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Abnormal Initiation and Conduction of Slow-Wave Activity in Gastroparesis, Defined by High-Resolution Electrical Mapping
Open accessAbstract
Background & Aims Interstitial cells of Cajal (ICC) generate slow waves. Disrupted ICC networks and gastric dysrhythmias are each associated with gastroparesis. However, there are no data on the initiation and propagation of slow waves in gastroparesis, because research tools have lacked spatial resolution. We applied high-resolution electrical mapping to quantify and classify gastroparesis slow-wave abnormalities in spatiotemporal detail. Methods Serosal HR mapping was performed, using flexible arrays (256 electrodes; 36 cm2), at stimulator implantation in 12 patients with diabetic or idiopathic gastroparesis. Data were analyzed by isochronal mapping, velocity and amplitude field mapping, and propagation animation. ICC numbers were determined from gastric biopsies. Results Mean ICC counts were reduced in patients with gastroparesis (2.3 vs 5.4 bodies/field; P<.001). Slow-wave abnormalities were detected by HR mapping in 11/12 patients. Several new patterns were observed and classified as ‘abnormal initiation’ (10/12; stable ectopic pacemakers or diffuse focal events; median 3.3 c/min, range 2.1-5.7), or ‘abnormal conduction’ (7/10; reduced velocities or conduction blocks; median 2.9 c/min; range 2.1-3.6). Circumferential conduction emerged during aberrant initiation or incomplete block and was associated with velocity elevation (7.3 vs 2.9 mm s−1; P=.002) and increased amplitudes beyond a low base value (415 vs 170 μV; P=.002). Conclusions HR mapping revealed new categories of abnormal human slow-wave activity. Abnormalities of slow-wave initiation and conduction occur in gastroparesis, often at normal frequency, which could be missed by tests that lack spatial resolution. Irregular initiation, aberrant conduction, and low amplitude activity could contribute to the pathogenesis of gastroparesis.
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Cites
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Self-citationCellular Changes in Diabetic and Idiopathic Gastroparesis
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Self-citationWhat is measured in electrogastrography?
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Origin and propagation of human gastric slow-wave activity defined by high-resolution mapping
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ACG Clinical Guideline: Gastroparesis
Camilleri, M., Kuo, B., Nguyen, L., Vaughn, V. M., Petrey, J., Greer, K., Yadlapati, R., & Abell, T. L. (2022) · American Journal of Gastroenterology · doi:10.14309/ajg.0000000000001874 · Cited by 332
Self-citationGastric emptying and glycaemia in health and diabetes mellitus
Phillips, L. K., Deane, A. M., Jones, K. L., Rayner, C. K., & Horowitz, M. (2015) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2014.202 · Cited by 273
Advances in the diagnosis and classification of gastric and intestinal motility disorders
on behalf of the International Working Group for Disorders of Gastrointestinal Motility and Function, Keller, J., Bassotti, G., Clarke, J., Dinning, P., Fox, M., Grover, M., Hellström, P. M., Ke, M., Layer, P., et al. (2018) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/nrgastro.2018.7 · Cited by 265
Bharucha, A. E., Kudva, Y. C., & Prichard, D. O. (2019) · Endocrine Reviews · doi:10.1210/er.2018-00161 · Cited by 252
Angeli, T. R., Cheng, L. K., Du, P., Wang, T. H.-H., Bernard, C. E., Vannucchi, M.-G., Faussone-Pellegrini, M. S., Lahr, C., Vather, R., Windsor, J. A., et al. (2015) · Gastroenterology · doi:10.1053/j.gastro.2015.04.003 · Cited by 236
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Metadata
- Authors
- O'Grady, G., Angeli, T. R., Du, P., Lahr, C., Lammers, W. J. E. P., Windsor, J. A., Abell, T. L., Farrugia, G., Pullan, A. J., & Cheng, L. K.
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2012-09
- Volume
- 143
- Issue
- 3
- Pages
- 589-598.e3
- ISSN
- 0016-5085 (ISSN-L)
- OpenAlex
- W2070564499
- Cited by
- 323
- References
- 39
- FWCI
- 17.31
- Type
- journal article
- Language
- en
- Open access
- green
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