A1194 AGA ABSTRACTS

5484

DIFFERENCES IN RESPONSE TO ANTIDEPRESSANT THERAPYBETWEEN MALE AND FEMALE PATIENTS WITH FUNC­TIONAL BOWEL DISORDERS.Charles W. Randall, Anitha Nair, Carlo Taboada, Methodist Hosp, SanAntonio, TX; Univ of Texas Health Sci Ctr, San Antonio, TX.

INTRODUCTION The use of tricyclic and other antidepressant agents inthe management of functional bowel disorders is gaining popularity. Thisstudy compared efficacy of treatment and side effects between males andfemales. METHODS 85 female(F) and 26 male(M) patients were followedprospectively over a range in time from 5-48 months (mean= 16 months).Response was judged as complete remission of symptoms (CR), nearremission (NR) where symptoms were sufficiently decreased in frequencyand intensity to allow a normal functional status, inadequately controlledsymptoms(IC), and no change from pretreatment condition (NC). 99 pa­tients were treated with amitriptyline (M=24, F=75), 10 with desipramine(M=2, F=8), 1 with imipramine (F= I), and 1 with trazodone (M= 1). Sideeffects were divided as neurological (fatigue, confusion and headache,dizziness), anticholinergic (constipation and dryness), cardiological (pal­pitations) and miscellaneous (reflux and diaphoresis). Functional disorderstreated included irritable bowel, nonulcer dyspepsia, irritable esophogus,and overlap syndromes that contained symptoms classic to 2 or more of theabove. RESULTS The average age for women was 53.0 years (range16-85) and men 50.3 years (range 17-72). IBM (69.2%) were found to bein CR and 8 (30.8%) in NR. Of the female patients 30 (35.3%) were in CRand 47 (55.3%) in NR. 4F (4.7%) each were in the IC and NC groups. Theaverage dose of amitriptyline required to achieve a status of CR or NR inmen was 32.4mg (range 10-130) and in women 24mg (range 5-150mg). SEwere seen in 4M (15.4%) with fatigue representing 3 (75%) of these. 28F(32.9%) had SE with 12 (43%) having fatigue, 5 (17.9%) with neurolog­ical, 2 (7.1%) with cardiac, 5 (17.9%) with anticholinergic, and 4 (14.2%)with miscellaneous. CONCLUSIONS 1. Males tend to require higher dosesof amitriptyline than do females to achieve a normal functional status 2.Fatigue is the most common SE in both M and F 3. SE tend to occur morefrequently in females than males

5485LONG TERM EFFECTS OF BIOFEEDBACK THERAPY ON ANO­RECTAL FUNCTION IN DYSSYNERGIC DEFECATION (DD).Satish Rao, Anderson Kiersten, Stessman Mary, Univ of Iowa, Iowa City,IA.

In the short term, biofeedback therapy improves symptoms and anorectalfunction in constipated patients with DD. But, the long term effects of thistreatment are unknown. Aim: To prospectively examine subjective andobjective parameters of anorectal function at 6 wks, 3,6 and 12 monthsafter training. Visual and verbal feedback techniques were used to performrectoanal coordination, sensory conditioning, and simulated defecation in100 (m1f=25175)consecutive constipated patients with DD (symptoms> Iyr). All patients answered a symptom questionnaire at I year. Results werecompared with baseline. RESULTS: Eighty patients completed trainingand attended follow up evaluation at 6 weeks(I00%), 57(71%) at 3 months,46(58%) at 6 months and 37(47%) at 12 months. Twenty patients droppedout after 1-2 sessions and were excluded. Important parameters of anorectalfunction are shown in Table(mean± sd). A dyssynergic pattern was cor­rected in all patients. Digital disimpaction was discontinued by all patients.Laxatives were discontinued by 20% and laxative consumption scoredecreased (p<0.05). Overall, 75% of patients were satisfied with bowelfunction. CONCLUSION: Biofeedback therapy improves objective param­eters of anorectal function in 90% and subjective parameters in 75% ofpatients. This improvement is sustained for one year. Periodic reinforce­ment may be benificial, but compliance decreases over time. Biofeedbackis an effective long term treatment for patients with dyssynergic defecation.

Bold=p<O.OOl, * =p<0.05

Baseline 6weeks 6 Months 12MonthsAnalresidual Pr(mmHg) 67±31 33±19 28±23 30±11Rectal Pressure (mmHg) 44±25 61±20 63±22 62±11Defecation index 0.8±0.5 2.6±1.7 3.1±2.1 2.3±0.7Desire to defecate (cc) 102±78 40±22 38±25 40±12Fecom expulsion (s) 207±124 78±104 64±94 79±101Stool frequencylwk 4.2±5.7 7.8±5.6 8.2±5.1 7.2±10.2*Straining score 2.6±0.6 1.7±0.6 1.7±0.5 1.7±0.6Visual analogue scale 16±14 67±24 72+20 76+18

5486POSTURALLY EVOKED CHANGES IN ELECTROGASTRO·GRAPHIC (EGG) RECORDINGS CORRESPOND TO AUTO·NOMIC FUNCTION TESTING (AFT) MEASUREMENTS.Hani M. Rashed, Ahmed El-Gammal, Sinji Ganguli, Debra Reser, ThomasL. Abell, AFT Lab, UT Bowld Hosp, Univ of Tennessee, Memphis,Memphis, TN; Univ of Tennessee-Memphis, Memphis, TN.

Introduction: Although the GI tract and enteric nervous system (ENS) isinfluenced by the autonomic nervous system (ANS), clinical measurementof their interaction is imprecise. The Electrogastrogram (EGG), a nonin-

GASTROENTEROLOGY Vol. 118, No.4

vasive ENS measures, can be provoked by several measures, in addition tothe fed state. We aimed to explore the interaction of ENS and ANS bychanges in body posture. Methods: We studied 54 patients (16 m & 38 f,mean age 38 yrs) with ANS measures of blood pressure (BP), skintemperature (ST), and total pulse amplitude (TPA), all mixed Sympathetic/cholinergic measures recorded as previously reported (GE 106: 945-50,1994), and EGG monitored by three electrodes over the epigastric area (GE98 (2): A320, 1990). After a 15 minute baseline, patients were monitoredsupine (SUP), then 80 degrees head-up-tilt (HUT) position for 15 min,followed by 10 min sitting (SIT). Paired t-test, Spearman correlationcoefficients and ANOVA were used for data analysis and reported asmean ± SEM. Results: Abnormal EGG (normal range 2.8-3.3) wasfound in 46/54 (85.2%) of SUP, 45/54 (83.3%) of HUT and 40148 (83.3)of SIT. Mean SUP EGG (4.22±0.1 cpm) decreased significantly duringHUT (3.9±0.1 cpm, p=O.OI). Mean SIT EGG frequency was similar tobaseline values (4.1±0.1 cpm, p>0.05) (see table below). EGG HUTcorrelated with the sympathetic cholinergic measure systolic BP HUT(r=0.3, p=O.Ol). SIT EGG correlated with the sympathetic cholinergicmeasure ST (r=-0.5 & p=O.OOOI). Conclusion: Our study demonstrated asignificant reduction in EGG frequency evoked by tilt and correlated withBP and ST. Both EGG (an ENS measure) and BP/STITPA (ANS measures)are modulated by changes in body position, which appears to be mixedsympathetic/cholinergic pathways. We conclude that, in this group ofpatients undergoing ANS evaluation, the ENS measure of EGG has po­tential for use as a clinical diagnostic tool.

Posture EGG/cpm Systolic BP/mmHg TPAIa u

Supine 4.2±0.1 113±21 3448 ± 325Tilt 3.9±0.1' 103±2.7' 546±65'Sitting 4.1 +0.1 103 + 3.2 6191 +385

, p< 0.01 inrelation tothe supine posture by paired T-test

5487GASTRIC ELECTRICAL ACTIVITY CORRELATES WITH URO·DYNAMIC MEASUREMENTS IN PATIENTS WITH SYMPTOMSOF GASTROPARESIS.Hani M. Rashed, Ragi Doggweiler, Nada Taleb, Debra Reser, JenniferNewell, Robert DuVell, Thomas L. Abell, AFT Lab, UT Bowld Hosp,Univ of Tennessee, Memphis, Memphis, TN; Dept of Urology, Univ ofTennessee, Memphis, Memphis, TN; GI Div , Dept of Int Medicine, Univof Tennessee, Memphis, Memphis, TN; Urology Dept, UT Memphis,Memphis, TN; UT Bowld Hosp Univ of Tennessee, Memphis, Memphis,TN; Univ of Tennessee-Memphis, Memphis, TN.

Introduction: Patients (pts) with Sx of gastroparesis (GP) often complain oflower urinary (LU) tract Sx. We previously reported the presence ofbladder abnormalities in pts with GI motility disorders (GE 112(4):A737,1997) and now report additional relationships between these twointra-abdominal organ systems. Patients: In a retrospective study, 30 pts(6M, 24F, mean age 43 yr) with GP Sx, 14 with diabetes mellitus (DM) and16 with idiopathic disease, underwent electrogastrograms (EGG) and uro­dynamic studies (UD) for: difficulty in emptying bladder 18/30 (60%),incontinence 15/30(50%), frequency 13/30(43%), and/or straining 16/30(53%). Methods: UD was via urofluorometry for peak (PK) (normal> 12mL/sec) and mean flow rates in mllsec and post void residual volumes(PVR) in mL (normal <150 mL) and multi-channel complex fluid cys­tometry of bladder capacity (CP) in mL (normal < 300) and first sensation(FS) in cc (normal < 150). EGG was measured by placing 3 electrodesover the epigastric area (GE 98 (2):A320, 1990) and reported as averagefrequency (normal 2.8-3.3 cpm). Spearman correlation coefficients andpredictive values were calculated between EGG and UD. Results: 22/30(73%) EGG and 28/30 (93%) UD were abnormal. All EGG also correlatedsignificantly with the urodynamic measure of FS (r=0.6, p=O.OOI). Seetable below. Conclusion: Based on this group of pts with Sx of GP, EGGabnormalities can predict urodynamic dysfunctions in both DM and/orIdiopathic pts. Further study of GI and GU motor dysfunctions should beinvestigated for possible shared mechanism(s) in pts with GP.

EGGOM Idiopathic

Urodynamic Measures OM (n=14) Idiopathic (n=16) Sens Spec Sens Spec

Post Void Residual 4/14 (29%) 10/16 (63%) 100 36 60 48Capacity 12/14 (86%) 14/16 (88%) 77 100 91 67First Sensation 7/14 (50%) 10116 (63%) 86 29 90 83Peak 6/14 (43%) 2/14(14%) 83 25 100 50EGG 11/14(79%) 11/16(69%)

(% abnormal results) DM=Diabetes Mellitus, Sens=Sensitivity, Spec=Specificity