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Pyloric Pressure Measurements in Gastroparesis Before and After Botulinium Toxin Injection
AGA Abstracts
male. The median age was 46 years (range 18-67). Etiology of gastroparesis in twenty one (91%) was Idiopathic and two (9%) had diabetic gastroparesis. Ten (44%) patients had a positive breath test for SIBO on the basis of hydrogen (70%), methane (30%), or both criteria (10%). The SIBO was negative in both patients with diabetic gastroparesis. Of the 14 (61%) patients who had constipation 5 tested positive for SIBO, 2 of them had a positive breath test on the basis of methane. Other conditions associated in the group studied were: 21 (91%) of them use PPI and 1 (5%) use narcotics. CONCLUSIONS: Our study shows that a positive breath test for SIBO occurs in (44%) of patients with gastroparesis including idiopathic gastroparesis. A high percentage of our patients studied were on PPI therapy, which could also be a contributing factor. SIBO should be considered as a potential cause of symptoms in patients with gastroparesis. Tu1385 Pyloric Pressure Measurements in Gastroparesis Before and After Botulinium Toxin Injection Anil K. Vegesna, Shital P. Prabhu, Aiswerya Madanam Sampath, Zeeshan Ramzan, Kian Makipour, Henry P. Parkman, Larry S. Miller Background: Botulinium Toxin (botox) injection into the pyloric muscle has been used to treat gastroparesis. It is thought that by decreasing the tone in the pyloric sphincter the resistance to gastric outlet will decrease and flow across the pylorus will increase. However, botox does not work in all gastroparetic patients. We hypothesize that the manometric response will correlate with the clinical response to botox injection into the pylorus in patients with gastroparesis. Purpose: To measure the pyloric pressure before and after injections of botox into the pyloric muscle and to correlate the pressure measurements with changes in symptoms. Methods: Six patients with documented gastroparesis on gastric emptying scans (42Yrs, 2M, 4F) underwent pyloric manometry (using a custom made manometry catheter with manometry sensors spaced 3mm apart) before and after botox injection into the pyloric muscle. The manometry catheter was attached to an Olympus ultrathin endoscope (GIF-N 180) so that when the endoscope was retroflexed in the duodenum the pressure ports of the manometry catheter crossed the pyloric sphincter. Using a MMS manometry system, peak and trough pyloric sphincter pressures were measured before and immediately after circumferential injection with 5ccs of 200 units of botox into the pyloric sphincter muscle. Patients were contacted one month after botox injection to determine their clinical response to the procedure. Results: The 3 patients who responded with a decrease in symptoms to botox injection had a decrease in both peak and trough pressures from a mean of 108.89 mmHg (8.33) to 23.89 mmHg (4.64) p<0.046 and 9.38 mmHg (3.57) to -8.17 mmHg (0.97) p=0.14 respectively. The 3 patients who did not respond symptomatically to botox injection had an increase or no change in peak and trough pressures from a mean of 18.09 mmHg (1.72) to 59.56 mmHg (8.24) p=0.13 and 0.26 mmHg (0.64) to 0.30 mmHg (1.35) p=0.49. The group of patients that responded with a decrease in symptoms had a significantly higher baseline peak pressure pre botox and a significantly greater pressure drop after botox than the group of patients that did not respond. Conclusions: Patients who had an improvement in their symptoms with botox injection into the pyloric sphincter, had a significantly higher baseline peak pressure pre botox and a significantly greater pressure drop post botox than the group of patients that did not respond clinically. By measuring pyloric pressures before and after botox injection into the pylorus we are able to distinguish between botox responsive and nonresponsive patients. We hypothesize that by measuring the pyloric pressure pre-Botox we will be able to predict which patients will respond symptomatically.
Pyloric pressures before and after botox injection in the pylorus Tu1386 Observation of Human Gastric Motility Using Remote-Controlled Capsule Endoscopy Jutta Keller, Christiane Fibbe, Viola Andresen, Peter H. Layer OBJECTIVES: Capsule endoscopy has been examined as diagnostic means for analysis of human small bowel but not gastric motility. Moreover, observation and analysis of motor events have been hampered by simultaneous transport of the video capsule. AIMS & METHODS: We aimed to demonstrate physiological human fasting gastric motor patterns using a modified capsule endoscope that includes magnetic material (Given Imaging Ltd) and can be remotely manipulated within the human stomach using an external magnetic field. Moderate gastric distension was achieved by application of sherbet powder and subsequent intragastric CO2 release. Data recording and continuous real-time viewing were performed throughout experiments. An external magnetic paddle was used to hold and manipulate the magnetic video capsule within the stomach of 10 healthy volunteers. Detailed visual analysis of motor patterns was performed after completion of the experiments using the capsule videos. RESULTS: No adverse events occurred. In all volunteers the capsule was clearly attracted by the outer magnet and responded to its movements. Mean gastric residence time was 39±24 minutes. The following motor events could be observed (n=number of subjects in whom these could be documented): Opening of the cardia during swallowing (n=7), lumen occluding and non-lumen occluding antral contractions (n=9), regular antral contractions at 3/min (phase III-like, n=5), opening and closing of the pylorus(n=9). The figure shows subsequent sequencies (1-3) with the capsule observing the pylorus while partially opened (A) and while closing during a strong contraction (B and C). The sequencies start 17 s apart suggesting an approximate 3/ min rhythm. CONCLUSION: This methodology allows to directly observe human gastric contractility, provides unique video material on physiological gastric motor events and, thus, may be useful for better understanding of gastric physiology and pathophysiology.
Contraction cycle of the human pylorus
AGA Abstracts
S-812
male. The median age was 46 years (range 18-67). Etiology of gastroparesis in twenty one (91%) was Idiopathic and two (9%) had diabetic gastroparesis. Ten (44%) patients had a positive breath test for SIBO on the basis of hydrogen (70%), methane (30%), or both criteria (10%). The SIBO was negative in both patients with diabetic gastroparesis. Of the 14 (61%) patients who had constipation 5 tested positive for SIBO, 2 of them had a positive breath test on the basis of methane. Other conditions associated in the group studied were: 21 (91%) of them use PPI and 1 (5%) use narcotics. CONCLUSIONS: Our study shows that a positive breath test for SIBO occurs in (44%) of patients with gastroparesis including idiopathic gastroparesis. A high percentage of our patients studied were on PPI therapy, which could also be a contributing factor. SIBO should be considered as a potential cause of symptoms in patients with gastroparesis. Tu1385 Pyloric Pressure Measurements in Gastroparesis Before and After Botulinium Toxin Injection Anil K. Vegesna, Shital P. Prabhu, Aiswerya Madanam Sampath, Zeeshan Ramzan, Kian Makipour, Henry P. Parkman, Larry S. Miller Background: Botulinium Toxin (botox) injection into the pyloric muscle has been used to treat gastroparesis. It is thought that by decreasing the tone in the pyloric sphincter the resistance to gastric outlet will decrease and flow across the pylorus will increase. However, botox does not work in all gastroparetic patients. We hypothesize that the manometric response will correlate with the clinical response to botox injection into the pylorus in patients with gastroparesis. Purpose: To measure the pyloric pressure before and after injections of botox into the pyloric muscle and to correlate the pressure measurements with changes in symptoms. Methods: Six patients with documented gastroparesis on gastric emptying scans (42Yrs, 2M, 4F) underwent pyloric manometry (using a custom made manometry catheter with manometry sensors spaced 3mm apart) before and after botox injection into the pyloric muscle. The manometry catheter was attached to an Olympus ultrathin endoscope (GIF-N 180) so that when the endoscope was retroflexed in the duodenum the pressure ports of the manometry catheter crossed the pyloric sphincter. Using a MMS manometry system, peak and trough pyloric sphincter pressures were measured before and immediately after circumferential injection with 5ccs of 200 units of botox into the pyloric sphincter muscle. Patients were contacted one month after botox injection to determine their clinical response to the procedure. Results: The 3 patients who responded with a decrease in symptoms to botox injection had a decrease in both peak and trough pressures from a mean of 108.89 mmHg (8.33) to 23.89 mmHg (4.64) p<0.046 and 9.38 mmHg (3.57) to -8.17 mmHg (0.97) p=0.14 respectively. The 3 patients who did not respond symptomatically to botox injection had an increase or no change in peak and trough pressures from a mean of 18.09 mmHg (1.72) to 59.56 mmHg (8.24) p=0.13 and 0.26 mmHg (0.64) to 0.30 mmHg (1.35) p=0.49. The group of patients that responded with a decrease in symptoms had a significantly higher baseline peak pressure pre botox and a significantly greater pressure drop after botox than the group of patients that did not respond. Conclusions: Patients who had an improvement in their symptoms with botox injection into the pyloric sphincter, had a significantly higher baseline peak pressure pre botox and a significantly greater pressure drop post botox than the group of patients that did not respond clinically. By measuring pyloric pressures before and after botox injection into the pylorus we are able to distinguish between botox responsive and nonresponsive patients. We hypothesize that by measuring the pyloric pressure pre-Botox we will be able to predict which patients will respond symptomatically.
Pyloric pressures before and after botox injection in the pylorus Tu1386 Observation of Human Gastric Motility Using Remote-Controlled Capsule Endoscopy Jutta Keller, Christiane Fibbe, Viola Andresen, Peter H. Layer OBJECTIVES: Capsule endoscopy has been examined as diagnostic means for analysis of human small bowel but not gastric motility. Moreover, observation and analysis of motor events have been hampered by simultaneous transport of the video capsule. AIMS & METHODS: We aimed to demonstrate physiological human fasting gastric motor patterns using a modified capsule endoscope that includes magnetic material (Given Imaging Ltd) and can be remotely manipulated within the human stomach using an external magnetic field. Moderate gastric distension was achieved by application of sherbet powder and subsequent intragastric CO2 release. Data recording and continuous real-time viewing were performed throughout experiments. An external magnetic paddle was used to hold and manipulate the magnetic video capsule within the stomach of 10 healthy volunteers. Detailed visual analysis of motor patterns was performed after completion of the experiments using the capsule videos. RESULTS: No adverse events occurred. In all volunteers the capsule was clearly attracted by the outer magnet and responded to its movements. Mean gastric residence time was 39±24 minutes. The following motor events could be observed (n=number of subjects in whom these could be documented): Opening of the cardia during swallowing (n=7), lumen occluding and non-lumen occluding antral contractions (n=9), regular antral contractions at 3/min (phase III-like, n=5), opening and closing of the pylorus(n=9). The figure shows subsequent sequencies (1-3) with the capsule observing the pylorus while partially opened (A) and while closing during a strong contraction (B and C). The sequencies start 17 s apart suggesting an approximate 3/ min rhythm. CONCLUSION: This methodology allows to directly observe human gastric contractility, provides unique video material on physiological gastric motor events and, thus, may be useful for better understanding of gastric physiology and pathophysiology.
Contraction cycle of the human pylorus
AGA Abstracts
S-812