ORGANIZATION OF ANTRAL, PYLORIC AND DUODENAL MOTILITY IN PATIENTS WITH GASTROPARESIS

The motor mechanisms associated with delayed gastric emptying are poor ly understood, and the contribution of abnormal patterns of gastroduod enal motility to gastroparesis is unknown. Limited data suggest an inc reased frequency of localized pyloric contractions contributes to dela yed gastric emptying. Antropyloroduodenal pressures and gastric emptyi ng of TC-99m chicken liver/ground beef were recorded simultaneously fo r 60 min in 16 patients with gastroparesis and 26 healthy subjects, us ing a sleeve/sidehole manometric assembly and a scintigraphic techniqu e. Manometric recordings were analysed for localized pyloric contracti ons (isolated pyloric pressure waves), basal pyloric pressure (tone), antral and duodenal pressure waves and the number of associated antrop yloroduodenal contractions greater-than-or-equal-to 6 cm in length. Th ere was no significant difference in median pyloric tone (1.1 (interqu artile range 0.3-2.1) vs 0.5 (0-.1.8)mmHg), number of isolated pyloric pressure waves (15 (4.5-25) vs 25 (12-37)) or antral pressure waves ( 47 (16-62) vs 46 (17-76) between the patients with gastroparesis and t he healthy controls. The number of duodenal pressure waves was signifi cantly less in the gastroparetics (54 (41-80) vs 102 (63-116), P < 0.0 5) as was the number of antropyloroduodenal pressure waves greater-tha n-or-equal-to 6 cm (5 (0.5-6) vs 12.5 (4-24), P < 0.05). There was no difference in the lag time for solid gastric emptying, but there was a reduction in the amount emptied after 60 min (1 (0-11) vs 10 (0-14)%, P < 0.01). These results suggest that abnormal patterns of antropylor oduodenal contractions contribute to slow gastric emptying in patients with gastroparesis. Localized pyloric contractions are not a major pa thogenetic mechanism.