Non-invasive identification of gastric contractions from surface electrogastrogram using back-propagation neural networks

Gastric contractions play an important role in the digestive process of the stomach. The established method for the measurement of gastric contractions is invasive and involves the insertion through the nose of a manometric probe into the stomach. A non-invasive method is introduced in this paper for the identification of gastric contractions using the surface electrogastrogram. The electrogastrogram (EGG) was measured by placing surface electrodes on the abdominal skin over the stomach in ten subjects. Gastric contractions were simultaneously monitored using an intraluminal manometric probe. The back-propagation neural network was applied to identify gastric contractions from the EGG. The input of the neural network was composed of spectral data points of the EGG which was computed using the exponential distribution method. Experiments were conducted to optimize network structures and parameters. Using the EGG data in five subjects as the training set and the EGG data in another five subjects as the testing set, an overall accuracy of 92% was achieved in the identification of gastric contractions with an optimized three-layer back-propagation neural network (number of nodes for input:hidden:output layers being 64:10:2).

What is the secretory potential of submucosal mucous glands within the human gullet in health and disease?

Histology of the human esophageal mucosa reveals numerous submucosal mucous glands, scattered along the esophagus and especially accumulated below the upper and above the lower esophageal sphincters. Mucin remains a major organic component of human esophageal secretion, collected using our newly developed esophageal perfusion catheter. Esophageal mucin is accompanied by nonmucin proteins, epidermal growth factor (EGF) and prostaglandin E2 (PGE2). Bicarbonate is the major inorganic component of esophageal secretion in humans. Mucosal exposure to an HC1/pepsin solution, mimicking the natural gastroesophageal scenario, significantly changed the secretory profile of all esophageal secretion components. The rate of secretion of esophageal mucin, EGF and PGE2 under the impact of HC1/pepsin in patients with reflux esophagitis appeared to be significantly impaired, although the basal rate of esophageal PGE2 output remained higher than in controls. These data indicate that a significant impairment in esophageal components of the preepithelial mucosal barrier, paralleling the severity of mucosal inflammation, may have a detrimental impact on the protective potential of the esophageal mucosal barrier, facilitating the development of reflux esophagitis.

Do salivary organic components play a protective role in health and disease of the esophageal mucosa?

Aggressive factors operating within the esophageal lumen during gastroesophageal reflux are balanced by adequately mobilized protective mechanisms. Esophageal mucosal protection operates at three different although complementary dimensions: (1) preepithelial, (2) epithelial and (3) postepithelial. Since aggressive factors predominantly operate within the esophageal lumen, preepithelial defense is pivotal in mucosal protection. The preepithelial barrier is significantly enhanced by the quantity and the quality of salivary organic components such as salivary mucin, nonmucin protein, salivary epidermal growth factor (EGF) and salivary prostaglandin E2. The rate of secretion of salivary mucin, nonmucin protein and EGF under the impact of intraesophageal mechanical (bolus) and chemical (HCl/pepsin) stimulation, mimicking the natural gastroesophageal reflux scenario, is significantly impaired in patients with RE, whereas the rate of salivary PGE2 output remains essentially unchanged. Salivary secretory response to esophageal mechanical and chemical stimuli in terms of organic components, mediated by the esophagosalivary reflex pathway, exhibits a significant impairment in patients with reflux esophagitis.

Clinical significance of gastric myoelectrical dysrhythmias

Normal rhythmic myoelectrical activity of the human stomach is 3 cpm, regulating gastric contractile activity. Dysrhythmia in gastric myoelectrical activity is found to be associated with functional disorders of the stomach. Gastric dysrhythmias are classified into tachygastria (frequency higher than normal), bradygastria (frequency lower than normal) and arrhythmia (no rhythmic activity). Clinical significance of gastric dysrhythmias is discussed in this paper, outlined as follows: (a) What is normal gastric myoelectrical activity and what is dysrhythmia? (b) How to detect gastric dysrhythmias? (c) Gastric dysrhythmias in clinical settings. (d) What may cause gastric dysrhythmias? (e) How to normalize gastric dysrhythmias?

What role do salivary inorganic components play in health and disease of the esophageal mucosa?

The integrity of the esophageal mucosa depends upon an equilibrium between aggressive factors and protective mechanisms. Esophageal mucosal protective mechanisms operate at three overlapping levels: (1) preepithelial, (2) epithelial and (3) postepithelial. Since aggressive factors always operate on the luminal side of the esophagus, preepithelial defense remains as the first line in mucosal barrier protection. Salivary secretion quantitatively and qualitatively contributes to the protective potential of the preepithelial barrier. Salivary volume and its buffering capacity are elaborated by lowering intraluminal pH within the esophagus, and are key factors in restoration of physiologic pH within the esophagus. Salivary secretory response to esophageal mechanical (bolus) and chemical (intraluminal pH) stimuli, mediated by the esophagosalivary reflex pathway, is impaired in patients with reflux esophagitis.

Declined human esophageal mucin secretion in patients with severe reflux esophagitis

It has been recently demonstrated that human esophageal submucosal mucous glands exhibit the ability to secrete copious amounts of mucin, well known within the gastrointestinal tract for its protective quality against hydrogen ion and pepsin. Since mucin may also play a protective role within the esophageal compartment, we have studied the rate of secretion of esophageal mucin in patients with RE. Mucin was assessed by periodic acid-Schiff methodology in esophageal secretion collected during continuous perfusion with saline (period I) followed by HCl (period II), HCl/pepsin (period III), and final saline (period IV), mimicking the natural gastroesophageal scenario. The basal rate of the luminal release of mucin in patients with grade II RE was 18% lower as compared with controls. During exposure of the esophageal mucosa to an HCl/pepsin solution, esophageal mucin output in the RE group was 52% lower than in the control group (0.154 +/- 0.027 vs 0.320 +/- 0.049 mg/cm2/min; P = 0.025). Furthermore, the rates of esophageal mucin output in patients with grade III RE during esophageal perfusion with saline and HCl/pepsin were 62% (0.090 +/- 0.021 vs 0.239 +/- 0.036 mg/cm2/min; P = 0.016) and 86% (0.048 +/- 0.010 vs 0.320 +/- 0.049 mg/cm2/min; P = 0.001) lower when compared with corresponding values in controls. After endoscopic healing of RE, the overall impairment in the rate of esophageal mucin secretion in patients with grade II improved from 31% to 17% at the end of therapy, whereas in patients with grade III the impairment in mucin secretion improved only marginally from 71% to 69%.(ABSTRACT TRUNCATED AT 250 WORDS)

Occupational exposure to Helicobacter pylori for the endoscopy professional: a sera epidemiological study

OBJECTIVES

The purpose of this prospective study was to determine if medical and nursing staff in the United States who are regularly involved in endoscopic procedures are at an increased risk of acquiring Helicobacter pylori infection.

METHODS

One hundred and twenty-two gastroendoscopists and endoscopy nurses attending an advanced gastroendoscopy course (17 women, 105 men) completed a questionnaire consisting of past medical and professional history. Serum from each subject was collected and tested using a validated ELISA assay (sensitivity 99%, specificity 96%). H. pylori prevalence in the experimental group was compared to that of 510 blood donors.

RESULTS

In all age groups, H. pylori positivity was significantly higher among the study subjects compared with controls. Caucasian subjects, when matched to controls for age, race, and level of education, had significantly higher rates of H. pylori positivity. Foreign-born subjects, when compared to US-born subjects, also had higher rates of H. pylori positivity. There was no statistical difference of H. pylori positivity with respect to gender, years involved in endoscopy, or number of endoscopies performed monthly.

CONCLUSION

H. pylori infection is more common in gastroendoscopists and endoscopy nurses than the general population and should be viewed as an occupational hazard.

Diminished luminal release of esophageal epidermal growth factor in patients with reflux esophagitis

OBJECTIVES

It has recently been demonstrated that human esophageal mucosa, containing numerous submucosal mucous glands, has the ability to elaborate significant amounts of esophageal epidermal growth factor (eEGF). Because of its role in the maintenance of the integrity of the esophageal mucosa, we elected to study the rate of secretion of eEGF in patients with reflux esophagitis (RE), compared with controls, using our newly developed esophageal perfusion model.

METHODS

Fourteen healthy asymptomatic volunteers and 14 patients with endoscopically confirmed esophagitis underwent esophageal perfusion with saline, HCl (0.01 M, pH 2.1) HCl/pepsin (0.5 mg/ml of HCl), and ending NaCl solution during four consecutive 8-min perfusion periods. All perfusates were assayed for EGF by RIA (Amersham). Results are expressed as mean +/- SEM. Student's t test was used for statistical analysis.

RESULTS

The basal rate of luminal EGF release in patients with RE was 3.78 +/- 0.29 ng/min. This value significantly declined (2.27 +/- 0.27 ng/min; p < 0.001) during mucosal exposure to HCl but was significantly enhanced when the HCl perfusing solution was supplemented with pepsin (4.20 +/- 0.29; p < 0.001 vs. HCl). Introduction of saline during the last perfusion period maintained a rate of luminal EGF release similar to that observed during the initial esophageal perfusion with saline. Luminal release of EGF in patients with RE was significantly lower, compared with corresponding values recorded in controls during perfusion with saline (3.78 +/- 0.29 vs. 14.1 +/- 1.25 ng/min; p < 0.00001), with HCl (2.27 +/- 0.27 vs. 5.95 ng/min; p < 0.0001), with HCl/pepsin solution (4.2 +/- 0.29 vs. 11.7 +/- 1.88 ng/min; p < 0.0001), and during the final perfusion period with saline (3.73 +/- 0.25 vs. 15.1 +/- 1.1 ng/min; p < 0.00001). Therefore, the rate of luminal EGF release in controls was 4-fold, 3-fold, 3-fold, and 4-fold higher than that of patients with RE during perfusion with initial saline, HCl, HCl/pepsin and final saline, respectively.

CONCLUSIONS

1) Decreased esophageal EGF in patients with RE may facilitate the development or delay the healing of mucosal injury. 2) Depletion of EGF from the mucus layer covering the epithelium under the impact of refluxed luminal acid/pepsin may be considered as one of the potential underlying mechanisms leading to damage of the esophageal mucosa during gastroesophageal reflux episodes.

The effect of esophageal mechanical and chemical stimuli on salivary mucin secretion in healthy individuals

Because of a newly developed model of esophageal perfusion in humans, the authors could study the role of esophago-salivary reflex in salivary neutral and acidic mucin output. The basal rate of neutral mucin output was 0.24 +/- 0.06 mg per minute. Placement of intraesophageal tubing and inflation of balloons resulted in a highly significant increase in salivary mucin output (2.10 +/- 0.22 mg per minute; p < 0.00001). However, implementation of esophageal perfusion with saline resulted in a significant decline of salivary mucin output (1.28 +/- 0.10 mg/mL NaCl4 versus 2.08 +/- 0.24 mg/mL NaCl1; p < 0.001). Esophageal perfusion with hydrochloric acid prevented the decline of salivary mucin output observed during perfusion with saline, whereas infusion of hydrochloric acid/pepsin resulted in a significant enhancement of salivary mucin output (2.89 +/- 0.31 mg per minute; p < 0.01). Therefore, mechanical and chemical stimulations resulted in an overall 9-fold and 12-fold increase in the rate of salivary mucin output over the basal value, respectively. The basal rate of acidic mucin secretion was 0.26 +/- 0.06 mg per minute. After placement of intraesophageal tubing, inflation of balloons, perfusion hydrochloric acid, or hydrochloric acid-pepsin solution, a significant enhancement in the rate of salivary acidic mucin output, similar to that observed during measurement of neutral mucin, was observed. Therefore, during mechanical and chemical stimulation, the rate of salivary acidic mucin output increased 7.3-fold and 11.1-fold over the basal value, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Human esophageal secretion: mucosal response to luminal acid and pepsin

BACKGROUND/AIMS

Although esophageal histology in humans reveals numerous submucosal mucous glands, their secretion has never been explored. Therefore, we have studied the chemical composition and physical characteristics of esophageal secretion under the impact of luminal saline, acid, and acid/pepsin solutions.

METHODS

The esophageal lumen in 21 healthy volunteers was continuously perfused with saline, HCI, or HCI/pepsin. Perfusates were assayed for mucin, protein, and viscosity. In addition, analysis of amino acid and sugar composition of purified esophageal mucin was performed.

RESULTS

Esophageal perfusion with saline resulted in luminal release of mucin at the rate of 0.23 +/- 0.03 mg.cm-2 x min-1. Acid/pepsin solution significantly enhanced luminal release of mucin (0.32 +/- 0.03 mg.cm-2 x min-1; P < 0.01). HCI/pepsin solution also significantly increased the luminal output of protein (P < 0.01) and significantly impaired the viscosity of the esophageal perfusate (P < 0.05). Threonine, serine, and proline were the major amino acids within the esophageal mucin, whereas galactose was the predominant carbohydrate.

CONCLUSIONS

Luminally released esophageal mucin, shown for the first time in humans, contributes significantly to maintaining the high viscosity of esophageal secretions. Significant increase in the luminal release of mucin under the impact of acid and pepsin, with subsequent decline of the perfusate viscosity, may indicate that mucin is the major target for gastric acid and pepsin, absorbing the deleterious impact of the gastroesophageal refluxate.

Impact of acid and pepsin on human esophageal prostaglandins

OBJECTIVES

Although the prostaglandin-mediated mucosal protection within the gastric compartment has been well established, its potential role in the maintenance of integrity of the esophageal mucosa in humans has not been explored due to the lack of appropriate methodology.

METHODS

We have recently developed an esophageal perfusion catheter, equipped with two balloons, compartmentalizing a 7.5-cm segment of the esophageal lumen. Using this catheter, we studied the impact of the luminal perfusion with saline, HCl (0.01 M, pH 2.1), and HCl/pepsin solutions (0.5 mg/ml) on esophageal luminal release of PGE2 in 21 asymptomatic, presumably healthy volunteers (12 M, 9F; mean age 40 yr). The content of PGE2 in its methyl oximated form was measured by RIA (Amersham, IL), using a novel iodinated label. Results are expressed as mean +/- SEM. Student's t test was used for statistical analysis.

RESULTS

Perfusion of the esophageal lumen resulted in continuous release of PGE2 into the perfusate at the rate of 1880 +/- 393 pg/min during the first 8-min perfusion period. During continuation of perfusion with saline, the luminal release of PGE2 was maintained at the rate of 1820 +/- 640 pg/min during the second 8-min perfusion period. This rate declined (although in nonsignificant fashion; p < 0.2) during the third perfusion period, reaching a plateau of 1220 +/- 473 pg/min and maintained during the last (period IV) perfusion period with saline. Introduction of acid during the perfusion period II in the second group of investigated subjects resulted in a rapid and statistically significant decline of the luminal release of PGE2 to the value of 1020 +/- 167 ng/min (p < 0.01). Continuation of esophageal perfusion with acid during the next 8-min perfusion period further diminished the luminal release of PGE2 to the value of 520 +/- 73; p < 0.001. The significant decline in the rate of luminal PGE2 release was still maintained despite the replacement of acid with saline during the ending 8-min perfusion (period IV; 560 +/- 80 ng/min; p < 0.001). Esophageal perfusion with HCl/pepsin solution, in group III subjects, potentiated luminal release of PGE2, reaching the value of 1553 +/- 340 pg/min, which is 3 times higher than the value of PGE2 observed during corresponding perfusion with HCl (period III; p < 0.03). This significant impact of HCl/pepsin solution was still maintained despite the substitution of HCl/pepsin with NaCl during the last perfusion period, and was still significantly higher (1260 +/- 220 pg/min; p < 0.02) than the corresponding value during the ending perfusion with NaCl after HCl (group II). This study for the first time demonstrates that luminal release of PGE2 in humans remains under a significant impact of luminal chemical factors such as acid and pepsin.

CONCLUSION

The modulatory effect of acid and pepsin on esophageal mucosal prostaglandin release may play a role in the development of reflux-related mucosal pathology.

Interrelationship between esophageal challenge with mechanical and chemical stimuli and salivary protective mechanisms

Using our newly developed model of esophageal perfusion in humans, we were able to study the esophagosalivary reflex in 20 healthy volunteers (12M, 8F; mean age 40 yr). The placement of the intraesophageal catheter resulted in a 6.3-fold increase in the salivation rate over the baseline value (2.27 +/- 0.28 vs. 0.36 +/- 0.06 ml/min; p = 0.02), whereas inflation of the catheter balloons evoked a 6.9-fold increase (2.52 +/- 0.21; p < 0.001) in the rate of salivation. A stepwise and significant decline of salivation (p = 0.02), observed during subsequent perfusion with NaCl was prevented when perfusion with HCl and HCl/pepsin solutions was implemented. The placement of the intraesophageal catheter resulted in a significant increase of salivary pH over its basal value (7.77 +/- 0.05 vs. 6.89 +/- 0.11; p < 0.001). A gradual decline of salivary pH during subsequent perfusion with NaCl was eliminated when saline was replaced with HCl or HCl/pepsin (7.76 +/- 0.04 vs. 7.46 +/- 0.09; p < 0.01). Intraesophageal tubing enormously potentiated the viscosity of saliva (44.50 +/- 9.0 vs. 9.3 +/- 1.0 mPa.s; p < 0.001). A subsequent decline of viscosity during continuous perfusion with saline was also prevented when HCl was substituted for NaCl (29.95 +/- 4.5 vs. 19.50 +/- 3.30; p < 0.05). A significant potentiation of salivary volume, viscosity, and pH during esophageal stimulation of mechano- and chemoreceptors may suggest a contributing role of the esophagosalivary reflex in the maintenance of the esophageal mucosal integrity under the impact gastroesophageal reflux.

Impairment of salivary epidermal growth factor secretory response to esophageal mechanical and chemical stimulation in patients with reflux esophagitis

OBJECTIVES

It has been demonstrated recently that salivary epidermal growth factor (sEGF) output in healthy individuals is strongly and significantly influenced by esophageal intraluminal mechanical and chemical stimuli. Therefore, we have studied the impact of intraesophageal mechanical and chemical stressors on the rate of secretion of sEGF in 14 patients with reflux esophagitis (RE), and compared these results with corresponding parameters measured in 14 sex- and age-matched controls.

METHODS

EGF was assessed in saliva collected during basal conditions, chewing of parafilm, placement of esophageal tubing, inflation of intraesophageal balloons, and perfusion with NaCl, HCl, and HCl/pepsin solutions. The concentration of sEGF was measured with an RIA kit from Amersham (Arlington Heights, IL).

RESULTS

The concentrations of sEGF were (mean +/- SEM) 2.50 +/- 0.32 ng/ml and 2.00 +/- 0.37 ng/ml in basal saliva and during stimulation by chewing the parafilm, respectively. Basal sEGF value appeared to be significantly higher than in controls (2.50 +/- 0.32 vs. 1.90 +/- 0.22 ng/ml, p < 0.05, in one-tailed t test). Placement of intraesophageal tubing resulted in a significant decline of sEGF concentration, compared with parafilm-stimulated conditions (1.25 +/- 0.12 vs. 2.00 +/- 0.37 ng/ml, p < 0.0001) and corresponding tubing-stimulated sEGF value in controls (1.25 +/- 0.12 vs. 1.52 +/- 0.16 ng/ml, p < 0.05). sEGF concentrations after inflation of intraesophageal balloons and subsequent perfusion with initial saline, HCl, HCl/pepsin, and ending saline were also highly significantly lower (1.05 +/- 0.18 ng/ml, p < 0.001; 1.10 +/- 0.20 ng/ml, p < 0.001; 1.10 +/- 0.18 ng/ml, p < 0.001; 1.10 +/- 0.19 ng/ml, p < 0.001; and 1.05 +/- 0.18 ng/ml, p < 0.001, respectively) than sEGF concentration recorded during stimulation with parafilm. Concentrations of sEGF during esophageal perfusion with HCl, HCl/pepsin, and ending saline were also significantly lower than corresponding values in controls (1.10 +/- 0.18 vs. 1.49 +/- 0.11 ng/ml, p < 0.05; 1.10 +/- 0.19 vs. 1.59 +/- 0.11 ng/ml, p < 0.05; and 1.05 +/- 0.18 vs. 1.65 +/- 0.13 ng/ml, p < 0.01, respectively). The rate of sEGF output, which was 1.30 +/- 0.24 ng/min during basal conditions, increased significantly during stimulation with parafilm (2.30 +/- 0.38 ng/min, p < 0.05). Both basal and parafilm-stimulated sEGF outputs were somewhat higher, although nonsignificantly, than corresponding values recorded in healthy individuals. Mechanical and chemical stimulation (initial NaCl, HCl, and ending NaCl) failed to evoke a significant increase in sEGF output over the value observed during parafilm stimulation in patients with RE, although such a significant increase was clearly demonstrated in healthy individuals. Therefore, sEGF output in patients with RE remained significantly lower than corresponding values recorded in controls during an entire mechanical stimulation (2.65 +/- 0.35 vs. 4.60 +/- 0.85 ng/min, p < 0.001, after placement of intraesophageal tubing and 2.80 +/- 0.54 vs. 5.15 +/- 0.70 ng/min, p < 0.001, after inflation of balloons). sEGF output in patients with RE remained also significantly lower than adequate control values during chemical stimulation (3.65 +/- 0.64 vs. 5.20 +/- 0.60 ng/min, p < 0.05, during perfusion with initial saline; 3.70 +/- 0.70 vs. 5.20 +/- 0.60 ng/min, p < 0.05, during perfusion with HCl; 3.70 +/- 0.52 vs. 5.55 +/- 0.72 ng/min, p < 0.01, during perfusion with HCl/pepsin, and 3.30 +/- 0.56 vs. 5.80 +/- 0.86 ng/min, p < 0.001, during ending saline).

CONCLUSION

Impairment in sEGF secretion during mechanical and chemical intraesophageal stimulation, mimicking the natural scenario occurring during gastroesophageal reflux, may facilitate the development of esophageal mucosal pathology and delay the healing of already developed mucosal injury.

Identification of gastric contractions from the cutaneous electrogastrogram

OBJECTIVE

The objective of this study was to investigate whether gastric contractions in the fasting and fed state can be identified from the cutaneous electrogastrogram.

METHODS

Simultaneous measurements of gastric myoelectrical and manometric activities were made in 10 healthy female volunteers from 1:00 AM to 9:45 AM. For manometric recording, a catheter incorporating solid state transducers was used. Cutaneous electrogastrography (EGG) was used for myoelectrical recording. All EGG data from 1:00 AM to 7:30 AM that occurred during motor quiescence, all EGG data that occurred during antral contractions, and 2-h EGG data after breakfast given at 7:30 AM were quantitatively analyzed and compared with each other. The EGG in three specific periods (fasting without antral contractions, fasting with contractions, and postprandial) was characterized by four parameters that include frequency, power, and stabilities of the frequency and power.

RESULTS

1) the peak power of the postprandial EGG was, respectively, 12.5 dB (about 2-fold increase in amplitude) and 6.8 dB (about 1-fold increase in amplitude) higher than that during motor quiescence (p < 0.05) and motor activity in the fasting state; 2) the dominant frequency of the postprandial EGG was, respectively, 6% and 13% higher than that during motor quiescence and motor activity (p < 0.05) in the fasting state; 3) the peak power of the fasting EGG was 48% more unstable during motor activity than motor quiescence (p < 0.05); 4) the stability of the EGG frequency was not significantly different during the three different periods.

CONCLUSION

The EGG provides important and useful information for the assessment of gastric motility. An unstable EGG peak power is indicative of gastric contractions in the fasting state. An increase in EGG peak power and/or dominant frequency after a solid test meal suggests a normal postprandial gastric motility.

Serosal and cutaneous recordings of gastric myoelectrical activity in patients with gastroparesis

The aims of this study were to 1) investigate gastric myoelectrical activity in patients with gastroparesis, 2) validate the cutaneous electrogastrogram (EGG) in tracking the frequency change of the gastric slow wave, and 3) investigate the effect of electrical stimulation on gastric myoelectrical activity. Gastric myoelectrical activity was recorded in 12 patients with documented gastroparesis using serosal electrodes for > 200 min in each subject. All recordings were made at least 4 days after surgery. Each session consisted of a 30-min recording in the fasting state and a 30-min recording after a test meal. The test meal (liquid or mixed) was selected according to patient's tolerance. Electrical stimulation was performed in three subjects via the serosal electrodes at a frequency of 3 cycles/min. Gastric myoelectrical activity was recorded using serosal electrodes in each session. The serosal recording showed slow waves of 2.5 to 4.0 cycles/min in all 12 subjects. Absence of spikes was noted in 11 of the 12 subjects. The simultaneous serosal and cutaneous recording of gastric myoelectrical activity showed that the frequency of the EGG was exactly the same as that of the serosal recording. Liquid meals resulted in a significant decrease in slow-wave frequency (Student's t test, P = 0.006), and the EGG accurately reflected this change. Electrical stimulation had no effect on the frequency of the gastric slow wave and did not induce spikes.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of esophageal intraluminal mechanical and chemical stressors on salivary epidermal growth factor in humans

Although various animal and clinical studies have demonstrated the significant effect of salivary epidermal growth factor (sEGF) on esophageal morphology and function, its secretory patterns still remain inadequately explored. Therefore, we have studied the impact of esophageal mechanical and chemical stimuli on sEGF in humans. sEGF was measured in saliva collected during basal conditions, chewing of parafilm, placement of esophageal tubing, inflation of intraesophageal balloons, and perfusion with NaCl, HCl, and HCl/pepsin solutions. The concentration of sEGF was measured with a radioimmunoassay kit from Amersham (Arlington Heights, IL). The concentration of sEGF in basal saliva was (mean +/- SEM) 2.08 +/- 0.22 ng/ml. Chewing the parafilm resulted in a significant decline of sEGF concentration to the value of 1.39 +/- 0.16 ng/ml (p < 0.0005). Similar decline in sEGF concentration also prevailed after placement of intraesophageal tubing (p < 0.03), and inflation of intraesophageal balloons (p < 0.01). This decline intensified significantly when prolonged esophageal perfusion with saline was implemented (p < 0.03 vs. tubing). Substitution of NaCl with HCl in the second and third perfusion periods prevented the decline in sEGF concentration, whereas HCl accompanied by pepsin enhanced sEGF concentration. The rate of sEGF output was 0.90 +/- 0.13 ng/min during basal conditions and increased significantly during parafilm chewing (1.53 +/- 0.25 ng/min; p < 0.05). However, sEGF secretion during both placement of esophageal tubing and inflation of balloons increased 4.1- and 4.9-fold, respectively (p < 0.002 and < 0.00005), over the basal value, and 2.4- and 2.9-fold, respectively, over the parafilm stimulated secretion. Subsequently, we observed a further significant decline of sEGF output (p < 0.05) which was sustained during perfusion of the esophagus with saline. Interestingly, esophageal perfusion with HCl prevented the decline of sEGF secretion observed during perfusion with saline. sEGF output during esophageal perfusion with HCl/pepsin exhibited a strong increase, reaching the value of 5.86 +/- 0.70 ng/ml. This value corresponds to a 58% increase over the secretory rate observed during mechanical stimulation by placement of esophageal tubing (3.71 +/- 0.47; p < 0.05). HCl/pepsin-induced potentiation of sEGF secretion was also highly significantly increased over both the value recorded during basal (p < 0.0005) and parafilm-stimulated (p < 0.002) conditions. Subsequent substitution of HCl/pepsin solution with a final saline perfusate still maintained enhanced sEGF output, compared with both basal (p < 0.02) and parafilm-stimulated conditions (p < 0.02).(ABSTRACT TRUNCATED AT 400 WORDS)

Bismuth subsalicylate suppression of Helicobacter pylori in nonulcer dyspepsia: a double-blind placebo-controlled trial

Gastritis caused by Helicobacter pylori (HP) is common in patients with nonulcer dyspepsia (NUD), but an etiologic relationship between the histologic lesion and clinical symptoms is unproven. HP is inhibited by bismuth subsalicylate (BSS), a traditional remedy for dyspeptic complaints. The aim of this study was to assess the short- and long-term effects of BSS on HP, gastritis, and symptoms in patients with NUD. One hundred twenty-six patients with NUD who were shown to be infected with H. pylori (HP+) were enrolled. There was a two-week placebo run-in period to eliminate placebo responders. Fifty patients remained symptomatic and were randomly assigned to therapy with either BSS liquid or a matching placebo. EGD, biopsy, and clinical evaluations were performed at entry, at week 5 (end of therapy), at week 9 (four weeks after therapy), or at time of symptomatic relapse. Twenty-seven patients received placebo and 23 patients received BSS. BSS suppressed H. pylori in 15/23 patients (65%) and eradicated it in one patient, whereas the placebo had no effect on H. pylori. Gastritis improved during therapy with BSS but relapsed by week 9. There was no significant change in level of dyspeptic symptoms during or after treatment, although one month after the end of treatment, the patients in the BSS group consistently had lower symptom scores and fewer symptomatic days for all symptoms measured. The study confirms that BSS given for three weeks suppresses but does not usually eradicate H. pylori. Such short-term suppression of H. pylori heals gastritis but does not result in clinical improvement.

Clinical applications of electrogastrography

Recently, electrogastrography (EGG) has received more and more attention. While gastroenterologists are interested in its clinical applications, concerns remain regarding the reliability and analysis of the EGG and the correlation between the EGG and gastric motility. The aims of this paper are to address these concerns and to review the potential clinical applications of the EGG. The following areas are discussed, based on the literature and our own experience with EGG: the refined method for the measurement of the EGG, the advanced techniques for quantitative analyses of the EGG, the reliability of the EGG in measuring gastric myoelectrical activity, the correlation between the EGG and gastric motility, and applications of the EGG in clinical gastroenterology.

Metronidazole susceptibility testing for Helicobacter pylori: comparison of disk, broth, and agar dilution methods and their clinical relevance

Since the methods for metronidazole susceptibility testing of Helicobacter pylori have not been standardized or validated, we compared three methods that are used to test the metronidazole susceptibilities of 25 isolates of H. pylori. Specifically, we examined the methods of Steer's replicator agar dilution, tube broth microdilution, and modified Kirby-Bauer disk diffusion. The metronidazole disk zone sizes obtained by the disk diffusion method correlated well (r = 0.74) with the MICs obtained by the agar dilution method. Afterward, the disk diffusion method was used to characterize the metronidazole susceptibilities of 44 isolates of H. pylori. Dual therapy (bismuth and metronidazole) proved to be highly effective against metronidazole-susceptible strains (81.6% eradication rate) but fared poorly against resistant strains (16.7% eradication rate; P < 0.01). Using agar dilution testing, we validated the modified Kirby-Bauer disk diffusion method for metronidazole susceptibility testing of H. pylori and conclude that it is practical, accurate, and clinically applicable.

Hepatitis C infection by polymerase chain reaction in alcoholics: false-positive ELISA results and the influence of infection on a clinical prognostic score

Antibody to hepatitis C as measured by the ELISA method is common in alcoholics. The presence of antibody to C 100-3 has been associated with more advanced disease. However, few studies have investigated the clinical significance of hepatitis C infection as defined by the presence of circulating viral RNA in alcoholics. We have prospectively examined 48 consecutive alcoholic patients for the presence of antibody to hepatitis C by an ELISA for antibody to the C100-3 antigen and by the reverse transcriptase polymerase chain reaction (PCR) using nested primers for the 5' nontranslated region of the viral RNA. Patients with liver disease were scored for disease severity by the combined clinical and laboratory index (CCLI). Overall, 12 of 48 patients (25%) were ELISA positive and eight of 48 (16%) were PCR positive. Among the 34 patients with liver disease, 10 (29%) were ELISA positive and six (18%) were PCR positive. All PCR-positive patients were also ELISA positive. There was no significant difference in the disease severity score (CCLI) or the duration of clinical disease in PCR-positive versus PCR-negative patients with liver disease. However, PCR-positive patients were significantly younger (43 +/- 6 vs. 55 +/- 10 yr, p = 0.001), indicating an earlier onset of severe disease in PCR-positive patients. There were no false-negative ELISA tests in either those with or those without liver disease. Among the 34 patients with liver disease, four of 10 patients with positive antibody were negative by PCR. Neither individual immunoglobulin levels (IgG, IgM, IgA) nor total globulins were significantly different between the ELISA-positive/PCR-negative patients and ELISA-positive/PCR-positive patients. When the entire group of 34 patients with liver disease was considered, we could not detect a significant correlation between ELISA absorbance and total globulins, and only a weak correlation between absorbance and immunoglobulin G (p = 0.49). These data show that the majority of alcoholic patients with liver disease and positive antibody to hepatitis C also have demonstrable viremia by PCR, and may require further evaluation and treatment. Elevated immunoglobulins in these patients do not correlate strongly with ELISA absorbance for anti-HCV. The presence of clinically advanced disease at a significantly younger age in the PCR-positive group is consistent with the concept of synergy between active viral infection and alcohol abuse in the development of liver disease in alcoholic patients.

Evidence on secretion of epidermal growth factor by the esophageal mucosa in humans

Luminal release of esophageal epidermal growth factor (EGF) into the perfusing solutions (saline, HCl, and HCl/pepsin), aspirated with the newly developed esophageal perfusion catheter, was measured in 20 healthy volunteers (12 male, 8 female; mean age 40 yr; range 30-56 yr). A potential salivary contamination was excluded by a complete seal (with two balloons) of perfused esophageal segment and by a simultaneous, carefully monitored, collection of saliva. The concentration of EGF in each of 16 fully recovered 2-min perfusion samples was measured by RIA kit (Amersham, IL). The concentration of EGF in recovered NaCl perfusate varied between (mean +/- SEM) 1.78 +/- 0.19 and 2.14 +/- 0.14 ng/ml, whereas output varied between 9.25 +/- 0.98 and 11.14 +/- 0.82 ng/min. During perfusion with HCl, both the concentration of EGF within the esophageal perfusate and its secretion declined significantly to a value of 0.68 +/- 0.17 ng/ml (p < 0.0001) and 3.56 +/- 0.90 ng/min (p < 0.0001), respectively. Introduction of pepsin into an acidic perfusion solution (0.5 mg/ml of HCl) resulted in a significant increase in EGF concentration (1.99 +/- 0.36 ng/ml; p < 0.001) and output (10.24 +/- 1.84; p < 0.01), compared with EGF values recorded during perfusion with HCl. EGF output, calculated from a sealed 7.5-cm segment of the esophagus, was 10.39 +/- 0.89 ng/min, and was maintained at a steady state throughout an entire saline perfusion procedure. We present evidence that human esophageal mucosa has an enormous EGF secretory potential. The rapid esophageal EGF secretory response to intraluminal challenge with aggressive factors implies its role in the maintenance of the mucosal integrity.