Evaluation of canine gastric motility with ultrasonography

For the evaluation of canine gastric motility with ultrasonography, contraction number of pyloric antrum and gastric emptying time (GET) by area and volume method developed by Bolondi et al.'s method were studied in 14 dogs. All experimental dogs were administered with saline and soup solution (10 ml/kg, B.W.). The mean values of contraction number of pyloric antrum in saline and soup group were 4.19 +/- 1.30/min and 4.82 +/- 0.65/min before feeding, and overall mean values were 4.66 +/- 1.37/min and 5.13 +/- 1.71/min, respectively. The mean values of the GET by area and volume method were 36.73 +/- 11.27, 40.00 +/- 8.87 min in saline group and 61.35 +/- 17.58, 59.11 +/- 14.46 min in soup group. In the GET in saline and soup groups, there was no significant difference between the area and volume method (p>0.05). Therefore, Bolondi et al.'s method by ultrasound can be used to evaluate the antropyloric motility and gastric emptying time with area and volume methods. The area method is easier to determine the GET than the volume method, but the latter is more accurate.

Relationship between ultrasonically detected phasic antral contractions and antral pressure

The relationships between gastric wall motion and intraluminal pressure are believed to be major determinants of flows within and from the stomach. Gastric antral wall motion and intraluminal pressures were monitored in five healthy subjects by concurrent antropyloroduodenal manometry and transabdominal ultrasound for 60 min after subjects drank 500 ml of clear soup. We found that 99% of antral contractions detected by ultrasound were propagated aborally, and 68% of contractions became lumen occlusive at the site of the ultrasound marker. Of the 203 contractions detected by ultrasound, 53% were associated with pressure events in the manometric reference channel; 86% of contractions had corresponding pressure events detectable somewhere in the antrum. Contractions that occluded the lumen were more likely to be associated with a pressure event in the manometric reference channel (P < 0.01) and to be of greater amplitude (P < 0.01) than non-lumen-occlusive contractions. We conclude that heterogeneous pressure event patterns in the antrum occur despite a stereotyped pattern of contraction propagation seen on ultrasound. Lumen occlusion is more likely to be associated with higher peak antral pressure events.

Two-dimensional noise-robust blind deconvolution of ultrasound images

This paper presents a new method for 2-D blind homomorphic deconvolution of medical B-scan ultrasound images. The method is based on noise-robust 2-D phase unwrapping and a noise-robust procedure to estimate the pulse in the complex cepstrum domain. Ordinary Wiener filtering is used in the subsequent deconvolution. The resulting images became much sharper with better defined tissue structures compared with the ordinary images. The deconvolved images had a resolution gain along the order of 3 to 7, and the signal-to-noise ratio (SNR) doubled for many of the images used in our experiments. The method gave stable results with respect to noise and grey levels through several image sequences.

[Self-poisonings of the addicted persons with corrosive substances]

In this paper we present two cases of suicidal behaviour; case (1)--patient dependent to medicines and case (2)--patient co-dependent, related with alcohol addicted person. Both of them combine suicidal corrosive substances consumption, but differ clinical course, finished by recover of addicted person and death of co-dependent person. In this paper we also present chemical burns of gastrointestinal tract algorithm procedure.

A simplified method for processing dynamic images of gastric antrum

By means of a dynamic acquisition protocol and a Fourier transform algorithm the scintigraphic technique can be used to assess gastric antral motility. In previous approaches, however, the definition of a region of interest (ROI) that gives rise to an unequivocal result of the analysis of the corresponding time-activity curve might be crucial. To overcome this problem we evaluated a new technique based on a fixed box-ROI and a simple weighting principle. Eight healthy volunteers ingested a meal that contained a 99Tcm-stannous colloid labelled omelette. Gastric emptying was assessed from static images taken at 30-mm intervals for 2 h. Anterior dynamic frames of 1 s each, which were acquired for 5 mm after each static acquisition, were used to determine the frequency of antral contractions. In order to allow for precise outlining of the antrum, each set of dynamic images was at first reframed into a single 5-mm image. The same ROI (20 pixels vertical, 15 pixels horizontal) was then positioned over the distal portion of the antrum on each reframed image. On each 1-s frame the obtained counts in each of the 15 columns of 20 pixels were summed. Then the localization of the geometric centre of radioactivity in the 15 columns was determined. On the assumption that the horizontal oscillations of the geometric centre of radioactivity in the ROI reflected the contractile activity of the antrum, the frequency of these contractions was calculated by fast Fourier transform analysis of the obtained time versus geometric centre curve. In all subjects, our technique gave unequivocal frequencies of antral contractions at each time point. Statistical analysis did not reveal any intraindividual variation in this frequency during gastric emptying. We believe that the simplified scintigraphic method is an advantageous alternative for assessing the frequency of antral contractions.

How do fiber-supplemented formulas affect antroduodenal motility during enteral nutrition? A comparative study between mixed and insoluble fibers

BACKGROUND

Fiber supplementation during enteral nutrition has been recommended, but the effect of soluble compared with insoluble fiber supplements on antroduodenal motility is unknown.

OBJECTIVE

The objective of this study was to compare antroduodenal motor patterns in 8 healthy volunteers during and after gastric infusion of 3 different diets: a fiber-free diet, an insoluble-fiber diet, and a mixed-fiber diet (50% soluble fiber and 50% insoluble fiber).

DESIGN

Manometric studies with the 3 different diets (2100 kJ) were performed in random order. Antroduodenal motility was monitored continuously for 6 h by using a pneumohydraulic system to calculate the number, amplitude, and duration of the pressure waves; the area under the curve (AUC); and the percentage of time occupied by motor activity before, during, and after each type of infusion. Variations in antral areas were measured by ultrasonography.

RESULTS

The gastric motor response was significantly higher, whatever the diet, in the distal antral recording site than in the 2 more proximal sites. In the proximal but not the distal antrum, the number of waves, the AUC, and the percentage of time occupied by motor activity were higher (P: < 0.04) with the mixed-fiber than with the insoluble-fiber diet. No significant differences in variations of antral area were observed among the 3 diets. In the duodenum, motor variables were not significantly different among the 3 diets.

CONCLUSIONS

A gastric infusion induced a greater motor response in the distal than in the proximal antrum. A mixed-fiber diet was associated with significantly greater proximal antral motility than was an insoluble-fiber diet. There was no significant difference among the 3 formulas in duodenal motor variables or in variations in antral area as measured by ultrasound.

Comparison of anterior and geometric mean liquid and solid gastric emptying rates in dogs and in patients after partial gastrectomy

OBJECTIVE

The purpose of this study was to determine if geometrical correction is necessary in the study of gastric emptying rate (GER) for liquids, using a low-energy radionuclide, such as 99mTc. Solid test meals were considered the reference.

METHODS

Both solid and liquid GERs were investigated using regional analysis. Anterior data were compared with geometrically corrected values in 15 dogs and 9 partial gastrectomy patients.

RESULTS

Anterior and geometrically corrected measurements differed significantly for solid food in the whole gastric region and in the antrum. Geometrically corrected values differed slightly from anterior data after partial gastrectomy. No difference was found for liquid food. Liquids redistributed much faster than solids within the stomach.

CONCLUSION

Measurement of GER using a single-phase liquid meal does not require geometrical correction. This is due to the rapid intragastric redistribution of the liquid. Geometrical correction for solid food can be omitted only after partial gastrectomy.

Effect of a water-soluble fiber (galactomannans)-enriched formula on gastric emptying time of regurgitating infants evaluated using an ultrasound technique

BACKGROUND

Milk formulas enriched with water-soluble fibers are a first-line measure for infants with gastroesophageal reflux. However, it has been reported that these compounds could affect gastric emptying. The aim of this study was to evaluate the effects of these thickeners on gastric emptying time in infants with frequent regurgitation or vomiting.

METHODS

Forty-seven infants, aged 1 to 12 months, with uncomplicated gastroesophageal reflux underwent two ultrasound evaluations of gastric emptying time after receiving either a standard formula or a formula enriched with 0.4 g galactomannan per 100 ml diluted milk. Gastric emptying time was calculated by measuring the antrum area at baseline and at defined intervals over the next 3 hours.

RESULTS

The gastric emptying time (mean +/- SD) for the standard and the thickened formula was 136 +/- 33 and 133 +/- 34 minutes, respectively. There was no significant difference in the gastric emptying patterns of the two formulas. Gastric emptying time was longer after the standard formula in 15 of the 47 subjects, shorter in 15 of the 47, and the same in 17 of the 47.

CONCLUSIONS

The ingestion of a water-soluble fiber-enriched formula does not have any significant influence on the gastric emptying time of infants with frequent regurgitation or vomiting.

Dyspepsia in AIDS is correlated to ultrasonographic changes of antral distension

OBJECTIVES

Patients with acquired immune deficiency syndrome (AIDS) frequently complain about dyspeptic symptoms. We set out to test whether changes in antral emptying or antral distension may account for these dyspeptic symptoms in AIDS.

METHODS

We studied antral emptying in ten patients with HIV infection (CDC 1993 classification stage C) by means of an established real-time ultrasonographic method. Organic abdominal lesions had been excluded. Six upper gastrointestinal symptoms were evaluated using a score ranging from 0 to 3. Fifteen subjects without any abdominal complaints and without any abdominal history served as controls. Antral cross sectional area was measured after an overnight fast and at 0, 15, 30, 45, 60, 90, 120 min after an semisolid test meal. Antral postprandial distension was expressed using an antral expansion ratio (postcibal antral area/fasting antral area). Gastric emptying of the test meal was derived from the measurement of the area under the postcibal antral distension curve (AUC).

RESULTS

Fasting antral cross sectional area and AUC (gastric emptying) were similar in both groups. Antral postprandial expansion tended to be lower in AIDS patients compared to controls (mean+/-S.D.): 288+/-84 versus 397+/-156%; P=0.08. In AIDS patients the symptom score of dyspepsia showed a positive correlation (r=0.55; P<0.05) with fasting antral area and a negative correlation (r=-0.62; P<0.05) with postprandial expansion. No signs of autonomic neuropathy were to be found in the AIDS patients tested in this study.

CONCLUSION

A wider fasting antral cross sectional area and an impaired antral postprandial expansion are related to dyspeptic symptoms in AIDS patients. This suggests the same relationship between dyspeptic symptoms and disturbed antral distension as seen in other patients with functional dyspepsia.

Impaired accommodation of the proximal stomach in children with recurrent abdominal pain

BACKGROUND

A new ultrasonographic method was applied in children with recurrent abdominal pain, to study accommodation of the proximal stomach to a meal.

METHODS

After an overnight fast, 20 patients with recurrent abdominal pain (age, 7-14 years) and 23 healthy control subjects (age, 7-13 years), were scanned by a 5-MHz transducer positioned in the epigastrium, to monitor the size of the proximal stomach before and after a test meal of meat soup.

RESULTS

Children with recurrent abdominal pain had a significantly smaller sagittal area of the proximal stomach at 10 and 20 minutes after the meal than in healthy control subjects (P = 0.01 for both) and significantly higher emptying fraction of the proximal stomach at 10 minutes after the meal than in healthy control subjects (P = 0.02). There was no significant difference in emptying of the distal stomach between the patients and healthy control subjects. Children with recurrent abdominal pain experienced more symptoms (pain, bloating) in response to the test meal than did healthy control subjects.

CONCLUSION

The results support the view that recurrent abdominal pain in children may be a motility disorder that can be detected in the proximal stomach as an impairment of adaptive relaxation in response to a meal. This new ultrasonographic method may become a valuable diagnostic tool in patients with recurrent abdominal pain.

Influence of a 5HT1 receptor agonist on gastric accommodation and initial transpyloric flow in healthy subjects

Sumatriptan, a 5HT1 receptor agonist, inhibits antral motor activity, delays gastric emptying and relaxes the gastric fundus. The aim of this study was to characterize the effect of sumatriptan on transpyloric flow and gastric accommodation during and immediately after ingestion of a liquid meal using duplex sonography. Ten healthy subjects were investigated twice on separate days. In random order either sumatriptan 6 mg (Imigran 0.5 mL) or a placebo were given s.c. 15 min before ingesting 500 mL of a meat soup. The subjects were examined during the 3-min period before ingestion of the liquid meal, the 3-min spent drinking the meal and 10 min postprandially. Sumatriptan caused a significant widening of both the gastric antrum (P=0.02) and the proximal stomach (P=0.01) 10 min postprandially as compared with placebo. It caused no significant differences in time to initial gastric emptying (P=0.2), but significantly delayed commencement of peristaltic-related transpyloric flow (P=0.04). Sumatriptan had no significant effect on mean abdominal symptom scores, but after sumatriptan there was a significant negative correlation between width of postprandial antral area and postprandial nausea and between width of postprandial antral area and postprandial bloating. We therefore conclude that sumatriptan causes a postprandial dilatation of both the distal and the proximal stomach with no change in dyspeptic symptoms nor in length of time to first gastric emptying. Time to commencement of peristaltic-related emptying is delayed.

Gastric electromechanical dysfunction in Parkinson's disease

This study was designed to evaluate gastric myoelectrical and mechanical activities in idiopathic Parkinson's disease (IPD) patients. Twenty patients with IPD (14 male and 6 female, mean age 42 +/- 9 years) were studied. Patients were divided into two groups: group A--early stage of disease (no. = 6) and group B--advanced IPD (no. = 14). Electrogastrography (EGG) was performed in fasting and postprandial conditions (Synectics system). The cross-sectional area of the gastric antrum was measured by sonography (Hitachi EUB-240). The antral area in fasting conditions was 2.1 +/- 0.4 and 4.2 +/- 1.2 cm2 and gastric emptying was 75 +/- 5 and 125 +/- 12 min in groups A and B respectively. EGG showed dysrhythmias (range 1-6 cycles per minute) in about 75% of both groups of IPD patients without increase in signal amplitude after a meal. Our results suggest that gastric motility is particularly impaired in patients with advanced IPD. It may be caused by the primary degenerative process in the autonomic nervous system of the gut.

Laparoscopic wedge resection of the gastric wall for gastric benign tumour. The collaboration of the laparoscopic surgeon and the endoscopist

INTRODUCTION

By the introduction of the laparoscopy for the management of gastric pathology many techniques are applied by now. In these techniques the collaboration of the endoscopist and the laparoscopic surgeon is mandatory.

AIMS OF THE STUDY

To emphasise the necessity of the collaboration of the endoscopist and the laparoscopic surgeon for the management of the gastric pathology using the double lifting and wedge resection technique.

METHOD

A case of a female with 2 x 2.5 cm submucosal tumour is presented. The tumour was located in the antrum. After the onset of the general anaesthesia the gastroscope was introduced to locate the position of the tumour, the free edges of the tumour were elevated by a double lifting method and the tumour was resected by a laparoscopic linear stapler. The process of the proper resection was all through observed and directed by the view of the gastroscope.

CONCLUSION

Correct wedge resection of the gastric wall can be safely performed, if the correct gastroscopic control is present. The collaboration of the endoscopist and the laparoscopic surgeon seems to be mandatory, thus avoiding the hazards arising from the use of tattooing.

Hypertrophied antral-pyloric fold: reassessment of radiographic findings in 40 patients

PURPOSE

To reassess the findings of a hypertrophied antral-pyloric fold on double-contrast barium studies.

MATERIALS AND METHODS

A search of radiologic files resulted in recovery of records of 1,796 patients with findings of antral gastritis on double-contrast upper gastrointestinal studies. According to radiologic reports, 40 patients had a hypertrophied antral-pyloric fold. The radiographs were reviewed retrospectively to determine the size, location, and morphologic features of the folds. Clinical, radiologic, and/or endoscopic follow-up data were obtained in 22 patients.

RESULTS

All but two patients were symptomatic, and all but one responded to medical treatment. The hypertrophied antral-pyloric fold was located on the lesser curvature of the distal antrum in all patients and extended to the pylorus in 25 (62%) and into the base of the duodenal bulb in 15 (38%). The fold appeared as a smooth or slightly lobulated submucosal mass in 37 (92%) patients and as a plaquelike lesion in three (8%). Other radiographic findings of antral gastritis were present in 26 (65%) patients. In nine patients who underwent endoscopy, endoscopic and/or histologic findings of antral gastritis were present in five, but none had evidence of tumor.

CONCLUSION

A hypertrophied antral-pyloric fold may be a sign of antral gastritis that is associated with characteristic radiographic findings. Endoscopy and biopsy may not be warranted when lesions with features typical of a hypertrophied antral-pyloric fold are seen on double-contrast barium studies.

Small-bowel motility disturbances: a comparison of small-bowel series and antroduodenal manometry

RATIONALE AND OBJECTIVES

The authors' purpose was to compare the findings of small-bowel series with those of antroduodenal manometry to determine whether normal findings from a small-bowel series would make it unnecessary to perform antroduodenal manometry.

MATERIALS AND METHODS

The findings from 33 small-bowel series performed on patients who had undergone antroduodenal manometry were retrospectively reviewed for abnormalities, including dilatation, transit time, fold thickening, and increased fluid. Antroduodenal manometry findings were classified into the following categories: normal, myopathy, neuropathy, obstructions, or nonspecific conditions.

RESULTS

Nine of 12 patients with specific abnormalities at antroduodenal manometry had abnormal results from the small-bowel series. Of seven patients with normal small-bowel series results, three had abnormal antroduodenal manometry results--two had previously undergone vagotomy with neuropathic changes and one had myopathic changes.

CONCLUSION

Small-bowel series and antroduodenal manometry are complementary examinations. Only a small number of patients with normal small-bowel series results will have abnormal results at antroduodenal manometry. A large number of patients with motility abnormalities have a combination of nonspecific changes, such as dilatation and increased fluid, at a small-bowel series.

Gastric involvement in progressive systemic sclerosis: electrogastrographic and sonographic findings

OBJECTIVE

To determine whether electrogastrography (EGG) can discern sonographically demonstrated motility disorders in patients with progressive systemic sclerosis (SSc) and to evaluate EGG as a possible diagnostic tool.

DESIGN

Prospective study with control group and testing for reliability.

SUBJECTS

15 SSc patients [women aged 33-70 years (mean 53.3 years)] and 15 healthy volunteers.

METHODS

Bipolar cutaneous EGG was recorded to obtain the following parameters: period dominant frequency (PDF), percentage of gastric dysrhythmia and normogastria (defined as 2-4/min), period dominant power (PDP) and its change after a standardized meal of 500 kcal (2093 kJ), and instability coefficients of dominant frequency and power (DFIC, DPIC). Simultaneously, real-time sonography was performed in the aortomesenteric plane (3.5-MHz curved-array probe). In 10 patients and 13 control subjects, the distance from the anterior wall of the gastric antrum to the abdominal skin was measured.

RESULTS

Three patients (20%) showed hypomotility of the gastric antrum sonographically. The percentage of bradygastria was significantly lower in these patients, but the PDF, DFIC and DPIC values were not significantly different. The distance between the cutaneous electrodes and the antrum bore a greater relationship to the PDP values than did the sonographically demonstrated number of gastric contractions.

CONCLUSIONS

Although cutaneous EGG can be performed in SSc patients without apparent derangement in frequency and stability of the signal, it offers no advantage over sonography in diagnosis and follow-up.

Measurement of gastric emptying by standardized real-time ultrasonography in healthy subjects and diabetic patients

The aim of this study was to simplify and standardize a reproducible, well-tolerated and clinically applicable method for the assessment of gastric emptying rate by real-time ultrasonography. A total of 33 subjects were examined, including 19 healthy subjects and 14 patients with insulin-dependent diabetes mellitus and clinically suspected delayed gastric emptying. Measurements of the gastric antrum were taken in the supine position and in relation to internal landmarks to obtain a standardized cross-sectional image producing the area of a selected slice of the antrum. Diabetic patients were examined on the condition that the fasting blood glucose level was 3.5 to 9.0 mmol/l. Gastric emptying rate was estimated and expressed as the percentage reduction in antral cross-sectional area from 15 to 90 min after the ingestion of a standardized semisolid breakfast meal (300 g rice pudding, 330 kcal). Interobserver and intraobserver measurement errors were assessed, as was the significance of age and sex on gastric emptying. In comparison to healthy subjects, diabetic patients showed significantly wider median values of the 90 min postprandial antral area, but only a mild tendency toward greater dilation of the gastric antrum prior to and 15 min after meal ingestion. The median value of gastric emptying rate in these diabetic patients was estimated at 29%, which was less than half of that in the healthy subjects (63%). Statistically the difference was highly significant. Interpersonal variability of gastric emptying rate and antral areas was large for both groups. Measurements of gastric emptying rate gave highly reproducible results on separate days and from different observers (interobserver systematic measurement error 0.3% and random measurement error 10.9%; intraobserver systematic measurement error 3.6% and random measurement error 9.5%). No difference in gastric emptying rate was found related to age or sex. We conclude that the use of standardized real-time ultrasonography to determine gastric antral cross-sectional area in a single section of the stomach is a valid method for estimating gastric emptying rate.

The development of hypertrophic pyloric stenosis in a patient with prostaglandin-induced foveolar hyperplasia

BACKGROUND

Hypertrophic pyloric stenosis (HPS) has been described in association with several obstructive antropyloric lesions including idiopathic foveolar hyperplasia (gastric mucosal hypertrophy), feeding tubes, eosinophilic gastroenteritis, and hypertrophic antral polyps. Non obstructive antral webs have also been described with HPS.

PATIENT AND METHODS

We present a case of gastric-outlet obstruction in association with HPS, namely, prostaglandin-induced foveolar hyperplasia. This entity has been previously described, but rarely in association with HPS. We report a female infant requiring prostaglandin therapy for pulmonary atresia who developed dose-related prostaglandin-induced foveolar hyperplasia and symptoms of progressive non-bilious vomiting.

RESULTS

Initially, ultrasonography demonstrated evidence of antral mucosal hypertrophy as the cause for gastric-outlet obstruction. The patient subsequently developed progressive thickening of the antropyloric muscle, resulting in sonographic appearances of hypertrophic pyloric stenosis. Pyloromyotomy was eventually required for treatment of HPS.

CONCLUSION

A common denominator of most of the above-described entities is thickening and/or hypertrophy of the antral mucosa. We suggest that the antropyloric musculature may hypertrophy in an effort to overcome the gastric-outlet obstruction caused by the adjacent thickened antral mucosa. In other words, these entities may represent examples of "secondary" hypertrophic pyloric stenosis.

[Gastric emptying in children with gastroesophageal reflux. Evaluation by real time ultrasonography of the pyloric antrum]

OBJECTIVE

We have studied gastric emptying using real time ultrasound in 25 healthy children and 25 children with RGE. Our aim was to establish the time and mode of gastric emptying and the volume and the degree of antral dilation in both groups at baseline and after a test meal. We also evaluated the same parameters in the RGE cases after supplying a prokinetic.

PATIENTS AND METHODS

The Bolondi technique was used to measure the basal antrum volume and emptying ratio, as well as the mode and final gastric emptying time at different time-points after a solid-liquid test meal.

RESULTS

Patients with RGE have a clearly longer gastric emptying time with respect to the healthy subjects in both children less than one year of age (238 +/- 48.4 vs 176.3 +/- 36.7 minute; p = 0.03) and those 1-14 years old (206.3 +/- 48.2 vs 163.3 +/- 48.1 minutes, p = 0.03). An anomalous gastric emptying, similar to a broken line, can be observed in children suffering from RGE. In contrast, a progressive reduction of antrum dilation ration was seen in healthy children and not in patients with RGE. After cisapride, gastric volume goes down at all test times in RGE children. Therefore, a decrease in final gastric emptying time cannot be observed.

CONCLUSIONS

Children suffering from RGE show an alteration in gastric emptying with a clearly greater time and an anomalous mode of emptying. The antrum remained dilated for longer periods after ingestion of test food.

The hypertrophied antral-pyloric fold: CT appearance

We report a patient found to have a hypertrophied antral-pyloric fold on barium study, in whom CT demonstrated a smooth soft tissue mass on the anterior wall of the pre-pyloric antrum. When this finding is encountered on CT, a double-contrast upper GI study should be performed as the next diagnostic test. Endoscopy can probably be avoided if the barium study shows the typical findings of a hypertrophied antral-pyloric fold.

A case of bleeding gastric lipoma: US, CT and MR findings

We report a case of gastric lipoma which manifested with an episode of acute gastrointestinal hemorrhage. Preoperative diagnosis was based on the US, CT, and MRI findings, as the results of gastrointestinal endoscopy were inconclusive. The role of current imaging methods, and particularly of MRI, is discussed.