Emptying Time Research Articles

Macronutrients effects on satiety and food intake in older and younger adults: A randomised controlled trial

Older adults are advised to increase their protein intake to maintain their muscle mass. However, protein is considered the most satiating macronutrient and this recommendation may cause a decrease in total energy intake. To date, satiety studies comparing all three macronutrients have been undertaken in young adults, and it is unclear if the same response is seen in older adults. The objective of this study was to compare the effect of preloads high in protein, fat, and carbohydrate but equal in energy (∼300 kcal) and volume (250 ml) on energy intake, perceived appetite, and gastric emptying in younger and older adults. Twenty older and 20 younger adults completed a single-blinded randomised crossover trial involving three study visits. Participants consumed a standard breakfast, followed by a preload milkshake high in either carbohydrate, fat, or protein. Three hours after the preload, participants were offered an ad libitum meal to assess food intake. Visual analogue scales were used to measure perceived appetite and gastric emptying was measured via the 13C-octanoic acid breath test. There was no significant effect of preload type or age on energy intake either at the ad libitum meal, self-recorded food intake for the rest of the test day or subjective appetite ratings. There was a significant effect of preload type on gastric emptying latency phase and ascension time, and an effect of age on gastric emptying latency and lag phase such that older adults had faster emptying. In conclusion, energy intake, and perceived appetite were not affected by macronutrient content of the preloads in both younger and older adults, but gastric emptying times differed.

Ultraprocessed Foods and Obesity Risk: A Critical Review of Reported Mechanisms.

Epidemiologic evidence supports a positive association between ultraprocessed food (UPF) consumption and body mass index. This has led to recommendations to avoid UPFs despite very limited evidence establishing causality. Many mechanisms have been proposed, and this review critically aimed to evaluate selected possibilities for specificity, clarity, and consistency related to food choice (i.e., low cost, shelf-life, food packaging, hyperpalatability, and stimulation of hunger/suppression of fullness); food composition (i.e., macronutrients, food texture, added sugar, fat and salt, energy density, low-calorie sweeteners, and additives); and digestive processes (i.e., oral processing/eating rate, gastric emptying time, gastrointestinal transit time, and microbiome). For some purported mechanisms (e.g., fiber content, texture, gastric emptying, and intestinal transit time), data directly contrasting the effects of UPF and non-UPF intake on the indices of appetite, food intake, and adiposity are available and do not support a unique contribution of UPFs. In other instances, data are not available (e.g., microbiome and food additives) or are insufficient (e.g., packaging, food cost, shelf-life, macronutrient intake, and appetite stimulation) to judge the benefits versus the risks of UPF avoidance. There are yet other evoked mechanisms in which the preponderance of evidence indicates ingredients in UPFs actually moderate body weight (e.g., low-calorie sweetener use for weight management; beverage consumption as it dilutes energy density; and higher fat content because it reduces glycemic responses). Because avoidance of UPFs holds potential adverse effects (e.g., reduced diet quality, increased risk of food poisoning, and food wastage), it is imprudent to make recommendations regarding their role in diets before causality and plausible mechanisms have been verified.

Usefulness of Mean Gastric Emptying Time in Late Preterm and Term AGA and SGA Newborns to Determine Feeding Frequency—An Observational Study

Objectives The primary objective is to calculate and compare mean gastric emptying time in appropriate for gestational age (AGA) and small for gestational age (SGA) newborns. The secondary objective is to compare mean gastric emptying time in SGA babies with or without antenatal Doppler changes and to measure gastric spheroidal volume at various intervals in AGA and SGA newborns with or without antenatal Doppler changes. Methods This prospective observational study was carried over 3 months from November 2022 to January 2023. A total of 30 newborns were enrolled and their gastric spheroidal volume was calculated by ultrasound pre-feed and post-feed every 30 minutes till it reached within 10% of pre-feed volume which was taken as gastric emptying time. Mean gastric emptying time was compared among AGA and SGA newborns and amongst SGA with or without antenatal Doppler changes. Results Mean gastric emptying time of AGA was 124 ± ± 25.01 minutes and for SGA was 132 ± 29.57 minutes which was statistically nonsignificant. Mean gastric emptying time when compared between SGA neonates with or without antenatal Doppler changes was similar ( P value .43). The gastric spheroidal volume was significantly smaller in SGA newborns compared to their AGA counterparts in pre-feed state ( P value .01) and it persisted till 60 minutes post feed ( P value .028); however, the mean gastric emptying time is similar in both the groups. Conclusion Mean gastric emptying time of AGA and SGA newborns is similar and hence a feeding interval of 1.5 to 2.5 hours is appropriate for these late preterm and term newborns. Antenatal Doppler changes in SGA babies did not alter their gastric emptying time hence similar feeding frequency can be used in both.

Associations Between Physical Activity and Gastrointestinal Transit Times in People with Normal Weight, Overweight, and Obesity

BackgroundRapid gastric emptying is associated with obesity and overeating, whereas delayed gastric emptying is associated with anorexia. Acute effects of exercise on gastric emptying have been investigated extensively, but the influence of habitual physical activity on gastric emptying and transit time in other regions of the gastrointestinal tract is poorly understood. ObjectiveThe objective was to investigate associations between objectively measured habitual physical activity and gastrointestinal transit times in adults with varying degrees of adiposity. Methods50 adults (58% women) were included in this cross-sectional study. Physical activity was measured by an accelerometer placed on the lower back for 7 d. Gastric emptying time, small bowel transit time, colonic transit time, and whole gut transit time were simultaneously evaluated by a wireless motility capsule, which was ingested together with a standardized mixed meal. Linear regression models were applied to assess the associations of total activity counts and time spent at different intensities—sedentary activity (0–100 counts/min), low light activity (101–759 counts/min), high light activity (760–1951 counts/min); moderate and vigorous activity (≥1952 counts/min)) with gastrointestinal transit times. ResultsMedian [Q1; Q3] age was 56.5 [46.6–65.5] y, and body mass index (BMI) was 32.1 [28.5–35.1] kg/m2. For every additional hour spent performing high light intensity physical activity, colonic transit time was 25.5 % [95% CI: 3.10, 42.7] more rapid (P = 0.028), and whole gut transit time was 16.2 % [95% CI: 1.84, 28.4] more rapid (P = 0.028) when adjusted for sex, age, and body fat. No other associations were observed. ConclusionsMore time spent on physical activity at high light intensity was associated with more rapid colonic and whole gut transit time, independent of age, sex, and body fat, whereas other intensities of physical activity and gastrointestinal transit times were not associated. Trial registrationClinicaltrials.gov IDs (NCT03894670, NCT03854656).

Analysis of the interplay of physiological response to food intake and drug properties in food-drug interactions

The effect of food on oral drug absorption is determined by the complex interplay among gut physiological factors and drug properties. The currently used dissolution testing and classification systems (biopharmaceutics classification system, BCS or biopharmaceutics drug disposition classification system, BDDCS) do not account for dynamic changes in gastrointestinal physiology caused by food intake. This study aimed to identify key drug properties that influence food effect (FE) using supervised machine learning approaches. The analysis showed that drugs with high logP, dose number, and extraction ratio have a higher probability of positive FE, while drugs with low permeability and high efflux saturation index have a greater likelihood of negative FE. Weakly acidic drugs also showed a greater probability of positive FE, particularly at pKa >4.3. The importance of drug properties in predicting FE was ranked as logP, dose number, extraction ratio, pKa, and permeability. The accuracy of FE prediction using the models was compared with BCS and extended clearance classification system (ECCS). Overall, the likelihood or magnitude of FE depends on physiological changes to food intake such as altered bile acid secretion rate, intestinal metabolism, transport kinetics, and gastric emptying time, which should be considered along with drug properties (e.g., solubility, logP, and ionization) in predicting FE of orally administered drugs.

SmartPill™ Administration to Assess Gastrointestinal Function after Spinal Cord Injury in a Porcine Model-A Preliminary Study.

Gastrointestinal (GI) complications, including motility disorders, metabolic deficiencies, and changes in gut microbiota following spinal cord injury (SCI), are associated with poor outcomes. After SCI, the autonomic nervous system becomes unbalanced below the level of injury and can lead to severe GI dysfunction. The SmartPill™ is a non-invasive capsule that, when ingested, transmits pH, temperature, and pressure readings that can be used to assess effects in GI function post-injury. Our minipig model allows us to assess these post-injury changes to optimize interventions and ultimately improve GI function. The aim of this study was to compare pre-injury to post-injury transit times, pH, and pressures in sections of GI tract by utilizing the SmartPill™ in three pigs after SCI at 2 and 6 weeks. Tributyrin was administered to two pigs to assess the influences on their gut microenvironment. We observed prolonged GET (Gastric Emptying Time) and CTT (Colon Transit Time), decreases in contraction frequencies (Con freq) in the antrum of the stomach, colon, and decreases in duodenal pressures post-injury. We noted increases in Sum amp generated at 2 weeks post-injury in the colon, with corresponding decreases in Con freq. We found transient changes in pH in the colon and small intestine at 2 weeks post-injury, with minimal effect on stomach pH post-injury. Prolonged GETs and CTTs can influence the absorptive profile in the gut and contribute to pathology development. This is the first pilot study to administer the SmartPill™ in minipigs in the context of SCI. Further investigations will elucidate these trends and characterize post-SCI GI function.

Gastroparesis: The Complex Interplay with Microbiota and the Role of Exogenous Infections in the Pathogenesis of the Disease.

Gastroparesis (GP) is a disorder of gastric functions that is defined by objective delayed gastric emptying in the absence of mechanical obstruction. This disease is characterized by symptoms such as nausea, post-prandial fullness, and early satiety. GP significantly impacts patients' quality of life and contributes to substantial healthcare expenses for families and society. However, the epidemiological burden of GP is difficult to evaluate, mainly due its significant overlap with functional dyspepsia (FD). GP and FD represent two similar diseases. The pathophysiology of both disorders involves abnormal gastric motility, visceral hypersensitivity, and mucosal inflammation. Moreover, both conditions share similar symptoms, such as epigastric pain, bloating, and early satiety. The latest evidence reveals that dysbiosis is directly or indirectly connected to gut-brain axis alterations, which are the basis of pathogenesis in both FD and GP. Furthermore, the role of microbiota in the development of gastroparesis was demonstrated by some clinical studies, which found that the use of probiotics is correlated with improvements in the gastric emptying time (GET). Infections (with viruses, bacteria, and protozoa) represent a proven etiology for GP but have not been sufficiently considered in current clinical practice. Previous viral infections can be found in about 20% of idiopathic GP cases. Moreover, delayed gastric emptying during systemic protozoal infections represents a huge concern for compromised patients, and few data exist on the topic. This comprehensive narrative review analyzes the relationship between microorganisms and GP. We explore, on the one hand, the correlation between gut microbiota dysbiosis and GP pathogenesis, including treatment implications, and, on the other hand, the association between exogenous infections and the etiology of the disease.

Alternate-day fasting induces metabolic and morphofunctional changes in the gastrointestinal tract of male rats.

Alternate-day fasting (ADF) is a nutritional intervention with modulatory and overall protective effects, but its role in the gastrointestinal (GI) tract is still uncertain. The aim of this study was to investigate the influence of ADF on the metabolic patterns and morphofunctional motility of the GI tract in rats. Thirty-two male Wistar rats were allocated into groups: control for 15 days (CON 15, n=8), control for 30 days (CON 30, n=8), ADF for 15 days (ADF 15, n=8), and ADF for 30 days (ADF 30, n=8). Blood glucose, body weight, and food and water consumption were measured. Frequency and amplitude of gastric contractions as well as gastric emptying time, small intestinal transit time, and cecum arrival time were measured. Intestinal histomorphometric, relative weight of organs, lipidogram, and leptin levels were also evaluated. ADF decreased water consumption and food consumption. The weight gain decreased; however, the relative kidney weight increased. ADF triggered an increase in the amplitude of gastric contractions and accelerated gastric emptying. However, small intestinal transit time was delayed in both ADF groups. Total cholesterol, triglycerides, non-HDL cholesterol, and very low-density lipoprotein cholesterol levels decreased, whereas villus height, depth of the crypts and thickness of the circular, and longitudinal muscular layers of intestine increased after ADF. In conclusion, our results showed ADF exert an effect on both metabolism and GI motility and impacts on overall digestive functions.

Effectiveness and safety of traditional Chinese medicine decoction for diabetic gastroparesis: A network meta-analysis.

Diabetic gastroparesis (DGP) is a prevalent complication of diabetes that impairs people's quality of life and places a significant financial burden on them. The gastrointestinal symptoms of DGP patients can be improved by several Traditional Chinese Medicine (TCM) decoctions that have been shown to be effective in treating the disease. There are still many unanswered questions regarding the identification of appropriate therapeutic agents for the treatment of DGP in clinical practice. To analyze the efficacy of several TCM decoctions in the treatment of DGP using Bayesian network meta-analysis for reference. PubMed, EMBASE, Cochrane Library, Web of Science, China National Kno-wledge Infrastructure, The China Biology Medicine DVD, Wanfang, and CQVIP were searched from inception to September 17, 2022, to collect randomized controlled trials (RCTs) about TCM decoctions for DGP. Clinical effects and symptom scores were the primary outcomes. Additionally, we assessed motilin (MOT), somatostatin (SS), gastrin (GAS), gastric emptying rate, gastric emptying time, and adverse drug events as secondary outcomes. A total of 67 eligible RCTs involving 4790 DGP patients and 7 TCM decoctions were included. The results of network meta-analysis (NMA) and surface under the cumulative ranking curve showed that with western medicine (WM) as a common control, the Banxia Xiexin Decoction (BXXD) + WM was most effective in clinical effects and enhancing early satiety scores; the Simo decoction (SMD) + WM was most effective in improving nausea and vomiting scores and anorexia scores, bloating scores; the Chaishao Liujunzi Decoction (CSLJD) was most effective in MOT, the Zhishi Xiaopi Decoction (ZSXPD) was most effective in SS and upgrading emptying rate; the Jianpi Xiaozhi Decoction was most effective in GAS; the CSLJD + WM was most effective in improving gastric emptying time. These NMA results suggest that the BXXD + WM and SMD + WM may be one of the potential optimal treatments. Due to various limitations, further large-sample, double-blind, multi-center randomized RCTs are needed.

An analysis of enhanced recovery pathways for bariatric surgery-preoperative fasting, carbohydrate loading, and aspiration risk: a position statement from the International Society for the Perioperative Care of Patients with Obesity.

Enhanced recovery pathways (ERPs) and recommendations have become widely accepted for metabolic and bariatric surgery, including recommendations for preoperative carbohydrate loading and duration of fasting status. There is still a lack of consensus regarding such protocols and the underlying issues of gastric emptying time, resting gastric volume and pH, and risk of aspiration in patients with severe obesity and in patients undergoing bariatric surgery. The goal of this position statement by the International Society for the Perioperative Care of Patients with Obesity (ISPCOP) is to provide an analysis of available data on preoperative fasting and loading with oral complex clear carbohydrate drinks as well its potential effects on perioperative risk of aspiration in the context of Enhanced Recovery Pathways for Metabolic and Bariatric Surgery (ERAMBS).

Evaluation of particle models of corn kernels for discrete element method simulation of shelled corn mass flow

Bulk handling behavior of grains can be studied experimentally, but large-scale investigations of grain flow especially at the commercial scale are expensive, time consuming, and are therefore limited in the treatment factors that can be evaluated in any one study. Recent research has demonstrated the potential of discrete element method (DEM) in simulating grain flow in handling operations. However, application of DEM for simulating grain flow, requires development of appropriate particle models for each grain type. In this study, particle models comprised of one to four overlapping spheres were developed for shelled corn and tested. With these models, measurement of bulk properties, namely bulk density and angle of repose, both involving bulk flow were simulated using EDEM™ software with published data of material and interaction properties of shelled corn as inputs associated with each particle shape. Predicted time for the complete outflow from the bulk density test hopper (hopper emptying time), designated as simulation time in the study, was also recorded as another discriminant for model selection. Variable inputs into the simulation modeling were material properties particle shape, particle size distribution, Poisson's ratio, shear modulus, and density and interaction properties particle coefficients of restitution, static friction, and rolling friction. Computation time is critical in DEM modeling so single sphere particle models were emphasized over multi-sphere particles in the research even though multi-sphere particles represent the corn kernel shape more precisely because their simplicity can provide markedly reduced computation times to complete simulations. Predicted results for hopper emptying time, bulk density, and angle of repose were compared to experimental results or published data to select the most appropriate particle models for simulating bulk behavior of corn kernels in free-flowing grain applications using DEM. From the study, the most appropriate particle model (particle shape/physical properties combination) for corn kernels involved a single-sphere shape particle shape with a particle coefficient of restitution of 0.30, particle coefficients of static friction of 0.30 for corn-corn contact and 0.20 for corn-steel contact, particle coefficient of rolling friction of 0.05, normal particle size distribution with a standard deviation factor of 0.4, and particle shear modulus of 20 MPa.

Physiologically based pharmacokinetic modeling to predict OAT3-mediated drug-drug interactions of meropenem in varying stages of chronic kidney disease

ObjectiveThis study aimed to predict OAT3-mediated meropenem DDIs in varying stages of CKD using physiologically based pharmacokinetic (PBPK) models. MethodsMeropenem DDI model was performed with OAT3 perpetrators probenecid (strong inhibitor), piperacillin (moderate inhibitor) and acyclovir (weak inhibitor). Firstly, whole-body PBPK models were developed for meropenem and piperacillin in healthy adults with PK-Sim®. Then the models were translated to patients with varying stages of CKD by accounting for changes in eGFR, kidney volume, kidney blood flow, hematocrit, gastric emptying time, small intestinal transit time, OAT transport function and non-renal clearance. Subsequently, meropenem DDI model was verified by comparing the model simulation results of the interaction between meropenem and probenecid with the observational data from clinical studies. Finally, pharmacokinetics of meropenem under co-administration of piperacillin and acyclovir were predicted through simulations with the virtual population in varying stages of CKD. ResultsThe developed PBPK models of meropenem and piperacillin adequately described the pharmacokinetic characteristics in healthy adults and in adults with varying stages of CKD. The predicted AUC ratio of meropenem co-administered with probenecid to meropenem given alone was within 1.5-fold of the observed clinical data. The predicted steady-state AUC values of meropenem in healthy adults co-administered with probenecid, piperacillin or acyclovir were 1.593-fold (95% CI, 1.436-1.6244), 1.031-fold (95% CI, 1.017-1.045) and 1.005-fold (95% CI, 1.004-1.005), respectively, as compared to the AUC of meropenem given alone. And all predicted probenecid-meropenem, piperacillin-meropenem and acyclovir-meropenem DDI AUC ratios were decreased in renal impairment. Our presented meropenem DDI model demonstrated that patients with CKD may be less vulnerable to OAT3-mediated DDIs compared with healthy adults. However, further clinical DDI studies are required to verify our prediction results. ConclusionPBPK analysis provided a quantitative basis for guiding the clinical application of meropenem combined with OAT3 inhibitor in varying stages of CKD.

Konjac Glucomannan: An Emerging Specialty Medical Food to Aid in the Treatment of Type 2 Diabetes Mellitus.

There are many factors causing T2DM; thus, it is difficult to prevent and cure it with conventional treatment. In order to realize the continuous intervention of T2DM, the treatment strategy of combining diet therapy and traditional medication came into being. As a natural product with the concept of being healthy, konjac flour and its derivatives are popular with the public. Its main component, Konjac glucomannan (KGM), can not only be applied as a food additive, which greatly improves the taste and flavor of food and extends the shelf life of food but also occupies an important role in T2DM. KGM can extend gastric emptying time, increase satiety, and promote liver glycogen synthesis, and also has the potential to improve intestinal flora and the metabolic system through a variety of molecular pathways in order to positively regulate oxidative stress and immune inflammation, and protect the liver and kidneys. In order to establish the theoretical justification for the adjunctive treatment of T2DM, we have outlined the physicochemical features of KGM in this article, emphasizing the advantages of KGM as a meal for special medical purposes of T2DM.

Prevalence of delayed gastric emptying in patients with gastroparesis-like symptoms.

The European consensus defined gastroparesis as a condition characterised by delayed gastric emptying (GE) in the absence of mechanical obstruction, with a symptom pattern of predominant nausea and/or vomiting and overlapping postprandial distress syndrome (PDS). The distinction between patients with gastroparesis and those with functional dyspepsia (FD), another gastrointestinal condition characterised by predominant PDS or epigastric pain syndrome symptoms, is ongoing. To investigate the extent that symptom patterns may differentiate gastroparesis from FD. This retrospective study included 637 patients from Leuven University Hospital in 2006-2021 who had upper gastrointestinal symptoms, underwent a GE test, and completed the Dyspepsia Symptom Severity (DSS) questionnaire. Patients were identified as with gastroparesis-like symptoms (GPLS; i.e., moderate to severe nausea with moderate to severe PDS) or FD symptoms (not fitting GPLS). We excluded patients aged <18 years, and those with diabetes, organic gastrointestinal disease or a history of abdominal surgeries. Demographic and clinical variables were compared. Among 545 patients, 238 reported GPLS and 307 reported FD symptoms. Those with GPLS had a significantly higher prevalence of delayed GE (half emptying time (T1/2) ≥109 min) and lower body mass index than those with FD (33.2% vs 17.6%, p< 0.01; 19.9 vs 21.2, p< 0.01, respectively). Among GPLS patients, those with delayed GE had higher DSS than those without (13.0 vs 12.0, p< 0.01). In tertiary care patients who reported gastroparesis or FD symptoms, the presence of delayed GE was associated with GPLS. In patients with GPLS, delayed GE was associated with higher symptom severity.

BARIUM SULFATE GELATIN AS A NOVEL APPROACH TO FACILITATE GASTROINTESTINAL TRACT POSITIVE CONTRAST STUDIES IN A CAPTIVE HARBOR SEAL (PHOCA VITULINA) AND CALIFORNIA SEA LIONS (ZALOPHUS CALIFORNIANUS) WITHOUT RESTRAINT.

Gastrointestinal tract contrast medium studies are a valuable diagnostic modality to evaluate gastrointestinal anatomy, motility, and pathology. Four positive contrast medium studies were performed twice on a harbor seal (Phoca vitulina) and once each on two California sea lions (Zalophus californianus) to evaluate for gastrointestinal abnormalities by using barium-impregnated gelatin. Because marine mammals in human care routinely receive plain gelatin as a component of their diet and as secondary reinforcement, feeding a barium gelatin mitigates the need for tube feeding or restraint. Operant conditioning was used to position the pinnipeds for voluntary radiographs. The barium gelatin permitted adequate evaluation of gastric emptying and intestinal transit times and good evaluation of the structure of the intestinal tract. Full evaluation of gastric anatomy was limited due to the gelatin blocks not conforming to the stomach in their solid form and the barium quickly exiting the stomach as barium gelatin blocks disintegrated and because orthogonal views could not always be acquired. Even with these limitations, barium gelatin resulted in diagnostically valuable contrast imaging in a stress-free patient setting with reduced risk of aspiration and eliminated the effects that anesthesia can have on gastric motility as well as other anesthesia-associated risks.

Assessing nitrogen dynamics model and the role of artificial lagoon in effluent loading of shrimp farms in Gomishan wetland, southern Caspian Sea

Shrimp farming increases the nutrients, especially nitrogen in the water resources reducing water quality. This study was conducted to evaluate the nitrogen dynamics in white shrimp (Litopenaeus vannamei) farms and the role of artificial lagoon (24 ha) in reducing nitrogen levels in Gomishan coastal wetland, the eastern Caspian Sea. The results indicated that at the end of the 4-month breeding period, the amounts of nitrogen and phosphorus introduced into Gomishan wetland were calculated as to 220.157 and 39 tons, respectively in a breeding area covering 830 hectares. Nitrogen values (based on nitrate) calculated based on the relationship between the basin and the discharge of the outlet channel of the site at the time of complete emptying of the farms, were calculated to be approximately 121.8 tons per breeding time that it had an important role in eliminating about 45% of nutrient pollution and reducing the concentration of dissolved nitrogen. Moreover, nitrogen isotopic trace was observed in shrimp samples, in similar levels in the samples of both shrimp pond and lagoon, which emphasizes the role of feeding from natural food, especially benthic fauna. Overall, due to the decline of Caspian Sea water level, Gomishan coastal wetland is drying, and the output of shrimp farms is currenly the only source supplying water for the wetland. Hence, appropriate management strategies could minimize the amounts of nutrients into the natural water whilst aiding wetland’s survaival.

Gastric Emptying and Its Correlation With Weight Loss and Body Mass Index in Patients With an Intragastric Balloon: A Prospective Study With Six Years of Follow-Up.

Background Obesity is the most well-established and prolonged pandemic in modern society. Having a better understanding of the available tools is important to improve weight loss and make the strategies more productive. This study aims to evaluate the effect of intragastric balloon (IGB) on gastric emptying time, its relationship with weight loss after IGB removal, and weight maintenance after six years. Methodology This prospective study analyzed data from patients undergoing IGB placement. A six-years follow-up was performed and data about weight maintenance were collected. We analyzed the impact of the IGB on gastrointestinal motility and its correlation with weight loss. Results Of the 20 patients included in the study, 52.4% were diagnosed with class I obesity and 47.6% with class II obesity. The mean weight of the patients was 96.5 ± 11.9 kg at baseline, 79.6 ± 11.4 kg at the time of IGB removal, 81.8 ± 9.1 kg at six months, and 93.2 ± 14.3 kg six years after IGB removal. The mean difference between the initial weight and that measured immediately after IGB removal was 16.68 ± 5.71 kg. Regarding gastric emptying time, there was a difference in retention on comparing the measurement before balloon placement to that after the balloon was in place (72.9% vs. 86.8%) after one hour of food intake. Comparing two hours after food intake, patients before IGB placement had a 30.6% food retention, while patients with IGB in place had a 69.2% retention. Conclusions In patients with class I or II obesity, the use of an IGB delayed gastric emptying of foods but showed no direct correlation with weight loss. Weight loss achieved after IGB placement was maintained in half of the patients at a six-year follow-up.

FLOATING DRUG DELIVERY SYSTEM: A REVIEW

Recent technological and scientific research has been devoted to the development of rate-controlled drug delivery system to overcome physiological adversities such as unpredictable gastric emptying times and gastric residence time. FDDS are of particular interest of drugs that are locally active and have narrow absorption window in stomach. FDDS offers numerous advantages, specially the drugs having narrow absorption window in GIT, primary absorption in the stomach, Prolonged gastric retention improves bioavailability, reduces drug waste, and improves solubility for drugs that are least soluble in a high pH environment. This review summarizes the design of the FDDS systems, factors that affect floating system, advantages, limitations, evaluation parameters and applications.

A REVIEW ON GASTRORETENTIVE DRUG DELIVERY SYSTEM

Gastroretentive drug delivery system comprised mainly of floating, bioadhesive, swelling, high density and magnetic systems have emerged as a current approaches of enhancing the bioavailability and controlled delivery of drugs that exhibit an absorption window. By prolonging the gastric emptying time of the dosage form, these systems not only provide controlled release of the drug for a prolonged period but also present the drug in an absorbable form at regions of optimal absorption. CR-GRDF provides a means to utilize all the pharmacokinetic (PK) and pharmacodynamic (PD) advantages of controlled release dosage forms for such drugs. Due to the complexity of pharmacokinetic and pharmacodynamic parameters, in vivo studies are required to establish the optimal dosage form for a specific drug. For a certain drug, interplay of its pharmacokinetic and pharmacodynamic parameters will determine the effectiveness and benefits of the CRGRDF compared to the other dosage forms.

IN VIVO MONITORING STRATEGIES FOR EVALUATION OF FLOATING DRUG DELIVERY SYSTEMS

In recent years, various advancements have been introduced in the development of controlled drug release devices for resolving different physiological problems for example, gastric retention inconsistency along with erratic gastric emptying time. Gastroretentive delivery formulations receive considerable attention to overcome these drawbacks and in optimizing the absorption of different medicaments. Gastroretentive technologies considerably extend the stomach retention time of dosage forms with increased bioavailability as well as therapeutic efficacy. Gastroretention can be successfully achieved utilizing gastric floating system. The rationale of the present manuscript focuses on current advancements of gastric floating systems so as to accomplish appropriate drug bioavailability and, subsequently drug targeting to the stomach. In vivo evaluation parameters, especially pivotal imaging techniques including roentgenography, gamma scintigraphy, gastroscopy, magnetic marker monitoring, magnetic resonance imaging, ultrasonography, 13C octanoic acid breath test etc. have been emphasized in this manuscript for monitoring drug formulation behavior which extensively revolutionized thorough understanding in the avenue of improved bioavailability of gastroretentive systems.