Assessment of gastric volume changes with sonometry compared with barostat
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Abstract Aim: The aim was to investigate the validity of sonometry on the assessment of gastric volumes in comparison with gastric barostat. Method: Six dogs were implanted with gastric serosal electrodes, sonometric sensors, and a gastric cannula. Experiments were performed to assess sensor distance when an intragastric balloon was inflated with different volumes, after a meal with or without a balloon, and with gastric electrical stimulation. Results: (i) The distance measured using sonometry was reproducible and stable, and there was a correlation between sensor distance and the gastric volume measured with barostat. (ii) Simultaneous recordings by sonometry and barostat showed a similar postprandial response, while the postprandial increase of the sensor distance was much smaller without the balloon (3.2 ± 0.2 mm vs 9.7 ± 1.5 mm, P < 0.02). (iii) The sensor distance was increased with gastric electrical stimulation. Conclusions: Sonometry is able to detect gastric volume changes as validated by gastric perturbations with distensions, food ingestion and electrical stimulation. The postprandial increase in gastric volume measured by sonometry with barostat balloon is greater because of the presence of the intragastric balloon.Keywords:
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Abstract Our hypothesis was that manometry in the colon was less sensitive than the electronic barostat in detection of colonic contractions. In ten healthy volunteers, we have characterised the pressure activity and tone of the colon by means of combined multilumen manometry and a barostatic balloon that was infinitely compliant, conformed to the colon's inner wall, and was clamped at a constant ‘operating’ pressure throughout the study. A computer program separated indices of the colon's motor function detected by the barostat: a baseline volume and phasic volume events. The barostat detects on average 70% more phasic pressure events than manometric sideholes located 2 em proximal to 7 cm distal to the balloon. Manometry becomes less sensitive than the barostat when the colonic diameter exceeds 5.6 em. The barostat detects on average 90% of all propagated and non‐propagated (>30 mmHg) manometric peaks. The baseline volume changes significantly after the ingestion of a 1000‐kcal meal, consistent with an increment in colonic tone, undetected by manometry. A combined barostat—manometry assembly appears to be preferable to manometry alone in the intraluminal evaluation of human colonic pressure activity and tone.
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It remains unclear whether postprandial symptom profiles in patients with visceral hypersensitivity and in those with impaired fundic accommodation differ. Therefore, we evaluated the postprandial symptoms in functional dyspepsia (FD) patients classified according to proximal stomach function. In addition, the effect of gastric relaxation induced by sumatriptan on postprandial symptoms was studied in FD patients with impaired fundic accommodation.Twenty-five healthy volunteers (HVs) and 44 FD patients filled out a disease-specific questionnaire (Nepean Dyspepsia Index) and underwent a gastric barostat study to evaluate visceral sensitivity, meal-induced fundic relaxation, and postprandial symptoms. Postprandial symptoms evoked by a drink test or reported during the barostat study were compared between FD patients subdivided according to the underlying pathophysiological mechanism. Finally, the effect of sumatriptan on postprandial symptoms evoked by a drink test was investigated in HVs and in FD patients with impaired fundic accommodation.There was no clear relationship between any of the 15 Nepean Dyspepsia Index symptoms and proximal stomach function. Postprandial symptoms evoked during the barostat study or after the drink tests were significantly higher in FD patients than in HVs; however, no clear differences in symptom profile could be demonstrated between the different subclasses of FD. Sumatriptan did not affect the maximal ingested volume or the postprandial symptoms in HVs or FD patients after a drink test.No clear relationship could be demonstrated between postprandial symptoms and proximal stomach function.
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Barostat methodology is widely used for assessing visceral perception. Different barostat protocols are described with respect to the measurement of rectal compliance and visceral perception. The choice of protocols affects the duration, which is normally 60-90 min, and accuracy of the procedure. This study aimed to shorten the procedure by using the semi-random distension protocol for both compliance and visceral perception measurement and a correction based on rectal capacity (RC) instead of minimal distension pressure (MDP).Twelve irritable bowel syndrome (IBS) patients (7 females) and 11 healthy controls (8 females) underwent a barostat procedure. Compliance was determined during both a staircase distension and a semi-random protocol. Visceral perception data were compared as a function of pressure or relative volume, corrected for MDP or RC, respectively.Compliance measurement using the semi-random protocol instead of the staircase distension protocol resulted in an overestimation in healthy volunteers, but not in IBS patients. The overall conclusion that IBS patients had a lower compliance compared to controls was not different between protocols. Data presentation of the visceral perception scores as a function of corrected volume instead of pressures corrected for MDP did not alter the conclusion that sensation scores in IBS patients were higher as compared to healthy controls.This study showed that barostat procedures may be shortened by approximately 20 min, without losing the ability to discriminate between healthy controls and IBS patients. A correction for RC instead of MDP may improve the accuracy of the procedure.
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The intragastric balloon, filled with air or liquid is used before elective bariatric surgery because its efficacy is limited. This might be the consequence of altered gastric functions. Therefore, we aimed to investigate, in an animal model, the changes in gastric motility and emptying induced by long-term insertion of a balloon used for weight reduction.Ten Göttingen mini-pigs were allocated into two groups with and without an intragastric balloon for 5 months. Balloons were inserted under endoscopy during general anesthesia and were filled with 350 mL of air. Gastric emptying was evaluated by scintigraphy. Gastric volume was measured by single photon emission computed tomography and proximal gastric compliance obtained using an electronic barostat. Changes in vagal tone were assessed by heart rate variability (HRV).After balloon insertion, gastric volume was significantly increased (2047 +/- 114.8 cm(3) after vs 1674 +/- 142.5 cm(3) before insertion, P < 0.05). Gastric compliance was also larger in balloon group (219 +/- 23.4 mL mmHg(-1) in balloon vs 168 +/- 7.7 mL mmHg(-1) in control group). Gastric emptying was reduced after insertion of the balloon (T(1/2) = 204 +/- 28.8 min vs 159 +/- 25.4 before vs after insertion). High frequency components of the spectral analysis of HRV, representing vagal tone, were increased in balloon group.The proximal stomach was enlarged after the insertion of a balloon in the stomach as a consequence of an increased gastric compliance. This change in compliance was probably causative for a reduction in gastric emptying rate of solids. These alterations were associated with increased vagal tone.
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