Chemical colostomy irrigation with glyceryl trinitrate solution

Al192 AGA ABSTRACTS GASTROENTEROLOGY Vol. 118, No.4

a.c. =before soup p.c. =after soup. 'p= 0.002, **p=0.008, tp=0.02, ttp=0.007 between FM andC. The other measurements had ap-value > 0.05

difference in SA or emptying fraction. The retention of food may partlyexplain the increased dyspeptic symptoms seen in women with FM.

a.c. p,c,1min 10min 20min

FM,AA 5.0' 15.9 12.7 10.3**C,AA 35 14.6 11.0 7.9FM,SA 267 234 19.5C,SA 268 230 180FM,FD 91 76t szrrC,FD 85 6.8 5.3FM, EF 0 0.25 0.48C,EF 0 031 0.56

5478

FAILURE TO RESPOND TO IV METOCLOPRAMIDE AT GAS­TRIC EMPTYING SCAN DOES NOT PREDICT FAILURE OFCLINICAL RESPONSE TO ORAL PROKINETICS.Remi R. Owo, Lawrence K. Gates, Univ of Kentucky, Lexington, KY.

Background Many centers routinely administer IV metoclopramide at thetime of radionuclide gastric emptying scanning (GES) to enhance theutility of the test. The assumption is that patients responding to IV meto­clopramide are more likely to respond to oral prokinetics. Aim To deter­mine if a positive response to IV metoclopramide at GES predicts apositive response to treatment with oral prokinetics. Methods Records ofall patients undergoing GES from 9-97 to 9/98 were reviewed for age, sex,etiology of gastroparesis, and results of the GES, including t 1/2 of gastricemptying before and after IV metoclopramide. Follow-up telephone inter­views were conducted with patients to determine their current symptomstatus, medications, and weight. Results A total of 16 patients wereavailable for interview. Results are shown in the following table. Conclu­sions Failure to respond to IV metoclopramide does not predict failure torespond clinically to treatment with oral prokinetics. In this regard, IVreglan does not appear to improve the utility of GES. However, 2 respond­ers had spontaneous resolution of symptoms. A larger prospective serieswill be useful to determine if response to metoclopramide predicts spon­taneous recovery.We are currently performing a prospective study toexamine metoclopramide GES as a predictor of spontaneous recovery andresponse to prokinetics.

NSNS

NSNSNS

PvalueResp. Non.Resp.

Age (yrs) 407± 5.6 45.9 ± 3.0M:F 4:5 1:6EtiologyDiabetes 2 2Surgery 1 0Idiopathic 5 5Notknown 1 0Spontaeous Recovery 2 0ImprOVed onMedication 6 7

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MODULATION OF CANINE GASTRIC EMPTYING BY ALOS­ETRON, A 5-HT3RECEPTOR ANTAGONIST.Theodore N. Pappas, Allen W. Mangel, Curtis Lawson, Duke Univ MedCtr, Durham, NC; Glaxo Wellcome, RTP, NC.

Objective: Alosetron, a potent and selective 5-HT3receptor antagonist, hasrecently been shown to improve symptoms in patients with irritable bowelsyndrome (lBS). The effects of alosetron were found to be preferential infemale, as compared to male, patients. In a dog model, alosetron attenuatesblood pressure changes following colorectal distension (Digestive Diseasesand Science 44:20-24, 1999). Reflex blood pressure changes with colorec­tal distension represents a validated model of visceral pain. As functionalbowel diseases are characterized by changes in motility as well as visceralsensitivity, we evaluated whether alosetron may have an effect of gastricemptying in dogs and specifically, whether gender specific differenceswere apparent. Methods: Twelve dogs (6 males, 6 females) with Thomascannulas were fasted overnight after receiving placebo or alosetron (1mgtkg) PO bid for 5 days. Animals were fed a standard meal containing 1 mCSulfur ColloidlTc99. The rate of gastric emptying was calculated bymeasuring the amount of radio-labeled meal remaining in the stomach at 15minute intervals up to 2 hours using a Picker Dyna 4 GastroscintigrapyCamera. Results: We evaluated gastric emptying over a 2 hour observationperiod. The half-time(TI/2)of emptying was approximately 85 minutes and60 minutes in male and female dogs, respectively. Following administra­tion of alosetron (Img/kg) the TI/2of emptying increased to 95 minutes and> 120 minutes in female and male dogs, respectively. Conclusion: Underbasal conditions, female dogs showed faster rates of gastric emptying thanmale animals. Alosetron increased the T 1/2 of emptying in both male andfemale animals with a more pronouced effect in males. These results areconsistent with modulatory activity of both sensory and motor processes inthe dog gastrointestinal tract by alosetron.

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ELECTROGASTROGRAPHY IN PATIENTS WITH CIRRHOSIS.Shuta Nishinakagawa, Taro Ishii, Hideaki Makino, Hideyo Tanaka, MasakiSanaka, Yasushi Kuyama, Hajime Takikawa, Teikyo Univ, Tokyo, Japan.

Aims:Although patients with liver cirrhosis(LC) often have upper abdom­inal discomfort suggestive of gastric dysmotility, knowledge is limitedregarding gastrointestinal motor function in LC. Ascites may playa role ininducing gastric dysmotility in LC. The aim of this study was to evaluatea possible effect of ascites on gastric motility using electrogastrog­raphy(EGG). Method:We studied 24 LC patients with massive ascites (14males, mean age of 65 years), 22 LC patients without ascites (11males,mean age of 59 years), and 16 healthy controls (10 meals, mean age of 51years). No peptic ulcers and malignancies were endoscopically recognizedin the patients and controls. Diabetic patients was excluded from this study.Following an overnight fast, EGG (time constant 3 s, low cut-off 1.2 cpm,high cut-off 12 cpm) was performed, including an Ih fasting study and anIh postprandial study, in sitting position. The 12 patients with ascitesunderwent further EGG after eliminating ascites. The EGG analysis wasbased on the fast Fourier transform technique. Results: The most dominantfrequency was 2.4-3.6 cpm, which was regarded as normal electricalactivity, in both patients and controls. Patients with ascites had a signifi­cantly lower percentage of the normal waves in both fasting and fed statesthan ascites-free patients and controls (in fasting state:48.2% vs 64.9% vs74.2%, respectively; in fed state: 64.7% vs 69.7% vs 84.6%, respectively). The percentage of the normal waves was increased after removing ascitesthan before its removal (in fasting state: 49.6% vs 70.3%; in fed state:61.2% vs 73.0%). Conclusions: Gastric motility is impaired in LC patientswith ascites. The gastric dysmotility may be ameliorated by removingascites.

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ANTRAL AREA AND PROXIMAL STOMACH SIZE IN FIBRO­MYALGIA AND CONTROLS MEASURED BY ULTRASONOGRA­PHY.Snorri Olafsson, Odd H. Gilja, Trygve Hausken, Arnold Berstad, Hauke­land Univ Hosp, Bergen, Norway.

Purpose: Patients with functional dyspepsia have a larger antrum and asmaller proximal stomach than controls when measured with ultrasoundfollowing soup ingestion. We wanted to see if the same applies to fibro­myalgia (FM). Methods: Thirty-one women with fibromyaliga (age 43.6)were compared with 47 control women (age 46.5) selected from a randompopulation sample (C). There was no difference in weight, height or BM!.Six of the FM and four of the C had esophagitis but none had a peptic ulcer.They were scanned fasting in a sitting position after drinking 500 ml ofmeat soup. The antral area (AA) was measured before soup ingestion andI, 10 and 20 min afterwards. The proximal stomach was measured with asagittal area (SA) and the maximal diameter in a oblique frontal section(FD). The emptying fraction was estimated with the formula (aVlmin­aVac,ual)/aVlmin where aV is SA*FD. Results: The FM women had 3.7times more dyspeptic symptoms than the C before ingestion and 1.9 timesmore afterwards. The ultrasound measurements are shown in the table.Conclusions: Women with FM had a larger AA a.c. and 20 min p.c. thanC. The FM patients had a larger FD at 10 and 20 min. There was no

5476

CHEMICAL COLOSTOMY IRRIGATION WITH GLYCERYLTRINITRATE SOLUTION.Austin O'Bichere, Paul Sibbons, Clare Bossom, Colin Green, Robin KsPhillips, St Mark's Hosp, Harrow, United Kingdom; St Mark's / NPIMR,Harrow, United Kingdom.

Introduction: Colostomy irrigation improves patient quality of life, but istime consuming. We examine whether GTN solution, through induction ofGIT smooth muscle relaxation, might accelerate stool expulsion by passiveemptying and shorten irrigation time. Method: 15 colostomy irrigators(>2yrs experience) performed washout with tap water, compared to watercontaining 0.025mg/kg GTN. Fluid inflow time (FIT), total washout time(TWT), and haemodynamic changes occurring during GTN irrigation weredocumented by an independent observer. Subjects recorded episodes offaecal leakage & overall satisfaction on a visual analogue scale. Cramps,headaches, whether or not stoma bag was used, were expressed as apercentage of number of irrigations. Comparison of FIT, TWT, leakage andsatisfaction was by Wilcoxon and headaches/cramps/stoma bags by Me­Nemar s test. Pulse rate (paired t-test) , systolic & diastolic BP (Wilcoxon)at 20 and 240 minutes after washout with GTN solution, were comparedwith baseline. Results: 15 patients (9 female), mean age of 53 (31-73)years, provided 30 sessions (15 water, 15 GTN). Medians (interquartileranges) for water vs GTN were: FIT [7 (4-10) vs 4 (3-5), p=O.OOI];TWT[40 (30-55) vs 21 (15-24), p<O.OOIJ,leakage [0 (0-1) vs 0 (0-0), p=0.02J,satisfaction [10 (8-10) vs 10 (9-10), p=0.31]. The number (%) of stomabags, cramps and headaches for water vs GTN were: 7(47%) vs 7(47%),p=1.0; 1(7%) vs 14(93%), p<O.OOI and 0(0%) vs 14(93%), p<O.oo1.Changes in pulse, systolic & diastolic BP, were maximal at 20 minutes(p<O.ool, p=O.ool and p=0.002) and had returned to baseline by 240minutes (p=0.52, p=0.08 and p= 1.0) respectively. Conclusion: GTNsolution significantly reduces colostomy irrigation time compared to thegenerally recommended tap water. Patients suffer fewer leakages, arehighly satisfied, but side-effects are potential drawbacks.