Abstract

The use of paracetamol as tool to determine gastric emptying was evaluated in a cross over study. Twelve healthy volunteers were included and each of them consumed two low and two high caloric meals. Paracetamol was mixed with a liquid meal and administered by a nasogastric feeding tube. The post prandial paracetamol plasma concentration time curve in all participants and the paracetamol concentration in the stomach content in six participants were determined. It was found that after paracetamol has left the stomach, based on analysis of the stomach content, there was still a substantial rise in the plasma paracetamol concentration time curve. Moreover, the difference in gastric emptying between high and low caloric meals was missed using the plasma paracetamol concentration time curve. The latter curves indicate that (i) part of the paracetamol may leave the stomach much quicker than the meal and (ii) part of the paracetamol may be relatively slowly absorbed in the duodenum. This can be explained by the partition of the homogenous paracetamol-meal mixture in the stomach in an aqueous phase and a solid bolus. The aqueous phase leaves the stomach quickly and the paracetamol in this phase is quickly absorbed in the duodenum, giving rise to the relatively steep increase of the paracetamol concentration in the plasma. The bolus leaves the stomach relatively slowly, and encapsulation by the bolus results in relatively slow uptake of paracetamol from the bolus in the duodenum. These findings implicate that paracetamol is not an accurate post prandial marker for gastric emptying. The paracetamol concentration time curve rather illustrates the food-drug interaction on absorption, which is not only governed by gastric emptying.Trial RegistrationClinicalTrials.gov NCT01335503 Nederlands Trial Register NTR2780

Highlights

  • In order to display a systemic biological effect most compounds first have to be absorbed from the gastro-intestinal tract

  • The rate of paracetamol uptake into the plasma would be governed by gastric emptying and gastric emptying might be deduced from the time course of the plasma concentration of paracetamol [2,3,4,5]

  • A liquid meal was administered as a slurry by a nasogastric feeding tube

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Summary

Introduction

In order to display a systemic biological effect most compounds first have to be absorbed from the gastro-intestinal tract. Gastric emptying is considered to be the bottleneck in uptake, and numerous studies have been conducted on the effect of nutrition and disease on this process. It is assumed that the passage time of paracetamol through the stomach is identical to that of the meal. Based on these assumptions, the rate of paracetamol uptake into the plasma would be governed by gastric emptying and gastric emptying might be deduced from the time course of the plasma concentration of paracetamol [2,3,4,5]

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