- Email: [email protected]
Gastric motility—? MRI
Vol. 98, No. 1, 2003 ISSN 0002-9270/03/$30.00
WHAT’S NEW IN GI EDITOR
Jon S. Thompson, M.D. University of Nebraska Medical Center Omaha, Nebraska SURGERY
Dmitry Oleynikov University of Nebraska Medical Center Omaha, Nebraska GASTROENTEROLOGY
Randall E. Brand Hermant K. Roy Northwestern University Chicago, Illinois Rene´e L. Young John K. DiBaise Timothy M. McCashland Mark E. Mailliard University of Nebraska Medical Center Omaha, Nebraska RADIOLOGY
Aurelio Matamoros, Jr. M. D. Anderson Cancer Center Houston, Texas PATHOLOGY
James L. Wisecarver James M. Gulizia University of Nebraska Medical Center Omaha, Nebraska BASIC SCIENCE
Carol A. Casey University of Nebraska Medical Center Omaha, Nebraska PEDIATRIC GASTROENTEROLOGY
David R. Mack Children’s Hospital of Eastern Ontario Ottawa, Ontario, Canada Simon Horslen University of Nebraska Medical Center Omaha, Nebraska
Gastric Motility—? MRI de Zwart IM, Mearadji B, Lamb HJ, et al. Gastric motility: Comparison of assessment with real-time MR imaging or barostat measurement—initial experience. Radiology 2002;224:592– 7. Gastric motility disorders, either primary or secondary, require diagnostic evaluation. Evaluation of proximal gastric motility can be performed using a barostat measurement, though this procedure is invasive and requires the use of fluoroscopy for correct positioning. Using set pressure and set volume, the barostat measures tonic and phasic changes in bag volume or pressure. The purpose of this study was to evaluate noninvasive MR imaging as an alternate method for measuring gastric motility and volume by comparing simultaneous MR imaging and barostat recordings. The study group consisted of six healthy adult volunteers who had no history of gastrointestinal symptoms, prior abdominal surgery, or use of medications. The barostat, being non-MR compatible, was placed outside the MRI suite. Intragastric pressure, gastric volume, and gastric compliance were constantly monitored and recorded. The MR protocol consisted of a three-dimensional volume acquisition pulse sequence and two-dimensional dynamic acquisition pulse sequence for assessment of dynamic gastric activity. Glucagon and erythromycin were used to relax and contract the stomach, respectively. The findings from this study demonstrate that: (1) the MR images show that phasic volume waves assessed with the barostat are the result of superimposed individual peristaltic con-
tractions of the stomach, (2) individual stomach contractions can be detected using MRI, (3) MRI measures the whole volume of the stomach compared with only the volume of the intragastric bag within the proximal portion of the stomach as measured by the barostat, and (4) MRI is a valid and noninvasive method for measuring gastric motility and gastric volume. Aurelio Matamoros, Jr., M.D.
Fissures: Diltiazem to the Rescue Jonas M, Speake W, Scholefield JH. Diltiazem heals glyceryl trinitrate-resistant chronic anal fissures. Dis Colon Rectum 2002;45:1091– 4. Chronic anal fissure remains a common problem requiring treatment. The traditional treatment of chronic anal fissure has been a surgical sphincterotomy to reduce the anal pressure. This is quite an effective therapy but does require an operation and has a low incidence of impaired sphincter function in the future. Thus, there has been great interest in alternative methods for treating chronic anal fissure. Chemical sphincterotomy with topical nitroglycerine appears to be effective at healing fissures in approximately one-half to two-thirds of patients with prolonged therapy. However, this is often poorly tolerated secondary to side effects, particularly headaches. Calcium channel blockers have recently been suggested as a medical alternative for facilitating relaxation of the internal anal sphincter and improving blood supply. Several recent studies have suggested that diltiazem may have a response rate which is similar to that of nitroglyc-
WHAT’S NEW IN GI
THE AMERICAN JOURNAL OF GASTROENTEROLOGY © 2003 by Am. Coll. of Gastroenterology Published by Elsevier Science Inc.
WHAT’S NEW IN GI EDITOR
Jon S. Thompson, M.D. University of Nebraska Medical Center Omaha, Nebraska SURGERY
Dmitry Oleynikov University of Nebraska Medical Center Omaha, Nebraska GASTROENTEROLOGY
Randall E. Brand Hermant K. Roy Northwestern University Chicago, Illinois Rene´e L. Young John K. DiBaise Timothy M. McCashland Mark E. Mailliard University of Nebraska Medical Center Omaha, Nebraska RADIOLOGY
Aurelio Matamoros, Jr. M. D. Anderson Cancer Center Houston, Texas PATHOLOGY
James L. Wisecarver James M. Gulizia University of Nebraska Medical Center Omaha, Nebraska BASIC SCIENCE
Carol A. Casey University of Nebraska Medical Center Omaha, Nebraska PEDIATRIC GASTROENTEROLOGY
David R. Mack Children’s Hospital of Eastern Ontario Ottawa, Ontario, Canada Simon Horslen University of Nebraska Medical Center Omaha, Nebraska
Gastric Motility—? MRI de Zwart IM, Mearadji B, Lamb HJ, et al. Gastric motility: Comparison of assessment with real-time MR imaging or barostat measurement—initial experience. Radiology 2002;224:592– 7. Gastric motility disorders, either primary or secondary, require diagnostic evaluation. Evaluation of proximal gastric motility can be performed using a barostat measurement, though this procedure is invasive and requires the use of fluoroscopy for correct positioning. Using set pressure and set volume, the barostat measures tonic and phasic changes in bag volume or pressure. The purpose of this study was to evaluate noninvasive MR imaging as an alternate method for measuring gastric motility and volume by comparing simultaneous MR imaging and barostat recordings. The study group consisted of six healthy adult volunteers who had no history of gastrointestinal symptoms, prior abdominal surgery, or use of medications. The barostat, being non-MR compatible, was placed outside the MRI suite. Intragastric pressure, gastric volume, and gastric compliance were constantly monitored and recorded. The MR protocol consisted of a three-dimensional volume acquisition pulse sequence and two-dimensional dynamic acquisition pulse sequence for assessment of dynamic gastric activity. Glucagon and erythromycin were used to relax and contract the stomach, respectively. The findings from this study demonstrate that: (1) the MR images show that phasic volume waves assessed with the barostat are the result of superimposed individual peristaltic con-
tractions of the stomach, (2) individual stomach contractions can be detected using MRI, (3) MRI measures the whole volume of the stomach compared with only the volume of the intragastric bag within the proximal portion of the stomach as measured by the barostat, and (4) MRI is a valid and noninvasive method for measuring gastric motility and gastric volume. Aurelio Matamoros, Jr., M.D.
Fissures: Diltiazem to the Rescue Jonas M, Speake W, Scholefield JH. Diltiazem heals glyceryl trinitrate-resistant chronic anal fissures. Dis Colon Rectum 2002;45:1091– 4. Chronic anal fissure remains a common problem requiring treatment. The traditional treatment of chronic anal fissure has been a surgical sphincterotomy to reduce the anal pressure. This is quite an effective therapy but does require an operation and has a low incidence of impaired sphincter function in the future. Thus, there has been great interest in alternative methods for treating chronic anal fissure. Chemical sphincterotomy with topical nitroglycerine appears to be effective at healing fissures in approximately one-half to two-thirds of patients with prolonged therapy. However, this is often poorly tolerated secondary to side effects, particularly headaches. Calcium channel blockers have recently been suggested as a medical alternative for facilitating relaxation of the internal anal sphincter and improving blood supply. Several recent studies have suggested that diltiazem may have a response rate which is similar to that of nitroglyc-
WHAT’S NEW IN GI
THE AMERICAN JOURNAL OF GASTROENTEROLOGY © 2003 by Am. Coll. of Gastroenterology Published by Elsevier Science Inc.