Transcutaneous Electrogastrography in Patients with Ileus

Abstract

Background: The aim of the prospective study was to characterize the disturbance of gastric electrical control activity in different types of ileus and to correlate surface electrogastrography (EGG) findings with a set of inflammatory markers. Patients and Methods: Fifty-four adult patients with mechanic, vascular and paralytic ileus proven on clinical and radiological exams and 14 age- and sex-matched controls were examined. Gastric myoelectrical activity was recorded using 3 Ag-AgCl disposable skin electrodes connected in pseudo-unipolar mode by Microdigitrapper device. The captured signal was amplified and digitalized. The dominant frequency was calculated using computerized algorithms (Fast Fourier transform and running spectrum analysis). The results were correlated with the known pathological diagnoses and 4 inflammatory parameters – interleukin (IL)-1β, IL-6, procalcitonin (PCT) and C-reactive protein. Results: Irregular EGG activity without a dominant frequency or bradygastria (electrical control activity frequency <2.4 cycles/min) was seen in all patients with both vascular and parayltic ileus and in 67.86% of the patients with obstructive ileus. Normogastria (2.4–3.7 cycles/min) was found in 32.14% of the patients with obstructive ileus. Among the patients with obstructive ileus and bradygastria, higher concentrations of IL-6 (642.0 ± 214.7 ng/l) and PCT (0.93 ± 0.22 µg/l) were observed compared with the patients with normogastria – IL-6 (354.5 ± 109.2 ng/l), PCT (0.69 ± 0.11 µg/l); p < 0.05 for both. The C-reactive protein concentration did not differ in both subgroups on p < 0.05. Conclusions: EGG examination confirmed a high sensitivity in the evaluation of gastric electrical control activity in both vascular and paralytic ileus. Significant correlation of EGG findings and both IL-6 and PCT plasma levels supports a role of the inflammatory milieu in the pathogenesis of impaired gastric electrical activity in patients with ileus.

Systemic Inflammatory Cytokines Predict the Infectious Complications but Not Prolonged Postoperative Ileus after Colorectal Surgery

“…Several experimental studies have reported the important role of IL-6 in the development of POI. Even little manipulation of the bowel induces activity of IL-6, which results in activation of nitric oxide and prostaglandins and causes migration of leucocytes into the circular muscle of the bowel and ends up with PPOI eventually [ 21 – 24 ]. However, with fruitful data obtained from animal studies, clinical attempts to predict POI by determining inflammatory mediator levels, the important mechanism in PPOI pathophysiology, remain limited.…”

“…Zhu et al found that peritoneal levels of IL-1, IL-6, and procalcitonin were higher in PPOI patients [ 10 ], indicating localized parameters are sensitive for PPOI prediction. Clinical data also found that IL-6 levels are higher in patients undergoing open surgery when compared with patients undergoing laparoscopic surgery [ 21 ], while open procedures had been demonstrated to delay recovery of POI [ 8 ].…”

Peritoneal Damage: The Inflammatory Response and Clinical Implications of the Neuro‐Immuno‐Humoral Axis

“…There is clear evidence that specific inflammatory transcription factors, cytokine and chemokine upregulation, and leukocyte recruitment have a very significant part to play, with a direct inhibitory effect on the muscularis externa of the bowel [83, 115,[134][135][136]. Furthermore, this affect seems to be age-dependent, with an increase in the proinflammatory mediator expression with increasing age [136].…”

Abdominal wound length influences the postoperative serum level of interleukin-6 and recovery of flatus passage among patients with colorectal cancer

“…In an animal experiment, abdominal laparotomy induced elevated serum IL-6 levels and inhibition of gastrointestinal transit in the same time course ( 12 ). In a human study, elevated serum IL-6 levels after abdominal surgery were involved in delayed recovery of gastric emptying and impaired gastric electrical activity in patients with postoperative ileus ( 13 , 14 ). Although these data have indicated the possible role of IL-6 in the development of POI, there is still a lack of clinical studies focusing on the association between postoperative alterations in IL-6 and the recovery of colonic motility of transit among patients undergoing surgical resection for colorectal cancer.…”