Journal of Neurology

, Volume 259, Issue 7, pp 1448–1452 | Cite as

Is there delayed gastric emptying in patients with multiple system atrophy? An analysis using the 13C-acetate breath test

  • Yuji Tanaka
  • Tomohiro Kato
  • Hiroshi Nishida
  • Megumi Yamada
  • Akihiro Koumura
  • Takeo Sakurai
  • Yuichi Hayashi
  • Akio Kimura
  • Isao Hozumi
  • Hiroshi Araki
  • Masahiko Murase
  • Masahito Nagaki
  • Hisataka Moriwaki
  • Takashi Inuzuka
Original Communication

Abstract

Autonomic failure is one of the criteria according to the second consensus statement for the diagnosis of multiple system atrophy (MSA). Gastrointestinal symptoms are frequent complaints in patients with MSA and may be associated with reduced gastrointestinal motility due to autonomic nervous system dysfunction. However, there are few reports on gastric emptying in patients with MSA. We investigated gastric emptying in 25 patients with MSA, 20 patients with sporadic adult-onset ataxia of unknown etiology (SAOA), and 20 healthy volunteers using the 13C-acetate breath test. Gastric emptying function is estimated by this test as the half-emptying time (HET) and peak time of the 13C-%-dose-excess curve (Tmax), with expirations collected for 4 h after a test meal and determination of 13CO2 content using an infrared (IR) spectrophotometer. The HET and Tmax of gastric emptying were significantly delayed in patients with MSA as compared to those in SAOA and controls (p < 0.01). The HET and Tmax were not significantly different between SAOA and controls. No correlation existed between the HET or Tmax and the duration or severity of the disease in MSA patients. These results suggested that gastric emptying was significantly delayed in patients with MSA, and the delay already appeared in the early stage of the disease. Delayed gastric emptying is one of the autonomic failures and may be a clinical marker of MSA.

Keywords

Multiple system atrophy Sporadic adult-onset ataxia of unknown etiology Gastric emptying 13C-Acetate breath test Autonomic failure 

References

  1. 1.
    Gilman S, Wenning GK, Low PA, Brooks DJ, Mathias CJ, Trojanowski JQ, Wood NW, Colosimo C, Dürr A, Fowler CJ, Kaufmann H, Klockgether T, Lees A, Poewe W, Quinn N, Revesz T, Robertson D, Sandroni P, Seppi K, Vidailhet M (2008) Second consensus statement on the diagnosis of multiple system atrophy. Neurology 71:670–676PubMedCrossRefGoogle Scholar
  2. 2.
    Thomaides T, Karapanayiotides T, Zoukos Y, Haeropoulos C, Kerezoudi E, Demacopoulos N, Floodas G, Papageorgiou E, Armakola F, Thomopoulos Y, Zaloni I (2005) Gastric emptying after semi-solid food in multiple system atrophy and Parkinson disease. J Neurol 252:1055–1059PubMedCrossRefGoogle Scholar
  3. 3.
    Ghoos YF, Maes BD, Geypens BJ, Mys G, Hiele MI, Rutgeerts PJ, Vantrappen G (1993) Measurement of gastric emptying rate of solids by means of a carbon-labeled octanoic acid breath test. Gastroenterology 104:1640–1647PubMedGoogle Scholar
  4. 4.
    Braden B, Adams S, Duan LP, Orth KH, Maul FD, Lembcke B, Hör G, Caspary WF (1995) The 13C-acetate breath test accurately reflects gastric emptying of liquids in both liquid and semisolid test meals. Gastroenterology 108:1048–1055PubMedCrossRefGoogle Scholar
  5. 5.
    Abele M, Bürk K, Schöls L, Schwartz S, Besenthal I, Dichgans J, Zühlke C, Riess O, Klockgether T (2002) The aetiology of sporadic adult-onset ataxia. Brain 125:961–968PubMedCrossRefGoogle Scholar
  6. 6.
    Abele M, Minnerop M, Urbach H, Specht K, Klockgether T (2007) Sporadic adult-onset ataxia of unknown etiology: a clinical, electrophysiological and imaging study. J Neurol 254:1384–1389PubMedCrossRefGoogle Scholar
  7. 7.
    Yoshihara M, Sumii K, Haruma K, Kiyohira K, Hattori N, Kitadai Y, Komoto K, Tanaka S, Kajiyama G (1998) Correlation of ratio of serum pepsinogen I and II with prevalence of gastric cancer and adenoma in Japanese subjects. Am J Gastroenterol 93:1090–1096PubMedCrossRefGoogle Scholar
  8. 8.
    Tanaka Y, Kato T, Nishida H, Araki H, Murase M, Nagaki M, Moriwaki H, Inuzuka T (2009) Is there a difference in gastric emptying between Parkinson’s disease patients under long-term l-dopa therapy with and without motor fluctuations? An analysis using the 13C-acetate breath test. J Neurol 256:1972–1976PubMedCrossRefGoogle Scholar
  9. 9.
    Tanaka Y, Kato T, Nishida H, Yamada M, Koumura A, Sakurai T, Hayashi Y, Kimura A, Hozumi I, Araki H, Murase M, Nagaki M, Moriwaki H, Inuzuka T (2011) Is there a delayed gastric emptying of patients with early-stage, untreated Parkinson’s disease? An analysis using the 13C-acetate breath test. J Neurol 258:421–426PubMedCrossRefGoogle Scholar
  10. 10.
    Gatti C, di Abriola FF, Dall’Oglio L, Villa M, Franchini F, Amarri S (2000) Is the 13C-acetate breath test a valid procedure to analyse gastric emptying in children? J Pediatr Surg 35:62–65PubMedCrossRefGoogle Scholar
  11. 11.
    Gonza′lez A, Mugueta C, Parra D, Labayen I, Martinez A, Varo N, Monreal I, Gil MJ (2000) Characterisation with stable isotopes of the presence of a lag phase in the gastric emptying of liquids. Eur J Nutr 39:224–228CrossRefGoogle Scholar
  12. 12.
    Mathias CJ (2006) Multiple system atrophy and autonomic failure. J Neural Transm 70:343–347CrossRefGoogle Scholar
  13. 13.
    Yoshida M (2007) Multiple system atrophy: alpha-synuclein and neural degeneration. Neuropathology 27:484–493PubMedCrossRefGoogle Scholar
  14. 14.
    Tsai A, Maehara K, Iizuka R (1992) Loss of catecholaminergic neuron in the hypothalamus of multiple system atrophy. Rinsho Shinkeigaku 32:125–130 (in Japanese with English abstract)PubMedGoogle Scholar
  15. 15.
    Nakamura S, Ohnishi K, Nishimura M, Suenaga T, Akiguchi I, Kimura J, Kimura T (1996) Large neurons in the tuberomammillary nucleus in patients with Parkinson’s disease and multiple system atrophy. Neurology 46:1693–1696PubMedCrossRefGoogle Scholar
  16. 16.
    Ozawa T, Oyanagi K, Tanaka H, Horikawa Y, Takahashi H, Morita T, Tsuji S (1998) Suprachiasmatic nucleus in a patient with multiple system atrophy with abnormal circadian rhythm of arginine-vasopressin secretion into plasma. J Neurol Sci 154:116–121PubMedCrossRefGoogle Scholar
  17. 17.
    Nishie M, Mori F, Fujiwara H, Hasegawa M, Yoshimoto M, Iwatsubo T, Takahashi H, Wakabayashi K (2004) Accumulation of phosphorylated alpha-synuclein in the brain and peripheral ganglia of patients with multiple system atrophy. Acta Neuropathol 107:292–298PubMedCrossRefGoogle Scholar
  18. 18.
    Ozawa T (2007) Morphological substrate of autonomic failure and neurohormonal dysfunction in multiple system atrophy: impact on determining phenotype spectrum. Acta Neuropathol 114:201–211PubMedCrossRefGoogle Scholar
  19. 19.
    Suzuki A, Asahina M, Ishikawa C, Asahina KM, Honma K, Fukutake T, Hattori T (2005) Impaired circadian rhythm of gastric myoelectrical activity in patients with multiple system atrophy. Clin Auton Res 15:368–372PubMedCrossRefGoogle Scholar
  20. 20.
    Stefanova N, Bücke P, Duerr S, Wenning GK (2009) Multiple system atrophy: an update. Lancet Neurol 8:1172–1178PubMedCrossRefGoogle Scholar
  21. 21.
    Colosimo C (2011) Nonmotor presentations of multiple system atrophy. Nat Rev Neurol 7:295–298PubMedCrossRefGoogle Scholar
  22. 22.
    Mabuchi N, Hirayama M, Koike Y, Watanabe H, Ito H, Kobayashi R, Hamada K, Sobue G (2005) Progression and prognosis in pure autonomic failure (PAF): comparison with multiple system atrophy. J Neurol Neurosurg Psychiatry 76:947–952PubMedCrossRefGoogle Scholar
  23. 23.
    Bennett T (1983) Physiological investigation of diabetic autonomic failure. In: Bannister R (ed) Autonomic failure. Oxford University Press, Oxford, pp 407–436Google Scholar
  24. 24.
    Ravits J, Hallett M, Nilsson J, Polinsky R, Dambrosia J (1996) Electrophysiological tests of autonomic function in patients with idiopathic autonomic failure syndromes. Muscle Nerve 19:758–763PubMedCrossRefGoogle Scholar
  25. 25.
    Yamamoto T, Sakakibara R, Uchiyama T, Liu Z, Ito T, Awa Y, Yamamoto K, Kinou M, Yamanishi T, Hattori T (2005) When is Onuf’s nucleus involved in multiple system atrophy? A sphincter electromyography study. J Neurol Neurosurg Psychiatry 76:1645–1648PubMedCrossRefGoogle Scholar
  26. 26.
    Ravits JM (1997) AAEM minimonograph #48: autonomic nervous system testing. Muscle Nerve 20:919–937PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Yuji Tanaka
    • 1
    • 2
  • Tomohiro Kato
    • 2
  • Hiroshi Nishida
    • 1
    • 2
  • Megumi Yamada
    • 1
  • Akihiro Koumura
    • 1
  • Takeo Sakurai
    • 1
  • Yuichi Hayashi
    • 1
  • Akio Kimura
    • 1
  • Isao Hozumi
    • 1
  • Hiroshi Araki
    • 2
  • Masahiko Murase
    • 2
  • Masahito Nagaki
    • 2
  • Hisataka Moriwaki
    • 2
  • Takashi Inuzuka
    • 1
  1. 1.Department of Neurology and Geriatrics, Graduate School of MedicineGifu UniversityGifu CityJapan
  2. 2.First Department of Internal Medicine, Graduate School of MedicineGifu UniversityGifu CityJapan

Personalised recommendations