Alisha Kabadi, MD1, Todd P. Coleman, PhD2, Holly S. Greenwald, MD1, David C. Kunkel, MD2
1University of California San Diego, San Diego, CA; 2University of California San Diego, La Jolla, CA
Introduction: Rapid gastric emptying is the sine qua non of Dumping Syndrome (DS), which can arise from multiple etiologies including gastric surgery and diabetes mellitus. The relationship between DS and gastric myoelectric activity is unknown, but dysautonomia may play a role. We sought to characterize features of gastric slow waves and autonomic indices among subjects with DS using the ambulatory high-resolution electrogastrogram (HR-EGG).
Methods: Eleven subjects completed 24-hour ambulatory HR-EGG. Fasting abdominal computed tomography scan was utilized for stomach localization and placement of the ambulatory HR-EGG array, consisting of 10 skin mounted electrodes. Subjects were divided into two groups: DS (4F, age 53.2±9.3, BMI 31.7±11, 79-93% gastric emptying at 1 hour on scintigraphy, two diabetics, one prior gastric surgery, one gastrointestinal amyloidosis) and healthy age-matched controls (4M/3F, age 47.6±28, BMI 24.5±3.7). All subjects completed the PAGI-SYM foregut symptom questionnaire and a diary capturing all meals and sleep/wake times.
Results: Subjects with DS had significantly higher mean PAGI-SYM foregut symptom severity scores (1.9±1.0 vs 0.1±0.1; p=0.0007). HR-EGG showed that DS subjects had a significantly lower slow wave speed (4.6 vs 5.9±0.4; p=0.0003) and higher post-prandial power change (11 vs 3.5±3.6; p=0.002) compared to healthy controls. The global percent stomach activity throughout the 24-hour ambulatory recordings was not different between groups. DS subjects trended towards higher post-prandial area under the curve EGG activity at both the 1-hour (261.9±360.7 vs 172.9±137.5) and 4-hour marks (1108.8±1589.4 vs 656.3±442.2). In addition, subjects with DS had significantly lower heart rate variability than controls: RMSDD (39.9±9.7 vs 58.1±7.8) and SDNN (12.6±4.2 vs 23.7±3.2); no differences were noted in mean heart rate (Table 1).
Discussion: Ambulatory HR-EGG clearly identifies that there are spatial abnormalities of the gastric slow wave present among subjects with DS. Moreover, reduced heart rate variability - a marker of autonomic dysfunction - was observed among subjects with DS. These findings suggest that gastric dysrhythmias and autonomic disturbances should be given important consideration in the pathogenesis of Dumping Syndrome.
Citation: Alisha Kabadi, MD; Todd P. Coleman, PhD; Holly S. Greenwald, MD; David C. Kunkel, MD. P1252 - HIGH-RESOLUTION ELECTROGASTROGRAM IDENTIFIES DISTURBED GASTRIC SLOW WAVES AND DYSAUTONOMIA IN SUBJECTS WITH DUMPING SYNDROME. Program No. P1252. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.