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Diagnosis and Treatment of Gastroparesis

In humans the gastric pacemaker is an ill-defined collection of cells on the greater curvature of the stomach, formed by the Interstitial Cells of Cajal. We recognize that the pacemaker is responsible for generating the intrinsic electrical rhythm in the stomach. The gastric pacemaker, in conjunction with the enteric nervous system, is responsible for the changes in gastric motor activity over the next several hours as you progress from a fasting pattern to a fed pattern, after eating your breakfast.

We know from a number of different studies over the years that an insult, for example inflammation of the stomach, can alter that electrical activity. We are all comfortable with the concept of post-infectious gastroparesis, specifically post-viral gastroparesis. We also recognize the concept of post-infectious functional dyspepsia. This often represents injury to the Interstitial Cells of Cajal, and/or to the enteric nervous system.

There is also data showing that prostaglandins may have an impact on nausea and vomiting and this could relate to the underlying gastric rhythm. We know from animal experiments that the antrumand the corpus in mice have a different electrical slow wave rhythm. The corpus has an intrinsic rhythm that is faster at about 6-8 slow waves per minute while the antrum in mice is slower at 2-4waves per minute.

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Diagnosis and Treatment of Gastroparesis