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Gastroenterologie
a hepatologie

Gastroenterology and Hepatology

Gastroent Hepatol 2020; 74(4): 285–294. doi:10.14735/amgh2020285.

Elektrogastrografie u systémové sklerodermie – pilotní studie

Helena Medková1, Alice Jansová1, Tomáš Soukup1, Darina Kohoutová2, Marcela Janebová1, Veronika Knoblochová1, Eva Peterová2, Blanka Kupková1, Ilja Tachecí1, Jan Bureš1

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Souhrn

Úvod:
Systémová sklerodermie (SSc – systemic sclerosis) je autoimunitní onemocnění s chronickým progresivním průběhem. Patogeneze SSc je charakterizována zánětem, vaskulopat a fibrózou. Mezi nejčastěji postižené orgány patří gastrointestinální trakt, a to až u 90 % nemocných. Klinické projevy jsou spojeny s dysmotilitou všech částí gastrointestinálního traktu, vč. žaludku. Elektrogastrografie (EGG) je neinvazivní metoda pro vyšetření žaludeční myoeletrické aktivity.

Cíl:
Cílem této prospektivní studie bylo podrobně posoudit EGG u SSc, vč. analýzy jednominutových intervalů a plochy amplitud.

Metoda:
Do studie bylo zařazeno 33 pacientů splňujících klasifikační kritéria SSc podle ACR/EULAR (5 mužů, 28 žen; průměrný věk 60 let). Pacienti byli rozděleni na klinické podskupiny: difúzní kožní forma SSc (dSSc) (n = 17), limitovaná kožní forma (lSSc) (n = 13) a ostatní (n = 3). Žaludeční myoelektrická aktivita byla vyšetřována pomocí EGG (MMS, Enschede, Nizozemsko).

Výsledky:
Celkem bylo vyhodnoceno 855 jednominutových intervalů EGG, u každého z nich byla hodnocena dominantní frekvence a posouzena plocha amplitud. Pouze jeden pacient měl plně normální EGG záznam. U většiny pacientů se EGG vyznačovala bradygastr (17 pacientů) nebo žaludeční arytm s převahou bradygastrie (6 pacientů). Postprandlní plocha amplitud se výrazně snížila ve srovnání s hodnotami nalačno. Poměr ploch amplitud po jídle: před jídlem byl ve všech intervalech nízký.

Závěr:
Bradygastrie a postprandlní snížení plochy amplitud byly nejcharakterističtějšími nálezy. Tyto změny byly obzvlášť vyjádřené u skupiny dSSc.

Klíčová slova

elektrogastrografie, systémová sklerodermie, žaludeční myoelektrická aktivita, dominantní frekvence, elektrogastrografická síla

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Literatura

1. Soukup T, Veleta T. Systemic sclerosis in 2017. Vnitř Lék 2018; 64 (2): 146–154.

2. Oreska S, Tomcik M. Gastrointestinal involvement in systemic sclerosis: overview, neglected aspects, malnutrition, body composition and management. In: Tomcik M (Ed). New Insights into Systemic Sclerosis. London: IntechOpen London 2019: 63–86. doi: 10.5772/intechopen.78254.

3. Cyrany J, Soukup T, Branda P et al. Hydrogen and methane breath tests in patients with systemic sclerosis. Gut 2009; 58 (Suppl 2): A111.

4. Bures J, Cyrany J, Kohoutova D et al. Small interstinal bacterial overgrowth. World J Gastroenterol 2010; 16 (24): 2978–2990. doi: 10.3748/wjg.v16.i24.2978.

5. Stoichita S, Suteano S, Pirvu V et al. Digestive disorders in sclerosis. Čs. Gastroenterol 1973; 27 (6): 367–370.

6. Koch KL, Stern RM. Handbook of Electrogastrography. Oxford: University Press 2004.

7. Parkman HP, Hasler WL, Barnett JL et al. Electrogastrography: a document prepared by the gastric section of the American motility society clinical GI motility testing task force. Neurogastroenterol Motil 2003; 15 (2): 89–102. doi: 10.1046/j.1365-2982.2003.00396.x.

8. Bures J, Kopacova M, Vorisek V et al. Correlation of electrogastrography and gastric emptying rate estimated by 13C-octanoic acid breath test in healthy volunteers. Folia Gastroenterol Hepatol 2007; 5 (1): 5–11.

9. Yin J, Chen JD. Electrogastrography: methodology, validation and applications. J Neurogastroenterol Motil 2013; 19 (1): 5–17. doi: 10.5056/jnm.2013.19.1.5.

10. Bures J, Kvetina J, Pavlik M et al. Impact of paraoxon followed by acetylcholinesterase reactivator HI-6 on gastric myoelectric activity in experimental pigs. Neuro Endocrinol Lett 2013; 34 (Suppl 2): S79–S83.

11. Tacheci I, Kvetina J, Kunes M et al. The effect of general anaesthesia on gastric myoelectric activity in experimental pigs. BMC Gastroenterol 2013; 13: 48. doi: 10.1186/1471-230X-13-48.

12. Bures J, Tacheci I, Kvetina J et al. Experimental electrogastrography. Gastroent Hepatol 2014; 68 (3): 237–242.

13. Bures J, Jun D, Hrabinova M et al. Impact of tacrine and 7-methoxytacrine on gastric myoelectrical activity assessed using electrogastrography in experimental pigs. Neuro Endocrinol Lett 2015; 36 (Suppl 1): S150–S155.

14. Bures J, Kvetina J, Tacheci I et al. The effect of different doses of atropine on gastric myoelectrical activity in fasting experimental pigs. J Appl Biomed 2015; 13 (4): 273–277. doi: 10.1016/j.jab.2015.04.004.

15. Kvetina J, Tacheci I, Pavlik M et al. Use of electrogastrography in preclinical studies of cholinergic and anticholinergic agents in experimental pigs. Physiol Res 2015; 64 (Suppl 5): S647–S652. doi: 10.33549/physiolres.933227.

16. Bures J, Kvetina J, Radochova V et al. The pharmacokinetic parameters and the effect of a single and repeated doses of memantine on gastric myoelectric activity in experimental pigs. PLoS One 2020; 15 (1): e0227781. doi: 10.1371/journal.pone.0227781.

17. Dolina J, Hep A, Prasek J et al. Is electrogastrography going to be a new diagnostic method in gastroenterology? Čes Slov Gastroenterol 1997; 51 (5): 177–180.

18. Frasko R, Maruna P, Gürlich R et al. Percutaneous electrogastrography in the perioperative period in laparoscopic gastric banding at the First Surgical Clinic of the General Faculty Hospital in Prague. Rozhl Chir 2001; 80 (11): 596–601.

19. Frasko R, Maruna P, Gürlich R et al. Percutaneous electrogastrography in the perioperative period in laparoscopic and classical cholecystectomy and in laparoscopic nonadjustable gastric banding. Sb Lek 2002; 103 (2): 247–255.

20. Dolina J, Hep A, Kroupa R. Contribution of oesophageal manometry and electrogastrography in diagnosis of functional disorders. Gastroent Hepatol 2005; 59 (Suppl 1): S33–S34.

21. Bures J, Kabelac K, Kopacova M et al. Electrogastrography in patients with Roux-en-Yreconstruction after previous Billroth gastrectomy. Hepatogastroenterology 2008; 55 (85): 1492–1496.

22. Frasko R, Maruna P, Gürlich R et al. Transcutaneous electrogastrography in patients with ileus. Relations to interleukin-1beta, interleukin-6, procalcitonin, and C-reactive protein. Eur Surg Res 2008; 41 (2): 197–202. doi: 10.1159/000134918.

23. Maruna P, Frasko R, Lindner J. Disturbances of gastric electrical control activity after laparotomic cholecystectomy are related to interleukin-6 concentrations. Eur Surg Res 2009; 43 (4): 317–324. doi: 10.1159/000235569.

24. Gürlich R, Maruna P, Frasko R. Transcutaneous electrogastrography in the perioperative period in patients undergoing laparoscopic cholecystectomy and laparoscopic non-adjustable gastric banding. Obes Surg 2003; 13 (5): 714–720. doi: 10.1381/096089203322509273.

25. Pfaffenbach B, Adamek RJ, Hagemann D et al. Effect of progressive systemic sclerosis on antral myoelectrical activity and gastric emptying. Z Gastroenterol 1996; 34 (9): 517–521.

26. Marycz T, Muehldorfer SM, Gruschwitz MS et al. Gastric involvement in progressive systemic sclerosis: electrogastrographic and sonographic findings. Eur J Gastroenterol Hepatol 1999; 11 (10): 1151–1156. doi: 10.1097/00042737-199910000-00013.

27. Hocke M, Seidel T, Sprott H et al. Ambulatory electrogastrography in patients with sclerodermia, delayed gastric emptying, dyspepsia, and irritable bowel syndrome. Is there any clinical relevance? Eur J Intern Med 2001; 12 (4): 366–371. doi: 10.1016/s0953-6205 (01) 00138-8.

28. Marie I, Levesque H, Ducrotté P et al. Gastric involvement in systemic sclerosis: a prospective study. Am J Gastroenterol 2001; 96 (1): 77–83. doi: 10.1111/j.1572-0241.2001.03353.x.

29. McNearney T, Lin X, Shrestha J et al. Characterization of gastric myoelectrical rhythms in patients with systemic sclerosis using multichannel surface electrogastrography. Dig Dis Sci 2002; 47 (4): 690–698. doi: 10.1023/a: 1014759109982.

30. Franck-Larsson K, Hedenström H, Dahl R et al. Delayed gastric emptying in patients with diffuse versus limited systemic sclerosis, unrelated to gastrointestinal symptoms and myoelectric gastric activity. Scand J Rheumatol 2003; 32 (6): 348–355. doi: 10.1080/03009740410005016.

31. Wollaston DE, Xu X, Tokumaru O et al. Patients with systemic sclerosis have unique and persistent alterations in gastric myoelectrical activity with acupressure to Neiguan point PC6. J Rheumatol 2005; 32 (3): 494–501.

32. McNearney TA, Sallam HS, Hunnicutt SE et al. Gastric slow waves, gastrointestinal symptoms and peptides in systemic sclerosis patients. Neurogastroenterol Motil 2009; 21 (12): 1269-e120. doi: 10.1111/j.1365-2982.2009.01350.x.

33. McNearney TA, Sallam HS, Hunnicutt SE et al. Prolonged treatment with transcutaneous electrical nerve stimulation (TENS) modulates neuro-gastric motility and plasma levels of vasoactive intestinal peptide (VIP), motilin and interleukin-6 (IL-6) in systemic sclerosis. Clin Exp Rheumatol 2013; 31 (2 Suppl 76): S140–S150.

34. van den Hoogen F, Khanna D, Fransen J et al. 2013 classification criteria for systemic sclerosis: an American College of Rheumatology/European league against Rheumatism collaborative initiative. Arthritis Rheum 2013; 65 (11): 2737–2747. doi: 10.1002/art.38098.

35. LeRoy EC, Medsger TA Jr. Criteria for the classification of early systemic sclerosis. J Rheumatol 2001; 28 (7): 1573–1576.

36. Diamanti A, Bracci F, Gambarara M et al. Gastric electric activity assessed by electrogastrography and gastric emptying scintigraphy in adolescents with eating disorders. J Pediatr Gastroenterol Nutr 2003; 37 (1): 35–41. doi: 10.1097/00005176-200307000-00006.

37. Ogawa A, Mizuta I, Fukunaga T et al. Electrogastrography abnormality in eating disorders. Psychiatry Clin Neurosci 2004; 58 (3): 300–310. doi: 10.1111/j.1440-1819.2004.01236.x.

38. Howe S, Eaker EY, Sallustio JE et al. Antimyenteric neuronal antibodies in scleroderma. J Clin Invest 1994; 94 (2): 761–770. doi: 10.1172/JCI117395.

39. Berger M, Steen VD. Role of anti-receptor autoantibodies in pathophysiology of scleroderma. Autoimmun Rev 2017; 16 (10): 1029–1035. doi: 10.1016/j.autrev.2017.07.019.

40. Kumar S, Singh J, Rattan S et al. Review article: pathogenesis and clinical manifestations of gastrointestinal involvement in systemic sclerosis. Aliment Pharmacol Ther 2017; 45 (7): 883–898. doi: 10.1111/apt.13963.

41. Méquinion M, Langlet F, Zgheib S et al. Ghrelin: central and peripheral implications in anorexia nervosa. Front Endocrinol (Lausanne) 2013; 4: 15. doi: 10.3389/fendo.2013.00015.

42. Cuntz U, Enck P, Frühauf E et al. Cholecystokinin revisited: CCK and the hunger trap in anorexia nervosa. PLoS One 2013; 8 (1): e54457. doi: 10.1371/journal.pone.0054457.

43. Goldblatt F, Gordon TP, Waterman SA. Antibody-mediated gastrointestinal dysmotility in scleroderma. Gastroenterology 2002; 123 (4): 1144–1150. doi: 10.1053/gast.2002.36057.

44. Singh J, Mehendiratta V, Del Galdo F et al. Immunoglobulins from scleroderma patients inhibit the muscarinic receptor activation in internal anal sphincter smooth muscle cells. Am J Physiol Gastrointest Liver Physiol 2009; 297 (6): G1206–G1213. doi: 10.1152/ajpgi.00286.2009.

45. Singh J, Cohen S, Mehendiratta V et al. Effects of scleroderma antibodies and pooled human immunoglobulin on anal sphintcter and colonic smooth muscle function. Gastroenterology 2012; 143 (5): 1308–1318. doi: 10.1053/j.gastro.2012.07.109.

46. Kumar S, Singh J, Kedika R et al. Role of muscarinic-3 receptor antibody in systemis sclerosis: correlation with dissease duration and effect of IVIG. Am J Physiol Gastrointest Liver Physiol 2016; 310 (11): G1052–G1060. doi: 10.1152/ajpgi.00034.2016.

47. Syngle A, Verma I, Krishan P. Interleukin-6 blockade improves autonomic dysfunction in rheumatoid arthritis. Acta Reumatol Port 2015; 40 (1): 85–88.

48. Byrne KG, Quigley EM. Antroduodenal manometry: an evaluation of an emerging methodology 1997. Dig Dis 1997; 15 (Suppl 1): S53–S63. doi: 10.1159/000171621.

49. Bures J, Kopacova M, Vorisek V et al. Examination of gastric emptying rate by means of 13C-octanoic acid breath test. Methods of the test for adults and results of the investigation of healthy volunteers. Čas Lek Čes 2005; 144 (Suppl 3): S18–S22.

50. Kuo B, McCallum RW, Koch Kl et al. Comparison of gastric emptying of a nondigestible capsule to a radio-labelled meal in healthy and gastroparetic subjects. Aliment Pharmacol Ther 2008; 27 (2): 186–196. doi: 10.1111/j.1365-2036.2007.03564.x.

51. de Zwart IM, de Roos A. MRI for the evaluation of gastric physiology. Eur Radiol 2010; 20 (11): 2609–2616. doi: 10.1007/s00330-010-1850-3.

52. Dickman R, Zilpera T, Steinmetz A et al. Comparison of continuous breath test and gastric scintigraphy for the measurement of gastric emptying rate in healthy and dyspeptic individuals. Eur J Gastroenterol Hepatol 2013; 25 (3): 291–295. doi: 10.1097/MEG.0b013e32835c075d.

53. Bruno G, Lopetuso LR, Ianiro G et al. 13C-octanoic acid breath test to study gastric emptying time. Eur Rev Med Pharmacol Sci 2013; 17 (Suppl 2): S59–S64.

54. Mazzawi T, Bartsch E, Benammi S. Gastric emptying of low- and high-caloric liquid meals measured using ultrasonography in healthy volunteers. Ultrasound Int Open 2019; 5 (1): E27–E33. doi: 10.1055/a-0783-2170.

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