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The Study of Gastric Emptying, Proximal Gastric Function, Gastric Myoelectrical Activity, Gastrointestinal Hormones and Electroacupuncture in Simple Obesity

Author: GaoLiMing
Tutor: YaoShuKun
School: Hebei Medical University
Course: Internal Medicine
Keywords: Simple obesity Gastric emptying EGG Stomach capacity Intragastric pressure Gastric compliance Motilin Leptin Auxin Glucagon peptide-1
CLC: R573
Type: PhD thesis
Year: 2008
Downloads: 290
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Abstract

The purpose of the first part of the simple obesity gastric emptying: by detecting simple obesity, normal weight subjects and patients with functional dyspepsia radionuclide gastric emptying, explore the relationship between the pathogenesis of gastric emptying and obesity. Methods: 30 simple obese patients with binge eating behavior of obese group, 15 men and women, average age 25.43 ± 6.74 years, body mass index (MBI) 32.96 ± 2.12kg/m2. 30 normal-weight healthy volunteers as a control group , each of 15 men and women, average age 27.23 ± 5.99 years, MBI 21.51 ± 1.40 kg/m2 32 functional dyspepsia (FD) patients with FD control group, 14 men, 18 women, average age 35.47 ± 7.21 years , MBI 23.09 ± 1.68 kg/m2. All subjects no digestive organ surgery, liver disease and gastrointestinal organic disease except via endoscopy, B-ultrasound and biochemical tests. The fasting subjects checking to radionuclide scintigraphy gastric emptying detection 12h, in the morning. Results: The obese group was 60 minutes, 90 minutes, 120 minutes gastric emptying rate (GEt%) were higher than the normal control group (44.27 ± 4.82 vs 39.60 ± 3.30, 72.90 ± 5.26 vs 56.83 ± 6.69, 91.20 ± 4.29 vs 76.00 ± 5.41 , P lt; 0.01), 2 hours the stomach retention rate and half gastric emptying time (T1 / 2) lower than the normal control group (8.8 ± 4.92 vs 24.00 ± 5.41, 70.43 ± 7.74 vs 83.10 ± 6.88, P lt; 0.01); among the three groups of gastric emptying rate, half-emptying time and two hours of gastric retention in pairwise comparisons the differences were statistically significant (P lt; 0.01). FD group gastric emptying was significantly delayed compared with the normal control group (P lt; 0.01). Conclusion: simple obesity with the gluttony actors radionuclide gastric emptying was significantly faster than the normal weight healthy, significantly delayed in patients with FD gastric emptying and normal weight healthy. Rapid gastric emptying may weaken the the stomach food satiety negative feedback, accelerate the uptake of nutrients in the the gastrointestinal transmission and intestinal absorption, promote hunger Iddo food gluttony energy surplus. Gastric emptying acceleration may cause stomach dynamic basis of appetite, hyperactivity and obesity. The second part of the simple obesity proximal gastric function and purpose of the electro-acupuncture stimulation: water load test and mechanical gastric dilatation, normal-weight and simple obesity associated with binge eating behavior detection to investigate the capacity of the stomach, gastric accommodation , intragastric pressure, the relationship between visceral perception thresholds proximal stomach function changes in the pathogenesis of obesity, and observe the electro-acupuncture on simple obesity with overeating actors proximal stomach function, provide a theoretical basis for scientific weight loss and reliable method. Methods: 40 patients with simple obesity associated with binge eating behavior as a test group, average age of 24.30 ± 4.99 years, BMI 32.07 ± 2.44kg/m2, 20 males and 20 females. Healthy volunteers, 35 patients of normal weight control group, with an average age of 22.26 ± 1.95 years, BMI the 21.00 ± 1.36kg/m2, 19 were male, female 16 cases. 30 cases of simple obesity with overeating actors as the control group, the average age of 24.50 ± 5.20 years, BMI 32.77 ± 2.01kg/m2, male 15 cases, female 15 cases. All subjects were gastrointestinal disease and a history of liver disease, no history of gastrointestinal surgery. The eating behavior of the test group and the control group as overeating, eating more or stop eating. The first day of the trial, the subjects fasted for 8h, receptivity to change the water load test observation stomach. Test the next day, subjects fasted for 12h, application barostat mechanical capacity of the stomach the expansion detection proximal stomach function. The end of the normal control group test. Test group acupuncture both Zusanli, Yin Ling Quan and Tianshu Point Yinlingquan, and Zusanli then electro-acupuncture stimulation Tianshu Point is not connected to the electro-acupuncture stimulation on time of 30min. The electric needle string Pulse stimulus stimulate 2s, stop 3s (12cpm), the serial pulse frequency 40Hz, pulse width 500μs, the output current is 1mA. Acupuncture control group deflated balloon catheter for 30 min reserved the fundic airbags inflate again, the two sets of duplicate proximal stomach function index detector. Results: 1. Drinking water load test: the water intake of the experimental group (1325.75 ± 196.79ml) is greater than the normal control group (1158.23 ± 195.61ml), the difference was statistically significant (P lt; 0.01); water intake of the experimental group and the control group ( 1359.67 ± 222.41ml) the difference was not statistically significant (P gt; 0.05); water intake of the control group was significantly greater than the normal control group (P lt; 0.01). Stomach volume comparison: the test group and the control group, the initial stomach volume and maximum tolerated stomach volume than the normal control group were significantly increased (P lt; 0.01); stomach volume of the test set of initial and maximum tolerated stomach volume control group, the difference was not statistically significant (P gt; 0.05). Intragastric pressure comparison: between the three groups of minimum expansion pressure, the initial gastric pressure and maximum tolerated intragastric pressure than the respective twenty-two showed no statistical significance (P gt; 0.05). 4. Stomach comparison of compliance: the smallest compliance of the test group and the control group compared with normal control group showed no significant difference (P gt; 0.05), initial compliance, the maximum tolerated compliance than the normal control group. increase (P lt; 0.01); minimum compliance test group, the initial compliance, the maximum tolerated compliance compared with control group showed no statistical significance (P gt; 0.05). EA stimulation of the stomach volume: the electroacupuncture stimulation test group after the initial stomach volume and maximum tolerated stomach volume than before acupuncture were significantly smaller (P lt; 0.01); control group, put the gas after the initial stomach volume and maximum tolerated stomach volume deflated than the difference was not statistically significant (P gt; 0.05). Electroacupuncture stimulation on intragastric pressure: electroacupuncture stimulation test group after minimal distending pressure before acupuncture than differences statistically significant (P gt; 0.05), while the initial intragastric pressure, maximum tolerated stomach increased internal pressure than acupuncture (P lt; 0.01). Minimum expansion pressure in the control group deflated initial intragastric pressure, maximum tolerated intragastric pressure discharge the gas ratio showed no statistical significance (P gt ago; 0.05). Electroacupuncture stimulation of minimum compliance with acupuncture before EA stimulation of gastric compliance: the experimental group differences without statistical significance (P gt; 0.05), while the initial compliance and maximum tolerated compliance than The pre-needled were significantly smaller (P LT; 0.01). The control group than the difference was not statistically significant (P gt; 0.05) before the minimum compliance initial compliance, the maximum tolerated compliance and deflated deflated. Conclusion: the obese overeating actors stomach the receptivity, compliance, stomach sensitivity is different from healthy normal weight, food intake exception occurs. Stomach volume increased compliance bigger receptivity enhanced satiety delay occurred obese patients with binge eating behavior. Electroacupuncture stimulation may reduce gastric accommodation to reduce food intake, while increasing the intragastric pressure can reduce the the satiety signal threshold in order to effectively reduce hunger, without hunger pain weight loss goal. The purpose of the third part simple obesity gastric electrical activity and electro-acupuncture stimulation: mechanical dilatation of the stomach at the same time, the obese binge eating behavior and normal weight healthy volunteers EGG detection. Explore simple obesity with gastric myoelectric activity features and pathogenesis of gluttony actors and electro-acupuncture stimulation of the obese gluttony actors gastric electrical. Methods: The subjects with the second part. Record of mechanical expansion before resting EGG, and then synchronized with proximal stomach function tests. In resting initial intragastric pressure of the maximum tolerated intragastric pressure tracings EGG 15min. The end of the normal control group test. 30min electroacupuncture stimulation test group received electroacupuncture stimulation control group was not deflated balloon catheter 30min reserved two groups before mechanical gastric dilatation in resting initial intragastric pressure, maximum tolerated intragastric pressure the tracings of electrogastrogram 15min. Results: 1. Mechanical gastric dilatation gastric electrical activity 1.1 resting state three groups of gastric electrical parameters of comparison: the frequency of the test group, the main power, stomach move too slow percentage tachygastria percentage Department of frequency instability number five parameters with normal control group and the control group pairwise comparisons among the three groups showed no significant difference (P gt; 0.05). Normal slow wave percentage of the test group and the control group were significantly lower than the control group (P lt; 0.01), while the main power instability coefficient is significantly higher than the normal control group (P lt; 0.05). Gastric electrical parameters of the test group and the control group showed no significant difference (P gt; 0.05). 1.2 Initial comparison of the the intragastric pressure state three groups of gastric electrical parameters: the experimental group clocked, stomach moving too slow percentage tachygastria percentage frequency the unstable coefficients of four parameters and the normal control group and the control group of three groups pairwise comparison between the difference was not statistically significant (P gt; 0.05). The main power of the test group and the control group were significantly higher than the normal control group (P lt; 0.01). Normal slow wave percentage of the test group and the control group were significantly lower than the normal control group (P lt; 0.05). Power instability coefficient of the test group and the control group, the main are significantly higher than the control group (P lt; 0.05). Gastric electrical parameters of the test group and the control group showed no significant difference (P gt; 0.05). 1.3 the maximum tolerated intragastric pressure state comparison of the three groups of gastric electrical parameters: frequency of the test group, motilin bradycardia percentage the tachygastria percentage frequency the unstable coefficients of four parameters and the normal control group and the control group differences between groups were not statistically significant (P gt; 0.05). The main power of the test group and the control group were significantly higher than the normal control group (P lt; 0.01). The percentage of normal slow wave of the test group and the control group were significantly lower than the normal control group (P lt; 0.01). Power instability coefficient of the test group and the control group, the main are significantly higher than the control group (P lt; 0.05). Gastric electrical parameters of the test group and the control group showed no significant difference (P gt; 0.05). Mechanical dilatation of the stomach of gastric electrical activity 2.1 test group comparison of gastric electrical parameters of the different gastric dilatation state: 40 simple obesity with overeating behavior with the intragastric pressure increase in the resting state, the initial intragastric pressure (IP) state, the state of maximum tolerated intragastric pressure (MP): frequency (DF) value downward trend, but the difference between the three was no statistical significance (P gt; 0.05). The upward trend, the main power (DP) and in the resting state and in the state of IP in MP state, the difference had statistical significance (P lt; 0.01), DP IP status compared differences in MP state statistics significance (P lt; 0.01). Normal slow wave percentage (N%) showed a downward trend, resting state compared with the MP state the difference was statistically significant (P lt; 0.05). Bradygastria percentage (B%), stomach the tachycardia percentage (T%) and the main power instability coefficient (DPIC) showed an upward trend, but no statistically significant difference among the three groups (P gt; 0.05). Frequency instability coefficient (DFIC) of an upward trend, and in the resting state compared with the MP state the difference was statistically significant (P lt; 0.05). 2.2 control group gastric dilatation state gastric electrical parameters of comparison: 30 simple obesity with overeating actors with the intragastric pressure increase in the resting state, the IP state MP state: the difference between the DF value of the three non-statistical significance (P gt; 0.05). The DP upward trend, resting state compared with IP status and MP status, the differences were statistically significant (P lt; 0.05, P lt; 0.01), IP status compared with MP status difference was statistically significant (P lt ; 0.05). N% downward trend, resting state compared with the MP state the difference was statistically significant (P lt; 0.05). B%, T% showed an upward trend, but among the differences were not statistically significant (P gt; 0.05). DFIC an upward trend, and in the resting state compared with the MP state the difference was statistically significant (P lt; 0.05). DPIC upward trend, but the difference between the three was no statistical significance (P gt; 0.05). 2.3 normal control group comparison of the different gastric dilatation state of gastric electrical parameters: 35 healthy volunteers of normal weight with the intragastric pressure increase in the resting state, the IP state MP state: the difference between the DF value of the three was not statistically significance (P gt; 0.05). The DP value upward trend the resting state DP and MP state value of the difference was statistically significant (P lt; 0.01). N% downward trend, and in resting and IP state and compared to the MP status, the differences were statistically significant (P lt; 0.01). B% upward trend, resting state differences were statistically significant (P lt; 0.05, P lt; 0.01) compared with the IP status and MP state. T%, DPIC showed an upward trend, and DFIC value, T% DPIC among differences were not statistically significant (P gt; 0.05), DFIC, in resting MP status differences have statistical significance (P lt; 0.05). Electroacupuncture stimulation of gastric electrical activity in the state of gastric dilatation 3.1 electroacupuncture stimulation of resting gastric electrical activity: EA stimulation of the test group DF value, B, T% DFIC DPIC and acupuncture before the difference was not statistically significant (P gt; 0.05). DP and N% is significantly lower than before acupuncture (P lt; 0.05); deflated after gastric electrical control group showed no statistical significance (P gt parameters deflated than; 0.05). 3.2 EA stimulation of the IP status gastric electrical activities: electroacupuncture stimulation test group after DF value, B, DFIC DPIC and acupuncture before the difference was not statistically significance (P gt; 0.05). DP, N% T%, significantly lower than before acupuncture (P lt; 0.05); deflated after gastric electrical control group showed no statistical significance (P gt parameters deflated than; 0.05). 3.3 EA stimulation of the MP status gastric electrical activities: electroacupuncture stimulation test group after DF value B% DFIC DPIC and acupuncture ago than the differences were not statistically significant (P gt; 0.05). The DP was significantly lower than before acupuncture (P lt; 0.01), N% T% was significantly lower than acupuncture before (P lt; 0.05); gastric electrical parameters deflated deflated control group showed no statistical significance (P gt; 0.05). Conclusion: simple obesity with overeating behavior dilatation of the stomach, gastric electrical rhythm abnormality rate than normal weight was significantly higher, increase the capacity of the stomach may be related to obesity, gastric accommodation enhanced compliance increases related, and of hunger plays an important influence and satiety. Simple obesity accompanied bulimic behavior by main power was significantly higher, have a strong stomach contraction force those with bulimic behavior, rapid gastric emptying results corroborated previous studies of obesity, the obese bulimic behavior could stomach row empty speed or power hyperthyroidism related. Electroacupuncture stimulation by increasing the gastric dysrhythmia and the weakened stomach contraction force, reduce appetite and gastric accommodation and slow gastric emptying, reduce food intake, this may be the electrophysiological basis of electro-acupuncture stimulation for weight control and weight loss. The purpose of the fourth part of the simple obesity gastric motility related hormones and electro-acupuncture stimulation: simple obesity associated with binge eating behavior and normal weight healthy meal after meal motilin, leptin, growth hormone, glucagon The glucagon peptide-1 detection of these hormones on obesity gastric motility, and verify the effectiveness of the electro-acupuncture treatment. Method: normal healthy volunteers (control group), 20 patients, 11 males and 9 females, average age 22.56 ± 6.23 years old, BMI 21.28 ± 1.84kg/m2. Bulimic behavior, the obese group (obese group) 32 cases, 17 males and 15 females, mean age 23.62 ± 6.24 years BMI 31.05 ± 1.55kg/m2. Fasted for 12h after 8:00 adopt fasting blood 12ml finished eating, then in 10min test meal, postprandial 30 minutes of the second blood collection 12ml -70 ° C freezer spare, enzyme-linked immunosorbent assay auxin (Ghrelin), glucagon peptide -1 (GLP-1); leptin (Leptin) were measured by radioimmunoassay, motilin (MTL). The obese group was given electro-acupuncture treatment, once a day, every 30min, for seven consecutive days. Eighth day repeat first day of the blood samples taken to process. Record the weight changes in the electro-acupuncture treatment after seven days. The results: 1. Hormone levels in obese group and control group comparison 1.1 motilin obese and control groups postprandial motilin level than those before a meal was significantly higher (P lt; 0.01). Preprandial or postprandial motilin levels of the obese group than in the control group was significantly higher (P lt; 0.01). 1.2 leptin obesity and control groups postprandial and preprandial leptin levels, the difference was not statistically significant (P gt; 0.05). Preprandial or postprandial leptin levels in obese group than in the control group was significantly higher (P lt; 0.01). 1.3 auxin obese and control groups postprandial the auxin level than before a meal were lower (P lt; 0.01). Preprandial or postprandial the obese group auxin level than those in the control group was significantly lower (P lt; 0.01). 1.4 glucagon peptide-1 control group postprandial GLP-1 levels compared with pre-dinner was significantly higher (P lt; 0.01), the obese group postprandial GLP-1 levels compared with hors d'release reduce (P lt; 0.01). Preprandial or postprandial GLP-1 levels of the obese group than in the control group was significantly lower (P lt; 0.01). Obesity treatment than before treatment weight change after weight loss of 3.55 ± 1.00kg. 3. Electroacupuncture treatment of postprandial motilin hormone levels 3.1 motilin obese group after treatment was significantly higher than that the hors d'(P lt; 0.05), whether it is before a meal or after a meal, the obese group after treatment compared with treatment The former was significantly decreased (P lt; 0.01). Postprandial leptin levels and hors d'3.2 leptin in obese group after treatment showed no significant difference (P gt; 0.05), both before a meal or after a meal, the obese group after treatment than before treatment was significantly decreased (P lt; 0.01). 3.3 auxin treatment of obesity postprandial auxin levels significantly lower than before a meal (P lt; 0.01) both before a meal or after a meal, the obese group after treatment before the differences were not statistically significance (P gt; 0.05 ). 3.4 glucagon peptide-1 in obese group therapy postprandial glucagon peptide-1 levels and hors d'difference had no statistical significance (P gt; 0.05), both before a meal or after a meal, the obese group therapy increased significantly (P lt; 0.01) than before treatment. Conclusion: The obese group leptin levels regardless of preprandial or postprandial significantly higher than the normal control group, and the meal had no significant effect on leptin levels, the obese gluttony actors leptin resistance may exist. Electroacupuncture stimulation leptin levels were significantly decreased. . Obese group, whether before a meal or postprandial auxin levels were significantly lower than the normal control group, indicating that auxin reduce obese patients positive energy balance physiological adjustment process. Obesity overeating behavior may exist eating Inhibition of auxin than normal weakened, and thus increase appetite. 3 obesity groups regardless of preprandial or postprandial motilin water on average significantly higher than that of the control group, the obese and control groups postprandial motilin levels significantly higher than those of the respective pre-dinner. Motilin significantly decreased after the treatment of the electric needle. 4. Reduced glucagon peptide-1 levels may cause obese gastric motility hyperthyroidism to accelerate gastric emptying, stomach feeling hesitant, satiety delay occurred mainly due to the other. Electro-acupuncture therapy can improve the obese group fasting and postprandial glucagon peptide-1 levels. Electro-acupuncture weight loss treatment.

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