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Gastric Neuromuscular Dysfunctions

Researchers have cited several changes in gastrointestinal function that result in regurgitation of duodenal content back into the stomach or esophagus and subsequent nausea and vomiting. This may occur even in the absence of food. It has been largely attributed to hormonal changes related to pregnancy.

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Offsite Research:

Gastrointestinal factors in nausea and vomiting of pregnancy.
Koch KL.
Division of Gastroenterology and Hepatology, The Milton S. Hershey Medical Center, The Pennsylvania State University, 17033-0850, USA. (e-mail: kkoch@psu.edu)
American Journal of Obstetrics and Gynecology. 2002 May;185(5 Suppl Understanding):S198-203

The objective of this review is to outline gastrointestinal factors that may be relevant to nausea and vomiting of pregnancy. Gastric neuromuscular dysfunctions of the stomach include abnormalities in gastric myoelectrical activity, gastric tone, and contractility, all of which may result in gastroparesis. These abnormalities in gastric neural activity and smooth muscle function are associated with nausea and vomiting in non-pregnant patients. Gastric dysrhythmias are disturbances of gastric pacesetter potential patterns that are present during the nausea of motion sickness, drug-induced nausea, in patients with diabetic gastropathy, and women with nausea of pregnancy. In pregnant women with abdominal pain, nausea, and vomiting, standard gastrointestinal diseases such as gastroesophageal reflux, peptic ulcers, and cholecystitis must be considered. A diagnostic approach and therapeutic options for treating nausea and vomiting of pregnancy based on understanding of gastric neuromuscular dysfunction is outlined.
 

Protein meals reduce nausea and gastric slow wave dysrhythmic activity in first trimester pregnancy.
Jednak MA, Shadigian EM, Kim MS, Woods ML, Hooper FG, Owyang C, Hasler WL.
Department of Internal Medicine, Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, Michigan 48109, USA.
American Journal of Physiology. 1999 Oct;277(4 Pt 1):G855-61

First trimester nausea is associated with gastric slow wave dysrhythmias (tachygastria, bradygastria). Symptomatic women reported mild to moderate nausea and exhibited increased dysrhythmias during fasting (P < 0.05). Protein-predominant meals reduced nausea and dysrhythmic activity to greater degrees than equicaloric carbohydrate and fat meals and noncaloric meals (P < 0.05). Meal consistency did not affect symptom responses, although liquid meals decreased dysrhythmias more than solids (P < 0.05). Carbohydrates and fats increased electrogastrographic power to similar degrees as proteins, whereas responses to noncaloric meals were less. In conclusion, protein meals selectively reduce nausea and gastric slow wave dysrhythmias in first trimester pregnancy. Meal consistency is a limited factor in the favorable effects of protein. Electrogastrographic power changes do not explain the symptom response to protein. Thus dietary modulation of gastric myoelectric rhythm with protein supplementation may provide symptomatic benefit in nausea of pregnancy.
 

Progesterone and estrogen are potential mediators of gastric slow-wave dysrhythmias in nausea of pregnancy.
Walsh JW, Hasler WL, Nugent CE, Owyang C.
Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0362, USA.
American Journal of Physiology. 1996 Mar;270(3 Pt 1):G506-14

Women in pregnancy experience nausea, which correlates with gastric slow-wave rhythm disruption. Mediators of these dysrhythmias were explored. Estradiol did not evoke dysrhythmias in nonpregnant women; however, progesterone induced increases in recording time in bradygastria plus tachygastria and increases in bradygastric signal power with corresponding decreases in signal power in the 3-cpm range (P<0.05). With estradiol and progesterone coadministration, an additive effect was observed at 3.3 +/- 0.8 h, with increased recording time in bradygastria alone and in bradygastria plus tachygastria with corresponding increases in bradygastric signal power and decreases in power in the 3-cpm range (P<0.05). In conclusion, women with nausea of pregnancy exhibit slow-wave rhythm disruption. Similar dysrhythmias are evoked in nonpregnant women by progesterone alone or in combination with estradiol in doses that reproduce levels in pregnancy. Thus gastric dysrhythmias in pregnancy may be due to a combination of elevated progesterone and estrogen levels.
 

Perspective as to pathogenesis and management of hyperemesis in pregnancy
Mogadam M.
Am J Gastroenterol 1992 Jun;87(6):806-8

Gastric myoelectrical activity in the first trimester of pregnancy: a cutaneous electrogastrographic study.
Riezzo G, Pezzolla F, Darconza G, Giorgio I.
Laboratorio di Fisiopatologia Sperimentale, Istituto Scientifico Gastroenterologico De Bellis, Castellana Grotte (BA), Italy.
Am J Gastroenterol 1992 Jun;87(6):702-7

Recently, it has been shown that changes in gastric electrical rhythm can be connected with clinical syndromes characterized by nausea and vomiting, among these the nausea of pregnancy. We studied gastric electrical activity during the first trimester of pregnancy in nine women with nausea and vomiting (study group) by means of cutaneous electrogastrography. Recordings were made before and after a standardized meal in the 6th-8th wk of gestation, and 2 months after voluntary interruption of pregnancy (VIP). The control group consisted of eight pregnant women without a history of nausea and vomiting. In the women in the study group there was more unstable cutaneous electrogastrographic (EGGc) activity and a reduced increase in postprandial power during pregnancy than after VIP, when a normal pattern with regular 3-cpm EGGc waves was reestablished. The coefficient of variation of gastric frequency during pregnancy was significantly higher than after VIP (p less than 0.01), whereas the postprandial to preprandial power ratio was lower (p less than 0.01). During the recording sessions, none of the subjects had clear episodes of tachygastria or bradygastria, and none of them had nausea, vomiting, or epigastric discomfort. Comparison of the EGGc data for the pregnant women in the study and control groups revealed a similar pattern of gastric electrical activity in the two, the only exception being the power ratio, which was lower in the study group (p less than 0.01). We conclude that pregnant women without symptoms of nausea and vomiting at the time of EGG recordings have normal 3-cpm myoelectrical activity, and that EGGc activity is more unstable and less responsive to the ingestion of food during pregnancy than after VIP. Furthermore, in pregnant women with a history of nausea and vomiting, EGGc activity is less responsive to the ingestion of food than it is in symptom-free pregnant women.
 

Hyperemesis gravidarum: a case report suggesting new concepts and research needs
Devitt NF.
Department of Family, University of New Mexico School of Medicine.
Fam Pract Res J 1991 Sep;11(3):279-82

Hyperemesis gravidarum has been considered an emotional disorder. Recent studies suggest that reflux esophagitis in combination with gastric dysrhythmias causes hyperemesis. A 10-week-pregnant 28-year-old woman treated successfully with antiemetics was shown to have fluctuations in gastric pH consistent with gastric dysrhythmia and reflux. Although drugs with antiemetic activity give symptomatic improvement, further research is needed to discover safe medications to treat the underlying gastric dysrhythmia.
 

Gastric dysrhythmias and nausea of pregnancy
Koch KL, Stern RM, Vasey M, Botti JJ, Creasy GW, Dwyer A.
Department of Medicine, Pennsylvania State University, Hershey 17033.
Dig Dis Sci 1990 Aug;35(8):961-8

Gastric dysrhythmias have been recorded from patients with a variety of nausea syndromes. The aim of this study was to measure gastric myoelectric activity in women with and without nausea during the first trimester of pregnancy. In 32 pregnant women gastric myoeletric activity was recorded for 30-45 min with cutaneous electrodes that yielded electrogastrograms (EGGs). Frequencies of the EGG waves were analyzed visually and by computer. Subjects rated their nausea at the time of EGG recording on a visual analog scale with 0 representing no nausea and 300 mm severe nausea. Gastric dysrhythmias were found in 26 pregnant subject: Seventeen had tachygastrias (EGG frequencies of 4-9 cpm), five had 1- to 2-cpm EGG waves, and four had flat-line patterns Mean nausea scores of the subjects with tachygastrias, 1- to 2-cpm, and flat-line patterns were 64.8 +/- 13, 93.4 +/- 23, and 77.2 +/- 36, respectively. Six pregnant subjects had normal 3-cpm EGG patterns, and their nausea scores averaged 2.8 +/- 1.1 (P less than 0.05 compared with nausea scores in subjects with tachygastrias, 1- to 2-cpm, and flat-line rhythms). Six subjects with gastric dysrhythmias during pregnancy were restudied after delivery; each of these subjects had normal 3-cpm EGG patterns and none had nausea. Thus, gastric dysrhythmias are objective pathophysiologic events associated with symptoms of nausea reported during the first trimester of pregnancy.
 

Gastric dysrhythmias: pathophysiologic and etiologic factors.
Dubois A.
Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Mayo Clin Proc 1989 Feb;64(2):246-50

Updated on: Apr. 18, 2013

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