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An '''electrogastrogram''' (EGG) is a graphic produced by an '''electrogastrograph''', which records the electrical signals that travel through the [[stomach]] muscles and control the muscles' contractions. An '''electrogastroenterogram''' (or '''gastroenterogram''') is a similar procedure, which writes down electric signals not only from the stomach, but also from [[intestines]].

These names are made of different parts: ''electro'', because it is related to electrical activity, ''gastro'', [[Greek language|Greek]] for stomach, ''entero'', Greek for intestines, ''gram'', a Greek root meaning "to write".

An electrogastrogram and a gastroenterogram are similar in principle to an [[electrocardiogram]] (ECG) in that sensors on the skin detect electrical signals indicative of muscular activity within. Where the electrocardiogram detects muscular activity in various regions of the heart, the electrogastrogram detects the wave-like contractions of the stomach ([[peristalsis]]).

[[Walter C. Alvarez]] pioneered early studies of electrogastrography in 1921-22.<ref>{{cite journal|doi=10.1001/jama.1922.02640680020008|author=Alvarez W. C.|title=The electrogastrogram and what it shows|journal=[[Journal of the American Medical Association|J Am Med Assoc.]]|volume=78|issue=15|pages=1116–19|date=April 15, 1922|url=http://jama.ama-assn.org/cgi/content/summary/78/15/1116}}</ref>

==Physiological basis of electrogastroenterography==
[[Motility]] of GI tract is results from coordinated contractions of [[smooth muscle]], which in turn derive from two basic patterns of electrical activity across the [[Cell membrane|membranes]] of smooth muscle cells&nbsp;— [[Slow wave potential|slow waves]] and [[action potential]]s.<ref>{{cite web|author=Bowen R.|title=Electrophysiology of Gastrointestinal Smooth Muscle|date=November 23, 1996|accessdate=February 12, 2008|url=http://www.vivo.colostate.edu/hbooks/pathphys/digestion/basics/slowwaves.html}}</ref> Slow waves are initiated by pacemakers&nbsp;— the [[interstitial cell of Cajal|interstitial cells of Cajal]] (ICC). Slow wave frequency varies in the different organs of the GI tract and is characteristic for that organ. They set the maximum frequency at which the muscle can contract:
* stomach&nbsp;— about 3 waves in a minute,
* [[duodenum]]&nbsp;— about 12 waves in a minute,
* [[ileum]]&nbsp;— about 8 waves in a minute,
* [[rectum]]&nbsp;— about 17 waves in a minute.<ref>{{cite book|url=http://www.lib.mcg.edu/edu/eshuphysio/program/section6/6ch3/s6ch3_5.htm|page=5|chapter=3|title=GI Smooth Muscle Electrophysiology: Slow Waves (Basal Electric Rhythm)|author=Ginzburg G. V., Costoff A.|chapter=Gastrointestinal Physiology. Gastrointestinal Motility}}</ref>
* [[jejunum]]&nbsp;— about 11 waves in a minute.<ref>{{cite journal |last1=Waldhausen |first1=JH |last2=Shaffrey |first2=ME |last3=Skenderis Bs |first3=2nd |last4=Jones |first4=RS |last5=Schirmer |first5=BD |author8=Waldhausen JH, Shaffrey ME, Skenderis BS, Jones RS, Schirmer BD |title=Gastrointestinal myoelectric and clinical patterns of recovery after laparotomy |journal=Ann. Surg. |volume=211 |issue=6 |pages=777–84; discussion 785 |date=June 1990 |pmid=2357140 |pmc=1358137 |doi=10.1097/00000658-199006000-00018 }}</ref>

The electrical activity of the GI tract can be subdivided into two categories: electrical control activity (ECA) and electrical response activity (ERA). ECA is characterized by regularly recurring electrical potentials, originating in the gastric pacemaker located in the [[body of stomach]].
The slow waves are not a direct reason of peristalsis of a GI tract, but a correlation between deviations of slow waves from norm and motility abnormalities however is proved.<ref>{{cite journal |author=Parkman HP, Hasler WL, Barnett JL, Eaker EY |title=Electrogastrography: a document prepared by the gastric section of the American Motility Society Clinical GI Motility Testing Task Force |journal=Neurogastroenterol. Motil. |volume=15 |issue=2 |pages=89–102 |date=April 2003 |pmid=12680908 |url=http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1350-1925&date=2003&volume=15&issue=2&spage=89 |doi=10.1046/j.1365-2982.2003.00396.x}}</ref>

==Cutaneous electrogastrography==
Electrogastrogram can be made from the gastrointestinal [[mucosa]], [[serosa]], or skin surface. The cutaneous electrogastrography and provides an indirect representation of the electrical activity but it is much easier and therefore cutaneous electrogastrography has been used most frequently.

Several EGG signals are recorded from various standardized positions on the abdominal wall and to select the one with the highest amplitude for further analysis. For this purpose usually use three or more [[Silver chloride electrode|Ag-AgCl]] electrodes.<ref name=Ste>{{cite book |author=Stendal, Charlotte |title=Practical guide to gastrointestinal function testing |publisher=Blackwell Science |location=Oxford |year=1997 |isbn=0-632-04918-9 }}</ref>  Recordings are made both fasting (usually 30 minutes) and after a meal (usually 60 minutes) with the patient lying quietly. Deviations from the normal frequency may be referred to as bradygastria or tachygastria.

In normal individuals the power of the electrical signals increases after the meal. In patients with abnormalities of stomach motility, the rhythm often is irregular or there is no postprandial increase in electrical power.

===Bradygastria, normogastria and tachygastria===
<!--Please do not correct the name of this section! On it there are references from other articles-->
Terms bradygastria and tachygastria are used at the description of deviations of frequency of an electric signal from slow waves are initiated by pacemaker in the stomach from normal frequency of 3 cycles per minute.

A '''bradygastria''' is defined, how decreased rate of electrical activity in the stomach, as less than 2 cycles per minute for at least 1 minute.

A '''tachygastria''' is defined, how increased rate of electrical activity in the stomach, as more than 4 cycles per minute for at least 1 minute.

A bradygastria and tachygastria may be associated with [[nausea]], [[gastroparesis]], [[irritable bowel syndrome]], and [[functional dyspepsia]].<ref>MediLexicon. [http://www.medilexicon.com/medicaldictionary.php Definitions of "Bradygastria" and "Tachygastria"].</ref>

===CPT and HCPCS codes for electrogastrography===
There are following [[Current Procedural Terminology]] (CPT) and [[Healthcare Common Procedure Coding System]] (HCPCS) codes (maintained by the [[American Medical Association]]) for cutaneous electrogastrography:<ref>[http://www.gastro.org/user-assets/Documents/12_eDigest/080907/2008%20Proposed%20HOPD%20ASC%20rule%2007-3509.pdf Federal Register. Vol. 72, No. 148 /Thursday, August 2, 2007/ Proposed Rules, 42997].</ref>
{| class="wikitable"
|-
! CPT/HCPCS-code
! Procedure
|-
| 91132
| Electrogastrography, diagnostic, transcutaneous
|-
| 91133
| Electrogastrography, diagnostic, transcutaneous; with provocative testing
|}

==Electrogastroenterography==
<!--Please do not correct the name of this section! On it there are references from other articles-->
An electrogastroenterography (EGEG) is based that different organs of a GI tract give different frequency slow wave.

{| class="wikitable"
|-
! Organ of gastrointestinal tract
! Investigated range ([[Hertz|Hz]])
! Frequency number (i)
|-
| [[Large intestine]]
| 0.01&nbsp;– 0.03
| 5
|-
| [[Stomach]]
| 0.03&nbsp;– 0.07
| 1
|-
| [[Ileum]]
| 0.07&nbsp;– 0.13
| 4
|-
| [[Jejunum]]
| 0.13&nbsp;– 0.18
| 3
|-
| [[Duodenum]]
| 0.18&nbsp;– 0.25
| 2
|}
EGEG electrodes are as much as possible removed from a stomach and an intestines&nbsp;—  usaually three electrodes are placed on the extremities. It allows to receive stabler and comparable results.

===The computer analysis of electrogastroenterograms===
[[Image:Example of 3D gastroenterogramm.jpg|thumb|300px|3D human gastroenterogramm. On a vertical axis a spectrum of signal from GI smooth muscle in µV. Frequency ranges from left to right: large intestine, stomach, ileum, jejunum, duodenum]]
An electrogastroenterography analysis program calculate<ref name=Stu>Stupin V. A., et al. [http://www.gastroscan.ru/above3/stup01.htm Peripheral Electrogastroenterography in Clinical Practice] // Лечащий Врач.-2005.-№ 2.-С. 60-62 {{ru icon}}.</ref>
*'''P(i)'''&nbsp;— capacities of an electric signal separately from each of organ of GI tract in corresponding range of frequencies:
: <math>P(i) = \sum_{n=st_i}^{n=fin_i} |S(n)|^2,    i = 1, \dots, 5 </math>
where '''S(n)'''&nbsp;— spectral components in the rank from st<sub>i</sub> to fin<sub>i</sub> (defined by received investigated range of this organ of GI tract) by [[Discrete Fourier transform]] of the electric signal from GI tract.
*'''PS'''&nbsp;—  the general (total) capacity of an electric signal from five parts of GI tract:
: <math>PS = \sum_{i=1}^{i=5} P(i).</math>
*'''P(i)/PS'''&nbsp;— the relative electric activity.
*'''Kritm(i)'''&nbsp;— rhythm factor
: <math>Kritm (i) =  \frac{1}{fin_i -st_i} \sum_{n=st_i}^{n=fin_i -1} |S(n)-S(n-1)|,    i = 1, \dots, 5 </math>

EGEG parametres for normal patients:<ref name=Stu/>
{| class="wikitable"
|-
! Organ of gastrointestinal tract
! Electric activity P(i)/PS
! Rhythm factor Kritm(i)
! P(i)/P(i+1)
|-
| Stomach
| 22.4±11.2
| 4.85±2.1
| 10.4±5.7
|-
| Duodenum
| 2.1±1.2
| 0.9±0.5
| 0.6±0.3
|-
| Jejunum
| 3.35±1.65
| 3.43±1.5
| 0.4±0.2
|-
| Ileum
| 8.08±4.01
| 4.99±2.5
| 0.13±0.08
|-
| Large intestine
| 64.04±32.01
| 22.85±9.8
|&nbsp;—
|}

==Psychological applications of electrogastrograms==
Psychologists have performed psychophysiological studies to see what happens in the body during affective experiences.  Electrogastrograms have recently been used to test physiological [[arousal]], which was already determined by measures such as [[heart rate]], [[Skin conductance|electrodermal skin responses]], and changes in hormone levels in [[saliva]].<ref name=genderdifferences>{{cite journal|last=Rohrmann|first=Sonja|coauthors=Hopp, Henrik, Quirin, Markus|title=Gender differences in psychophysiological responses to disgust|journal=Journal of Psychophysiology|year=2008|volume=22|issue=2|pages=65–75}}</ref>

Currently, a pattern of interest to psychologists is an increase in bradygastria,which is when electrical activity in the stomach drops to below 2 cpm resulting in a slower stomach rhythm, when exposed to [[disgust]] stimuli, which may be a precursor to nausea and vomiting, both physiological responses to disgust.<ref name=Bradygastria>{{cite journal|last=Meissner|first=Karin|coauthors=Muth, Eric R., Herbert, Beate M.|title=Bradygastic activity of the stomach predicts disgust sensitivity and perceived disgust intensity|journal=Biological Psychology|date=1 Oct 2010|year=2011|volume=86|pages=9–16|doi=10.1016/j.biopsycho.2010.09.014}}</ref> In this study, the presence of bradygastria was able to predict trait and state disgust, which no other physiological measure used in the study was able to detect.<ref name=Bradygastria /> This abnormal myoelectrical activity is usually combined with other precursors to nausea and vomiting, such as increased salivary production, which further supports the idea that these rhythms show early signs of nausea and vomiting. These reactions are viewed as a way in which the body rejects unhealthy foods,<ref name=Bradygastria /> which is linked with the view that disgust is an [[evolution]]ary adaptation to help humans avoid consuming toxic substances.<ref name=Bradygastria /><ref name=Tofudogs />

During sham feeding sessions of both appetizing and unappetizing foods, 3 cycles per minute (cpm) power was measured. During the sham feeding of appetizing foods, 3cpm power increased. This increase was not reported in the sham feeding of unappetizing foods.<ref name=Tofudogs>{{cite journal|last=Stern|first=Robert M.|coauthors=Jokerst, M.D., Levine, M.E., Koch, K.L.|title=The stomach's response to unappetizing food: cephalic-vagal effects on gastric myoelectric activity|journal=Neurogastroenterology and Motility|date=April 2001|year=2001|volume=13|issue=2|pages=151–154}}</ref> The researchers concluded that the presence of this pattern seems to mark the beginning of the body preparing for [[digestion]], and the absence of this pattern in the disgust condition could indicate that the body is readying to reject the food.<ref name=Tofudogs /> The increase of 3cpm power is also linked with increased saliva and digestive juice production, all of which support the idea that this reflex, called the [[Regulation of gastric function|cephalic-vagal reflex]],<ref name=Tofudogs /> is the precursor of digestion. The differential response to appetizing and unappetizing foods suggest that the body uses disgust as a cue to whether a food is good to eat and responds accordingly.

Another emotion with a bodily effect that can be measured by EGG is that of [[stress (psychological)|stress]].  When the body is stressed and engages in the [[fight-or-flight response]], blood flow is directed to the muscles in the arms and legs and away from the digestive system. This loss of blood flow slows the digestive system, and this slowing can be seen on the EGG.<ref name=handbookofpsychophysiology>{{cite book|last=Stern|first=Robert M.|title=Handbook of Psychophysiology|year=2007|publisher=Cambridge University Press|location=Cambridge|pages=211–230|edition=3rd|coauthors=Koch, Kenneth L, Levine, Max E., Muth, Eric R.|editor=Cacioppo, John T., Tassinary, Louis G., Berntson, Gary G.}}</ref> However, this response can vary from person to person and situation to situation.<ref name=handbookofpsychophysiology />

All of these examples are part of a larger theory of a [[Neurogastroenterology|brain–gut connection]]. This theory states that the [[vagus nerve]] provides a direct link between the brain and the gut so that emotions can affect stomach rhythms and vice versa.<ref name=Tofudogs /><ref name=handbookofpsychophysiology /> This idea originated in the mid-1800s when [[Alexis St. Martin]], a man with a gunshot-induced [[fistula]] in his abdomen, experienced lower secretions of digestive juices and a slower stomach emptying when he was upset.<ref name=handbookofpsychophysiology /> In this case, the emotions St. Martin was feeling affected his physiological reaction, but the reverse can also be true. In a study with [[Crohn's disease]] patients where patients and unaffected controls watched happy, frightening, disgusting, and saddening films, patients with active Crohn's disease had more responsive EGG (a greater physiological response) and reported feeling more aroused when feeling the negative emotions of disgust or sadness.<ref name=increasedfeelings>{{cite journal|last=Vianna|first=Eduardo P.M.|coauthors=Weinstock, Joel, Elliot, David, Summers, Robert, Tranel, Daniel|title=Increased feelings with increased body signals|journal=Scan|year=2006|volume=1|pages=37–48}}</ref> This leads researchers to believe that increased physiological activation can influence increased experience of emotions.<ref name=increasedfeelings />  Another study published in 1943 that studied the fistulated man Tom discovered that if "Tom was fearful or depressed his gastic activity decreased but when he was angry or hostile his gastric activity increased".<ref name=handbookofpsychophysiology /> This finding is contrasted by an EGG study by Ercolani et al. who had subjects perform either difficult or easy mental arithmetic or puzzles. They found that new tasks slowed down the myoelectrical activity of the stomach, suggesting that [[Stress (psychological)|stress]] tends to impede gastric activity and that this can be picked up on an EGG.<ref name=effectsoftwotasks>{{cite journal|last=Ercolani|first=Mauro|coauthors=Baldaro, Bruno, Trombini, Giancarlo|title=Effects of Two Tasks and Two Levels of Difficulty on Surface Electrogastrograms|journal=Perceptual and Motor Skills|year=1989|volume=69|pages=99–110}}</ref> While there is still much research to be done on the brain-gut connection, research thus far has indeed shown that your stomach does indeed churn differently when you are emotionally aroused,<ref name=gasticmyoelectricalactivityemotionalarousal>{{cite journal|last=Vianna|first=E.P.M.|coauthors=Tranel, D.|title=Gastric Myoelectrical Activity as an Index of Emotional Arousal|journal=International Journal of Psychophysiology|year=2006|volume=61|pages=70–76}}</ref> and this could be the basis of the gut feeling that many people describe experiencing.

===Gender differences===
In recent years, some research has been done about [[Sex differences in humans|gender differences]] in the perception and experience of disgust.  One such study, upon presenting both male and female subjects with video clips designed to trigger disgust and found that although women reported feeling more disgust than men at these stimuli, the physiological responses did not show much difference.<ref name=genderdifferences /> This could mean that, psychologically, women are more sensitive to disgust than men; however this assertion cannot be supported with physiological data.<ref name=genderdifferences /> More research has to be done in this area to see if there are gender differences in the psychophysiological experience of disgust.

==Not solved problems==
There are some lacks limiting an electrogastroenterography use in practice:
*an absence of a standard technique of performance peripheral electrogastroenterography,
*an absence of a standard norms of electrophysiological parametres of bioelectric activity GT tract,
*an impossibility of an estimation of change of motility abnormalities during the concrete moments of time on local sites of GI tract.

==Other updatings of  electrogastrography==
* 24-hour electrogastrography and electrogastroenterography.
* The joint electrogastroenterography with [[24-hours pH-metry]].
* [[Wavelet analysis]] of electrogastroenterogram.<ref>{{cite journal |author=Tokmakçi M |title=Analysis of the electrogastrogram using discrete wavelet transform and statistical methods to detect gastric dysrhythmia |journal=J Med Syst |volume=31 |issue=4 |pages=295–302 |date=August 2007 |pmid=17685154 |url=http://www.ingentaconnect.com/content/klu/joms/2007/00000031/00000004/00009069 |doi=10.1007/s10916-007-9069-9}}</ref>
* [[Telemetry]] capsule for the EGG monitoring in a stomach and an intestines.<ref>Jung E.S., et al. [http://www.actapress.com/PaperInfo.aspx?PaperID=23412&reason=500 Design and Implementation of the Telemetry Capsule for Measuring of Electrogastrography]. Proceedings of the 24th IASTED international conference on Biomedical engineering. Innsbruck, Austria, pp. 209-213, 2006,
ISBN 0-88986-578-7.</ref>

==Clinical applications of electrogastrography and gastroenterography==
Electrogastrography or gastroenterography used when a patient is suspected of having a motility disorder, which can be shown, as recurrent nausea and vomiting, signs that the stomach is not emptying food normally. The clinical use of electrogastrography has been most widely evaluated in patients with gastroparesis and functional dyspepsia.

==See also==
*[[Interstitial cell of Cajal]]

==Sources==
*{{cite book |author=Stern, Robert Mitchell; Koch, Kenneth |title=Handbook of electrogastrography |publisher=Oxford University Press |location=Oxford [Oxfordshire] |year=2004 |isbn=0-19-514788-X }}
*Mintchev M. [http://www.enel.ucalgary.ca/People/Mintchev/stomach.htm Selected Topics on Electrogastrography: Electrical phenomena in the human stomach].
*{{cite book |author=Kosenko P.M.; Vavrinchuk S.A. |title=Electrogastroenterography in patients with complicated peptic ulcer disease |url = http://www.gastroscan.ru/literature/pdf/vavrinchuk-sa-3.pdf |publisher=Science Book Publishing House |location=Yelm, WA, USA | year=2013 |pages = 142 |isbn=978-1-62174-026-1 }}

==References==
{{reflist|2}}

{{Digestive system procedures}}
{{Electrodiagnosis}}

[[Category:Diagnostic gastroenterology]]
[[Category:Electrodiagnosis]]