Clonidine inhibits postprandial response of antral myoelectrical activity

Gastric myoelectrical and neurohormonal changes associated with nausea during tilt-induced syncope

BACKGROUND

Nausea is a common prodromal symptom of neurally mediated syncope, but the biological factors linking nausea with syncope have not been studied. We aimed to characterize nausea during tilt-induced syncope by exploring related changes in gastric myoelectrical activity and plasma epinephrine, norepinephrine, and vasopressin concentrations across study phases of recumbency, tilt, syncope, and recovery.

METHODS

Electrogastrographic and plasma hormone changes were compared between patients with tilt-induced syncope and nausea (n = 18) and control subjects (n = 6) without symptoms or hemodynamic changes during tilt-table testing.

KEY RESULTS

Over a 4-minute period preceding syncope, sequential electrogastrography epochs demonstrated an increase over time in bradygastria (P = .003) and tachygastria (P = .014) power ratios, while the dominant frequency (P < .001) and the percent normogastria (P = .004) decreased. Syncope led to significant differences between cases and controls in electrogastrographic power ratios in each frequency range: bradygastria (P = .001), tachygastria (P = .005), and normogastria (P = .03). Nausea always followed electrogastrographic changes, and nausea resolution always preceded electrogastrographic normalization. Plasma vasopressin (676.5 ± 122.8 vs 91.2 ± 15.3 pg/mL, P = .012) and epinephrine (434 ± 91.3 vs 48.7 ± 2.5 pg/mL, P = .03), but not norepinephrine (P > .05), also differed with syncope between cases and controls.

CONCLUSIONS AND INFERENCES

The nausea related to tilt-induced syncope is temporally associated with changes in gastric myoelectrical activity and increases in plasma vasopressin and epinephrine. The biological mechanisms that induce syncope are physiologically distinct from other experimental models of nausea such as illusory self-motion, yet nausea with syncope appears to have similarly associated electrogastrographic and hormone changes. Thus, tilt-induced syncope could serve as an informative experimental model for nausea research.

Effects of clonidine and tricyclic antidepressants on gastric smooth muscle contractility

To determine if and how clonidine and tricyclic antidepressants affect gastric contractility. Guinea pig fundic and antral circular muscle strips were studied in vitro. The effects of clonidine or amitriptyline added in graded concentrations on contractions to electric field stimulation (EFS), acetylcholine (ACh), and SP in the presence of N(epsilon)-nitro-l-arginine methyl ester (l-NAME) were studied. EFS produced frequency dependent contractions of fundic and antral muscle that were abolished by atropine or tetrodotoxin (TTX). ACh contractions were abolished by atropine but not TTX. Clonidine reduced contractile response to EFS but had no effect on ACh contractions. The threshold concentration of clonidine to inhibit EFS contractions was lower in the fundus than in the antrum. Amitriptyline reduced contractions to both EFS and ACh but not to SP. The threshold concentration of amitriptyline to inhibit EFS contractions was lower in the antrum than in the fundus. Both clonidine and amitriptyline affect gastric contractility. At threshold concentrations, clonidine affects fundic contractility whereas amitriptyline affects antral contractility. Clonidine affects gastric contractility in response to EFS but not to ACh, suggesting alpha-2 receptors on cholinergic nerves that reduce ACh release. Amitriptyline inhibits gastric contractility to EFS and ACh suggesting an inhibitory muscle effect.

Electroacupuncture accelerates gastric emptying in association with changes in vagal activity

Gastroparesis is a disorder with a lack of treatment options and this study investigated the effect of electroacupuncture on gastric emptying and involved mechanisms. Dogs implanted with a duodenal cannula and serosal electrodes were fed with Ensure mixed with phenol red, and the gastric effluent was collected. Electroacupuncture was performed from 30 min before until 45 min after the meal. Gastric myoelectrical activity and electrocardiogram were recorded. Gastric emptying was significantly improved with electroacupuncture. Vagal activity assessed from the spectral analysis of heart rate variability was markedly increased with electroacupuncture. Electroacupuncture increased the regularity of gastric slow waves in both the proximal and distal stomach. It also increased the number of spike bursts in the distal but not proximal stomach. Electroacupuncture accelerates gastric emptying of liquid in dogs and its potential for treating gastroparesis may be explored. The effect may be attributed to improvement in gastric slow-wave rhythmicity and antral contractile (spike) activity and may possibly involve the vagal pathway.