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Electrogastrogram

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Title: Electrogastrogram


1
Electrogastrogram
  • Jayson
  • Franky
  • Dana

2
Discovery
  • William Beaumont 1833
  • First to notice gastric psychological changes
    induced by various emotions.
  • Later noted emotion causes increased and
    decreased gastric acid formation
  • Also causes reflux of bile into stomach causing
    the slowing of gastric emptying

3
  • October 14, 1921
  • First recording of Electrogastrogram
  • Scientists begin to discover changes due to
    specific stimuli such as stress and anxiety
  • Use EEG to measure gastric emptying
  • Recent research has shown that improving quality
    of life will improve gastrointestinal disease.

4
What is EGG
  • Like EKG and heart
  • Measures muscle activity related to the stomach
    and abdominal region.
  • Measured from a baseline reading containing a
    regular rhythm. In a normal subject a current
    increase is observed after a meal.
  • Still an early experimental procedure because it
    has yet to become a standard medical procedure.

5
Gastrointestinal Problems
  • Nausea
  • Gastric Reflux
  • Peptic Ulcer
  • Irritable Bowel Syndrome
  • Cirrhosis

6
Nausea
  • Uneasy feeling feeling of vomiting
  • Commonly associated with stomach but including
    all parts of the body
  • Brought on by any and all physiological stimuli
  • May cause dehydration or esophageal erosion and
    irritation

7
Gastric Reflux
  • Very common
  • Reflux of stomach content into esophagus
  • Causes damage to lining if occurring often
  • Heartburn, burning pain
  • Treatable with weight reduction, avoiding food
    and activities that cause reflux, avoiding
    situations that cause reflux, and some medication.

8
Peptic Ulcers
  • Break in surface of organ
  • Excessive HCl formation, infection, some drugs
    (asprin, anti inflammatory)
  • Indigestion, nausea, vomiting, bleeding
  • Monitor pH levels in stomach
  • Use biofeedback to maintain appropriate HCl
    amounts

9
Irritable Bowel Syndrome
  • Most common psychophysiological disease
  • Caused by stress and anxiety and effects all
    parts of the digestive tract
  • Stress increases corticotropin-releasing factors
    from brain inhibiting gastric emptying

10
IBS (Cont)
  • Causes various symptoms abdominal pain, altered
    bowel habit, bloating, bowel noises, indigestion,
    nausea, headaches, etc.
  • Avoid problematic food, improve bowel function,
    antidepressant medication, relaxation therapy,
    psychological counseling

11
Cirrhosis
  • Extended liver damage
  • Not directly caused by emotional stimuli
  • Alcohol abuse, drug abuse (hepatitis), AIDs
  • Generally found amoung older individuals
  • Irreversible

12
References
  • Mai FM. 1988. Beaumonts Contribution to gastric
    psychophysiology a reappraisal. Can J
    Psychiatry. 33 650-653.
  • Muth ER, Koch KL, Stern RM, Thayer JF. 1999.
    Effect of autonomic nervious system
    manipulations on gastric myoelectrical activity
    and emotional responses in healthy human
    subjects. Psychosom Med. 61 297-303.
  • www.gastro.net.au/gastrodiseases/index.php3

13
Electrogastrography (EGG)
14
Electrogastrography
  • How it works.
  • Difficulties.
  • Precautions.
  • EGG setup.
  • Data acquisition and analysis.
  • Capabilities and limitations of EGG.
  • Applications.

15
How EGG Works
  • Very similar to EKG.
  • Recording of electrical signals produced by the
    muscles of the stomach that control constriction.
  • Two forms.

16
Difficulties
  • The main difficulty is the human EGG signal.
  • 3 cycles/min sinusoid.
  • Data obtained is difficult to analyze and
    abnormalities difficult to define.
  • Interference from the duodenum and from the
    transverse and descending colon.

17
Precautions
  • Optimal recording conditions.
  • Electrodes produce noise to an extent.
  • Noise must be reduced (0-0.5Hz).
  • Electrodes should be recessed.
  • Skin abrasion.
  • Ideally impedance below 10 Kila-ohmes.

18
EGG setup
  • EGG signal is recorded by electrodes that are
    placed over the upper abdomen.

19
EGG setup
  • EGG sample amplitude is typically in the 50-100
    micro-Volt range.
  • Must be filtered.
  • Removes artifacts.
  • Provides a low and high frequency cutoff (1cpm
    and 18cpm)

20
Data acquisition and analysis
  • Bradygastrias
  • O-2.4cpm
  • Tachygastrias
  • 3.6-9.9cpm
  • These Gastric Dysrhythmias have clinical
    relevance.

21
Capabilities and Limitations (Frequency)
  • Most reliable EGG parameter.
  • Stable frequencies obtained over a population.
  • Low standard deviation between measurements.
  • Slight increase in gastric frequency obtained
    after feeding (only in some people).

22
Capabilities and Limitations (Amplitude)
  • With decrease between electrode distance mean
    power of the major EGG component decays.
  • Bipolar channels yield stronger signals but are
    more sensitive to movement artifacts.
  • Results over a population were surprisingly
    varied after having eaten.
  • Poor correlation between amplitude of the EGG
    signal and the presence of gastric contractions.
  • In dogs data was recorded for contractions that
    had been blocked by atropine and glucagon.

23
Capabilities and Limitations (Time Shifts)
  • Shifts during periods of greatest stability of
    EGG channel pairs near non existent regardless of
    relative difference.
  • However simultaneous internal recordings from
    dogs and patients show well defined time shifts.

24
Capabilities and Limitations (Waveform)
  • Increased inter electrode distance in internal
    bipolar recordings results in a change of
    waveform. (biphasic to sinusoidal)
  • Occasional changes in waveform will be found in
    any participant including those deemed normal.

25
Capabilities and Limitations (Discussion)
  • Frequency is most reliable parameter for clinical
    applications.
  • Electrodes.
  • Artifact filtering.
  • Amplification techniques.
  • Recorded deviations will be related to gastric
    electrical abnormalities.

26
Applications
  • Motion Sickness
  • Gastric Emptying and Motility
  • Nausea and Vomiting
  • Gastric Dysrhythmias
  • EGG in Children

27
References
  • Chen, J. A. McCallum, R. W. (1994).
    Electrogastrography Principles and Applications.
    Raven Press., New York.

28
Current Research in Gastric Psychophysiology
29
  • A lot of research has been done to investigate
    the effects of the mind, mood, and voluntary
    behaviors on the digestive system
  • Gastric psychophysiology refers to the stomach or
    anything relating to it

30
Psychophysiology of Nausea
  • (A study conducted by R.M. Stern in 2002)
  • Investigation Topic nausea (uncomfortable
    sensation usually associated with the stomach and
    occasionally followed by vomiting)
  • Nausea (like emotional pain or motion sickness)
    is a private sensation, so little is known.
  • Hypothesis each individual has a personal
    threshold for nausea dependant on interaction of
    inherent factors and changeable physiological
    factors.

31
Results and Conclusions of Nausea Study
  • Results subjects observed showed an increase in
    sympathetic nerve activity, decrease in
    parasympathetic nerve activity, increase in
    abnormal dysrhythmic gastric activity, increase
    in plasma vasopressin
  • Conclusions beneficial selective reduction of
    nausea depends on a greater knowledge of its
    psychophysiological variables.

32
Psycho-Physiological Aspects of Gastroesophageal
Reflux Disease
  • (a review study by Kamolz, Bammer, Pasuit,
    Pointner in 2002)
  • Investigation Topic confirmed the strong
    relationship between psychophysiological aspects
    and gastrointestinal diseases
  • Additionally investigated interventions into
    these relationships and focused in on
    Gastroesophageal reflux disease (GERD).

33
GERD study
  • Gastroesophageal reflux disease (more commonly
    known as acid reflux) occurs when the liquid
    contents of the stomach are regurgitated into the
    esophagus, thus damaging the lining of the
    esophageal walls
  • Occurs in as many as 10 of Americans per day, 44
    expressing symptoms at least once a month
  • can be caused/contributed to by the lower
    esophageal sphincter, significant stressors,
    hiatal hernias, esophogeal contractions, and the
    emptying of the gastric chamber.

34
GERD
  • Other physiological factors that may contribute
    to GERD
  • Delayed clearance of physiological reflux by
    saliva
  • Decreased bicarbonate secretion by esophageal
    submucosal glands
  • Attenuated ability of cells lining esophagus to
    resist acid injury

35
GERD
  • Treatments
  • Prilosec (a proton pump inhibitor)
  • Antacids
  • Lifestyle changes
  • Elevate head of bed 6inches, decrease fat intake,
    smoking cessation, weight reduction, avoiding
    large meals
  • Endoscopy
  • Ambulatory pH monitoring (a pH monitor is placed
    on the esophageal sphincter)

36
Psychological and Sex Features of delayed gut
transit in functional gastrointestinal disorders
  • Study by Bennett, et al. in 2000.
  • Investigation Topic comparing psychosocial and
    demographic features of patients w/ functional
    gastrointestinal disorders and delayed transit in
    the gastrointestinal tract regions
  • 110 subjects, 46 w/ delayed transit in region 1,
    32 delayed transit for region II, and 17 had
    normal transit

37
Delayed Gut Transit Study
  • Gut transit was assessed using a scintigraphic
    technique, psychometric measures were used to
    judge psychological status
  • RESULTS delayed transit was increased in
    females, those with depressive mood states,
    increasing age, frequent control of anger, and
    severe gastric stasis, whereas Increased transit
    was found in males and hypochondriasis.
  • CONCLUSIONS a distinct psycho physiological
    subgroup defined by delayed gut transit is
    indicative of gastrointestinal disorders.

38
Effects of different psychophysiological
stressors on the cutaneous electrogastrogram in
healthy subjects.
  • A study by Riezzo, Porcelli, Guerra, and Giorgio
    in 1996
  • Investigation Topic following
    psychophysiological stress on gastric electrical
    activity
  • Apparatus used a non invasive, cutaneous
    electrogastrography (EGG)

39
Cutaneous EGG study
  • 3 stressful tests (a cold pressor test,
    arithmetic test, and Stroop color-word test
  • A non stressful tests (reading a booklet)
  • EGG parameters were measured dominant
    frequency, coefficient variation of dominant
    frequency, and gastric power) and were recorded
    during baseline, task, and rest periods.

40
Cutaneous EGG study
  • RESULTS
  • Non stressful task had no effects
  • During stress (especially arithmetic test)
    gastric power significantly increased. Stroop
    test showed nearly significant trend to increases
    in gastric power.
  • CONCLUSIONS increased individual susceptibility
    to psychological stress may influence the EGG
    responses and thus increase gastric electrical
    activity.

41
Antidepressants Attenuate Increased
Susceptibility to Colitis in Murine Model of
Depression
  • Varghese, et al. in 2005.
  • Based on the theory that psychiatric factors
    determine gastrointestinal health
  • Investigation Topic using a model of
    depression, attempted to find alterations in gut
    physiology and to assess association with
    increased sensitivity to experimental colitis in
    adulthood. (also investigated effects of
    antidepressants therapy)

42
Depression Study
  • Using mice some mouse pups were seperated from
    their mother, some werent.
  • At 8 weeks, pups were evaluated on behavior
    changes, intestinal permeability, and sensitivity
    to colitis.
  • RESULTS adult mice that had been seperated
    showed depressive behaviors and enhanced
    intestinal permeability with more severe colitis.
  • CONCLUSIONS maternal seperation can lead to
    depression/increased responsiveness to stress,
    impaired intestinal function, and vulnerability
    to gastric inflammation.

43
Peptic Ulcer Disease nothing but an infection?
  • M. Gross C. Herrmann in 1999.
  • Investigated duodenal and gastric ulcers and
    stressors
  • RESULTS
  • 73 of patients had gastric ulcers, 92 had
    duodenal ulcers. Relapse was 50 and 66,
    respectively after 1 year without eradication of
    the ulcer. After eradication, relapse rates
    reduced to 0 and 6, respectively, suggesting an
    infectious agent.

44
Peptic Ulcer
  • HOWEVER only a minority had the Helicobacter
    pylori infection!
  • CONCLUDED chronic physiological stress is an
    ulcerogenic co-factor, interaction between stress
    and infection can cause ulcers, acute
    psychological stressors show increased risk of
    gastric ulcer formation.

45
REFERENCES
  • Bennett, E., Evans, P., Scott, A., Badcock, C,
    Shuter, B., Hoscle, R., Tennant, C., Kellow, J.
    (2000). Psychological and sex features of delayed
    gut transit in functional gastrointestinal
    disorders. GUT. 46(1) 83-87.
  • Gross, M. Herrmann, C. (1999). Peptic Ulcer
    Disease- nothing but an infection? Zeitschrift
    Fur Psychosomatische Medizin Und Psychotherapie.
    45 (4) 390-400.
  • Kamolz, T, Bammer, T., Pasuit, M., Pointner, R.
    (2002). Psycho-physiological aspects of
    gastroesophageal reflux disease. Psychotherapie
    Psychosomatik Medizinische Psychologie 52 (3-4)
    159-165.
  • Riezzo, G., Porcelli, P., Guerra, V., Giorgio,
    I. (1996). Effects of different
    psychophysiological stressors on the cutaneous
    electrogastrogram in healthy subjects. Archives
    of Physiology and Biochemistry 104(3) 282-286.
  • Stern, R.M. (2002). The psychophysiology of
    Nausea. Acta Biologica Hungarica 53(4) 589-599.
  • Varghese, A., Verdu, E., Bercik, P., Khan, W.,
    Blennerhassett, P., Szectman, H., Collins, S.
    (2006) Gastroenterology 130(6) 1743-1753.
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