DOZ047.02: Effect of prokinetics on gastric function in children with esophageal atresia and tracheoesophageal fistula (EA-TEF)

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
S Birro ◽  
S Kelly ◽  
T Omari ◽  
U Krishnan
Keyword(s):  
Gastric Emptying ◽  
Delayed Gastric Emptying ◽  
Statistical Significance ◽  
Small Sample ◽  
Power Ratio ◽  
Gastric Function ◽  
Gastric Myoelectrical Activity ◽  
Myoelectrical Activity ◽  
Qt Interval Prolongation ◽  
The Mean

Abstract Background To the aim of this study was to determine the effect of domperidone on gastric function in the EA-TEF cohort. Methods Five participants with previously demonstrated abnormal gastric myoelectrical activity and/or delayed gastric emptying on electrogastrography (EGG) and 13C-octanoic acid breath test (OBT), respectively, were recruited. These participants were treated with domperidone (0.2 mg/kg/dose twice a day), for a minimum of 2 weeks, and EGG and OBT investigations were repeated along with a validated PedsQL gastrointestinal symptom questionnaire. A baseline and follow-up ECG was done to check for potential QT interval prolongation. Results Mean gastric emptying half-time was135.4 minutes off therapy and 277.01 minutes on therapy (p = NS) while the mean gastric emptying coefficients were 3.34 and 3.25, respectively (p = NS). All five participants’ gastric myoelectrical activity on EGG remained abnormal. Although the mean percentage of gastric slow waves spent in normal frequency decreased by 1.65%, the post- prandial-to-resting power ratio increased by 8.452 (p = NS). Both parent- and child-reported overall PedsQL scores increased as did the child-reported PedsQL scores based on symptoms related to gastric function (p = NS). Conclusions Domperidone in standard doses did not result in significant change in gastric emptying in EA-TEF children with delayed gastric emptying. This may be due to abnormalities in gastric innervation, in children with EA-TEF. There was however an improvement in the power ratio on EGG. There was also improvement in the PedsQL scores. The lack of statistical significance may be due to our small sample size.

scholarly journals Monitoring gastric myoelectric activity after pancreaticoduodenectomy for diet “readiness”

2018 ◽  
Vol 315 (5) ◽  
pp. G743-G751 ◽  
Author(s):  
Monica M. Dua ◽  
Anand Navalgund ◽  
Steve Axelrod ◽  
Lindsay Axelrod ◽  
Patrick J. Worth ◽  
...  
Keyword(s):  
At Risk ◽  
Gastric Emptying ◽  
Delayed Gastric Emptying ◽  
Oral Intake ◽  
Myoelectric Activity ◽  
Gastric Myoelectrical Activity ◽  
Myoelectrical Activity ◽  
Gastric Myoelectric Activity ◽  
Patients At Risk ◽  
Late Group

Postoperative delayed gastric emptying (DGE) is a frustrating complication of pancreaticoduodenectomy (PD). We studied whether monitoring of postoperative gastric motor activity using a novel wireless patch system can identify patients at risk for DGE. Patients ( n = 81) were prospectively studied since 2016; 75 patients total were analyzed for this study. After PD, battery-operated wireless patches (G-Tech Medical) that acquire gastrointestinal myoelectrical signals are placed on the abdomen and transmit data by Bluetooth. Patients were divided into early and late groups by diet tolerance of 7 days [enhanced recovery after surgery (ERAS) goal]. Subgroup analysis was done of patients included after ERAS initiation. The early and late groups had 50 and 25 patients, respectively, with a length of stay (LOS) of 7 and 11 days ( P < 0.05). Nasogastric insertion was required in 44% of the late group. Tolerance of food was noted by 6 versus 9 days in the early versus late group ( P < 0.05) with higher cumulative gastric myoelectrical activity. Diminished gastric myoelectrical activity accurately identified delayed tolerance to regular diet in a logistical regression analysis [area under the curve (AUC): 0.81; 95% confidence interval (CI), 0.74–0.92]. The gastric myoelectrical activity also identified a delayed LOS status with an AUC of 0.75 (95% CI, 0.67–0.88). This stomach signal continued to be predictive in 90% of the ERAS cohort, despite earlier oral intake. Measurement of gastric activity after PD can distinguish patients with shorter or longer times to diet. This noninvasive technology provides data to identify patients at risk for DGE and may guide the timing of oral intake by gastric “readiness.” NEW & NOTEWORTHY Limited clinical indicators exist after pancreaticoduodenectomy to allow prediction of delayed gastric emptying (DGE). This study introduces a novel, noninvasive, wireless patch system capable of accurately monitoring gastric myoelectric activity after surgery. This system can differentiate patients with longer or shorter times to a regular diet as well as provide objective data to identify patients at risk for DGE. This technology has the potential to individualize feeding regimens based on gastric activity patterns to improve outcomes.

Gastric myoelectrical activity, gastric emptying and correlation with symptoms in children with functional abdominal pain

2003 ◽  
Vol 124 (4) ◽  
pp. A513 ◽  
Author(s):  
Zhiyue Lin ◽  
Richard W. McCallum ◽  
Craig A. Friesen ◽  
Linda Andre ◽  
Glen Seidel ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Gastric Emptying ◽  
Functional Abdominal Pain ◽  
Gastric Myoelectrical Activity ◽  
Myoelectrical Activity

Outcomes of Minimally Invasive Esophagectomy without Pyloroplasty: Analysis of 109 Cases

2010 ◽  
Vol 76 (10) ◽  
pp. 1135-1138 ◽  
Author(s):  
Ninh T. Nguyen ◽  
Chirag Dholakia ◽  
Xuan-Mai T. Nguyen ◽  
Kevin Reavis
Keyword(s):  
Gastric Emptying ◽  
Minimally Invasive ◽  
Delayed Gastric Emptying ◽  
Operative Time ◽  
Minimally Invasive Esophagectomy ◽  
Gastric Function ◽  
Invasive Esophagectomy ◽  
Significant Difference ◽  
Botox Injection

Pyloroplasty is performed during esophagectomy to avoid delayed gastric emptying. However, studies have shown that gastric function is minimally impaired even without a pyloroplasty when a gastric tube rather than the whole stomach is used for reconstruction. The aim of this study was to evaluate outcomes of minimally invasive esophagectomy without performance of a pyloroplasty. We performed a retrospective review of 145 patients who underwent a minimally invasive esophagectomy. The 30-day mortality was 2.1 per cent with an in-hospital mortality of 3.4 per cent. Of the 140 patients with more than 90 days follow-up, 31 patients had a pyloroplasty and 109 patients did not. One (3.2%) of 31 patients with pyloroplasty versus six (5.5%) of 109 patients without pyloroplasty developed delayed gastric emptying. There was no significant difference in the leak rate between the two groups (9.7% vs 9.6%, respectively). Total operative time was significantly shorter in the group without pyloroplasty (360 vs 222 minutes with a pyloroplasty, P < 0.01). Patients with delayed gastric emptying responded well to endoscopic pyloric dilation or Botox injection. The routine performance of a pyloroplasty during minimally invasive esophagectomy can be safely omitted with a reduction in operative time and minimal adverse effects on postoperative gastric function.

scholarly journals Cholinergic effects on human gastric motility

Gut ◽  
1999 ◽  
Vol 45 (3) ◽  
pp. 346-354 ◽  
Author(s):  
H P Parkman ◽  
D M Trate ◽  
L C Knight ◽  
K L Brown ◽  
A H Maurer ◽  
...  
Keyword(s):  
Gastric Emptying ◽  
Gastric Motility ◽  
Normal Subjects ◽  
Cholinergic Stimulation ◽  
Gastric Myoelectrical Activity ◽  
Solid Meal ◽  
Myoelectrical Activity ◽  
Motility Index ◽  
Antroduodenal Manometry ◽  
Cholinergic Effects

BACKGROUNDCholinergic regulation of chronotropic (frequency) and inotropic (force) aspects of antral contractility and how these impact on gastric emptying are not well delineated.AIMSTo determine the effects of cholinergic stimulation and inhibition on myoelectric, contractile, and emptying parameters of gastric motility.METHODSTen normal subjects underwent three studies each, using simultaneous electrogastrography (EGG), antroduodenal manometry, and gastric emptying with dynamic antral scintigraphy (DAS). After 30 minutes of baseline fasting manometry and EGG, subjects received saline intravenously, atropine (0.6 mg then 0.25 mg/hour intravenously), or bethanechol (5 mg subcutaneously). This was followed by another 30 minutes’ recording and by three hours of postprandial recording after ingestion of a technetium-99m labelled solid meal.RESULTSDuring fasting, atropine decreased, whereas bethanechol increased, the antral manometric motility index and EGG power. Postprandially, atropine decreased the amplitude of antral contractions by DAS, decreased the postprandial antral manometric motility index, and slowed gastric emptying. Atropine caused a slight increase in postprandial frequency of antral contractions by DAS and gastric myoelectrical activity by EGG. Bethanechol slightly increased the amplitude, but slightly decreased the frequency of antral contractions by DAS and decreased the frequency of gastric myoelectrical activity by EGG, with no significant increase in the motility index or gastric emptying.CONCLUSIONSCholinergic antagonism with atropine reduces antral contractility and slows gastric emptying. Cholinergic stimulation with bethanechol increases antral contractility, but decreases the frequency of antral contractions, without altering the antral motility index or gastric emptying.

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