Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website http://www.gastrores.org

Original Article

Volume 9, Number 1, February 2016, pages 10-16

Autonomic Evaluation of Patients With Gastroparesis and Neurostimulation: Comparisons of Direct/Systemic and Indirect/Cardiac Measures

Figure 1. Symptoms, autonomic and enteric measures at baseline and 1 year after gastric stimulation at center one. EGG: electrogastrography; Gp: gastroparesis; SAF: sympathetic adrenergic function; VCF: vagal cholinergic function.

Figure 2. Symptoms and heart rate variability measures in patients undergoing gastric electrical stimulation at center two. LF: adrenergic/low-frequency; HF: cholinergic/high-frequency.

Figure 3. Comparison of autonomic function testing and heart rate variability in five patients with diabetic gastroparesis at baseline at center three. VCF: vagal cholinergic function; RR: R-to-R interval; VR: Valsalva ratio; SAF: sympathetic adrenergic function; VC: vasoconstriction; PAR: postural adjustment ratio; EGG: electrogastrography; LF: adrenergic/low-frequency; HF: cholinergic/high-frequency; HRV: heart rate variability.

**Table 1.** Autonomic and Enteric Measures at Baseline and 1 Year Post-Gastric Electrical Stimulation at Center One
Group 1: 39 patients	Baseline	Follow-up	P-value
Gastroparesis (Gp) symptoms	40.5 ± 1.8	25.4 ± 2.9	< 0.001
Cardio-vagal function (VCF)	21.9 ± 2.3	26.2 ± 3.4	0.15
Sympathetic-adrenergic function (SAF)	104.7 ± 5.7	82.9 ± 8.4	< 0.05
Electrogastrography (EGG)	3.8 ± 0.2 cpm	3.6 ± 0.1 cpm	0.3

Table 1. Autonomic and Enteric Measures at Baseline and 1 Year Post-Gastric Electrical Stimulation at Center One

Group 1: 39 patients

Baseline

Follow-up

P-value

Gastroparesis (Gp) symptoms

40.5 ± 1.8

25.4 ± 2.9

< 0.001

Cardio-vagal function (VCF)

21.9 ± 2.3

26.2 ± 3.4

0.15

Sympathetic-adrenergic function (SAF)

104.7 ± 5.7

82.9 ± 8.4

< 0.05

Electrogastrography (EGG)

3.8 ± 0.2 cpm

3.6 ± 0.1 cpm

0.3

**Table 2.** Symptoms and Heart Rate Variability in Patients Undergoing Gastric Electrical Stimulation at Center Two
Group 2: 35 patients	Baseline	Follow-up	P-value
Symptoms	39.0 ± 1.9	19.9 ± 3.7	< 0.001
Low to high frequency ratio	1.4 ± 0.1	1.1 ± 0.07	0.1

Table 2. Symptoms and Heart Rate Variability in Patients Undergoing Gastric Electrical Stimulation at Center Two

Group 2: 35 patients

Baseline

Follow-up

P-value

Symptoms

39.0 ± 1.9

19.9 ± 3.7

< 0.001

Low to high frequency ratio

1.4 ± 0.1

1.1 ± 0.07

0.1

**Table 3.** Comparison of Heart Rate Variability and Autonomic Nervous System With Electrogastrogram Values in a Pilot Study of Five Patients at Center Three
Subject	HRV %Δ LF/HF with meal	HRV interpretation	SAF %VC	SAF PAR	Total SAF = VC + PAR	Total VCF = RR + VR + 30/15	AFT interpretation	EGG %Δ in frequency with meal
AFT: autonomic nervous system testing; EGG: electrogastrography; Gp: gastroparesis; HF: cholinergic/high frequency; HRV: heart rate variability; LF: adrenergic/low-frequency; SAF: sympathetic adrenergic function; VCF: vagal cholinergic function.
1	33.33	Sympathetic dominant	92	3.3	95.30	20.23	Normal parasympathetic/abnormal sympathetic (PAR)	-24.10
2	21.57	Sympathetic dominant	79	2.2	81.20	14.28	Abnormal sympathetic (PAR)	79.86
3	-22.47	Parasympathetic dominant	NA	11	NA	26.41	Abnormal sympathetic (PAR)	-26.37
4	-42.62	Parasympathetic dominant	84.5	3.5	88.00	9.13	Abnormal parasympathetic > abnormal sympathetic (PAR)	-18.37
5	92.00	Sympathetic dominant	98	14	112.00	20.61	Normal parasympathetic/abnormal sympathetic (PAR)	-27.88

Table 3. Comparison of Heart Rate Variability and Autonomic Nervous System With Electrogastrogram Values in a Pilot Study of Five Patients at Center Three

Subject

HRV %Δ LF/HF with meal

HRV interpretation

SAF %VC

SAF PAR

Total SAF = VC + PAR

Total VCF = RR + VR + 30/15

AFT interpretation

EGG %Δ in frequency with meal

AFT: autonomic nervous system testing; EGG: electrogastrography; Gp: gastroparesis; HF: cholinergic/high frequency; HRV: heart rate variability; LF: adrenergic/low-frequency; SAF: sympathetic adrenergic function; VCF: vagal cholinergic function.

33.33

Sympathetic dominant

3.3

95.30

20.23

Normal parasympathetic/abnormal sympathetic (PAR)

-24.10

21.57

Sympathetic dominant

2.2

81.20

14.28

Abnormal sympathetic (PAR)

79.86

-22.47

Parasympathetic dominant

26.41

Abnormal sympathetic (PAR)

-26.37

-42.62

Parasympathetic dominant

84.5

3.5

88.00

9.13

Abnormal parasympathetic > abnormal sympathetic (PAR)

-18.37

92.00

Sympathetic dominant

112.00

20.61

Normal parasympathetic/abnormal sympathetic (PAR)

-27.88