Proceedings of the International Conference on Computer and Communication Engineering 2008 May 13-15, 2008 Kuala Lumpur, Malaysia

Investigation of Digestive System Disorders using Electrogastrogram

G.Gopu1, R.Neelaveni2, K.Porkumaran3

1
Dept. of EEE. PSG College of Technology, Coimbatore- 04
2
Dept. of EEE. PSG College of Technology, Coimbatore- 04
3
Dept. of BME, Sri Ramakrishna Engineering College, Coimbatore-22
Email (gopugovindasamy@gmail.com))

Abstract recurrent nausea, vomiting, Dyspepsia, Stomach ulcer,

Most of the people around the world face the
problems related to health especially due to the food
intake and disorders in the digestive system. Nowadays
Endoscope procedure is followed to investigate the
problems in the digestive system disorders, which is a
tedious, expensive and invasive method. A non-
invasive, cheap and painless method called
Electrogastrogram (EGG) has been devised for the
detection of electrical signal cutaneously from the
stomach and it is an initial mode of investigation for
gastric disorders before encouraging the Endoscope
procedure for uncomplicated Gastric disease and
benign (non cancer). The main objective of this paper
is to propose a simple method of finding the digestive
system’s disorders more easily and accurately using
Virtual Instrumentation (VI) based EGG. The
recording setup or the model explained in this
proposed system helped us to record the EGG for more
than hundred patients, nearly 70-75% of the patient
results in digestive system’s disorder such as
Dyspepsia (D), Stomach Ulcer (SU), Gastric
Esophagus Reflux Disease (GERD), Nausea (N),
Cyclic Vomiting Syndrome, etc. For the above said
digestive system’s disorder dissimilarity is found in its
frequency, amplitude, power spectrum analysis and the
statistical analysis compared with its normal
individual parameter at a high fair amount of
accuracy.
Keywords:
Digestive system, Electrogastrogram, Dyspepsia,
Gastric Esophagus Reflux Disease, Nausea, Virtual
Instrumentation.
I. INTRODUCTION
An EGG is a non-invasive test used to measure
gastric myoelectrical activity [1, 2]. The normal gastric
myoelectrical activity consists of a slow wave and
spike potential. The abnormality arises due to
Cyclic vomiting syndrome, etc which signals that the
stomach is not emptying food normally. If the EGG is
abnormal, it confirms that the problem probably is with
the stomach's muscles or the nerves that control the
muscles. This paper deals with the novel approach of
recording of the electrical signals that travel through
the muscles of the stomach and control the muscle’s
contraction. The EGG can be considered as an
experimental procedure since its exact role in the
diagnosis of digestive disorders of the stomach has not
been defined yet.
II. ELECTROGASTROGRAM
An EGG is similar to an electrocardiogram of the
heart. It is a recording of the electrical signals that
travel through the muscles of the stomach and control
the muscle’s contraction. EGG used when there is a
suspicion that the muscles of the stomach or the nerves
controlling the muscles are not working normally.
EGG done by placing the electrode cutaneously over
the stomach and the electrical signals coming from the
stomach’s muscles are sensed by the electrode and
recorded on a computer for analysis by lying patient
quietly. In normal individuals the EGG is a regular
electrical rhythm generated by the muscles of the
stomach and the power (voltage) of the electrical
current increases after the meal. In patients with
abnormalities of the muscles or nerves of the stomach,
the rhythm often is irregular or there is no post-meal
increase in electric power. EGG will not have any side
effects and it is painless study.
III. PROPOSED EGG RECORDING SETUP
The sensors used in this recording setup are
Ag/Agcl electrodes [4, 3, 5]. The electrodes are used to
tap the electrical signals directly surface of the
stomach. The electrical signals generated are usually of
very low amplitude ranging from 0.01 to 0.5 mV.This
is given as a input to an instrumentation amplifier
which has a gain of 1000 to 10,000. The amplified

978-1-4244-1692-9/08/$25.00 ©2008 IEEE 201

signals are input to a second order low pass
Butterworth filter to remove the noises and ripples.
The analog output of the filtered signal is converted
to digital through Analog to Digital Converter (ADC)
and then through a zero crossing detector circuit to
obtain the amplitude and frequency of the signals
respectively. These outputs are then given to a
microcontroller circuit which transfers the digital
outputs to the PC, where the LabVIEW software is
installed to view them in a readable form. A serial
interfacing circuit (RS232) is used to interface the
Microcontroller to the PC as shown in Figure 1 below.
Figure 1. General block diagram for recording EGG
IV. ELECTRODES POSITIONING
The electrical signals are generally produced in the
mid-corpus of the stomach where the electrical activity
takes place. The positioning of the Ag/ Agcl
electrodes
Figure 2. Electrode Positioning for Recording EGG
202
for tapping of these signals is as shown Figure 2. Two
electrodes A and B are placed in the fundus and the
mid corpus of the stomach. The third electrode C is
placed as ground at the end of the stomach region for
patient safety [4].
V. MATERIALS AND METHOD
The digestive system disorder patients
consecutively attending a hospital outpatient’s
gastroenterology clinic were studied. All patients were
considered by their general practitioner to have
significant symptoms to merit referral to a specialist
clinic for further evaluation and investigation. The
patients included 70 with Dyspepsia, 20 with Nausea,
and 30 with Stomach ulcer shown in Table 1.
Hematological and biochemical profiles were normal
in all patients.
SEX AND AGE DISTRIBUTION OF PATIENT GROUPS
Disorders D SU N
(n=70) (n=30) (n=20)
Mean age (yr) 44 33 44
Female / Male 30/40 14/16 6/14
n- No. patients: D- Dyspepsia; SU- Stomach Ulcer; N- Nausea.
A gastrointestinal symptom profile was recorded on
all patients immediately before the EGG [10, 11]. This
profile detailed the presence or absence of the
following dyspeptic symptoms in the previous 2
weeks: Dyspepsia (D), Stomach ulcer (SU), Nausea
(N) and Cyclic vomiting syndrome. The EGG was
performed after a 6 hours fasting. All medication with
the potential affect to gastric function was
discontinued for more than 48 hours before the
recording. Patients were studied in a semi recline
position and requested to avoid any major movements.
The skin was lightly abraded with gauze before
placement of adhesive gel EGG electrodes. Two
bipolar skin electrodes were placed on the abdomen,
one on the fundus and the other on the mid-corpus. A
reference electrode was placed on the right side of the
abdomen. The electrodes were connected to a signal
conditioning unit (SCU). The EGG recording included
a 1 hour fasting study, after which the patient ate a
sandwich (575 kcal, 50% carbohydrate, 25% protein,
25% fat) and drank 200ml of water. This was
immediately followed by another 1 hour recording.
Visual inspection of the waveform detected any
obvious major movement artifacts. These were defined
as abnormally large positive or negative peaks in the
tracing and were detected from the analysis. The EGG
data was observed by the LabVIEW software running
on a personal computer. The EGG frequency
,amplitude are recorded and its respective values are
stored for further analysis of the same to investigate
the digestive system disorders as shown in Figure 3.
Figure 3. A and B are recorded EGG from Dyspepsia, Nausea
patients respectively.
A sampling frequency of 4Hz was used. The EGG
analysis is based on the frequency and amplitude of the
signals. For the periods before and after the test meal,
the frequency and amplitude values are observed.
Normal electrical activity was defined as a frequency
between 2-4 cycles per minute [6, 7]. Activity of 0-2
203
cycles per minute was termed bradygastria, and 4-9
cycles per minute as tachygastria. The percentage of
normal electrical activity, bradygastria, and
tachygastria were calculated both before and after the
test meal. The amplitude of the dominant frequency
was measured both before and after the test meal. The
electrical frequency is stable and does not change
significantly after a standard test meal.
VI. ALGORITHM
1. Lightly abrade the skin with abrasive pads, and put a
spot of gel on the electrode contact area.
2. Two electrodes are placed on the Fundus and the
mid-corpus and a reference electrode is placed on
the right side of the abdomen.
3. The output of the electrodes is given to the
Instrumentation amplifier.
4. The amplified output signal is filtered using Second
order Low pass Butterworth filter.
5. The output of the filter is given to zero crossing
detectors which convert the voltage to frequency.
6. This frequency is then given to the microcontroller
which takes all the data collected per second.
7. This collected data is taken in by the microcontroller
and this is transferred to the computer with a serial
interface circuit for bit by bit transfer.
8. This data is displayed on the PC using LabVIEW
software and the data’s are recorded for preprandial
and postprandial conditions.
9. The threshold for detection of various disorders was
fixed based on the observations and in consultation
with the physician. It is observed to be similar to the
E J Van der Schee findings.
VII. RESULTS AND DISCUSSION
The effectiveness of the proposed methodology is
illustrated and the Table 2 shows the range of
frequencies and amplitudes for various abnormalities
at preprandial and postprandial condition as observed
from the recording setup in consultation of physician
for about 120 subjects. The Figure 4 shows the various
waveforms obtained for various diseases. In this study,
we used the EGG to record myoelectrical activity for
the patients suffering from Dyspepsia, Stomach ulcer,
and Nausea. The abnormal EGG has a high specificity
for the detection of abnormal myoelectrical activity
[8]. The observation that the test meal can worsen or
correct the EGG reflects the interaction between
fasting, feeding, and electrical activity. The effect of
fasting or feeding indicates that both an abnormality
and change in the EGG recording. A postprandial
power reduction has been proposed as an EGG
abnormality, and correlated with gastroparesis [7, 9].
 FREQUENCY AND AMPLITUDE RANGES OF
VARIOUS DISORDERS OF STOMACH
Figure 4. Waveforms for different disease patterns. Normal
patient Waveform with 3 cycles per minute as frequency
(recording A). A dyspepsia patient wave pattern (recording B). A
Nausea patient wave pattern (recording C). A Vomiting patient
wave pattern (recording D).An Ulcer patient wave pattern
(recording E).
However, in this study, eight subjects demonstrated a
postprandial power reduction, indicating that power
reduction is an unreliable sign. The significance of
power reduction after meals has also been questioned
by a recent study comparing internal gastric electrical
activity with the EGG. There are important practical
implications stemming from this study. In the absence
204
of readily available tests in functional dyspepsia, there
has been an assumption that patients with functional
dyspepsia entered into clinical trials represent a
homogeneous group. This study indicates that it is
possible to identify a subgroup of patients with EGG
evidence of abnormal gastric myoelectrical activity
that is likely to have antral hypomotility. The EGG
could help distinguish stomach ulcer from dyspepsia in
clinical trials. The treatment of dyspepsia should be
aimed at correcting physiological abnormalities [10]. A
normal or abnormal EGG will not only help
distinguish patient heterogeneity in clinical studies but
might also provide a useful objective marker of
treatment effect. Further studies of statistical analysis,
power spectrum and by using LabVIEW software in
dyspepsia patients, with and without an abnormal EGG
will help to determine whether these other
abnormalities define more coherent or overlapping
subtypes of disorder.
VIII. CONCLUSIONS
A simplified novel approach is proposed in this
paper for recording of gastro electrical activity. The
EGG setup is used to record the activity of patients
suffering from digestive disorders like Dyspepsia (D),
Stomach ulcer (SU), Nausea (N) and Cyclic vomiting
syndrome. About more than 100 patients were tested
using this setup and the results are summarized based
on the observation. In future, NI based LabVIEW can
be used with its associated Data Acquisition card and
hardware to perform further analysis which may
improve the accuracy of diagnosis and also increase
the scope.
ACKNOWLEDGMENT
The authors acknowledge their indebtedness to the
following medical experts Dr L Venkatakrishnan,
M.D., D.M.,D.N.B., Head of Gastroenterology Dept.,
Dr.J.Krishnaveni, M.D.,D.N.B., Gastroenterologist
from PSG Hospitals, Coimbatore and Dr M G Shekar,
M.S., D.N.B., M.R.C.S., Laparoscopic surgeon Stanley
Medical College and Hospital, Chennai for their
support and for permitting us to use the facilities at the
hospitals for live testing of the recording setup and
sharing valuable patient database with us.
REFERENCES
[1] W.C.Alvarez. “The Electrogastrogram and what it shows”.
JAMA 1922, vol 78, pp.1116–1118.
[2] A.J.P.M. Smout, E.J. Van Der Schee, J.L.Grashuis,” What is
measured in electrogastrography?” Digestive Diseases and
Sciences 1980, pp.253.
[3] T.L.Abell, J.R.Malagelada,” Electrogastrography: Current
assessment and future perspectives”. Digestive Diseases and
Sciences 1988, vol 33, pp.982–992.
[4] J. Chen, R.W. McCallum,” Electrogastrography: measurement,
analysis and prospective applications”. Medical &Biological
Engineering & Computing 1991, vol 29, pp.339–350.
[5] G.Riezzo, F.Pezzolla,J. Thouvenot , et al,” Reproducibility of
cutaneous recordings of electrogasography in the fasting state
in man. Pathology Biology 1992, vol 40, pp.889–894.
[6] M.P. Mintchev, Y.J. Kingma, K.L. Bowes,” Accuracy of
coutaneous recordings of gastric electrical activity”.
Gastroenterology 1993, vol 104, pp.1273–1280.
[7] J. Chen, R.W. McCallum,”Gastric slow wave abnormalities in
patients with gastroparesis”. Am J Gastroenterology 1992, vol
87, pp.477-482.
205
[8] B.Pfaffenban,R.J.Adamek, K.kuhn, et al. “Electrogastrography
in healthy subjects. Evalation of normal values influences of
age and gender”. Digestive Diseases and Sciences 1995, vol 40,
pp.445-450.
[9] J.D.Z.Chen,Z.Lin, I.Pan, et al.”Abnormal gastric myoelectrical
activity and delayed gastric emptying in patients with
symptoms suggestive of gastroparesis”. Digestive Diseases and
Sciences 1996, vol 41, pp.1538-1545.
[10] A.Leahy, K.Besherdas, C.Clayman, I.Mason, O.Epstein.
”Abnormalities of the electrogastrogram in functional
dyspepsia”. American Journal of Gastroenterology 1999, vol
94(4), pp.1023–1028.
[11] DZ Chen, Zhiyue Lin ,” Electrogastrogram-Encyclopedia of
Medical Devices and Instrumentation”, Second Edition, edited
by John G. Webster, John Wiley & Sons,Inc.2006.