Assessment of the post-prandial distribution of intragastric contents using an automated technique.

The distribution of intragastric contents has been studied using operator-dependent methods. We devised an automated technique for determining post-prandial intragastric distribution of radiolabeled meals, based on the calculation of the 'center of activity' (CA) of the radioactivity contained in the stomach in any given scintigraphic image. Twelve healthy volunteers and eleven functional dyspepsia (FD) patients ingested a liquid meal (320 mL, 450 kcal) labeled with (99m)Technetium-phytate. Images of the stomach were acquired every 5-10 min for 2 h, and counted to determine the percentage of total activity retained in the upper half of the stomach, as visually delineated. Each image was then processed using an algorithm for calculating a CA value representing the average of image-forming points corrected by pixel number. The relative CA position along the main longitudinal axis of the stomach, as defined by a digital 'skeletonizing' process, was expressed in a '0 to 1' scale. In the FD patients, the average of all CA determinations was significantly higher than in the controls (0.56, 0.30-0.80 versus 0.48, 0.33-0.68, p < 0.05) and correlated significantly with proximal stomach retention values assessed by a visual method (R = -0.64, p < 0.001). Assessing post-prandial intragastric distribution by a novel automated method is feasible and yields reliable data, while being much less operator dependent.

Relationships between intragastric food maldistribution, disturbances of antral contractility, and symptoms in functional dyspepsia.

We investigated the relationships between intragastric food maldistribution and antral dysmotility in functional dyspepsia, and whether these abnormalities relate to meal-induced symptoms. Intragastric distribution of food throughout gastric emptying was determined in patients (n = 24) and controls (n = 38) after a liquid nutrient meal labeled with (99m)technetium phytate. Antral contractility was also periodically assessed by dynamic scintigraphy and postprandial symptoms were monitored with visual analog scales. Residence of food in the proximal stomach was decreased in 8 (33%) and antral contractility was increased in 9 (37.5%) and decreased in 2 (8%) patients. Proximal and distal stomach motor abnormalities were neither significantly correlated nor associated. Increased antral contractility was significantly correlated (Rs = 0.54; P < .01) with postprandial nausea. We conclude that diminished residence of food in the proximal stomach and disturbed antral contractility occur independently in different subsets of functional dyspepsia patients. Increased antral contractility seems to play a role in postprandial nausea in functional dyspepsia.

Diminished retention of food in the proximal stomach correlates with increased acidic reflux in patients with gastroesophageal reflux disease and dyspeptic symptoms.

This work aimed at evaluating the intragastric distribution of food in patients with GERD and dyspepsia and its relationship to acidic reflux episodes. Gastric emptying and food retention in the proximal stomach were evaluated by scintigraphy in 12 healthy subjects and 19 patients with GERD and dyspepsia after a liquid test meal. Patients also underwent 24-hr esophageal pH monitoring, which included a 2-hr postprandial period following a similar test meal. Total gastric emptying was similar in patients and controls, whereas proximal gastric retention (AUCprox/AUCtot) was significantly decreased in patients (mean +/- SD: 0.48 +/- 0.07 vs. 0.56 +/- 0.06; P = 0.02). Within the GERD-dyspepsia group, a significant negative correlation was found between proximal gastric retention and the number of acidic reflux episodes. We concluded that abnormally decreased retention of gastric contents in the proximal stomach after a liquid meal may contribute to the pathogenesis of acidic reflux episodes in patients with GERD and dyspepsia.

Analise de nossa experiencia com esclerose endoscopica de varizes esofagicas / Analysis of our experience with the endoscopic sclerosis of esophageal varices

Foram realizadas 273 sessoes de esclerose endoscopica de varizes esofagicas(EEVE) em 62 pacientes a partir de out/82 ate fev/87 no HGF-INAMPS e em alguns outros hospitais e clinicas privadas, utilizando-se sempre o oleato de monoetanolamina nas dosagens de 1,8 e 2,0% paravasais e, em alguns casos a 5% intravasais.A media de idade foi de 44,5 anos(minima: 8a e maxima 77a). Sexo: 47 masculinos e 15 femininos. As patologias encontradas foram: esquitossomose: 20; cirrose: 18; fibrose hepatica congenita, hepatite cronica ativa, metaplasia mieloide e trombose de via esplenica: um caso de cada e hepatopatias cronicas nao determinadas: 20 casos. Os resultados foram divididos em dois grupos: Grupo I vigencia do sangramento(20)-metodo eficaz em 80%(16 pacientes) com interrupçao do sangramento. Grupo II, eletivamente-desaparecimento ou diminuiçao significativa das varizes em 54%, mas houve controle dos episodios hemorragicos em 77,7%. Os efeitos colaterais mais encontrados formam: dor toracica, sangramento leve, disfagia e ulceras de esofago