Emptying Rate Research Articles

Prognostic Tests of Intolerance to Postpyloric Feeding in Early Acute Pancreatitis

Aim. To evaluate the effectiveness of postpyloric feeding in early predicted severe acute pancreatitis using acetaminophen absorption test and gastric emptying rate.Material and methods. An open observational prospective cohort study in the intensive care unit of OAO «Neftyanik» hospital in the city of Tyumen, Russia, from November 2012 to October 2018 was performed. All included patients were diagnosed with predicted severe acute pancreatitis (inclusion criterion). The rate of gastric emptying was assessed using an original ultrasound technique which involved measuring the fluid volume 30 min and 60 min after administering of 200 mL aliquote of water into the stomach. Acetaminophen absorption test was performed according to the following procedure: 0.5 g of acetaminophen was administered through the nasojunal tube placed 30–40 cm distal to the Treitz ligament using endoscope, the blood level of the drug was measured 5–20 min later.Results. Gastric fluid volume at 60 min (OR=1.049, 95% CI: 1.028–1.07, P<0.001 with AUC=0.921, 95% CI: 0.808–0.944 and cutoff value of 73.5) was a significant predictor of residual gastric volume ≥ 500 mL/d and intolerance to enteral feeding through the nasojejunal tube (OR=1.023, 95% CI: 1.009–1.036, P=0.001 with AUC 0.752, 95% CI: 0.629–0.875, with cutoff value of 79.5). The acetaminophen small intestine absorption test was reliable in predicting the residual gastric volume ≥ 500 mL/d for the early period of disease. The acetaminophen absorption test was a significant predictor of intolerance to enteral feeding through the nasojejunal tube only in patients with severe acute pancreatitis (OR=0.834, 95% CI: 0.733–0.949, P<0.001 with AUC=0.894, 95% CI: 0.770–0.1 with cutoff value of 14.6).Conclusion. Throughout the early period of acute pancreatitis, gastric fluid volume measured 60 min after the administration of 200 mL of water, accurately predicts the residual gastric volume I 500 mL/day. Acetaminophen absorption test in the small intestine can reliably predict intolerance to postpyloric feeding only for patients with severe acute pancreatitis.

A Pilot Study to Assess Glucose, Insulin, and Incretin Responses Following Novel High Resistant Starch Rice Ingestion in Healthy Men.

IntroductionA newly developed resistant starch (RS) rice line with double mutation of starch synthase IIIa and branching enzyme IIb (ss3a/be2b) exhibits a tenfold greater percentage RS value than the wild-type rice line. Currently, the effects of cooked rice with such high RS content on secretion and action of glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) are unclear. Therefore, we conducted a pilot study to assess postprandial responses of GLP-1 and GIP along with glucose and insulin and also gastric emptying after ingestion of the high-RS cooked rice with ss3a/be2b in healthy subjects.MethodsIn a non-randomized crossover design, five healthy men ingested two test foods, control (low-RS) and high-RS cooked rice, with at least 1-week washout period between testing days. Plasma glucose, serum insulin, plasma total GLP-1, plasma total GIP, and also gastric emptying rate were measured after ingestion of each test food, and the incremental area under the curves (iAUC) was calculated for each biochemical parameter using the values from 0 to 180 min after ingestion.ResultsThe high-RS cooked rice ingestion tended to reduce iAUC-glucose (p = 0.06) and significantly reduced iAUC-insulin (p < 0.01) and iAUC-GLP-1 (p < 0.05) but not iAUC-GIP (p = 0.21) relative to control cooked rice ingestion. In addition, the high-RS cooked rice ingestion did not affect gastric emptying.ConclusionsThe present results indicate that the suppressive effects of the high-RS cooked rice ingestion on postprandial responses of glucose and insulin may be provided through attenuation in GLP-1 secretion along with its low digestibility into glucose. We suggest that the high-RS rice with ss3a/be2b may serve as a better carbohydrate source and also as a novel functional food for dietary interventions to improve postprandial hyperglycemia and hyperinsulinemia without both enhancing GLP-1 secretion and affecting gastric emptying in patients with diabetes.

Impact of the Structural Modifications of Potato Protein in the Digestibility Process under Semi-Dynamic Simulated Human Gastrointestinal In Vitro System.

The raising consumer demand for plant-derived proteins has led to an increased production of alternative protein ingredients with varying processing histories. In this study, we used a commercially available potato protein ingredient with a nutritionally valuable amino acid profile and high technological functionality to evaluate if the digestibility of a suspension with the same composition is affected by differences in the structure. Four isocaloric (4% protein, w/w) matrices (suspension, gel, foam and heat-set foam) were prepared and their gastrointestinal fate was followed utilizing a semi-dynamic in vitro digestion model. The microstructure was observed by confocal laser scanning microscopy, protein breakdown was tested by electrophoresis and free amino acids after intestinal digestion was estimated using liquid chromatography/triple-quadruple-mass spectrometry (LC-TQMS). The heat-treated samples showed a higher degree of hydrolysis and lower trypsin inhibitory activity than the non-heat-treated samples. An in vitro digestible indispensable amino acid score was calculated based on experimental data, showing a value of 0.9 based on sulfur amino acids/valine as the limiting amino acids. The heated samples also showed a slower gastric emptying rate. The study highlights the effect of the food matrix on the distribution of the peptides created during various stages of gastric emptying.

Vomiting and Gastric Motility in Early Brain Damaged Children With Congenital Zika Syndrome.

This study investigated the occurrence of vomiting and gastric dysmotility in dysphagic children with congenital Zika syndrome (CZS) and assessed possible associations of these findings with the severity of dysphagia and the presence of tube feeding. Forty-six children with CZS were assessed for dysphagia, and the occurrence of vomiting, dietary volume tolerance <15 mL/kg, and feeding time per meal >30 minutes were evaluated. Gastric antrum ultrasonography was used to detect the frequency of contractions and measure antral areas (at fasting and 15 minutes postprandial), from which the gastric emptying rate (GER) was calculated. Antral ultrasonography findings were compared with those of ten healthy controls. Vomiting and gastric motility were compared between CZS patients according to the severity of dysphagia and the requirement for tube feeding. Overall, 76% (35/46) of children with CZS had moderate-to-severe dysphagia (MSD), among whom 60% (21/35) were tube fed [MSD tube fed (MSDTF)]. Vomiting occurred in 54% (25/46) of children, whereas dietary volume intolerance and prolonged feeding time were observed in 59% (27/46) and 37% (17/46), respectively, most frequently in MSDTF patients. On ultrasound, 61% (28/46) of children with CZS had no antral contractions, whereas 90% (9/10) of controls did. Compared to healthy controls, GER was eight-fold lower in children with CZS and 60-fold lower in MSDTF children. In dysphagic children with CZS, vomiting, volume intolerance, and prolonged feeding time were frequent and possibly associated with impaired antral contraction and delayed gastric emptying, especially in cases of severe dysphagia and tube feeding.

THERAPY OF ENDOCRINE DISEASE: Amylin and calcitonin - physiology and pharmacology.

Type 2 diabetes is a common manifestation of metabolic dysfunction due to obesity and constitutes a major burden for modern health care systems, in concert with the alarming rise in obesity worldwide. In recent years, several successful pharmacotherapies improving glucose metabolism have emerged and some of these also promote weight loss, thus, ameliorating insulin resistance. However, the progressive nature of type 2 diabetes is not halted by these new anti-diabetic pharmacotherapies. Therefore, novel therapies promoting weight loss further and delaying diabetes progression are needed. Amylin, a beta cell hormone, has satiating properties and also delays gastric emptying and inhibits postprandial glucagon secretion with the net result of reducing postprandial glucose excursions. Amylin acts through the six amylin receptors, which share the core component with the calcitonin receptor. Calcitonin, derived from thyroid C cells, is best known for its role in humane calcium metabolism, where it inhibits osteoclasts and reduces circulating calcium. However, calcitonin, particularly of salmon origin, has also been shown to affect insulin sensitivity, reduce the gastric emptying rate and promote satiation. Preclinical trials with agents targeting the calcitonin receptor and the amylin receptors, show improvements in several parameters of glucose metabolism including insulin sensitivity and some of these agents are currently undergoing clinical trials. Here, we review the physiological and pharmacological effects of amylin and calcitonin and discuss the future potential of amylin and calcitonin-based treatments for patients with type 2 diabetes and obesity.

Effects of Ganoderic Acid A on Gastrointestinal Motility and Brain-Gut Peptide in Rats with Functional Dyspepsia.

Objective The therapeutic effect of drugs for functional dyspepsia (FD) is still limited. Ganoderic acid A (GAA) has anti-inflammatory and cellular protective activities. The aim of this study is to explore the therapeutic effect of GAA on FD. Methods The FD rat model was established via tail damping and forced exercise fatigue. The gastric emptying rate and intestinal propulsion rate of the rats in each group were then detected, and the pathological damage of gastric antrum and duodenum tissues was observed by hematoxylin-eosin (HE) staining. An enzyme-linked immunosorbent assay (ELISA) was conducted to determine the levels of motilin (MTL), vasoactive intestinal peptide (VIP), leptin, gastrin (GAS), calcitonin gene-related peptide (CGRP), and somatostatin (SS) in plasma, and Western blot was used to detect the protein expression levels of occludin, zonula occluden-1 (ZO-1), and junctional adhesion molecule-1 (JAM-1) in the duodenal tissue. Results Treatment with GAA significantly raised the gastric emptying rate and intestinal propulsion rate of FD rats and histologically alleviated the gastric and duodenal damage. Meanwhile, GAA positively regulated the secretion of brain-gut proteins, such as upregulation of MTL, GAS, and SS and downregulation of VIP, leptin, and CGRP. In addition, GAA treatment increased the protein expression levels of occludin, ZO-1, and JAM-1 in the duodenal tissue of the FD rats. Conclusion GAA may exhibit protective effects on FD by regulating the secretion of brain-gut peptide, protecting the intestinal barrier and improving gastrointestinal motility.

Discovery of the GI Effects of GLP-1: An Historical Perspective.

In 1993, my laboratory published an article in Digestive Diseases and Sciences that clearly demonstrated the pronounced effects of the newly discovered intestinal hormone, glucagon-like peptide-1 (GLP-1), on a number of gastrointestinal functions, including gastric emptying rate, gastric acid secretion, and pancreatic enzyme secretion. The gut hormone is released in response to nutrient intake, and in further experiments, its release from the ileum paralleled inhibition of both gastric and pancreatic secretions. Based on these studies, it was concluded that GLP-1 is an important regulator of the so-called ileal brake, a term given for the observation that ileal perfusion of lipids delayed gastric emptying, reduced food intake, and induced satiety Welch et al. (1985), in addition to its functions as an incretin hormone. GLP-1 was subsequently identified as a physiological inhibitor of appetite and food intake, and based on these actions, the GLP-1 receptor agonists are today considered among the most powerful and effective antiobesity and antidiabetic agents available, with the added benefits of reducing the risk of the cardiovascular and renal complications associated with these conditions.

Aqueous Extract of Phyllanthus emblica L. Alleviates Functional Dyspepsia through Regulating Gastrointestinal Hormones and Gut Microbiome In Vivo.

Phyllanthus emblica L. fruits were extracted by a hot water assistant with ultrasonication to obtain aqueous Phyllanthus emblica L. extract (APE). The ameliorating functional dyspepsia (FD) effect of a low dose (150 mg/kg) and a high dose (300 mg/kg) of APE was exhibited by determining the gastrointestinal motility, gastrointestinal hormones, and gut microbiome shifts in reserpine induced FD male balb/c mice. APE increased the gastrointestinal motility including the gastric emptying (GE) rate and small intestinal transit (SIT) rate. The level of serum gastrointestinal hormones such as motilin (MTL) and gastrin (GAS) increased, and the vasoactive intestinal peptide (VIP) level decreased after the administration of APE. Furthermore, the gut microbiome analysis demonstrated that APE could regulate the microbiome structure and restore homeostasis by elevating useful bacterial abundance, while simultaneously decreasing harmful bacterial abundance. This study demonstrated the ameliorating FD effect of APE and its potential efficacy in curing functional gastrointestinal disorders and maintaining a healthy digestive tract.

Comparative Study of Pyloromyotomy and H-M Pyloroplasty in Proximal Gastrectomy for Adenocarcinoma of Esophageal-Gastric Junction

IntroductionThe incidence of adenocarcinoma of esophageal-gastric junction (AEJ) has been increasing in recent years. Esophagogastrostomy after proximal gastrectomy (PG-EG) is the most commonly used surgical method for this disease which causes a constant spasm of the pyloric sphincter by cutting the vagus nerve around the esophagus, so H-M pyloroplasty (Heineke-Mikulicz pyloroplasty) is often operated after PG-EG to prevent delayed gastric emptying. However, H-M pyloroplasty destroys anti-reflux structure of pylorus and leads to serious bile reflux. The present study was designed to compare pyloromyotomy and H-M pyloroplasty in proximal subtotal gastrectomy through clinical studies and animal experiments. MethodsWe retrospectively evaluated the outcomes of 73 AEJ patients (39 underwent PG-EG with an H-M pyloroplasty and 34 underwent PG-EG with a pyloromyotomy) between January 2016 and August 2020, and perioperative variables were compared. In the animal experiment, 48 rats were randomly divided into four groups (n = 12): vagotomy group (V group), H-M pyloroplasty group (HM group), pyloromyotomy group (PM group), and control group (O group). Gastric emptying and bile reflux were evaluated in each group. ResultsIn the retrospective clinic study, pyloromyotomy and H-M pyloroplasty could all prevent delayed gastric emptying effectively, and the incidence of bile reflux found by electronic gastroscopy in the PM group was significantly lower than that in the HM group (HM, 14/39; PM, 4/34; P = 0.028). In the animal experiment, there was no significant between-group difference of gastric emptying rate (%) in the HM group and PM group (HM, 70.6 ± 16; PM, 72.3 ± 12; P = 0.68) while the gastric emptying rate (%) was significantly lower in the V group than in the HM, PM, and control group (P values were 0.037, 0.021, and 0.001 respectively). The gastric mucosa bile acid concentration was significantly higher in the HM group than other group (P values were all less than 0.001). ConclusionsThe pyloromyotomy could prevent delayed gastric emptying effectively after PG-EG for types II and III AEJ and reduce bile reflux compared to Heineke-Mikulicz pyloroplasty.

Gastric emptying rate of a solid meal in patients with anterior open bite malocclusion: A preliminary study

Objectives: The objective of the study was to investigate the relationship between anterior open bite (AOB) malocclusion and digestion by evaluating mastication and gastric emptying (GE) of a solid meal. Material and Methods: We recruited 26 female participants and divided them into two groups according to their occlusion status: The control group with normal occlusion (n = 11; age: 25.2 ± 2.8 years; and body mass index [BMI]: 21.1 ± 1.9 kg/m2) and the AOB group with AOB malocclusion (n = 15; age: 23.2 ± 5.5 years; BMI: 21.0 ± 1.6 kg/m2). GE, chewing, and occlusion were assessed simultaneously. A food questionnaire survey was also administered on the same day. Results: A significant positive correlation was noted between open bite and the occlusal analysis findings. Negative correlations were found between the food questionnaire score and both the open bite and occlusal analysis findings, which confirmed that AOB affects mastication. However, no significant difference in the GE rate parameters was observed between the two groups. Conclusion: Adaptive mechanisms may have a compensatory effect on the GE rate. However, the lack of tooth contact in the anterior occlusal region resulted in reduced masticatory ability. Orthodontic treatment should thus be considered, regardless of the presence of digestive problems, to improve mastication.

Flow-controlled expiration improves respiratory mechanics, ventilation, and gas exchange in anesthetized horses.

Mechanical ventilation is usually achieved by active lung inflation during inspiration and passive lung emptying during expiration. By contrast, flow-controlled expiration (FLEX) ventilation actively reduces the rate of lung emptying by causing linear gas flow throughout the expiratory phase. Our aim was to evaluate the effects of FLEX on lung compliance and gas exchange in anesthetized horses in dorsal recumbency. 8 healthy horses. All animals were anesthetized twice and either ventilated beginning with FLEX or conventional volume-controlled ventilation in a randomized, crossover design. Total anesthesia time was 3 hours, with the ventilatory mode being changed after 1.5 hours. During anesthesia, cardiac output (thermodilution), mean arterial blood pressures, central venous pressure, and pulmonary arterial pressure were recorded. Further, peak, plateau, and mean airway pressures and dynamic lung compliance (Cdyn) were measured. Arterial blood gases were analyzed every 15 minutes. Data were analyzed using ANOVA (P < 0.05). FLEX ventilation resulted in significantly higher arterial oxygen partial pressures (521 vs 227 mm Hg) and Cdyn (564 vs 431 mL/cm H2O) values compared to volume-controlled ventilation. The peak and plateau airway pressure were lower, but mean airway pressure was significantly higher (4.8 vs 9.2 cm H2O) in FLEX ventilated horses. No difference for cardiovascular parameters were detected. The results of this study showed a significant improvement of the Pao2 and Cdyn without compromising the cardiovascular system when horses were ventilated by use of FLEX compared to conventional ventilation.

Perinatal High Fat Diet and Acute Stress alters the Chloride Gradient in Dorsal Motor Nucleus of the Vagus Neurons Controlling Gastric Function

The US is currently facing an obesity epidemic, though the concurrent rise in maternal obesity rates receives less attention. Maternal obesity is an important factor that influences intrauterine and early postnatal environment and is associated with developmental changes in the offspring, including alterations in metabolic function and susceptibility to anxiety and depression, all of which are associated with abnormal gastrointestinal (GI) tract function. Previous work from this lab has shown that perinatal high fat diet (pHFD) leads to developmental changes to vagal neurocircuits, including changes to GABAA receptor subunits on dorsal motor nucleus of the vagus (DMV) neurons. However, the manner of neuronal recordings (whole‐cell patch clamp) disrupted internal chloride (Cl‐) concentration, preventing accurate assessment of the extent of GABA‐mediated inhibition. KCC2, a Cl‐ transporter, is important in determining GABAergic inhibition and stress outcomes in hypothalamic neurons, however its role in regulating these factors in DMV neurons is unknown. The current study was designed to test the hypothesis that pHFD reduces KCC2 levels in DMV neurons, subsequently collapsing the Cl‐ gradient and leading to altered gastric output.Sprague‐Dawley rats were fed either a control (14% kcal from fat) or high fat (60% kcal from fat) diet starting on embryonic day 13. After weaning on postnatal day 28, brainstem slices were made to conduct patch clamp recordings on DMV neurons. This was done in both naïve (unstressed) or stressed conditions, in which rats underwent a 10 minute forced swim (FS). To determine the Cl‐ reversal, perforated patch clamp recordings were performed in order to preserve the internal Cl‐ concentration. Then, DMV neurons were voltage clamped from ‐90 to ‐40 mV and the amplitude of the current response to picospritz of the GABAAagonist muscimol (100 μM) was measured. These events were plotted on an I‐V curve, with the x‐intercept representing the reversal of Cl‐. To determine a potential mediator in the shift in the Cl‐ reversal, changes in KCC2 levels following pHFD exposure were evaluated immunohistochemically. Lastly, gastric emptying (GE) assays were performed using the 13C octanoic acid breath assessment.In both pHFD and control diet + FS DMV neurons, there was a depolarizing shift in the Cl‐ reversal compared to naïve rats (‐43.05 mV and ‐44.58 mV respectively, compared to ‐64.56 mV in naïve conditions; p &lt; 0.0001). It was also found that there is a significant reduction in KCC2 expression in pHFD DMV region compared to controls (2.237% area fluorescence in pHFD compared to 5.335% in control diet; p=0.0147). Lastly, pHFD rats had significantly delayed GE rates compared to those fed a control diet (83.7 minutes for half‐decay in pHFD compared to 66.7 minutes in controls; p &lt; 0.05), resembling previously published data which showed a delay in GE following an acute stress. These results demonstrate that both a pHFD and acute stress lead to depolarizing shifts in the Cl‐ reversal and that this may be through a mechanism involving a reduction in KCC2 expression. As the gastric emptying rates demonstrate, these changes could lead to a maladaptive GI stress response in pHFD rats.Determining the mechanism in which pHFD and acute stress modulate DMV function, as well as the impact of their intersection on the gastric stress response, will better inform our understanding of the reduced stress resiliency seen in pHFD offspring.

Mediators of Amylin Action in Metabolic Control.

Amylin (also called islet amyloid polypeptide (IAPP)) is a pancreatic beta-cell hormone that is co-secreted with insulin in response to nutrient stimuli. The last 35 years of intensive research have shown that amylin exerts important physiological effects on metabolic control. Most importantly, amylin is a physiological control of meal-ending satiation, and it limits the rate of gastric emptying and reduces the secretion of pancreatic glucagon, in particular in postprandial states. The physiological effects of amylin and its analogs are mediated by direct brain activation, with the caudal hindbrain playing the most prominent role. The clarification of the structure of amylin receptors, consisting of the calcitonin core receptor plus receptor-activity modifying proteins, aided in the development of amylin analogs with a broad pharmacological profile. The general interest in amylin physiology and pharmacology was boosted by the finding that amylin is a sensitizer to the catabolic actions of leptin. Today, amylin derived analogs are considered to be among the most promising approaches for the pharmacotherapy against obesity. At least in conjunction with insulin, amylin analogs are also considered important treatment options in diabetic patients, so that new drugs may soon be added to the only currently approved compound pramlintide (Symlin®). This review provides a brief summary of the physiology of amylin’s mode of actions and its role in the control of the metabolism, in particular energy intake and glucose metabolism.

Why upright standing men urinate more efficiently than in supine position: A morphological analysis with real-time magnetic resonance imaging.

Few studies have examined the effects of body position on urination efficiency morphologically. We aimed to dissect out the anatomical changes of pelvic organs during urination in the upright and supine positions by a real-time magnetic resonance imaging (rtMRI) system. Thirteen healthy male volunteers aged 26-60 years were included in the study. The sagittal real-time two-dimensional images were taken to evaluate urinary efficiency, along with change in six morphological indices at the time of storage and the beginning of voiding, in both upright ant supine positions. Urination was more efficient in upright position than in supine position, as expressed by higher average rate of bladder emptying (9.9 ± 4.2 vs. 6.8 ± 2.9 ml/s, p < 0.05) and also by fewer participants showing significant residual urine (1/13 vs. 7/13, p < 0.05). At the onset of voiding in standing position, the levator ani (LA) muscle moves downward and backward followed by descent of the bladder neck and rotation of the prostate around the symphysis. Such changes were expressed by two morphological indices. One was posterior vesicourethral angle at the start of voiding, 152 ± 7 versus 140 ± 1 in upright and supine position (p < 0.05). The other index was the change in angle between the LA line and pubo-coccygeal line in upright and supine position, 9.4 ± 9.9 versus 1.6 ± 7.9 before voiding (p < 0.05) and 30.2 ± 14.0 versus 17.3 ± 12.9 after the start of voiding (p < 0.05). The dynamic relaxation of LA seemed to be a key movement that enables more efficient urination in standing position than in supine position.

Acute Exercise with Moderate Hypoxia Reduces Arterial Oxygen Saturation and Cerebral Oxygenation without Affecting Hemodynamics in Physically Active Males.

Hemodynamic changes during exercise in acute hypoxia (AH) have not been completely elucidated. The present study aimed to investigate hemodynamics during an acute bout of mild, dynamic exercise during moderate normobaric AH. Twenty-two physically active, healthy males (average age; range 23–40 years) completed a cardiopulmonary test on a cycle ergometer to determine their maximum workload (Wmax). On separate days, participants performed two randomly assigned exercise tests (three minutes pedaling at 30% of Wmax): (1) during normoxia (NORMO), and (2) during normobaric AH at 13.5% inspired oxygen (HYPO). Hemodynamics were assessed with impedance cardiography, and peripheral arterial oxygen saturation (SatO2) and cerebral oxygenation (Cox) were measured by near-infrared spectroscopy. Hemodynamic responses (heart rate, stroke volume, cardiac output, mean arterial blood pressure, ventricular emptying rate, and ventricular filling rate) were not any different between NORMO and HYPO. However, the HYPO test significantly reduced both SatO2 (96.6 ± 3.3 vs. 83.0 ± 4.5%) and Cox (71.0 ± 6.6 vs. 62.8 ± 7.4 A.U.) when compared to the NORMO test. We conclude that an acute bout of mild exercise during acute moderate normobaric hypoxia does not induce significant changes in hemodynamics, although it can cause significant reductions in SatO2 and Cox.

Possible role of serotonin in the gastrokinetic activity of Amorphophallus paeoniifolius tuber

Background: Amorphophallus paeoniifolius (Dennst.) Nicolson (Araceae) tuber is consumed by various tribes for the treatment of constipation, hemorrhoids, functional dyspepsia and abdominal pain as ethnomedicinal practices. In our previous study, the tuber extract showed alteration of gastric emptying in healthy rats and ameliorated the gastrointestinal motor disorders, constipation and piles. Aim of the study: Hence, the present study evaluated the effect of Amorphophallus paeoniifolius tuber on experimentally-induced delayed gastric emptying in rats as well as investigated the plausible mechanism involved therein. Methods: Methanolic extract of Amorphophallus paeoniifolius (APME) was orally administered at the doses of 125, 250 and 500 mg/kg for 7 days. Delayed gastric emptying was induced in rats by cisplatin (10 mg/kg, i.p.) on the last day of extract treatment and gastric emptying was studied. To study the involvement of serotonergic system, the effect of APME (500 mg/kg) was investigated on gastric emptying in p-chlorophenylalanine (PCPA, a serotonergic neurotoxin) treated rats. Ex-vivo studies in isolated tissue preparation were also conducted to test the effect of APME on fundus contractility. Results: APME significantly reversed the delayed gastric emptying caused by cisplatin comparable to standard prokinetic drug, metoclopramide. Interestingly, the co-administration of sub-maximal doses of APME and metoclopramide showed synergistic effect on delayed gastric emptying. Further, in PCPA treated rats, APME (500 mg/kg) did not show any significant influence on delayed gastric emptying similar to metoclopramide. In Ex-vivo studies, the contractile response of APME remained unaltered in presence of atropine while it was potentiated significantly (P < 0.001) in presence of 5-HT as compared to the individual responses of 5-HT or APME. Phytochemical studies revealed the presence of betulinic acid in APME which is partial serotonergic agonist. Conclusion: The tuber of Amorphophallus paeoniifolius exhibited gastrokinetic activity and may be beneficial on functional dyspepsia. The effect may be ascribed to modulation of serotonergic neurotransmission in GIT.

Letter to the Editor: Regarding the article “Comparison of milk replacer composition and effects on growth and health of preruminant lambs, and health-associated costs of artificial rearing,” by

The April 2021 issue included an article by McCoard et al. (2021). This letter brings to the attention of readers several fundamental issues relating to the study design and the conclusions reported. The cost and scarcity of skim milk powders has driven research into alternative protein sources for young ruminants (Terosky et al., 1997; Lammers et al., 1998). Careful trial design, ensuring diets have a very comparable nutrient profile (Toullec et al., 1994) have improved our understanding of the suitability of different raw material sources for milk replacers (MR) for young animals. Research also has shown that the osmolality of MR, determined by the lactose and mineral contents of the MR (Amado et al., 2019; Wilms et al., 2020), will affect both rate of gastric emptying and DM content of feces produced by lambs. The authors conclusions that MR containing vegetable ingredients are not suitable for feeding to neonatal lambs in the first 5 to 6 wk of life and that increased systemic antibiotic use is a consequence of MR composition are not supported by the results presented. The conclusion that greater fecal moisture observed in lambs fed a milk replacer containing hydrolyzed wheat protein was a consequence of, or caused by, disease is not supported by the results presented and is more likely a consequence of the osmolality of the reconstituted MR, which is influenced by both the nutrient composition of the MR and the rate at which MR is mixed with water. A comparative assessment of the suitability of different ingredients for use in MR requires that the comparison be made using MR with an equivalent nutrient composition. Thus, it is not possible to conclude that MR containing vegetable (wheat in the case of this study) protein and fat sources is inferior and should be avoided.

Formulation and Evaluation of Stomach Specific Floating Tablets of Eluxadoline

Floating Drug Delivery Systems (FDDS) have a bulk density lower than gastric fluids and thus remain buoyant in the stomach for a prolonged period of time, without affecting the gastric emptying rate. While the system is floating on the gastric contents, the drug is released slowly at a desired rate from the system. These floating tablets mainly prepared for reduction of lag time and release the drug up to 12 hours and may also increase the bioavailability of the drugs by utilizing the drug to full extent avoiding unnecessary frequency of dosing. The study included formulation of floating tablets using polymers like Hydroxypropylmethylcellulose K4M and Carbopol 934 as matrix forming agents. The tablets were directly compressed using multi station rotary punching machine. FTIR studies conformed that there was no incompatibility between the polymers and the drug. Tablet preformulation parameters were within the Pharmacopoeias limit. Tablet showed buoyancy for &gt;12 h. The in- vitro drug release pattern of floating tablets was fitted to different kinetic models which showed highest regression for higuchi model. Formulation E6 found stable during 1 month stability study.

Effect of electroacupuncture combined with mosapride on gastric motility in diabetic gastroparesis rats

To observe the effect of electroacupuncture (EA) at "Zusanli" (ST 36) combined with mosapride on gastric emptying rate and gastric motility in the rats with diabetic gastroparesis. Using random number table method, 68 male SD rats were divided into a blank group (12 rats) and a model establishment group (56 rats). In the model establishment group, the models of diabetic gastroparesis were established with intraperitoneal injection of streptozotocin combined with high-fat and high-sugar diet. Six weeks later, the successful rat models in the model establishment group were randomized into a model group, an EA group, a mosapride group and a combined treatment group, 12 rats in each one. In the EA group, EA was exerted at "Zusanli" (ST 36) (disperse-dense wave, 2 Hz/15 Hz in frequency, 2 mA in intensity) for 20 min. In the mosapride group, mosapride was intervened with intragastric administration (2 mg/kg). In the combined treatment group, electroacupuncture at "Zusanli" (ST 36) was combined with intragastric administration of mosapride. The intervention was given once daily in each group. There was 1 day at interval after 6-day intervention, consecutively for 5 weeks. At the end of intervention, the random blood glucose, gastric emptying rate and the data of gastric motility (average intra-gastric pressure, amplitude and frequency of gastric motility) were detected. Compared with the blank group, blood glucose was increased in the model group (P<0.001). Blood glucose was reduced in the EA group, the mosapride group and the combined treatment group as compared with the model group separately (P<0.001, P<0.01), whereas, compared with the mosapride group, blood glucose was decreased in the combined treatment group (P<0.05). In comparison with the blank group, the gastric emptying rate, the average intra-gastric pressure and the amplitude of gastric motility were all decreased in the model group (P<0.001) and the frequency of gastric motility was increased (P<0.001). Gastric emptying rate, the average intra-gastric pressure and the amplitude of gastric motility were increased in the EA group, the mosapride group and the combined treatment group (P<0.01, P<0.05, P<0.001) and the frequency of gastric motility was decreased (P<0.001) as compared with the model group respectively. Compared with the EA group, the average intra-gastric pressure and the amplitude of gastric motility were increased in the combined treatment group (P<0.001). In comparison with the mosapride group, the gastric emptying rate, the average intra-gastric pressure, the amplitude and frequency of gastric motility in the combined treatment group, as well as the frequency of gastric motility in the EA group were all increased (P<0.05, P<0.001, P<0.01). Electroacupuncture at "Zusanli" (ST 36) combined with intragastric administration of mosapride could regulate blood glucose and improve the gastric motility in the rats with diabetic gastroparesis. The effect is better than either simple electroacupuncture or mosapride.

2-Arachidonoyl glycerol suppresses gastric emptying via the cannabinoid receptor 1-cholecystokinin signaling pathway in mice.

2-Monoacylglycerol (2-MAG) is one of the digestion products of dietary lipids. We recently demonstrated that a 2-MAG, 2-arachidonoyl glycerol (2-AG) potently stimulated cholecystokinin (CCK) secretion via cannabinoid receptor 1 (CB1) in a murine CCK-producing cell line, STC-1. CCK plays a crucial role in suppressing postprandial gastric emptying. To examine the effect of 2-AG on gastric emptying, we performed acetaminophen and phenol red recovery tests under oral or intraperitoneal administration of 2-AG in mice. Orally administered 2-AG (25mg/kg) suppressed the gastric emptying rate in mice, as determined by the acetaminophen absorption test and phenol red recovery test. Intraperitoneal administration of a cholecystokinin A receptor antagonist (0.5 mg/kg) attenuated the gastric inhibitory emptying effect. In addition, both oral (10 mg/kg) and intraperitoneal (0.5 mg/kg) administration of a CB1 antagonist counteracted the 2-AG-induced gastric inhibitory effect. Furthermore, intraperitoneal 2-AG (25mg/kg) suppressed gastric emptying. These results indicate that 2-AG exhibits an inhibitory effect on gastric emptying in mice, possibly mediated by stimulating both CCK secretion via CB1 expressed in CCK-producing cells and acting on CB1 expressed in the peripheral nerves. Our findings provide novel insights into the 2-MAG-sensing mechanism in enteroendocrine cells and the physiological role of 2-MAG.