Gastric myoelectrical activity and its relationship to the development of nausea and vomiting after intensive chemotherapy and autologous stem cell transplantation

OBJECTIVES: Gastric motor dysfunction may be responsible, in some patients, for the nausea and emesis that occur after high-dose chemotherapy (HDT) an d autologous stem cell transplantation (SCT). Because gastric myoelectrical abnormalities may result in nausea and vomiting in other contexts, we soug ht to define the prevalence of these abnormalities and their relationship t o the development of nausea and vomiting in patients undergoing autologous HDT and SCT, and to determine whether electrogastrography (EGG) could serve to detect gastric motor dysfunction in this population. METHODS: We prospectively studied patients with a variety of malignancies w ho received standard transplantation doses of chemotherapeutic agents and a ntiemetics. Gastric emptying scintigraphy was performed before HDT. Gastric myoelectrical activity was assessed before HDT and on days 0, 7, 14, 21, a nd 28 from SCT using cutaneous EGG electrodes and a portable EGG recorder, and was analyzed by means of a dedicated software program after removal of motion artifact. Symptom assessment was obtained daily from initiation of H DT to 28 days after SCT. RESULTS: A total of 25 patients were studied: 13 women and 12 men, with a m edian age of 50 yr (range = 32-65 yr). Before HDT, gastric emptying scintig raphy was normal in all patients (median T-1/2 of 50 min [range = 22-75 min ]) and only one patient had mild nausea and anorexia. Nausea, emesis, and a norexia occurred in all patients, peaked in severity at day +7 from SCT and , with the exception of anorexia, had returned toward baseline levels by da y +28. Fasting dysrhythmias were present in 63% of the studies at baseline. Serial EGG recordings revealed significant slowing of the dominant frequen cy with a consequent decrease in tachygastria and increase in normogastria and bradygastria as the symptoms peaked in severity with a subsequent retur n to baseline values at the study's end. The only clinical variable that wa s predictive of symptom severity was gender. Women had a higher risk of dev eloping anorexia (score greater than or equal to2) at day +14 compared to m en (odds ratio = 11.2; 95% CI = 1.7-76.9; p = 0.01). CONCLUSIONS: Baseline abnormalities in gastric myoelectrical activity occur frequently in patients who undergo HDT and autologous SCT despite normal g astric emptying scintigraphy and an absence of symptoms. Although slowing o f the dominant frequency was seen as symptoms worsened, we failed to identi fy any EGG parameter at baseline that could predict the severity of nausea, vomiting or anorexia after transplantation. (Am J Gastroenterol 2001;96: 2 873-2881. (C) 2001 by Am. Coll. of Gastroenterology).