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Constipation is not associated with increased frequency of cholecystectomy
April 2000
AGAA1159
mean DF and tachygastria.Decreased post prandial power was seen only in symptomatic patients.
RESULTS OF (cpm) PP NPO Symptomatic patients Asymptomatic patients
Brady (%J PP NPO
Nonno(%) PP NPO
Tachy (%) NPO PP
~P
dB
365
3.8
6.5
5,4
48
47
45
47
009
339
37
115
45
57
56
31
39
024
Brady=bradygastria «2.5 cpm), Normo=normogastria (2.5-3.5 cpm) Tachy=tachygastria (>3.5 cpm)
5335 CONSTIPATION IS NOT ASSOCIATED WITH INCREASED FREQUENCY OF CHOLECYSTECTOMY. Paul Alberdo, Jinhong Xing, Larive Bret, Edy E. Soffer, The Cleveland Clin Fdn, Cleveland, OH. Background: Recent data suggest that prolonged large bowel transit is associated with increased risk of cholelithiasis. The proposed mechanism is altered bile composition, resulting in increased cholesterol saturation. However, it is not known if constipation is a risk factor for symptomatic gallstones. The purpose of this study was to determine if the prevalence of constipation in patients undergoing cholecystectomy is higher than the expected prevalence of constipation in the general population. Methods: Chart review of all patients undergoing cholecystectomy during the course of the last two years at the Cleveland Clinic. Only patients operated for complications of gallstones were selected. Patients complaining of chronic constipation, and using laxatives, were included in the constipation group. A range of prevalence rates of constipation, from a number of large US surveys, was used for comparison. Association tests were made using Chi-Square and Fisher's exact tests. Significance level for each P-value was set at 0.0013 using a Bonferroni correction for multiple comparisons. Results: Of 1042 patients who had cholecystectomy, 833 patients were included, of which 545 patients (65%) were females. Constipation was documented in 15 patients (1.8%). Group prevalence, as well as prevalence rates obtained by further analysis of gender and age, were not higher than reported rates in the general population. Conclusion: The increased prevalence of cholelithiasis in patients with constipation is not associated with clinically important complications of gallstones. This is consistent with the fact that in most patients with cholelithiasis, gallstones remain silent.
5336 GASTRIC EMPTYING OF FLUIDS BY ANTRUMPLANIMETRY IN HEALTHY VOLUNTEERS: AGE·(IN-)DEPENDENT? Elmar Almus, Claudia Gerards, Thorsten R. Cleusters, Volker Meister, Burkard May, Andreas Tromm, Bergmannsheil, Bochum, Germany; Marienhospital, Vechta, Germany. Introduction: Many investigations on gastric emptying have been made in the past. The sonographic method of antumplanimetry is one of them. In former studies only small and young groups have been investigated to get normal standard values. In this study a larger and older (regarding to the average age) was examined. Method: Gastric emptying of 300 rnl water (I T'C) was performed in 48 healthy, non-smoking volunteers [29 F, 19 M, age: 39,7:': 16,1 y.] by sonographic sagittal antrumplanimetry. The area of the antrum (A) was determinated every three minutes as the mean of three single measurements. Volunteers were divided in three groups: <30; 30-39 and >39 years. The estimated parameters are: Ao, To: end of fluid intake, T E nd e : Ao was reached again, %-increase: max. percent increase of A [(Am ax / Ao) x 100], EFG (German short cut for: functional-emptying-line): T Ende depending on %-increase. A significant correlation (Pearson's correlation coefficient) was found between the %-increase and T Ende (r= +0,434). EFG was made. There were no significant differences between the estimated parameters in the three age-divided groups. Discussion: The sonographic measurement of the gastric emptying of fluids with the method of antrumplanimetry is a sure, well accepted method in the determination of gastric emptying of fluids. This study shows that there is no influence of age in the gastric emptying in fluids. With these data it is easier in the future to look if the gastric emptying of fluids is normal or under consideration of the intraindividuel EFG pathological.
Results age(years) <30 30·39 >39
Ao(cm')
Am,,(cm')
%·incline (%)
TE"".(min)
2,55 (±0,89) 3,51 (±1,3) 3,14 (±0,88)
4,78 (±1,61) 6,3(±2,03) 7,42 (±3,15)
203,1 (±86) 184,8 (±36,1) 228,9 (±73, 1)
13,5 (±4,91) 13,1 (±4,1) 15,3 (±5,73)
5337 RESULTS OF CONTINUOS ELECTROGASTROGRAPHY (EGG) IN CHRONIC RENAL FAILURE (CRF) ON DIALYSIS. Sternberg Amos, Younis Raed, Zonder Hellikiu, Stroch Shimon, Fireman Zvi, Hillel Yaffe Med Ctr, Hadera, Israel. Background: Upper Gl symptoms are common in-patients with CRF suggestive to delayed gastric emptying. EGG examines the electrochemical signal excreted by the stomach. Normal waves range between 2-4 cycles per minutes (CPM), while slower rate is labeled as Bradygastria (BR) and faster ones as Tachygastria (TA). Crude correlation exists between BR and slow gastric evacuation, but further studies are needed to establish the EGG examination the clinical field. 2 types of EGG studies exist: stationary and 24 hours EGG recording. Aim: to compare the ambulatory 24 hours EGG recording, in CRF patients on dialysis with and without dyspepsia. Methods: 16 CRF patients on dialysis were enrolled, 68.8% male and 31.2% female, the mean age 55.43:':9.56 yr. (range 36 to 63 yr.). All the patients were attached to EGG recorder (Synectics ®) and the recording was conducted for 24 hours during the of dialysis. Results: BR was noted in 6.7:':2.6% of the patients. Normal CPM was noted in 79.8:!: 10.7% of the patients and TA was noted in 1O.0:!:3.5% of the patients. 5 patients (31.2%) were without GI symptoms, while II patients (68.8%) were dyspeptic. Comparison between total EGG results and GI symptoms is presented in table. Conclusions: there is no statistical difference in either normal or meal EGG, between dyspeptic and asymptomatic CRF patients on dialysis. Comparison be1ween total EGG results and GIsymptoms
NoDyspepsia Dyspepsia PValue
Bradygastria (%)
Nonnal CPM(%)
Tachygastria(%)
7.9±2.1 6.2±2.7 NS
80A±23 79.5±130 NS
10.8±35 9.6±3.6 NS
EGG-Electrogastrography, GI·Gastrointestinal CPM·cycle per minutes,
5338 NO ALTERATION OF SLOW WAVE FREQUENCY IN THE INTESTINE OF CONNEXIN40 DEFICIENT MICE. Luc J. Andries, Tina Smets, Marcel Borgers, Olaf Krueger, Klaus Willecke, Jean Marie Vanderwinden, Janssen Research Fdn, Beerse, Belgium; Inst fur Genetik, Bonn, Germany; Brussels, Belgium. Interstitial cells of Cajal (ICC) can generate slow waves and modulate neurotransmission in the gastrointestinal tract. The role of gap junction channels, composed of connexin40 (Cx40) and connexin43 (Cx43) proteins, which are involved in pacemaker activity of the heart, is not known in the function of ICCs. Therefore we compared slow wave activity in wild type and in Cx40 deficient mice (Kirchhoff et al., Curro BioI. 8, 299-302, 1998). The distribution of Cx40 and Cx43 immunoreactivity (Cx40-ir and Cx43-ir, respectively) was also studied in mouse and guinea pig ileum. The frequency of slow waves, recorded by an extracellular suction electrode in the proximal intestine, was similar in wild type and Cx40 knock-out mice (42.7 :!: 3.4 cycles/min, n=6 versus 40.5 :!: 1.7 cycles/min, n=6; mean :': SEM, n.s.). No structural abnormalities were noticed in the muscularis externa and in the mucosa of Cx40 knock-out mice. Confocal microscopy of whole mounts and of cryosections, after double immunostaining for c-kit and Cx40, showed that Cx40 was not associated with ICCs in wild type mice. Cx40-ir was mainly present in endothelium of arteries and arterioles. In knock-out mice, Cx40-ir was absent in cryosections of ileum, colon and heart. The distribution of Cx43-ir in circular muscle and ICCs was similar between wild type and Cx40 knock-out mice. In contrast to murine ICC, distinct Cx40-labeling was observed in ICCs of the deep muscular plexus (ICC-DMP) of guinea pig ileum, which usually coincided with Cx43stained gap junctions. ICC-DMP of guinea pig were characterised by a higher density of Cx43-ir gap junctions than mouse ICC-DMP. ICCs of mouse and guinea pig myenteric plexus (ICC-MY) lacked Cx40 staining and showed few Cx43-ir gap junctions. These data suggest that Cx40 does not playa role in the propagation of slow waves in mice. Gap junctional communication between ICC-MY and smooth muscle cells might occur via channels composed of other connexin proteins.
AGAA1159
mean DF and tachygastria.Decreased post prandial power was seen only in symptomatic patients.
RESULTS OF (cpm) PP NPO Symptomatic patients Asymptomatic patients
Brady (%J PP NPO
Nonno(%) PP NPO
Tachy (%) NPO PP
~P
dB
365
3.8
6.5
5,4
48
47
45
47
009
339
37
115
45
57
56
31
39
024
Brady=bradygastria «2.5 cpm), Normo=normogastria (2.5-3.5 cpm) Tachy=tachygastria (>3.5 cpm)
5335 CONSTIPATION IS NOT ASSOCIATED WITH INCREASED FREQUENCY OF CHOLECYSTECTOMY. Paul Alberdo, Jinhong Xing, Larive Bret, Edy E. Soffer, The Cleveland Clin Fdn, Cleveland, OH. Background: Recent data suggest that prolonged large bowel transit is associated with increased risk of cholelithiasis. The proposed mechanism is altered bile composition, resulting in increased cholesterol saturation. However, it is not known if constipation is a risk factor for symptomatic gallstones. The purpose of this study was to determine if the prevalence of constipation in patients undergoing cholecystectomy is higher than the expected prevalence of constipation in the general population. Methods: Chart review of all patients undergoing cholecystectomy during the course of the last two years at the Cleveland Clinic. Only patients operated for complications of gallstones were selected. Patients complaining of chronic constipation, and using laxatives, were included in the constipation group. A range of prevalence rates of constipation, from a number of large US surveys, was used for comparison. Association tests were made using Chi-Square and Fisher's exact tests. Significance level for each P-value was set at 0.0013 using a Bonferroni correction for multiple comparisons. Results: Of 1042 patients who had cholecystectomy, 833 patients were included, of which 545 patients (65%) were females. Constipation was documented in 15 patients (1.8%). Group prevalence, as well as prevalence rates obtained by further analysis of gender and age, were not higher than reported rates in the general population. Conclusion: The increased prevalence of cholelithiasis in patients with constipation is not associated with clinically important complications of gallstones. This is consistent with the fact that in most patients with cholelithiasis, gallstones remain silent.
5336 GASTRIC EMPTYING OF FLUIDS BY ANTRUMPLANIMETRY IN HEALTHY VOLUNTEERS: AGE·(IN-)DEPENDENT? Elmar Almus, Claudia Gerards, Thorsten R. Cleusters, Volker Meister, Burkard May, Andreas Tromm, Bergmannsheil, Bochum, Germany; Marienhospital, Vechta, Germany. Introduction: Many investigations on gastric emptying have been made in the past. The sonographic method of antumplanimetry is one of them. In former studies only small and young groups have been investigated to get normal standard values. In this study a larger and older (regarding to the average age) was examined. Method: Gastric emptying of 300 rnl water (I T'C) was performed in 48 healthy, non-smoking volunteers [29 F, 19 M, age: 39,7:': 16,1 y.] by sonographic sagittal antrumplanimetry. The area of the antrum (A) was determinated every three minutes as the mean of three single measurements. Volunteers were divided in three groups: <30; 30-39 and >39 years. The estimated parameters are: Ao, To: end of fluid intake, T E nd e : Ao was reached again, %-increase: max. percent increase of A [(Am ax / Ao) x 100], EFG (German short cut for: functional-emptying-line): T Ende depending on %-increase. A significant correlation (Pearson's correlation coefficient) was found between the %-increase and T Ende (r= +0,434). EFG was made. There were no significant differences between the estimated parameters in the three age-divided groups. Discussion: The sonographic measurement of the gastric emptying of fluids with the method of antrumplanimetry is a sure, well accepted method in the determination of gastric emptying of fluids. This study shows that there is no influence of age in the gastric emptying in fluids. With these data it is easier in the future to look if the gastric emptying of fluids is normal or under consideration of the intraindividuel EFG pathological.
Results age(years) <30 30·39 >39
Ao(cm')
Am,,(cm')
%·incline (%)
TE"".(min)
2,55 (±0,89) 3,51 (±1,3) 3,14 (±0,88)
4,78 (±1,61) 6,3(±2,03) 7,42 (±3,15)
203,1 (±86) 184,8 (±36,1) 228,9 (±73, 1)
13,5 (±4,91) 13,1 (±4,1) 15,3 (±5,73)
5337 RESULTS OF CONTINUOS ELECTROGASTROGRAPHY (EGG) IN CHRONIC RENAL FAILURE (CRF) ON DIALYSIS. Sternberg Amos, Younis Raed, Zonder Hellikiu, Stroch Shimon, Fireman Zvi, Hillel Yaffe Med Ctr, Hadera, Israel. Background: Upper Gl symptoms are common in-patients with CRF suggestive to delayed gastric emptying. EGG examines the electrochemical signal excreted by the stomach. Normal waves range between 2-4 cycles per minutes (CPM), while slower rate is labeled as Bradygastria (BR) and faster ones as Tachygastria (TA). Crude correlation exists between BR and slow gastric evacuation, but further studies are needed to establish the EGG examination the clinical field. 2 types of EGG studies exist: stationary and 24 hours EGG recording. Aim: to compare the ambulatory 24 hours EGG recording, in CRF patients on dialysis with and without dyspepsia. Methods: 16 CRF patients on dialysis were enrolled, 68.8% male and 31.2% female, the mean age 55.43:':9.56 yr. (range 36 to 63 yr.). All the patients were attached to EGG recorder (Synectics ®) and the recording was conducted for 24 hours during the of dialysis. Results: BR was noted in 6.7:':2.6% of the patients. Normal CPM was noted in 79.8:!: 10.7% of the patients and TA was noted in 1O.0:!:3.5% of the patients. 5 patients (31.2%) were without GI symptoms, while II patients (68.8%) were dyspeptic. Comparison between total EGG results and GI symptoms is presented in table. Conclusions: there is no statistical difference in either normal or meal EGG, between dyspeptic and asymptomatic CRF patients on dialysis. Comparison be1ween total EGG results and GIsymptoms
NoDyspepsia Dyspepsia PValue
Bradygastria (%)
Nonnal CPM(%)
Tachygastria(%)
7.9±2.1 6.2±2.7 NS
80A±23 79.5±130 NS
10.8±35 9.6±3.6 NS
EGG-Electrogastrography, GI·Gastrointestinal CPM·cycle per minutes,
5338 NO ALTERATION OF SLOW WAVE FREQUENCY IN THE INTESTINE OF CONNEXIN40 DEFICIENT MICE. Luc J. Andries, Tina Smets, Marcel Borgers, Olaf Krueger, Klaus Willecke, Jean Marie Vanderwinden, Janssen Research Fdn, Beerse, Belgium; Inst fur Genetik, Bonn, Germany; Brussels, Belgium. Interstitial cells of Cajal (ICC) can generate slow waves and modulate neurotransmission in the gastrointestinal tract. The role of gap junction channels, composed of connexin40 (Cx40) and connexin43 (Cx43) proteins, which are involved in pacemaker activity of the heart, is not known in the function of ICCs. Therefore we compared slow wave activity in wild type and in Cx40 deficient mice (Kirchhoff et al., Curro BioI. 8, 299-302, 1998). The distribution of Cx40 and Cx43 immunoreactivity (Cx40-ir and Cx43-ir, respectively) was also studied in mouse and guinea pig ileum. The frequency of slow waves, recorded by an extracellular suction electrode in the proximal intestine, was similar in wild type and Cx40 knock-out mice (42.7 :!: 3.4 cycles/min, n=6 versus 40.5 :!: 1.7 cycles/min, n=6; mean :': SEM, n.s.). No structural abnormalities were noticed in the muscularis externa and in the mucosa of Cx40 knock-out mice. Confocal microscopy of whole mounts and of cryosections, after double immunostaining for c-kit and Cx40, showed that Cx40 was not associated with ICCs in wild type mice. Cx40-ir was mainly present in endothelium of arteries and arterioles. In knock-out mice, Cx40-ir was absent in cryosections of ileum, colon and heart. The distribution of Cx43-ir in circular muscle and ICCs was similar between wild type and Cx40 knock-out mice. In contrast to murine ICC, distinct Cx40-labeling was observed in ICCs of the deep muscular plexus (ICC-DMP) of guinea pig ileum, which usually coincided with Cx43stained gap junctions. ICC-DMP of guinea pig were characterised by a higher density of Cx43-ir gap junctions than mouse ICC-DMP. ICCs of mouse and guinea pig myenteric plexus (ICC-MY) lacked Cx40 staining and showed few Cx43-ir gap junctions. These data suggest that Cx40 does not playa role in the propagation of slow waves in mice. Gap junctional communication between ICC-MY and smooth muscle cells might occur via channels composed of other connexin proteins.