The Study Of Gastric Emptying, Proximal Gastric Function, Gastric Myoelectrical Activity, Gastrointestinal Hormones And Electroacupuncture In Simple Obesity

Part One Gastric emptying in simply obesityObjective: To evaluate the relationship of gastric emptying with obese pathogenesis with scintigraphical measurement in simply obesity, normal control and FD patients.Methods: 30 simple binge-eating obesity include 15 males and 15 females with mean age 25.43±6.74y and MBI of 32.96±2.12kg/m2, 30 healthy volunteers including 15 males and 15 females with mean age of 25.43±6.74y and MBI of 32.96±2.12kg/m2, and 32 FD patients including 14 males amd 18 females with mean age of 35.47±7.21y and MBI of 23.09±1.68kg/m2 were enrolled in this study. None had gastrointestinal and hepatic disorders. scintigraphic gastric emptying assays were performed with a radionuclide technique methods as previously decribed in the morning after twelve hours fasting.Results: The gastric emptying rates at timepoint of 60 min, 90 min and 120 min in obese group were significantly higher than those of matched control with 44.27±4.82 vs 39.60±3.30, 72.90±5.26 vs 56.83±6.69 and 91.20±4.29 vs 76.00±5.41(P<0.01), respectively. Half-emptying time and gastric retention rate at 120 min were shorter and lower than those in control (8.8±4.92 vs 24.00±5.41, 70.43±7.74 vs 83.10±6.88, P<0.01). FD patients showed a significant delay of gastric emptying compared with control group at timepoint of 60 min, 90 min and 120 min (31.41±8.57 vs 39.60±3.30, 43.06±11.99 vs 56.83±6.69, 54.97±12.50 vs 76.00±5.41, P<0.01). Half-emptying time and gastric retention rate at 120 min were longer and higher than those in control (107.2±25.94 vs 83.10±6.88, 45.03±12.50 vs 24.00±5.41, P<0.01). Conclusion: Our data demonstrated that obese group had faster gastric empty than normal control and FD patients. Rapid gastric emptying may induce rapid gastrointestinal transit of ingested nutrients and decreased satiety feeling, promote rapid intestinal absorption and enhance hunger feeling in simply obesity with binge eater to draw them to overeat. Our data implied that Rapid gastric emptying maybe the the foundament of overeating so as to obesity.Part Two Proximal gastric function and Electroacupuncture in simple obesityObjective: To evaluate the relation among gastric capacity, accommodation, intragastric pressure, visceral sensitivity and obesity in 70 simply binge-eating obesity and 30 normal control with water load test and mechanical gastric distension method. Observe the effece of electro- acupuncture on proximal gastric function of simply obesity with binge eater in order to provid evidence with scientific and reliable for weight loss therapy.Methods: 105 subjects were divided into three groups: experiment group (40 simple obesity with binge eater, 20 males, 20 females, mean age 24.30±4.99y, BMI 32.07±2.44kg/m2), normal control group (30 healthy volunteers with normal body weight, 19 males, 16 females, mean age 22.26±1.95y, BMI 21.00±1.36kg/m2), control group (30 simple obesity with binge eater, 15 males, 15 females, mean age 24.50±5.20y, BMI 32.77±2.01kg/m2). None of the subjects had any gastrointestinal organic diseases or hepatopathy or a history of gastrointestinal surgery. On the first day, the water load test was performed. On the second day, accommodation, intragastric pressure and gastric compliance using an electronic barostat were measured by mechanical distension. The test of normal control group was over. For subjects of experiment group, Zusanli (ST36) and Yinlingquan (SP9) were punctured and stimulated with an electric pulse generator for 30 min by setting the parameters being 1mA in strength, 500s in the duration of pulses, 40Hz in frequency, 12cpm of pulse trains. Tianshu (ST25) was punctured with the needle retained. Acupuncture was not performed in control group. The repeated isovolumetric gastric distention was performed in the subjects of experiment group and control group.Results:1. the water load test: The consumption of water of experiment group and control group were all increased significantly comparison with that in normal control group (1325.75±196.79ml,1359.67±222.41ml vs 1158.23±195.61ml, P<0.01).2. Gastric capacity: The initial volume (IV) and maximal tolerance volume (MV) in experiment and control group were all significantly larger than those in normal control group (P<0.01). No significant difference in IV and MV were found between experiment group and control group (P>0.05).3. Intragastric pressure: No statistically significant difference in minimal distention pressure (MDP), initial intragastric pressure (IP) and maximal tolerance pressure (MP) were found among the three groups (P>0.05).4. Gastric compliance:Minimal distention compliance (MDC) in experiment and control group were not all different from normal control group (P>0.05). The initial gastric compliance (IC),maximal tolerance compliance (MC) in experiment and control group were all significantly larger than those in normal control group (P<0.01). MDC, IC and MC in experiment group were not different from control group (P>0.05).5. The effect of electroacupuncture on gastric capacity: After stimulation of electroacupuncture, IV and MV in experiment group were lower remarkably than those before (P<0.01). In control group, IV and MV in the first test were not different from those in the second test (P>0.05).6. The effect of electroacupuncture on intragastric pressure: After stimulation, MDP was similar to before (P>0.05), whereas IP and MP were increased noticeably in comparison with before (P<0.01). In control group, IP and MP in the first test were not different from those in the second test (P>0.05).7. The effect of electroacupuncture on gastric compliance: After stimulation, MDC was similar to before (P>0.05), whereas IC and MC were decreased noticeably in comparison with before (P<0.01). In control group, IC and MC in the first test were not different from those in the second test (P>0.05).Conclusion:1. The proximal gastric functions of simple obesity with binge eater were different from those of healthy people with normal body weight. With the alteration of proximal gastric functions, food intake was increased. Appropriate satiety signals were not triggered in response to gastric distension. Large gastric volume, big gastric compliance and delayed satiety signals were the main reasons of simple obesity with binge eater.2. Stimulation of electroacupuncture caused food intake decreased by lowing gastric capacity, whereas caused threshold of satiety signal and feeling of hunger decreased by increasing intragastric pressure, so it meet the aim of weight loss without hunger suffering.Part Three Gastric myoelectrical activity and Electroacupuncture in simple obesityObjective: To explore the characteristics of gastric myoelectrical activity induced by mechanical distension in simply obese people with binge eater and healthy volunteers with normal body weight; to discuss the relation between gastric myoelectrical activity and obesity; to evaluate the effect of electroacupuncture on electrogastrography (EGG) in simply obese people with binge-eating.Methods: Standards of subjects selected, rulled out and subjects are the same as above those of Part two. At the first time, all subjects'EGGs were recorded at baseline. All of the subjects were measured with electronic Barostat and Digitrapper electrogastrography equipments at the same time during mechanical distension. EGG was recorded at baseline, IP and MP state for 15 min respectively. Then the test of normal control group was over. The stimulation of electroacupuncture was enforced on experiment group for 30 min. Acupuncture was not performed in control group. The repeated isovolumetric gastric distention and EGG were performed on the experiment and control group.Results:1. Gastric myoelectrical activity during mechanical distension1.1 Comparison of parameters in EGG at the state of baseline among three groups: Five parameters of EGG (DF, DP, B%, T%, DFIC) were not found different significantly respectively among three groups (P>0.05). The percentage of normal slow wave (N%) in experiment and control group were all lower than those in normal control group respectively (P<0.01), whereas DPIC were higher than those in normal control group respectively (P<0.05). No statistically significant difference was found in parameters of EGG between experiment group and control group (P>0.05).1.2 Comparison of parameters in EGG at the state of IP among three groups: Four parameters of EGG (DF, B%, T%, DFIC) were not found different significantly respectively among three groups (P>0.05). Two parameters of EGG (DP, DPIC) in obese and control group were all higher compared with those in normal control group (P<0.01, P<0.05), whereas N% were lower than those in normal control group respectively (P<0.05). No statistically significant difference were found in parameters of EGG between experiment group and control group (P>0.05).1.3 Comparison of parameters in EGG at the state of MP among three groups: Four parameters of EGG (DF, B%, T%, DFIC) were not found different significantly respectively among three groups (P>0.05). Two parameters of EGG (DP, DPIC) in experiment and control group were all higher compared with those in normal control group (P<0.01, P<0.05), whereas N% were lower than those in normal control group respectively (P<0.01). No statistically significant difference were found in parameters of EGG between experiment group and control group (P>0.05).2. Effect of mechanical distension on gastric myoelectrical activity2.1 Comparison of EGG in experiment group at different gastric dilatation: Four parameters of EGG (DF, B%, T%, DPIC) were not found different significantly respectively among three states (P>0.05). Form baseline state, IP state to MP state, DP was increased significantly (30.33±3.81 dB vs 33.01±4.70 dB vs 36.23±4.02 dB, P<0.01); N% was decreased (53.65±14.22 vs 50.37±12.20 vs 47.86±11.65), N% of MP state was lower significantly compared with that of baseline state (P<0.05); DFIC was increased (0.42±0.14 vs 0.45±0.11 vs 0.51±0.16), DFIC of MP state was higher significantly compared with that of baseline state (P<0.05).2.2 Comparison of EGG in control group at different gastric dilatation: Four parameters of EGG (DF, B%, T%, DPIC) were not found different significantly respectively among three states (P>0.05). Form baseline state, IP state to MP state, DP was increased significantly(30.42±3.13 vs 33.28±4.79 vs 36.15±4.78); N% was decreased (54.03±16.65 vs 50.33±12.41 vs 45.90±11.93), N% of MP state was lower significantly compared with that of baseline state (P<0.05); DFIC was increased (0.43±0.16 vs 0.45±0.13 vs 0.51±0.17), DFIC of MP state was higher significantly compared with that of baseline state (P<0.05).2.3 Comparison of EGG in normal control group at different gastric dilatation: Three parameters of EGG (DF, T%, DPIC) were not found different significantly respectively among three states (P>0.05). Form baseline state, IP state to MP state, DP was increased (29.02±3.27 vs 30.28±3.76 vs 32.06±4.84), DP of MP state was higher significantly compared with that of baseline state (P<0.01); N% was decreased (69.20±15.09 vs 57.50±15.54 vs 56.61±12.80), N% of MP and IP state were all lower significantly compared with that of baseline state (P<0.01); DFIC was increased (0.40±0.12 vs 0.44±0.17 vs 0.49±0.17), DFIC of MP state was higher significantly compared with that of baseline state (P<0.05).3. Effects of acupuncture and electrical stimulation on EGG during mechanical distension3.1 Effects of acupuncture and electrical stimulation on EGG at state of baseline: Five parameters of EGG (DF, B%, T%, DFIC, DPIC) in experiment group were not found different significantly respectively between before and after electroacupuncture (P>0.05). After electroacupuncture, DP and N% were both lower noticeably compared with before electroacupuncture (DP: 28.55±3.50 vs 30.33±3.81, P<0.05), (N%: 47.56±11.78 vs 53.56±14.22, P<0.05); In control group, the parameters of EGG in the first test were not different from those in the second test (P>0.05).3.2 Effects of acupuncture and electrical stimulation on EGG at state of IP: Four parameters of EGG (DF, B%, DFIC, DPIC) in experiment group were not found different significantly respectively between before and after electroacupuncture (P>0.05). After electroacupuncture, DP and N% were both lower noticeably compared with before electroacupuncture (DP: 30.68±4.58 vs 33.01±4.70, P<0.05), (N%: 44.30±13.18 vs 50.37±12.20, P<0.05), whereas T% was higher noticeably compared with before electroacupuncture (23.59±11.10 vs 18.44±11.97, P<0.05); In control group, the parameters of EGG in the first test were not different from those in the second test (P>0.05).3.3 Effects of acupuncture and electrical stimulation on EGG at state of MP: Four parameters of EGG (DF, B%, DFIC, DPIC) in experiment group were not found different significantly respectively between before and after electroacupuncture (P>0.05). After electroacupuncture, DP and N% were both lower noticeably compared with before electroacupuncture (DP: 33.35±5.11 vs 36.23±4.02, P<0.01), (N%: 41.77±12.35 vs 47.86±11.65, P<0.05), whereas T% was higher noticeably compared with before electroacupuncture (25.23±9.66 vs 20.06±10.05, P<0.05); In control group, the parameters of EGG in the first test were not different from those in the second test (P>0.05).Conclusion:1. Obese people have remarkable abnormalities in gastric myoelectrical activity. Gastric compacity, accommodation and compliance increase in obese people perhaps play much more important role in above changes of gastric myoelectrical activity. The changes of gastric myoelectrical activity may influence feeling of hunger and satiety in human。2. A remarkable increasement of DP in the obese suggested that the obese with binge-eater had stronger contraction in comparison with normal subjects. This is evidence of correlation between simply obesity with binge eater and rapid gastric emptying.3. Stimulation of electroacupuncture in the obese lowed appetite and accommodation by increased abnormalities in gastric myoelectrical activity and weakened gastric contraction. Prolonged gastric emptying and decreased food intake are the electrophysiological foundaments on weight reduction.Part Four Hormons correlated with gastric motility and Electroacu- puncture in simply obese peopleObjective: To detdect serum Motilin, Leptin, Ghrelin, Glucogan-like peptide-1 in 32 simply binge-eating obesity and 20 normal control; to explore the relationship among serum MTL, Leptin, Ghrelin, GLP-1 and gastric motility of obese people and to verify the availability of electroacupuncture.Methods: 32 simply obese subjects with binge eater (17 males, 15 females, BMI 31.05±1.55kg/m2, age 23.62±6.24y) and 20 healthy subjects with normal weight (11 males, 9 females, BMI 21.28±1.84kg/m2, age 22.56±6.23y) were enrolled. At 8:00 in the morning venous blood was collected after an overnight fast period. and 30 minutes after meal (Kangshifu convenient noodles 127g: carbohydrate 88g, fat 25g, protein 14g, total kalorie 633Kcal) venous blood was recollected and stored at -70℃; Serum Ghrelin, GLP-1 were detected with ELISA method; MTL, Leptin were detected with RI method. 30 min stimulation of electroacupuncture was performed daily on the obese for a week. On the eighth day, blood samples of the obese were collected again. Recorded the loss of weight of the obese for the week.Results:1. Comparison of hormones between the obese and the control1.1 Motilin: Before and after meal, Serum MTL in obese people were higher than those in the control (283.95±83.84pg/ml vs 125.76±33.09pg/ml; 368.80±137.5pg/ml vs 276.8±50.55pg/ml, P<0.01);Compared with pre-meal MTL, post-meal MTL increased significantly in both groups (P<0.01).1.2 Leptin: Before and after meal, Serum Leptin in obese people were higher than those in the control, (7.42±4.66ng/ml vs 1.33±0.51ng/ml, 7.53±4.98 ng/ml vs 1.21±0.55ng/ml, P<0.01); Post-meal Leptin level was similar to pre-meal Leptin level in obese and control group (P>0.05).1.3 Ghrelin: Before and after meal, Serum Ghrelin in obese people was lower than those in the control, (3.23±1.24pg/ml vs 9.72±7.10pg/ml, 1.45±0.96pg/ml vs 3.36±2.38pg/ml, P<0.01); Compared with pre-meal Ghrelin, post-meal Ghrelin decreased significantly in both groups (P<0.01).1.4 GLP-1: Before and after meal, Serum GLP-1 in obese people were lower than those in the control, (1.67±0.36pg/l vs 3.64±1.42pg/l, 1.08±0.81pg/l vs 6.59±1.23pg/l, P<0.01); Compared with pre-meal GLP-1, post-meal GLP-1 increased significantly in the control (P<0.01), while in the obese, post-meal GLP-1 secretion decreased (P<0.05).2. A mean weight loss for a week: 3.55±1.00kg.3. Effects of acupuncture and electrical stimulation on hormones3.1 Motilin: Before and after meal, Serum MTL were lower than those before stimulation (230.73±9.25 vs 283.95±83.84, 264.52±91.51 vs 368.80±137.5, P<0.01). After stimulation in obese group, post-meal MTL increased significantly comared with pre-meal MTL (P<0.05).3.2 Leptin: Before and after meal, Serum Leptin were lower than those before stimulation (3.31±1.28 vs 7.42±4.66, 3.49±1.35 vs 7.53±4.98, P<0.01). After stimulation in obese group, post-meal Leptin level was similar to pre-meal Leptin level (P>0.05).3.3 Ghrelin: Before and after meal, Serum Ghrelin level were similar to those before stimulation (3.20±1.21 vs 3.23±1.24, 1.43±0.92 vs 1.45±0.96, P>0.05). After stimulation in obese group, post-meal Ghrelin decreased significantly comared with pre-meal Ghrelin (P<0.01).3.4 GLP-1: Before and after meal, Serum GLP-1 increased significantly in comparison with those before stimulation (2.55±0.72 vs 1.67±0.36, 2.65±1.12 vs 1.08±0.81, P<0.01). After stimulation in obese group, post-meal GLP-1 level was similar to pre-meal GLP-1 level (P>0.05).Conclusion:1. Before and after meal, Serum Leptin in obese people with binge eater were higher than those in the control. Food intake has no effect on Serum Leptin level. Leptin resistance existed in the obese so that the role of inhibition eating cannot run. Stimulation of electroacupuncture for a week made Serum Leptin decreased significantly.2. Before and after meal,Serum Ghrelin in obese people were lower than those in the control. Low Ghrelin level suggested that it adapted to positive energy balance. Perhaps food intake inhibition on Ghrelin was down-regulation, and then trigger appetite increased.3. Before and after meal, Serum MTL level were lower than those before stimulation. Compared with pre-meal MTL, post-meal MTL increased significantly in both groups. Stimulation of electroacupuncture for a week made Serum MTL decreased significantly.4. Serum GLP-1 level decreased resulted in gastric hypermotility, fast empting of stomach, visceral sensitivity obtuse and satiety occurence delayed. Stimulation of electroacupuncture for a week made Serum Leptin increased significantly.5. The therapeutic effects of electroacupuncture on the simply obese with binge eater were sure.