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World J Gastroenterol 2002;8(1):180-182
World Journal of Gastroenterology
Copyright © 2002 by The WJG Press ISSN 1007-9327
• BASIC RESEARCH •
Gastric myoelectrical activity and gastric emptying
in diabetic patients with dyspeptic symptoms
Hui-Bin Qi, Jin-Yan Luo, You-Ling Zhu, Xue-Qin Wang
Hui-Bin Qi, Jin-Yan Luo, You-Ling Zhu, Xue-Qin Wang, Department of
Gastroenterology, The Second Hospital of Xi’an Jiaotong University,
Xi’an 710004,Shannxi,China
Correspondence to: Hui-bin Qi, Xiwu Road 36, Xi’an 710004,Shannxi,
China. qihuibin123@163.net
Telephone: +86-29-7262029 Fax: +86-29-7231758
Received 2001-04-05 Accepted 2001-07-10
(1883J).This was immediately followed by another 30-min
recording.The EGG data was analyzed by the “multigram”
Synectics software package running on a personal computer.
The EGG parameters including dominant frequency(DF),
dominant power(DP), postprandial / preprandial DF,
postprandial /preprandial DP.
Qi HB, Luo JY, Zhu YL, Wang XQ. Gastric myoelectrical activity and
gastric emptying in diabetic patients with dyspeptic symptoms.
World J Gastroenterol 2002;8(1):180-182
Statistical analysis
INTRODUCTION
RESULTS
Gastric emptying test
Recently,electrogastrography(EGG) has received more and more
attention.Although gastroenterologists are interested in its
clinical application,concerns remain to the reliability and
analysis of the EGG and the correlation between the EGG and
gastric motility [1-13]. This study was to investigate gastric
myoelectrical activity and gastric emptying(GE) and their
relationship in diabetic patients with dyspeptic symptoms using
electrogastrography and isotopic method.
MATERIALS AND METHODS
Subjects
The study was performed on 22 healthy asymptomatic subjects
(11 women,11 men,mean age 50 yr) and 32 non-insulin dependent
diabetes mellitus(NIDDM) patients with dyspeptic symptoms (15
women,17 men,mean age 51 yr) based on clinical and laboratory
diagnoses. NIDDM was diagnosed by the WHO criteria(1980).All
patients had a minimum 3-month history of chronic,persistent,or
recurrent epigastric pain and fullness,early satiety, nausea
and/or vomiting.The result of esophagogastroduodenoscopic
examination were negative for any focal lesions, including
esophagitis,gastric,or duodenal ulcers or erosions,or esophageal
or gastric malignancy.Exclusion criteria were: history of abdominal
surgery; history of gastroesophageal reflux disease or irritable
bowel syndrome; evidence of cardiovascular, pulmonary,
hepatic,or renal disease.All subjects fasted an overnight before
the study and took no medications known to affect gastrointestinal
motility during 3 d before the study.
Gastric emptying test
Gastric emptying test was taken by using SPECT technique.The
standard meal for gastric emptying test consisted of 100g scrambled
eggs labeled with 99mTc-DTPA(11.1MBq) and 200mL of water. After
eating, the anterior/posterior images of the stomach were taken by
the same operator using a technetium scanner for 2 h.Retention
and half-emptying time(T1/2) were calculated by a specialist at the
Department of Nuclear Medicine.Delayed gastric emptying was
defined as the half-emptying time x+2s as controls.
Recording of gastric myoelectrical activity
Gastric myoelectrical activity was measured with surface
EGG. The EGG recording including a 30-min fasting study
using an EGG recording unit (Digitrapper, Synectics Medical,
Sweden), after which the patient ate a standard test meal
Data were expressed as x±s. Statistical analyses used are t test
and χ2 test.Statistical significance is taken as P<0.05.
The mean percentage of gastric retenton and half-emptying
time in diabetic patients with dyspeptic symptoms were
substantially higher than in the healthy subjects (Table 1). Of
32 patients, 15 (47%) had delayed gastric emptying. Of 22
controls,1 (5%) had delayed gastric emptying. The incidence
of gastric emptying delay was higher in patients than in
controls(P<0.01).
Table 1 Gastric Emptying In NIDDM (x±s)
Groups
n
NIDDM
Controls
32
22
a
Percentage of gastric retenton %
30min
60min
90min
120min
75±7 a
61±7
61±8 b
45±6
54±10b 43±10b
33±4
24±10
T 1/2 min
92±10 b
49±9
P<0.05 vs controls; bP<0.01vs controls
Electrogastrographic findings
EGG dominant frequency corresponds to gastric slow wave.
DF ranging from 2.4 to 3.7 cycle per min(cpm) was considered
as normogastria,DF<2.4 cpm was defined as bradygastria, DF>
3.7 cpm was defined as tachygastria. DF<2.4 cpm and/or DF>3.7
cpm was defined as dysrhythmia or abnormal EGG. The patients
had a lower incidence of normogastria than did controls both
in the fed state (34% vs 86%,P<0.01) and in the fasting state
(38% vs 96%,P<0.01).However,the patients had a higher
incidence of dysrhythmia (tachygastria and bradygastria) than
did controls both in the fed state (66% vs 14%, P<0.01) and in
the fasting state (63% vs 5%,P<0.01). The mean postprandial
dominant frequency and postprandial/preprandial dominant
frequency ratio were lower in patients than in controls (2.61±0.
29 cpm vs 3.76 ±0.14 cpm,P<0.05;1.01±0.10 vs 1.28±0.11,P<0.
05). The mean postprandial dominant power increase and the
mean postprandial/preprandial dominant power ratio was
significantly less in the patients than in the controls(121.50±67.
02 V2.cpm vs 688.61±72.73 V2.cpm,P<0.01; 0.71±0.60 vs 2.40±0.
61,P<0.01).No differences were found in the mean preprandial
dominant frequency and the mean preprandial dominant power
(2.57±0.24 cpm vs 2.91 ±0.22 cpm,P>0.05; 144.10±27C40 V2.cpm
vs 288.40±56.72 V2.cpm,P>0.05).
Comparison of EGG and gastric emptying
Of 32 diabetic patients with dyspeptic symptoms,15 (47%) had
Qi HB, et al. Gastric Myoelectrical Activity and Emptying in Diabetes
delayed gastric emptying and 21 (66%) patients with dysrhythmia.
12 patients with dysrhythmia had slow gastric emptying. There
was no significant correlation between gastric electrical rhythm
and gastric emptying (P>0.05).
DISCCUSION
Gastric emptying and EGG were measured in diabetic patients with
dyspeptic symptoms in this study. The results showed that fifteen
of 32 (47%) diabetic patients with dyspeptic symptoms had delayed
gastric emptying, and 21 of 32 (66%) patients had abnormal gastric
myoelectrical activity. 12 patients with dysrhythmia had slow
gastric emptying. The major abnormalities in gastric myoelectrical
activity observed in diabetic patients with dyspeptic symptoms
were the abnormal rhythmicity of the gastric slow wave and the
reduced postprandial increase in the dominant power.
Our findings in this study are similar to those in previous studies
in patients with various gastric motor disorders[14-19]. In studies using
cutaneous electrodes,abnormal EGG were found in 50% of patients
with functional dyspepsia[14]. In an electrogastrographic study using
cutaneous electrodes,a high proportion of adult patients (60%)
with functional dyspepsia had abnormally slow gastric emptying
and abnormalities in gastric myoelectrical activity[15]. We found that
66% of the patients had abnormal rhythmicity of the gastric slow
wave(bradygastria and tachygastria)and some patients had a
reduced postprandial increase in the dominant power. EGG findings
similar to those in this study have been also reported in studies in
patients with gastroparesis[20,21]. However,Pfaffenbach et al. reported
that the EGG values obtained in diabetics did not differ significantly
from those in healthy subjects and did not correlate with
radioscintigraphy, the EGG values in diabetics with delayed gastric
emptying(about 40%) did not differ from data in diabetics without
gastroparesis[22]. Jebbink et al. also reported that no differences
between patients with functional dyspepsia and healthy volunteers
were found in the incidence of dysrhythmias [23] . These
discrepencies probably results from differences in patient
selection ,differences in definition of dyspepsia and EGG analysis
method [24]. Prior studies have demonstrated that gastric emptying
in dyspeptic patients was found to be delayed in 30~80% of the
patients [15,20, 25-28]. In agreement with prior studies,this study
demonstrated 47% delayed gastric emptying in diabetic patients
with dyspeptic symptoms. The present study shows that 12
patients with dysrhythmia had delayed gastric emptying,but there
was no correlation between gastric rhythmicity and gastric
emptying. An other interesting finding was the reduced increment
of amplitude(power),expressed as absolute or relative changes
(fed/fasting power ratio). A possible cause for a decrease in the
power ratio was the reduced gastric distention or/and contractility
of the stomach. A increase in amplitude were reported in
numerous studies in normal adults and in normal children[29-32].
Some authors believed that it was related to the increased
contractility of the stomach after the meal[30,33-35],whereas others
reported a major effect of gastric distention. Faure et al. suggested
that both gastric distention and motor activity contributed to
the increase in EGG amplitude, the greater contribution being
attributable to gastric distention[36]. Gastric emptying and EGG
findings were agreement with our finding in previous study[37]
and other authors’findings[38]. A study by Barbar et al. showed
that EGG did not correlate with nuclear scintigraphic gastric
emptying studies in children with suggestive symptoms of gastric
motility disorders[38]. Zhang et al. reported that they can’t predict
a delayed GET by an abnormal EGG[39]. However,controversial
findings were reported. Pfaffenbach et al. reported that in 25 adult
patients with functional dyspepsia,patients with delayed gastric
emptying showed significantly more pre- and post pradial
tachygastrias than patients with normal gastric emptying[40]. Gastric
emptying is a complex procedure. EGG reflects gastric myoelectrical
181
activity and gastric emptying reflects gastric motility,so EGG and
gastric emptying should complement each other in studying gastric
motor disorders[14,41].
In conclusion, diabetic patients with dyspeptic symptoms
have delayed gastric emptying and abnormalities in gastric
myoelectrical activity including dysrhythmia and the reduced
postprandial increase in the dominant power. However, the
abnormal EGG isn’t able to predict delayed gastric emptying.
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