Measurement of electrical activity of the human small intestine using surface electrodes

Body Surface Gastrointestinal Potential Mapping: A Simulation Framework to Evaluate Source Separation Algorithms. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023;2023:1-4. [PMID: 38083102 DOI: 10.1109/embc40787.2023.10340911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Gastrointestinal (GI) potential mapping could be useful for evaluating GI motility disorders. Such disorders are found in inflammatory bowel diseases, such as Crohn's disease, or GI functional disorders. GI potential mapping data originate from a mixture of several GI electrophysiological sources (termed ExG) and other noise sources, including the electrocardiogram (ECG) and respiration. Denoising and/or source separation techniques are required, however, with real measurements, no ground truth is available. In this paper we propose a framework for the simulation of body surface GI potential mapping data. The framework is an electrostatic model, based on fecgsyn toolbox, using dipoles as electrical sources for the heart, stomach, small bowel and colon, and an array of surface electrodes. It is shown to generate realistic ExG waveforms, which are then used to compare several ECG and respiration cancellation techniques, based on, fast independent component analysis (FastICA) and pseudo-periodic component analysis (PiCA). The best performance was obtained with PiCA with a median root mean squared error of 0.005.

Gastrointestinal Myoelectric Measurements via Simultaneous External and Internal Electrodes in Pigs

INTRODUCTION

Currently, there is no accurate noninvasive measurement system to diagnose gastrointestinal (GI) motility disorders. Wireless skin patches have been introduced to provide an accurate noninvasive measurement of GI myoelectric activity which is essential for developing neuro-stimulation devices to treat GI motility disorders. The aim of this study is to compare the external and internal electrical signal measurements in ambulatory pigs.

METHODS

Yucatan pigs underwent placement of internal electrodes on the stomach, small intestine, and colon. Wires were brought through the abdominal wall. Signals were collected by a wireless receptor. Four external patches were placed on the abdominal skin to record the signals simultaneously. Pigs were kept for 6 d while the sensors were continuously recording the data from both systems.

RESULTS

Internal sensors detected rich signals from each organ. The stomach had a dominant frequency that ranged from 4 to 4.5 cpm, with occasional higher frequencies at 2, 3 and 4 times that. Small intestine signals had their primary energy in the 12-15 cpm range. Colon signals primarily displayed a dominant broad peak in the 4-6 cpm region. External skin patches detected a substantial fraction of the activities measured by the internal electrodes. A clear congruence in the frequency spectrum was observed between the internal and external readings.

CONCLUSIONS

Internally measured myoelectrical signals confirmed different patterns of rhythmic activity of the stomach, small intestine, and colon. Skin patches provided GI myoelectric measurement with a range of frequencies that could be useful in the diagnosis and treatment of motility disorders.

Bioelectrical Signals for the Diagnosis and Therapy of Functional Gastrointestinal Disorders

Coordinated contractions and motility patterns unique to each gastrointestinal organ facilitate the digestive process. These motor activities are coordinated by bioelectrical events, sensory and motor nerves, and hormones. The motility problems in the gastrointestinal tract known as functional gastrointestinal disorders (FGIDs) are generally caused by impaired neuromuscular activity and are highly prevalent. Their diagnosis is challenging as symptoms are often vague and difficult to localize. Therefore, the underlying pathophysiological factors remain unknown. However, there is an increasing level of research and clinical evidence suggesting a link between FGIDs and altered bioelectrical activity. In addition, electroceuticals (bioelectrical therapies to treat diseases) have recently gained significant interest. This paper gives an overview of bioelectrical signatures of gastrointestinal organs with normal and/or impaired motility patterns and bioelectrical therapies that have been developed for treating FGIDs. The existing research evidence suggests that bioelectrical activities could potentially help to identify the diverse etiologies of FGIDs and overcome the drawbacks of the current clinically adapted methods. Moreover, electroceuticals could potentially be effective in the treatment of FGIDs and replace the limited existing conventional therapies which often attempt to treat the symptoms rather than the underlying condition.

Colon Myoelectric Activity Measured After Open Abdominal Surgery with a Noninvasive Wireless Patch System Predicts Time to First Flatus

BACKGROUND

Passage of flatus after abdominal surgery signals resolution of physiological postoperative ileus (POI) and often, particularly after complex open surgeries, serves as the trigger to initiate oral feeding. To date, there is no objective tool that can predict time to flatus allowing for timely feeding and optimizing recovery. In an open, prospective study, we examine the use of a noninvasive wireless patch system that measures electrical activity from gastrointestinal smooth muscles in predicting time to first flatus.

METHODS

Eighteen patients who underwent open abdominal surgery at El Camino Hospital, Mountain View, CA, were consented and studied. Immediately following surgery, wireless patches were placed on the patients' anterior abdomen. Colonic frequency peaks in the spectra were identified in select time intervals and the area under the curve of each peak times its duration was summed to calculate cumulative myoelectrical activity.

RESULTS

Patients with early flatus had stronger early colonic activity than patients with late flatus. At 36 h post-surgery, a linear fit of time to flatus vs cumulative colonic myoelectrical activity predicted first flatus as much as 5 days (± 22 h) before occurrence.

CONCLUSIONS

In this open, prospective pilot study, noninvasive measurement of colon activity after open abdominal surgery was feasible and predictive of time to first flatus. Interventions such as feeding can potentially be optimized based on this prediction, potentially improving outcomes, decreasing length of stay, and lowering costs.

Magnetoenterography for the Detection of Partial Mesenteric Ischemia

BACKGROUND

Acute mesenteric ischemia represents a life-threatening gastrointestinal condition. A noninvasive diagnostic modality that identifies mesenteric ischemia patients early in the disease process will enable early surgical intervention. Previous studies have identified significant changes in the small-bowel electrical slow-wave parameters during intestinal ischemia caused by total occlusion of the superior mesenteric artery. The purpose of this study was to use noninvasive biomagnetic techniques to assess functional physiological changes in intestinal slow waves in response to partial mesenteric ischemia.

METHODS

We induced progressive intestinal ischemia in normal porcine subjects (n = 10) by slowly increasing the occlusion of the superior mesenteric artery at the following percentages of baseline flow: 50%, 75%, 90%, and 100% while simultaneous transabdominal magnetoenterogram (MENG) and serosal electromyogram (EMG) recordings were being obtained.

RESULTS

A statistically significant serosal EMG amplitude decrease was observed at 100% occlusion compared with baseline, whereas no significant change was observed for MENG amplitude at any progressive occlusion levels. MENG recordings showed significant changes in the frequency and percentage of power distributed in bradyenteric and normoenteric frequency ranges at 50%, 75%, 90%, and 100% vessel occlusions. In serosal EMG recordings, a similar percent power distribution (PPD) effect was observed at 75%, 90%, and 100% occlusion levels. Serosal EMG showed a statistically significant increase in tachyenteric PPD at 90% and 100% occlusion. We observed significant increase in tachyenteric PPD only at the 100% occlusion level in MENG recordings.

CONCLUSIONS

Ischemic changes in the intestinal slow wave can be detected early and noninvasively even with partial vascular occlusion. Our results suggest that noninvasive MENG may be useful for clinical diagnosis of partial mesenteric ischemia.

A Flexible Multiring Concentric Electrode for Non-Invasive Identification of Intestinal Slow Waves

Developing new types of optimized electrodes for specific biomedical applications can substantially improve the quality of the sensed signals. Concentric ring electrodes have been shown to provide enhanced spatial resolution to that of conventional disc electrodes. A sensor with different electrode sizes and configurations (monopolar, bipolar, etc.) that provides simultaneous records would be very helpful for studying the best signal-sensing arrangement. A 5-pole electrode with an inner disc and four concentric rings of different sizes was developed and tested on surface intestinal myoelectrical recordings from healthy humans. For good adaptation to a curved body surface, the electrode was screen-printed onto a flexible polyester substrate. To facilitate clinical use, it is self-adhesive, incorporates a single connector and can perform dry or wet (with gel) recordings. The results show it to be a versatile electrode that can evaluate the optimal configuration for the identification of the intestinal slow wave and reject undesired interference. A bipolar concentric record with an outer ring diameter of 30 mm, a foam-free adhesive material, and electrolytic gel gave the best results.

Noninvasive biomagnetic detection of intestinal slow wave dysrhythmias in chronic mesenteric ischemia

Chronic mesenteric ischemia (CMI) is a challenging clinical problem that is difficult to diagnose noninvasively. Diagnosis early in the disease process would enable life-saving early surgical intervention. Previous studies established that superconducting quantum interference device (SQUID) magnetometers detect the slow wave changes in the magnetoenterogram (MENG) noninvasively following induction of mesenteric ischemia in animal models. The purpose of this study was to assess functional physiological changes in the intestinal slow wave MENG of patients with chronic mesenteric ischemia. Pre- and postoperative studies were conducted on CMI patients using MENG and intraoperative recordings using invasive serosal electromyograms (EMG). Our preoperative MENG recordings showed that patients with CMI exhibited a significant decrease in intestinal slow wave frequency from 8.9 ± 0.3 cpm preprandial to 7.4 ± 0.1 cpm postprandial (P < 0.01) that was not observed in postoperative recordings (9.3 ± 0.2 cpm preprandial and 9.4 ± 0.4 cpm postprandial, P = 0.86). Intraoperative recording detected multiple frequencies from the ischemic portion of jejunum before revascularization, whereas normal serosal intestinal slow wave frequencies were observed after revascularization. The preoperative MENG data also showed signals with multiple frequencies suggestive of uncoupling and intestinal ischemia similar to intraoperative serosal EMG. Our results showed that multichannel MENG can identify intestinal slow wave dysrhythmias in CMI patients.

Enhancement of non-invasive recording of electroenterogram by means of a flexible array of concentric ring electrodes

Monitoring intestinal myoelectrical activity by electroenterogram (EEnG) would be of great clinical interest for diagnosing gastrointestinal pathologies and disorders. However, surface EEnG recordings are of very low amplitude and can be severely affected by baseline drifts and respiratory and electrocardiographic (ECG) interference. In this work, a flexible array of concentric ring electrodes was developed and tested to determine whether it can provide surface EEnG signals of better quality than bipolar recordings from conventional disc electrodes. With this aim, sixteen healthy subjects in a fasting state (>8 h) underwent recording. The capability of detecting intestinal pacemaker activity (slow wave) and the influence of physiological interferences were studied. The signals obtained from the concentric ring electrodes proved to be more robust to ECG and respiratory interference than those from conventional disc electrodes. The results also show that intestinal EEnG components such as the slow wave can be more easily identified by the proposed system based on a flexible array of concentric ring electrodes. The developed active electrode array could be a very valuable tool for non-invasive diagnosis of disease states such as ischemia and motility disorders of the small bowel which are known to alter the normal enteric slow wave activity.

Experimental and Automated Analysis Techniques for High-resolution Electrical Mapping of Small Intestine Slow Wave Activity

BACKGROUND/AIMS

Small intestine motility is governed by an electrical slow wave activity, and abnormal slow wave events have been associated with intestinal dysmotility. High-resolution (HR) techniques are necessary to analyze slow wave propagation, but progress has been limited by few available electrode options and laborious manual analysis. This study presents novel methods for in vivo HR mapping of small intestine slow wave activity.

METHODS

Recordings were obtained from along the porcine small intestine using flexible printed circuit board arrays (256 electrodes; 4 mm spacing). Filtering options were compared, and analysis was automated through adaptations of the falling-edge variable-threshold (FEVT) algorithm and graphical visualization tools.

RESULTS

A Savitzky-Golay filter was chosen with polynomial-order 9 and window size 1.7 seconds, which maintained 94% of slow wave amplitude, 57% of gradient and achieved a noise correction ratio of 0.083. Optimized FEVT parameters achieved 87% sensitivity and 90% positive-predictive value. Automated activation mapping and animation successfully revealed slow wave propagation patterns, and frequency, velocity, and amplitude were calculated and compared at 5 locations along the intestine (16.4 ± 0.3 cpm, 13.4 ± 1.7 mm/sec, and 43 ± 6 µV, respectively, in the proximal jejunum).

CONCLUSIONS

The methods developed and validated here will greatly assist small intestine HR mapping, and will enable experimental and translational work to evaluate small intestine motility in health and disease.

Noninvasive biomagnetic detection of isolated ischemic bowel segments

The slow wave activity was measured in the magnetoenterogram (MENG) of normal porcine subjects (N = 5) with segmental intestinal ischemia. The correlation changes in enteric slow wave activity were determined in MENG and serosal electromyograms (EMG). MENG recordings show significant changes in the frequency and power distribution of enteric slow-wave signals during segmental ischemia, and these changes agree with changes observed in the serosal EMG. There was a high degree of correlation between the frequency of the electrical activity recorded in MENG and in serosal EMG (r = 0.97). The percentage of power distributed in brady- and normoenteric frequency ranges exhibited significant segmental ischemic changes. Our results suggest that noninvasive MENG detects ischemic changes in isolated small bowel segments.

Active concentric ring electrode for non-invasive detection of intestinal myoelectric signals

Although the surface electroenterogram (EEnG) is a weak signal contaminated by strong physiological interference, such as ECG and respiration, abdominal surface recordings of the EEnG could provide a non-invasive method of studying intestinal activity. The goal of this work was to develop a modular, active, low-cost and easy-to-use sensor to obtain a direct estimation of the Laplacian of the EEnG on the abdominal surface in order to enhance the quality of bipolar surface monitoring of intestinal activity. The sensor is made up of a set of 3 concentric dry Ag/AgCl ring electrodes and a battery-powered signal-conditioning circuit. Each section is etched on a different printed circuit board (PCB) and the sections are joined to each other by surface mount technology connectors. This means the sensing electrodes can be treated independently for purposes of maintenance and replacement and the signal conditioning circuit can be re-used. A total of ten recording sessions were carried out on humans. The results show that the surface recordings of the EEnG obtained by the active sensor present significantly less ECG and respiration interference than those obtained by bipolar recordings. In addition, bioelectrical sources whose frequency fitted with the slow wave component of the EEnG (SW) were identified by parametric spectral analysis in the surface signals picked up by the active sensors.

Mechanisms and potential applications of intestinal electrical stimulation

PURPOSE

Electrical stimulation of the gut has recently been under intensive investigation and various studies have revealed therapeutic potentials of gastrointestinal electrical stimulation for gastrointestinal motility disorders and obesity. While there have been a number of reviews on gastric electrical stimulation, there is a lack of systematic reviews on intestinal electrical stimulation. The aim of this review is to provide an overview on the effects, mechanisms, and applications of intestinal electrical stimulation.

RESULTS

We evaluated published data on intestinal electrophysiology, pathophysiology, and different methodologies on intestinal electrical stimulation and its possible mechanisms in both research and clinical settings using the MEDLINE database for English articles from 1963 to 2008. Based on this systematic review, intestinal electrical stimulation has been reported to alter intestinal slow waves, contractions and transit; the effects were mediated via both vagal and adrenergic pathways. Intestinal electrical stimulation has been reported to have potentials for treating various intestinal motility disorders and obesity.

CONCLUSIONS

It is concluded that intestinal electrical stimulation may have promising applications for treating motility disorders associated with altered intestinal contractile activity. The most recent studies have revealed possible applications of intestinal electrical stimulation for the treatment of obesity. Basic research results are promising; however, further clinical studies are needed to bring IES from bench to bedside.

Combined method for reduction of high frequency interferences in surface electroenterogram (EEnG)

Surface electroenterogram (EEnG) recording is a novel technique for monitoring intestinal motility non-invasively. However, surface EEnG recordings are contaminated by cardiac activity, the respiratory artefact, movement artefacts and other types of interference. The goal of this work is to remove electrocardiogram (ECG) interference and movement artefacts from surface EEnG by means of a combined method of empirical mode decomposition and independent component analysis. For this purpose, 11 recording sessions were conducted on animal models. In order to quantify the effectiveness of the proposed method, several parameters were calculated from each session: signal-to-ECG interference ratio (S/I), energy over 2 Hz (EF2) which quantifies the intestinal motility index of external EEnG recording and the variation of EF2. The proposed method removes both ECG interference and movement artefacts from surface EEnG, obtaining a significantly higher S/I ratio and considerably reducing the non-physiological variation of EF2. Furthermore, after applying the combined method, the correlation coefficient between internal recording EF2 and surface recording EF2 rises significantly. The proposed method could therefore be a useful tool to reduce high frequency interference in EEnG recording and to provide more robust non-invasive intestinal motility indexes.

The detection of intestinal spike activity on surface electroenterograms

Myoelectrical recording could provide an alternative technique for assessing intestinal motility, which is a topic of great interest in gastroenterology since many gastrointestinal disorders are associated with intestinal dysmotility. The pacemaker activity (slow wave, SW) of the electroenterogram (EEnG) has been detected in abdominal surface recordings, although the activity related to bowel contractions (spike bursts, SB) has to date only been detected in experimental models with artificially favored electrical conductivity. The aim of the present work was to assess the possibility of detecting SB activity in abdominal surface recordings under physiological conditions. For this purpose, 11 recording sessions of simultaneous internal and external myolectrical signals were conducted on conscious dogs. Signal analysis was carried out in the spectral domain. The results show that in periods of intestinal contractile activity, high-frequency components of EEnG signals can be detected on the abdominal surface in addition to SW activity. The energy between 2 and 20 Hz of the surface myoelectrical recording presented good correlation with the internal intestinal motility index (0.64 +/- 0.10 for channel 1 and 0.57 +/- 0.11 for channel 2). This suggests that SB activity can also be detected in canine surface EEnG recording.

Detection of small bowel slow-wave frequencies from noninvasive biomagnetic measurements

We report a novel method for identifying the small intestine electrical activity slow-wave frequencies (SWFs) from noninvasive biomagnetic measurements. Superconducting quantum interference device magnetometer measurements are preprocessed to remove baseline drift and high-frequency noise. Subsequently, the underlying source signals are separated using the well-known second-order blind identification (SOBI) algorithm. A simple classification scheme identifies and assigns some of the SOBI components to a section of small bowel. SWFs were clearly identified in 10 out of 12 test subjects to within 0.09-0.25 cycles per minute. The method is sensitive at the 40.3 %-55.9 % level, while false positive rates were 0 %-8.6 %. This technique could potentially be used to help diagnose gastrointestinal ailments and obviate some exploratory surgeries.

Combined method for artifact reduction in surface electroenterogram

Surface electroenterogram (EEnG) is a non-invasive method for monitoring the intestinal motility. However, surface EEnG recordings are contaminated by movement artifact, cardiac activity, respiratory artifact and other interferences. The aim of this work is to remove movement artifacts by means of a combined method of empirical mode decomposition (EMD) and independent component analysis (ICA). Four recording sessions were conducted on canine model. Surface signals from 4 different channels are decomposed using EMD. Resulting intrinsic mode functions are the inputs of ICA analysis which permits to separate and identify the activities of different origin. Signal components associated to movement artifacts are removed and the original signals are reconstructed by means of an inverse procedure. The results show that the proposed method allows extracting and cancelling movement artifacts from surface EEnG, avoiding the presence of irregular peaks in external intestinal motility indexes. Therefore, the proposed method could be useful to reduce artifacts in EEnG recording and to provide more robust non-invasive intestinal motility indicators.

Quantification of combined method for interferences reduction in multichannel surface electroenterogram

Surface electroenterogram (EEnG) is a non-invasive method for monitoring the intestinal motility. However, surface EEnG signals are contaminated by strong physiological interferences. The main interferences which affect high-frequency components of surface EEnG are cardiac activity and movement artifacts. The aim of this work is to quantify the effectiveness of a combined method based on empirical mode decomposition and independent component analysis to remove these interferences from multichannel surface EEnG. In order to do so, several parameters were calculated from five recording sessions: Signal-to-ECG interference ratio (S/I) and variation of energy over 2 Hz (EF2). The results show that the S/I of processed signals was significantly higher than that of original signals, moreover the improvement of the S/I ratio is due to the attenuation of energy associated to interference. The proposed method also allows cancelling movement artifacts from surface EEnG, reducing considerably the non-physiological variation of EF2. Furthermore after the application of the combined method, correlation coefficient between EF2 of internal recording with EF2 of surface recording is greatly higher. Therefore, the proposed method could be helpful to reduce high-frequency interferences in EEnG recording and to provide more robust non-invasive intestinal motility indicators.

Discrete Laplacian recordings of the electroenterogram from abdominal surface in humans

The first aim of this study was to obtain the discrete Laplacian of the myoelectric small intestine signal (electroenterogram, EEnG) from bipolar recordings on the abdominal surface in humans. In addition, the objective was to identify the slow wave (SW) component of the EEnG in the estimated Laplacian, as well as to compare this signal with the bipolar surface recordings. It was carried out 8 recording sessions in 6 healthy volunteers. The discrete Laplacian of the surface potential was performed using Hjorth's Laplacian estimation method. In order to identify the SW component of the EEnG, an adaptive filter, which removes breath interference from abdominal surface recordings, was designed. After that, periodograms and their dominant frequency were obtained. The results show that this frequency, in all surface recording channels and in their corresponding Laplacian, ranges from 0.12 to 0.16 Hz (7.3 to 9.8 cycles per minute) inside of the SW frequency range, whereas the frequencies of the respiration ranges from 0.21 to 0.31 Hz (12.9-18.4 cpm). Furthermore abdominal surface Laplacian potential contains averaged SW, information unless any bipolar surface channel do not record properly this signal. Consequently EEnG surface recordings can become a low cost technique to study bowel motility non-invasively.

Identification of the slow wave component of the electroenterogram from Laplacian abdominal surface recordings in humans

The electroenterogram (EEnG) is a surface recording of the myoelectrical activity of the smooth muscle layer of the small intestine. It is made up of two signals: a low-frequency component, known as the slow wave (SW), and high-frequency signals, known as spike bursts (SB). Most methods of studying bowel motility are invasive due to the difficult anatomic access of the intestinal tract. Abdominal surface EEnG recordings could be a noninvasive solution for monitoring human intestinal motility. However, surface EEnG recordings in humans present certain problems, such as the low amplitude of the signals and the influence of physiological interference such as the electrocardiogram (ECG) and respiration. In this study, a discrete estimation of the abdominal surface Laplacian potential was obtained using Hjorth's method. The objective was to analyze the enhancement given by Laplacian EEnG estimation compared to bipolar recordings. Eight recording sessions were carried out on eight healthy human volunteers in a state of fasting. First, the ECG interference content present in the bipolar signals and in the Laplacian estimation were quantified and compared. Secondly, to identify the SW component of the EEnG, respiration interference was removed by using an adaptive filter, and spectral estimation techniques were applied. The following parameters were obtained: the dominant frequency (DF) of the signals, stability of the rhythm (RS) of the DF detected and the percentage of DFs within the typical frequency range for the SW (TFSW). Results show the better ability of the Laplacian estimation to attenuate ECG interference, as compared to bipolar recordings. As regards the identification of the SW component of the EEnG, after removing respiration interference, the mean value of the DF in all abdominal surface recording channels and in their Laplacian estimation ranged from 0.12 to 0.14 Hz (7.3 to 8.4 cycles min(-1) (cpm)). Furthermore in 80% of the cases, the detected DFs were inside the typical human SW frequency range, and the ratio of frequency change in the surface bipolar and Laplacian estimation signals, in 90% of the cases, was within the frequency change accepted for human SW. Significant statistical differences were also found between the DF of all surface signals (bipolar and Laplacian estimation) and the DF of respiration. In conclusion, it was demonstrated that the discrete Laplacian potential estimation attenuated the physiological interference present in bipolar surface recordings, especially ECG. Furthermore, a slow frequency component, whose frequency, rhythm stability and amplitude fitted with the SW patterns in humans, was identified in bipolar and Laplacian estimation signals. This could be a useful non-invasive tool for monitoring intestinal activity by abdominal surface recordings.

Empirical mode decomposition: a method to reduce low frequency interferences from surface electroenterogram

The surface electroenterogram (EEnG) is a non-invasive method of studying myoelectrical bowel activity. However, surface EEnG recordings are contaminated by cardiac activity, respiratory and motion artifacts, and other sources of interference. The aim of this work is to remove the respiration artifact and the very low frequency components from surface EEnG by means of empirical mode decomposition (EMD). Eleven recording sessions were carried out on canine model. Several parameters were calculated before and after the application of the method: signal-to-interference ratio (S/I ratio) and the attenuation level of the signal and of interference. The results show that the S/I ratio was significantly higher after the application of the method (3.68+/-5.54 dB vs. 10.45+/-3.65 dB), the attenuation level of signal and of interference is -0.49+/-0.80 dB versus -7.26+/-5.42 dB, respectively. Therefore, EMD could be a useful aid in identifying the intestinal slow wave and in removing interferences from EEnG recordings.

Adaptive Spectrogram for Surface EEnG Analysis

Electroenterogram (EEnG) is the myoelectrical signal of the small bowel. It is the result of a permanent slow wave (low frequency component) and series of spike bursts (high frequency component) that are only present when a bowel contraction occurs. This means spectral content of EEnG changes throughout time. The definition of a t-f distribution that adapts to changes in EEnG spectrum could be very helpful to study this signal. Nine recording sessions of surface EEnG were carried out in three Beagle dogs in fast state. It was proposed an algorithm that selects the window length of spectrogram depending on the maximum frequency of interest of signal in previous window. The proposed adaptive spectrogram was applied to surface EEnG. When only slow waves are present, the adaptive spectrogram enlarges window length in order to present good frequency resolution to characterize the low frequency component of the EEnG. When spike bursts appear, windows of analysis are shorter reducing time resolution to identify individual units of slow waves accompanied by SB. The proposed adaptive spectrogram can be a helpful tool to identify surface EEnG activity in time and frequency domain. It is also likely to be adapted to study other multicomponent signals.

Fasting and postprandial small intestinal slow waves non-invasively measured in subjects with total gastrectomy

BACKGROUND AND AIM

Slow wave is essential to initiate gastrointestinal tract motility. Subjects with total gastrectomy (TG) provide an opportunity to study small intestinal slow wave in the absence of stomach interference. The aims of this study were to determine the origin of 3 cycles per min (cpm) slow wave recorded via electrogastrogram (EGG) and the characteristics of putative small intestinal slow waves in TG subjects.

METHODS

Thirty-three subjects with TG (25 male, age: 44-83 years) were consecutively enrolled. In each subject, the myoelectricity-like signals of the gastrointestinal tract were recorded using 3-channel EGG. Fourier transform-based spectral analysis was performed to derive the EGG parameters including dominant frequency/power, % normal rhythm (2-4 cpm), and power ratio.

RESULTS

Neither visual nor spectral analysis of the EGG revealed any waves at a frequency of about 3 cpm. The most frequently observed peaks in the power spectra of all subjects were those at approximately 1, approximately 6 and approximately 11 cpm with occurrences of 97%, 6.1% and 90.9%, respectively. Based on visual analysis of all recorded signals, the approximately 11 cpm signal was exactly rhythmically recorded rather than the approximately 1 cpm. The recorded approximately 11 cpm wave had a frequency of 10.9 +/- 1.0 cpm in the fasting state and 10.9 +/- 1.3 cpm in the fed state (NS), and a power of 31.5 +/- 3.2 dB in the fasting state and 35.2 +/- 3.8 dB in the fed state (P < 0.0001). None of other factors, including sex, age, and body mass index, had any impact on this approximately 11 cpm wave.

CONCLUSIONS

Small intestinal slow wave can be recorded non-invasively using EGG via cutaneous electrodes in TG subjects. Sex, age and body mass index have no effect on the intestinal slow waves. The power rather than frequency of intestinal slow wave is increased after a solid meal.

Long-term signal detection, segmentation and summarization using wavelets and fractal dimension: a bioacoustics application in gastrointestinal-motility monitoring

The current paper describes a wavelet-based method for long-term processing and analysis of gastrointestinal sounds (GIS). Windowing techniques are used to select sequential blocks of the prolonged multi-channel recordings and proceed to various wavelet-domain processing stages. De-noising, significant-activity detection, automated segmentation and extraction of summary curves are applied in an integrated mode, allowing for enhanced content manipulation and analysis. The proposed analysis scheme combines flexible long-term graphical representation tools, while maintaining the ability of quick browsing via visualization and auralization of the detected short-term events. This work is part of a project aiming to implement non-invasive diagnosis over gastrointestinal-motility (GIM) physiology. However, the proposed techniques might be applied to any study of long-term bioacoustics time series.

Computational simulations of the human magneto- and electroenterogram

Many functional pathologies of the small intestine are difficult to diagnose clinically without an invasive surgical intervention. Often such conditions are associated with a disruption of the normal electrical activity occurring within the musculature of the small intestine. The far field electrical signals on the torso surface arising from the electrical activity within the small intestine cannot be reliably measured. However, it has been shown that abnormal electrical activity in the small intestine can be distinguished by recording the magnetic fields of intestinal origin immediately outside the torso surface. We have developed an anatomically-based computational model to simulate slow wave propagation in the small intestine, the resulting cutaneous electrical field and the magnetic field outside the torso. Using both a one-dimensional and a three-dimensional model of the duodenum we investigate the degree of detail that is required to realistically simulate this far field activity. Our results indicate that some of the qualitative behavior in the far field activity can be replicated using a one-dimensional model, although there are clear situations where the greater level modeling detail is required.

Adaptive filtering of ECG interference on surface EEnGs based on signal averaging

An external electroenterogram (EEnG) is the recording of the small bowel myoelectrical signal using contact electrodes placed on the abdominal surface. It is a weak signal affected by possible movements and by the interferences of respiration and, principally, of the cardiac signal. In this paper an adaptive filtering technique was proposed to identify and subsequently cancel ECG interference on canine surface EEnGs by means of a signal averaging process time-locked with the R-wave. Twelve recording sessions were carried out on six conscious dogs in the fasting state. The adaptive filtering technique used increases the signal-to-interference ratio of the raw surface EEnG from 16.7 +/- 6.5 dB up to 31.9 +/- 4.0 dB. In addition to removing ECG interference, this technique has been proven to respect intestinal SB activity, i.e. the EEnG component associated with bowel contractions, despite the fact that they overlap in the frequency domain. In this way, more robust non-invasive intestinal motility indicators can be obtained with correlation coefficients of 0.68 +/- 0.09 with internal intestinal activity. The method proposed here may also be applied to other biological recordings affected by cardiac interference and could be a very helpful tool for future applications of non-invasive recordings of gastrointestinal signals.

Inhibitory effects of sildenafil on small intestinal motility and myoelectrical activity in dogs

Previous studies have shown that sildenafil inhibits the esophageal motility in both humans and animals. The aim of this study was to investigate the effects of sildenafil on intestinal myoelectrical activity and motility. The study was composed of 2 experiments and performed in 7 healthy female dogs with a duodenal cannula 20 cm beyond pylorus (19-26 kg). The first experiment was designed to study the effects of sildenafil on intestinal myoelectrical activity and it included 2 sessions each consisting of 30-minute baseline, 15-minute posttreatment (placebo or 100 mg sildenafil) and 90 minutes after a liquid meal. Intestinal myoelectrical activity was recorded during the entire experiment period. The second experiment was aimed to investigate the effect of sildenafil on intestinal motility and was performed immediately after a solid meal. Intestinal motility was measured by a manometric catheter inserted into the small intestine via the duodenum cannula for 30 minutes at baseline and 60 minutes after sildenafil. Sildenafil significantly reduced the amplitude but had no effect on the frequency and regularity of the intestinal myoelectrical activity. Sildenafil significantly inhibited postprandial intestinal contractions. Although the frequency of the contractions was not altered, the mean area under the curve was significantly reduced during the first 30 minutes (P < .03) and second 30 minutes after sildenafil (P < .03); the power of intestinal contractile activities was also significantly reduced during the first 30 minutes (P < .0004) and second 30 minutes after sildenafil (P < .0003) in comparison with baseline. In conclusion, sildenafil inhibits the amplitude of both intestinal contractile activity and intestinal slow waves.

Signal noise ratio of small intestine myoelectrical signal recorded from external surface

Electroenterogram (EEnG), which is the myoelectrical activity of the small bowel, can be non-invasively recorded from abdominal external surface. However, this bioelectrical signal is weak and noisy compared to internal recording from bowel serous layers, because of bioelectric transmission through abdominal layers. Furthermore, it is contaminated with several interferences from other biological activities as cardiac muscle (ECG), skeletal muscles (EMG), or respiration movements. The goal of present work is to study abdominal recording of EEnG and its signal-to-noise ratio by means of the coherence estimation technique. External and internal recordings were obtained simultaneously in 12 sessions, which went on more than two hours in six beagle dogs. Coherence function, based on periodograms, is estimated in periods of 15 minutes. Thus, SNR is calculated from coherence estimation for each recording session. Results show that SNR reaches a maximum value of 8.8 dB for 0.31 Hz, which corresponds to fundamental frequency of the EEnG slow wave. However, SNR is weak at frequencies upper 2 Hz, which corresponds to rapid action potentials (spike bursts) of the EEnG. In conclusion, slow wave can be clearly identified in abdominal recording; however spike bursts are contaminated by noise, attenuation and biological interferences.

Noninvasive Measurement and Analysis of Intestinal Myoelectrical Activity Using Surface Electrodes

Intestinal myoelectrical activity (IMA), which determines bowel mechanical activity, is the result of two components: a low-frequency component [slow wave (SW)] that is always present, and a high-frequency component [spike bursts (SB)] which is associated with bowel contractions. Despite of the diagnostic significance of internal recordings of IMA, clinical application of this technique is limited due to its invasiveness. Thus, surface recording of IMA which is also called electroenterogram (EEnG) could be a solution for noninvasive monitoring of intestinal motility. The aim of our work was to identify slow wave and spike burst activity on surface EEnG in order to quantify bowel motor activity. For this purpose, we conducted simultaneous recordings of IMA in bowel serosa and on abdominal surface of five Beagle dogs in fast state. Surface EEnG was studied in spectral domain and frequency bands for slow wave and spike burst energy were determined. Maximum signal-to-interference ratio (7.5 dB +/- 36%) on SB frequency band was obtained when reducing upper frequency limit of signal analysis. Energy of external EEnG in reduced SB frequency band (2-7.9 Hz) presented a high correlation (0.71 +/- 7%) with internal intensity of contractions. Our results suggest that energy of SB can be quantified on external EEnG which could provide a noninvasive method for monitoring intestinal mechanical activity.

Therapeutic potential of duodenal electrical stimulation for obesity: acute effects on gastric emptying and water intake

OBJECTIVES

No satisfactory treatment is available for obesity. Previous animal studies suggested the therapeutic potential of intestinal electrical stimulation for obesity. The aim of this study was to investigate the effects of duodenal electrical stimulation (DES) on gastric emptying and water intake in healthy humans.

METHODS

The study was performed in 12 healthy volunteers intubated with a feeding tube in the duodenum under endoscopy. There were three ring electrodes at the end tip of the tube and the two distal electrodes were used for recording and electrical stimulation. On two separate days, each subject underwent a session of DES with various stimulation parameters, a water-intake test with DES or with sham-DES, and a gastric-emptying test with DES or with sham-DES.

RESULTS

DES did not induce any noticeable dyspeptic symptoms. The amount of water drunk by the subjects was significantly reduced from 897 +/- 88 ml with sham-DES to 673 +/- 63 ml with DES (p < 0.002). The mean T(50) of gastric emptying was significantly increased from 113.1 +/- 10.0 min with sham-DES to 176.5 +/- 20.8 min with DES state (p < 0.005). The gastric retention at 2 h was increased with DES (42.8 +/- 4.5% vs 61.4 +/- 4.7%; p < 0.02).

CONCLUSIONS

DES delays gastric emptying and reduces water intake. It may have a potential application for the treatment of obesity.

Modelling gastrointestinal bioelectric activity

The development of an anatomically realistic biophysically based model of the human gastrointestinal (GI) tract is presented. A major objective of this work is to develop a modelling framework that can be used to integrate the physiological, anatomical and medical knowledge of the GI system. The anatomical model was developed by fitting derivative continuous meshes to digitised data taken from images of the visible man. Structural information, including fibre distributions of the smooth muscle layers and the arrangement of the networks of interstitial cells of Cajal, were incorporated using published information. A continuum modelling framework was used to simulate electrical activity from the single cell to the whole organ and body. Also computed was the external magnetic field generated from the GI electrical activity. The set of governing equations were solved using a combination of numerical techniques. Activity at the (continuum) cell level was solved using a high-resolution trilinear finite element procedure that had been defined from the previously fitted C1 continuous anatomical mesh. Multiple dipolar sources were created from the excitation waves which were embedded within a coupled C1 continuous torso model to produce both the cutaneous electrical field and the external magnetic field. Initial simulations were performed using a simplified geometry to test the implementation of the numerical solution procedure. The numerical procedures were shown to rapidly converge with mesh refinement. In the process of this testing, errors in a long standing analytic solution were identified and are corrected in Appendix B. Results of single cell activity were compared to published results illustrating that the key features of the slow wave activity were successfully replicated. Simulations using a two-dimensional slice through the gastric wall produced slow wave activity that agreed with the known frequency and propagation characteristics. Three-dimensional simulations were also performed using the full stomach mesh and results illustrated the slow wave propagation throughout the stomach musculature.

Electrical activity from colon overlaps with normal gastric electrical activity in cutaneous recordings

The stability of EGG recordings is affected by a variety of artifacts. The aim of this study was to investigate possible overlapping of dominant frequencies in recorded cutaneous electrical activity arising simultaneously from the stomach and/or colon. Ten normal volunteers, eight posttotal colectomy patients, and four patients posttotal gastrectomy were studied. Fasting cutaneous recordings were obtained using four pediatric ECG electrodes attached to the abdominal surface. Electrical activity was recorded and digitally analyzed using custom-designed software. Spectral analysis after gastrectomy and colectomy showed persistence of power peaks in the gastric electrical activity range of frequency (2.5-3.75 cpm). In conclusion, noninvasively obtained colonic frequencies overlap EGG. This hypothesis is supported by the persistence of power peaks in the EGG range of frequency after gastrectomy and colectomy. Therefore, we conclude that contribution of electrical activity arising from the colon could substantially affect EGG recordings.

Volume conductor effects on the spatial resolution of magnetic fields and electric potentials from gastrointestinal electrical activity

An analysis of the relative capabilities of methods for magnetic and electric detection of gastrointestinal electrical activity is presented. The model employed is the first volume conductor model for magnetic fields from GEA to appear in the literature. A mathematical model is introduced for the electric potential and magnetic field from intestinal electrical activity in terms of the spatial filters that relate the bioelectric sources with the external magnetic fields and potentials. The forward spatial filters are low-pass functions of spatial frequency, so more superficial external fields and potentials contain less spatial information than fields and potentials near the source. Inverse spatial filters, which are reciprocals of the forward filters, are high-pass functions and must be regularised by windowing. Because of the conductivity discontinuities introduced by low-conductivity fat layers in the abdomen, the electric potentials recorded outside these layers required more regularisation than the magnetic fields, and thus, the spatial resolution of the magnetic fields from intestinal electrical activity is higher than the spatial resolution of the external potentials. In this study, two smooth muscle sources separated by 5cm were adequately resolved magnetically, but not resolved electrically. Thus, sources are more accurately localized and imaged using magnetic measurements than using measurements of electric potential.

Spatial and temporal variations in the magnetic fields produced by human gastrointestinal activity

Magnetoenterography (MENG) is a new, non-invasive technique that measures gastrointestinal magnetic signals near the body surface. This study was undertaken to evaluate the temporal and spatial characteristics of the magnetic signals generated by gastric and duodenal slow wave activity. The gastrointestinal magnetic fields of eight normal subjects were measured for 60 minutes in both the fasting and fed state using 36 magnetic sensors simultaneously. The results were displayed as a succession of maps over time showing the temporal evolution of the spatial distribution of the signal over the upper abdomen. In all subjects, slow wave activity of the stomach centred at 3.0 +/- 0.5 cycles min-1 in both the fasting and fed state was observed. The duodenal signal at 11.0 +/- 1.0 cycles min-1 was observed in four subjects. The spatial distribution of these two signals is distinctly different. The observed spatial and temporal variations are described in terms of a model used previously to explain the potentials observed in electrogastrography (EGG).

The human vector magnetogastrogram and magnetoenterogram

Electrical activity in the gastrointestinal system produces magnetic fields that may be measured with superconducting quantum interference device magnetometers. Although typical magnetometers have detection coils that measure a single component of the magnetic field, gastric and intestinal magnetic fields are vector quantities. We recorded gastric and intestinal magnetic fields from nine abdominal sections in nine normal human volunteers using a vector magnetometer that measures all three Cartesian components of the magnetic field vector. A vector projection technique was utilized to separate the magnetic field vectors corresponding to gastric and intestinal activity. The gastric magnetic field vector was oriented in a cephalad direction, consistent with previously observed data, and displayed oscillatory characteristics of gastric electrical activity (f = 3.03 +/- 0.18 cycles/min). Although the small bowel magnetic field vector showed no consistent orientation, the characteristic frequency gradient of the small bowel electrical activity was observed. Gastric and intestinal magnetic field vectors were oriented in different directions and were thus distinguished by the vector projection technique. The observed difference in direction of gastric and intestinal magnetic field vectors indicates that vector recordings dramatically increase the ability to separate physiological signal components from nonphysiological components and to distinguish between different physiological components.

Magnetoenterography (MENG): noninvasive measurement of bioelectric activity in human small intestine

The basic electrical rhythm (BER) of the gastrointestinal tract creates minute magnetic fields that have been measured in animals using a Superconducting QUantum Interference Device (SQUID) gradiometer. The aim of this study was to measure noninvasively the biomagnetic fields of human stomach and small intestine. Twenty-one human volunteers were studied using a 37-channel SQUID gradiometer positioned over the epigastrium and umbilicus. In one volunteer additional biomagnetic recordings were performed in order to map the spatial variation of the biomagnetic fields. Cyclical waveforms consistent with gastric BER [3.0+/-0.5 cycles per minute (cpm)] and small intestine BER (10.26+/-1.74 cpm) were seen in the epigastrium and umbilicus, respectively. The mapping study identified the expected frequency gradient (12.0 cpm in duodenum, 11.3 cpm in jejunum, to 9.7 cpm in ileum) within the small intestine. Noninvasive recordings of human gastric and small intestinal BER can be obtained using a SQUID gradiometer.

Adaptive cancellation of the respiratory artifact in surface recording of small intestinal electrical activity

In the human small intestine there is omnipresent electrical activity with a frequency of 0.15-0.2 Hz. The electrical activity of the small intestine can be measured by surface electrodes placed on the abdominal skin. The most annoying problem in the surface electrical recording is the respiratory artifact which is not discernible from the small intestinal signal. The frequency of the respiration is about 0.2-0.4 Hz, which is very close to that of small intestinal activity, making the use of the conventional bandpass filtering impractical. In this paper a selective frequency domain adaptive filter was proposed for the cancellation of the respiratory artifact. The basic principle of the selective frequency domain adaptive filter is that only selected filter weights are adapted based on the frequency characteristics of the respiratory artifact. Therefore, a substantial reduction of computation is achieved. A series of computer simulations was conducted for the optimization of the system parameters and for the investigation of the system performance. It was demonstrated in this paper that the selective frequency domain adaptive filter is as effective as, but more efficient than, the conventional frequency domain adaptive filter. The adaptive system for the cancellation of the respiratory artifact based on the selective frequency domain adaptive filter is very efficient in computation, has a fast convergence (about 100 adaptations), substantial reduction of the respiratory artifact and little effect (or distortion) on the small intestinal electrical signal.