

Gastric electric stimulation is an emerging therapy for refractory gastroparesis. Several methods have been used to electrically stimulate the stomach. Initial studies used gastric electrical pacing, which entrains and paces the gastric slow waves at a slightly higher rate than the patient's normal myoelectric frequency of 3 cycles per minute (cpm).

Advances in the management of gastroparesis.

The treatment goals for patients with gastroparesis are to control symptoms; to correct fluid, electrolyte, and nutritional deficiencies; and to identify and treat the underlying cause of gastroparesis. For mild symptoms, dietary modifications and a low-dose antiemetic and/or prokinetic agent might provide satisfactory control of symptoms. Dietary treatments include decreasing the solid food component while increasing the liquid nutrient component of meals.

High-resolution solid-state manometry of the antropyloroduodenal region.

Manometric recording from the pyloric channel is challenging and is usually performed with a sleeve device. Recently, a solid-state manometry system was developed, which incorporates 36 circumferential pressure sensors spaced at 1-cm intervals. Our aim was to use this system to determine whether it provided useful manometric measurements of the pyloric region.

Regional gastric emptying abnormalities in functional dyspepsia and gastro-oesophageal reflux disease.

To characterize proximal and distal stomach emptying in functional dyspepsia (FD) and gastro-oesophageal reflux disease (GORD). Eighty-three patients underwent gastric emptying (GE) scintigraphy and symptom scoring for the evaluation of upper gastrointestinal symptoms and were divided into three groups: FD (n = 25), GORD (n = 20) and FD + GORD (n = 38). Total, proximal and distal gastric retention were determined scintigraphically and compared with normal controls.

Abnormal ghrelin and pancreatic polypeptide responses in gastroparesis.

Vagal nerve dysfunction has been implicated in the pathogenesis of diabetic gastroparesis, but its role in idiopathic gastroparesis remains uncertain. The increase in pancreatic polypeptide with sham feeding is often used as a measure of vagal integrity. Ghrelin has been suggested to function as an appetite-stimulating hormone from the gut to the brain acting through vagal afferent pathways.