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We continuously measured blood pressure by tonometry in 30 patients during endoscopy to determine the influence of upper gastrointestinal endoscopy on cardiac events. Patients were divided into two groups: one group treated with scopolamine butylbromide as premedication (SB group) and another group without premedication (C group). Time- and frequency domain analyses of beat-to-beat systolic blood pressure variability were performed for 128 consecutive beats. For time-domain analysis, we calculated the coefficient of variation of systolic blood pressure (CV(BP)). For the frequency domain analysis, we determined the low-frequency (LF(BP); 0.04-0.15 Hz) and high-frequency (HF(BP); 0.15-0.40 Hz) powers of the variation in systolic blood pressure and the ratio of LF(BP) to HF(BP) (LF(BP)/HF(BP)) during endoscopy. The CV(BP) and HF(BP), indicators of parasympathetic tone, increased in the early phase of endoscopy but decreased significantly in the middle and late phases compared with the pre-endoscopy value. The ratio of LF(BP)/HF(BP), an indicator of indirect sympathetic tone, increased throughout the endoscopic procedure. Moreover, premedication with scopolamine butylbromide prevents the excessive parasympathetic nervous reflex when an endoscope passes through the upper digestive tract and also brings both decreased parasympathetic tone and increased sympathetic tone at the late phase of endoscopic procedure. Our results indicate that gastrointestinal endoscopy induced an autonomic nervous abnormality, which may contribute to the occurrence of cardiac events during endoscopic procedures.

Background:The relationship between 1/f¯uctuation of the heart rate variability and Helicobacter pylori infection was evaluated, in order to clarify whether autonomic nervous dysfunction is a necessary condition for chronic peptic ulcer formation. Methods: The subjects were 11 patients with recurrent chronic peptic ulcer and 20 age-matched normal subjects. Holter ECGs were recorded over 24 h, and the 1/f ±x¯u ctuation of the heart rate was computed. The 1/f ±x¯u ctuation of the heart rate is a novel index of autonomic function that has been shown to re¯ect a patient's pleasant mood. For 1/f ±x¯u ctuation, the slope of the regression line (±x) was determined and cosine ®tting of the absolute slope of the regression line over a 24-h period was performed.

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