Abnormal Electrogastrography and Gastric Emptying Time in Patients with Cyclic Vomiting Syndrome during Symptom Free Interval

ABSTRACT

PURPOSE: Cyclic vomiting syndrome is characterized by repeated, unpredictable, explosive and unexplained bouts of vomiting and recur after intervals of uncertain length. In the absence of either known etiology or pathogenesis, deciphering the mystery of cyclic vomiting syndrome presents us with a daunting clinical challenge. As we seek to understand this mysterious vomiting disorder of unknown etiology and pathogenic mechanism, we perfomed electrogastrography (EGG) and measured radionuclide gastric emptying time and compared the data with that of control. METHODS: Total 13 patients with cyclic vomiting (ages from 1 yr 6 m to 13 yr 3 m mean 7 yr 2 m ) and 9 normal controls (ages from to 1 yr 8 m to 13 y 4 m, mean; 7 y 6 m) were enrolled in this study. Among them 16 children (9 patients and 7 controls) undertook gastric emptying time and 13 children (7 patients and 5 controls) undertook EGG. EGG after midnight NPO, total 3 triplet of electrodes (two for the recoding of gastric electricity along the antral axis, and the other one for references) were used. After 1 hour recording of EGG we analysed the dominant frequencies. Gastric emptying gastric emptying was evaluated by a radiolabeled (1mCi [99mTc] sulfur colloid incorporated into egg albumin) solid phase meal after an overnight fast of at least 8 hr. Radioisotope counts were obtained immediately after ingestion and continued for 10-min intervals for 120 min. The half emptying time (T1/2) and percent gastric residual at 2 hr were calculated. RESULTS: EGG the dominant frequencies were significanlty different between case and control group (p=0.005, median values; 4.1 Hz and 3.1 Hz in case group and control group respectively ). Gastric emptying time the gastic emptying rates at 120 min were 53.1+/-16% and 66.9+/-7.0% in patients and control groups respectively, which showed the gastric emptying was significantly delayed in patient groups (p=0.042) CONCLUSIONS: With the results of our study, we felt that the patients with cyclic vomiting has a some sort of motility disorders, like as a variant of chronic idiopathic intestinal pseudoobstruction or gastroparesis. But further sophisticated designed studies are needed to confirm this.