Fasting Gastric Volume Research Articles

Assessing Full Stomach Prevalence with Ultrasound Following Preoperative Fasting in Diabetic Patients with Dysautonomia: A Comparative Observational Study.

Traditionally, diabetics have been considered patients with a high risk of aspiration due to having delayed gastric emptying; However, the evidence concerning residual gastric volume (GV) in fasting diabetic patients is inconsistent. This study aimed to compare the fasting GV of diabetic patients with or without dysautonomia with control patients scheduled for elective surgery using gastric ultrasound. This bicentric prospective single-blinded case-control study was conducted at 2 university hospitals in Spain. Patients aged over 18 years, classified as American Society of Anesthesiologists (ASA) physical statuses I to III and having similar fasting statuses, were included in the study. The primary outcome was to compare the prevalence of risk stomach using the Perlas gastric content grading scale evaluated by ultrasound in the 3 groups. Secondary outcomes included the measurement of cross-sectional area (CSA) and GV in the right lateral decubitus (RLD) position, as well as the prevalence of solid gastric residue. A total of 289 patients were recruited for the study, comprising 145 diabetic patients (83 of whom had dysautonomia) and 144 patients in the control group. The percentage of patients classified as Perlas grade 2 was 13.2% in the control group, 16.1% in diabetic patients without dysautonomia, and 22.9% in diabetic patients with dysautonomia (P = .31). Antral CSA was significantly higher in diabetic patients with dysautonomia (6.5 [4.8-8.4]) compared to the control group (5.4 [4.0-7.2]; P = .04). However, no significant differences were observed between groups in residual GV. Among diabetic patients with dysautonomia, 12% exhibited solid gastric residue, which was twice the percentage observed in diabetic patients without dysautonomia (4.8%) and 3 times higher than that in the control group (3.5%; P = .03). The presence of dysautonomia was associated with an increased odds ratio of solid gastric residue (odds ratio [OR], 3.37; 95% confidence interval [CI], 1.28-8.87; P = .01) after adjusting for confounding factors. This study offers insights into the relationship between dysautonomia in patients with diabetes mellitus and the presence of full stomach, underscoring the significance of preoperative gastric ultrasound evaluation in managing perioperative risks in this population.

STUDY TO COMPARE FASTING GASTRIC VOLUME USING ULTRASOUND IN DIABETIC AND NON DIABETIC PATIENTS POSTED FOR ELECTIVE SURGERIES

Objective: To study the comparison of fasting gastric volume using ultrasound in diabetic and nondiabetic patients in elective surgeries. To compare the incidence of delayed gastric emptying in diabetic and nondiabetic after standard fasting guidelines Material and Methods: After institutional ethical committee approval, CTRI registration and patient consent, prospective study was conducted in 30 diabetic and 30 non-diabetic patients aged 30-60years of American society of anesthesiologists- physical status I-III having similar fasting intervals. Pre operatively, quantitative assessments of gastric antrum in supine and right lateral decubitus (RLD) positions were performed using curvilinear probe in accordance to standard gastric scanning. USG grade, cross-sectional area (CSA) of the antrum and gastric volume were calculated. The gastric antrum was classified as Grade 0, 1 or 2, signifying empty antrum, fluid in RLD position only and antral fluid in both supine and RLD positions, respectively. Results:The CSA of 2.35 ± 1.07 cm2 and 3.51 ± 1.4 cm2 in diabetic were significantly higher (P = 0.001) than 1.37 ± 0.32 cm2 and 2.19 ± 1.15 cm2 of control, in supine and RLD positions, respectively. GV was 3.85± 20.06 ml in control group and 6.5±23.51 ml in diabetic group. Conclusion: Diabetic patients have higher gastric antral cross-sectional area and gastric volumes as observed by gastric ultrasound than the non-diabetic patients. Reference - 1. Robinson M, Davidson A. Aspiration under anaesthesia: Risk assessment and decision-making. Contin Edu Anaesth Crit Care Pain. 201314:171–5. 2.Perlas A, Chan VW, Lupu CM, Mitsakakis N, Hanbidge A. Ultrasound assessment of gastric content and volume. Anesthesiology. 2009111:82–9. 3. Smith I, Kranke P, Murat I, Smith A, OSullivan G, Soreide E, et al. Perioperative fasting in adults and children: Guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 201128:556–69.

Assessment of fasting gastric volume using ultrasound in patients undergoing cholecystectomy and other elective surgeries: A prospective observational study

ABSTRACT Background: Prevention of pulmonary aspiration is an important aspect of anaesthesia practice. Strictly following the pre-operative fasting guidelines can pre-empt pulmonary aspiration in most patients undergoing elective surgeries. Ultrasonographic assessment of patients scheduled for laparoscopic cholecystectomy with symptomatic gall bladder disease has shown a higher incidence of a full stomach. Aim: The primary objectives of this study were to assess and compare gastric volume and contents in fasted patients undergoing elective laparoscopic cholecystectomy and other elective surgeries and to evaluate the relationship of fasting gastric volume and contents with other comorbidities and body mass index (BMI). Materials and Methods: On the day of surgery, hours of fasting were noted. Patients scheduled for laparoscopic cholecystectomy were in Group L, and patients scheduled for other surgeries were in Group O. Ultrasonography was performed before induction of anaesthesia in the pre-operative room by an experienced anaesthesiologist. The patients were classified based on the Perlas grading scale. To assess the risk of aspiration, the classification previously established by Ven de Putte and Perlas was used. Sixty patients were included in Group L and 60 patients in Group O. Results: The incidence of a full stomach was 3.33% in Group O and 20% in Group L. There was no significant association between BMI and gastric residual volume (GRV) in this study. There was no significant difference between GRV between diabetic and non-diabetic patients in Group L and Group O. Conclusion: Patients with gall bladder pathologies scheduled for cholecystectomy could have delayed gastric emptying; therefore, anaesthesiologists should be cautious, and bedside assessment tools such as ultrasound, which is easy and non-invasive, should be utilised to stratify the risk of aspiration in such patients.

Baseline Gastric Volume in Fasting Diabetic Patients Is Not Higher than That in Nondiabetic Patients: A Cross-sectional Noninferiority Study.

The physiology of diabetes mellitus can increase the risk of perioperative aspiration, but there is limited and contradictory evidence on the incidence of "full stomach" in fasting diabetic patients. The aim of this study is to assess the baseline gastric content (using gastric ultrasound) in diabetic and nondiabetic patients scheduled for elective surgery who have followed standard preoperative fasting instructions. This was a prospective, noninferiority study of 180 patients (84 diabetic and 96 nondiabetic patients). Bedside ultrasound was used for qualitative and quantitative assessment of the gastric antrum in the supine and right lateral decubitus positions. Fasting gastric volume was estimated based on the cross-sectional area of the gastric antrum and a validated model. The hypothesis was that diabetic patients would not have a higher baseline fasting gastric volume compared to nondiabetic patients, with a noninferiority margin of 0.4 ml/kg. Secondary aims included the comparison of the incidence of full stomach (solid content or more than 1.5 mL/kg of clear fluid), estimation of the 95th percentile of the gastric volume distribution in both groups, and examination of the association between gastric volume, glycemic control, and diabetic comorbidities. The baseline gastric volume was not higher in diabetic patients (0.81 ± 0.61 ml/kg) compared to nondiabetic patients (0.87 ± 0.53 ml/kg) with a mean difference of -0.07 ml/kg (95% CI, -0.24 to 0.10 ml/kg). A total of 13 (15.5%) diabetic and 11 (11.5%) nondiabetic patients presented more than 1.5 ml/kg of gastric volume (95% CI for difference, -7.1 to 15.2%). There was little correlation between the gastric volume and either the time since diagnosis or HbA1C. The data suggest that the baseline gastric volume in diabetic patients who have followed standard fasting instructions is not higher than that in nondiabetic patients.

An association between gastric contents and gastric volume with gender and comorbidities: An observational study

Abstract Background and Aims: The data regarding fasting gastric contents and gastric volume in patients with comorbidity are lacking. The present study was conducted to determine an association between gender and comorbidities with gastric contents and gastric volume determined by ultrasonography in 8 h fasting patients. It was hypothesized that there is no association between gastric contents and gastric volume with gender and comorbidities. Materials and Methods: The present cross-sectional observational study was conducted in patients aged between 18 and 60 years posted for elective surgery. The patients were advised to overnight fast for a minimum of 8 h. Preoperative bedside ultrasonography was done in the right lateral decubitus position. According to the appearance on the ultrasound, the contents were identified as either empty, clear liquids, or solids. Antral cross-section area was measured and gastric volume was estimated. Statistical Package for Social Sciences for Windows, version 22, was used for analysis. Comparison of the distribution of categorical variables was done using the Chi-square test/Fisher’s exact test. Comparison of parametric and nonparametric continuous variables was done using unpaired t-test and Kruskal–Wallis test, respectively. Results: The mean gastric volume among males and females was 64.8 mL and 64.2 mL, respectively (P = 0.896). The median gastric volume and the median gastric volume in mL/kg were significantly higher in patients who had chronic kidney disease (4.53 mL/kg and 125.5 mL) as compared to other comorbidities such as diabetes mellitus (1.88 mL/kg and 52.3 mL), hypertension (2.05 mL/kg and 53.9 mL), hypothyroidism (1.69 mL/kg and 48.9 mL), and obesity (2.18 mL/kg and 65.6 mL). The percentage of patients who had no gastric content was significantly higher in males as compared to females. There was no statistically significant difference in the type of gastric contents and comorbidities. Conclusions: There was an association between gastric volume and comorbidities, but there was no association between gastric contents and comorbidities. There was an association between gastric contents and gender, but there was an association between gastric volume and gender.

Preoperative clear fluid fasting and endoscopy-measured gastric fluid volume in children.

In light of new recommendations to shorten clear fluid fasting time before anesthesia, our study aimed at exploring residual fluid volume in the stomach after different fasting times. We intended to perform direct endoscopic aspiration of stomach contents under vision, as part of routine gastroscopy assessment. Hereby we would be able to quantify true residual gastric fluid volume and acidity in children and measure their correlation with fasting times. The study was performed as a single-center, prospective study in pediatric perioperative day care at a university-affiliated tertiary care center. Aspiration of gastric fluid contents was performed in anesthetized children aged 1-18 years undergoing an elective gastroscopy. Recorded data included patient fast time, last meal content, last clear fluid content, and aspirated gastric volume and pH, as well as patient characteristics. We included 253 gastroscopies, performed in 245 children. Mean fasting time for clear fluids was 6.9h (range 1h 40 min - 18 h 35 min) (SD 4.5). Mean age was 9.8 years (SD 5.1) and mean body weight was 33.2kg (SD 18.7). Mean residual gastric volume was 12 mL (0-90) (SD 13.5) or 0.34 mL/kg (SD 0.37) and mean pH was 1.5 (SD 0.9). No significant correlation was observed between clear fluid fasting time and the child's residual gastric fluid volume per kg body weight (r= -.103, p= .1), nor between clear fluid fasting time and the pH of the residual gastric fluid (r= -.07, p= .3). In more than half of the patients the residual gastric volume was less than 10mL, unrelated to fasting time. In children undergoing gastroscopy, we could not demonstrate any association between clear fluid fasting time and the child's residual gastric fluid volume per kg body weight. Since we did not see a clinically relevant association between clear fluids fasting time and gastric residual volume, this study may support the recommendation to shorten clear fluids fasting time.

A Comparative Study of Fasting Gastric Volume in Diabetic and Non-diabetic Patients Undergoing Elective Surgeries Using Ultrasonography: A Prospective Observational Study.

Gastric ultrasound can be used to evaluate the residual gastric volume (GV) and contents before anesthetizing a patient. Autonomic gastropathy in patients with diabetes increases the risk of pulmonary aspiration of gastric contents. Therefore, the present study was conducted to assess the fasting GV among diabeticsand healthy individuals using point-of-care (POC) ultrasonography. This prospective observational study was conducted in a tertiary care hospital between January 2021 and February 2022. A total of 122 patients included in the study were divided into two groups: group D (n = 61) patients had a history of diabetes mellitus and group C (n = 61) patients were non-diabetics (control).Gastric ultrasound was performed in supine and right lateral decubitus (RLD) positions. The following parameters were measured: duration of fasting, craniocaudal (CC) diameter, anteroposterior (AP) diameter, cross-sectional area (CSA), and GVusing CC and AP diameters. The mean age of the participants was found to be 46.60 ± 13.77 years with 51.6% femalepatients and 48.4% male patients. Among the patients, there was a significantly higher mean level of CC diameter, AP diameter, and CSA in the supine position in diabetics compared to controls(p < 0.05). Similarly, there was a significantly higher mean level of CC diameter, AP diameter, and CSA in the RLD position in diabetics compared to healthy individuals (p < 0.05). The GV was significantly higher in diabetics (9.96 ± 14.520) compared to healthy individuals (-8.991 ± 20.95; p < 0.05). Fasting GV assessed using POC ultrasonography in diabetic individuals was higher when compared to non-diabetics after similar periods of fasting.

Effects of liraglutide on gastrointestinal functions and weight in obesity: A randomized clinical and pharmacogenomic trial.

This study aimedto determine the effects of a long-acting glucagon-like peptide-1 (GLP-1) receptor agonist, liraglutide, and placebo subcutaneously over 16 weeks on weight and gastric functions and to evaluate associations of single-nucleotide polymorphisms in GLP1R (rs6923761) and TCF7L2 (rs7903146) with effects of liraglutide. The study conducted a randomized, parallel-group, placebo-controlled, 16-week trial of liraglutide, escalated to 3 mg subcutaneously daily in 136 otherwise healthy adults with obesity. Weight, gastric emptying of solids (GES), gastric volumes, satiation, and body composition measured at baseline and after treatment were compared in two treatment groups using analysis of covariance. Liraglutide (n=59) and placebo (n=65) groups completed treatment. Relative to placebo, liraglutide increased weight loss at 5 and 16 weeks (both p < 0.05), slowed time to half GES (T1/2 ) at 5 and 16 weeks (both p < 0.001), and increased fasting gastric volume (p=0.01) and satiation (p < 0.01) at 16 weeks. GES T1/2 was positively correlated with weight loss on liraglutide (both p < 0.001). After 16 weeks of liraglutide, GLP1R rs6923761 (AG/AA vs. GG) was associated with reduced percent body fat (p=0.062), and TCF7L2 rs7903146 (CC vs. CT/TT) was associated with lower body weight (p=0.015). Liraglutide, 3 mg, induces weight loss with delay in GES T1/2 and reduces calorie intake. Slowing GES and variations in GLP1R and TCF7L2 are associated with liraglutide effects in obesity.

A retrospective analysis of maternal complications and newborn outcomes of general anesthesia for cesarean delivery in a single tertiary hospital in China

BackgroundEither neuraxial anesthesia or general anesthesia can be performed for cesarean delivery. Generally, neuraxial anesthesia is the first choice with the risk and benefit balance for both the mother and fetus. However, general anesthesia is also applicable most commonly in the emergent setting. This study analyzed maternal complications associated with general anesthesia for cesarean delivery and suggested lowering pregnancy-related maternal and newborn adverse outcomes.MethodsWith the approval of the Institutional Ethics Review Board (No: 2017016), data on cesarean delivery and related anesthesia were collected from the Electronic Health Record System from 1/1/2013 to 12/31/2016. Statistical software STATA version 15.1 was used for data analyses. All statistical tests were two-sided, and a level significance of 0.05 was assumed.ResultsThe rate of general anesthesia for cesarean delivery increased steadily during 2013–2016, 3.71% in 2013 to 10.23% in 2016 (p < 0.001). Repeat cesarean delivery among general anesthesia group increased significantly from 16.22% in 2013 to 54.14% in 2016 (p < 0.001). Morbidly adherent placenta (MAP) was the first reason among pregnancy-related complications, which accounted for 33% in total in general anesthesia group (38% in 2013 to 44% in 2016). The laryngeal mask airway (LMA) was used in airway management, and the proportion of LMA increased from 28.38% in 2013 to 92.99% in 2016 (p < 0.001). There were significant differences in newborn outcomes between general anesthesia and neuraxial anesthesia groups, including newborn weight, newborn Apgar score at 1 min and 5 min and newborn admission to the NICU (p < 0.001).ConclusionsThe growing incidence of general anesthesia was consistent with the trend of rising repeat cesarean delivery and MAP. low newborn Apgar score and high newborn admission to the NICU in general anesthesia group compared with neuraxial anesthesia group. The LMA was performed safely for airway management with enough fasting and careful gastric volume evaluation.

Clinical trial: a single-centre, randomised, controlled trial of tradipitant on satiation, gastric functions, and serum drug levels in healthy volunteers.

Tradipitant, an NK1 receptor antagonist, improved symptoms in patients with gastroparesis. It is unclear whether these effects are mediated centrally (e.g., vomiting centre) or on gastric functions. As a class, NK1 antagonists may retard gastric emptying (GE) or increase fasting and postprandial gastric volumes (GV). To evaluate the effects of tradipitant relative to placebo on gastric motor functions, satiation, postprandial symptoms, and pharmacokinetics. We conducted a randomised, double-blind, placebo-controlled, single-centre study of tradipitant 85 mg or matching placebo b.i.d. for 9 consecutive days in 24 healthy volunteers. During the last 2 days of treatment, participants underwent scintigraphic measurements of GE of 320 kcal egg meal, fasting and postprandial GV by SPECT, and satiation by nutrient drink ingested to maximum tolerated volume (MTV) and symptoms 30 min later. Treatments were compared by Wilcoxon rank sum test. The study had 80% power to detect group differences of 23.6% in GV and 29.2% in GE T1/2 . The two groups of healthy participants were well balanced based on demographic features, age, and BMI. There were nonsignificant positive correlations between blood levels of tradipitant and accommodation GV and GE at 4h. There were no significant effects of tradipitant, 85 mg b.i.d. for 9 days compared to placebo on GE, GV, satiation, or symptoms 30 min after MTV. Tradipitant, 85 mg b.i.d., does not significantly affect gastric motor functions (GV or GE). Importantly, there was no retardation of GE by tradipitant, which is important in relation to its potential use in patients with gastroparesis. ClinicalTrials.gov #NCT04849559.

Gastric Sensory and Motor Functions and Energy Intake in Health and Obesity-Therapeutic Implications.

Sensory and motor functions of the stomach, including gastric emptying and accommodation, have significant effects on energy consumption and appetite. Obesity is characterized by energy imbalance; altered gastric functions, such as rapid gastric emptying and large fasting gastric volume in obesity, may result in increased food intake prior to reaching usual fullness and increased appetite. Thus, many different interventions for obesity, including different diets, anti-obesity medications, bariatric endoscopy, and surgery, alter gastric functions and gastrointestinal motility. In this review, we focus on the role of the gastric and intestinal functions in food intake, pathophysiology of obesity, and obesity management.

Gastric accommodation influences proximal gastric and total gastric emptying in concurrent measurements conducted in healthy volunteers.

Gastric emptying and gastric accommodation play a role in generation of upper gastrointestinal symptoms. Although both functions have been measured simultaneously using MRI or 99mTc SPECT methodology, the correlation of these two functions has not been evaluated simultaneously using a solid and liquid meal. To study relationships of whole or proximal stomach volumes to emptying, we concurrently measured postprandial gastric accommodation and emptying (over 4 h) of a 111In-labeled mixed solid and liquid meal. A semiautomated method allowing selection of a segmentation threshold based on a grayscale image was used to measure volume of the proximal half of the stomach, defined as the top half of axial slices along the vertical length of the stomach. A correction factor derived from phantom studies was applied for upscatter from the 99mTc to the 111In window. Relationships of time to emptying 10%, 25%, 50%, and 75% of the meal to fasting and postprandial gastric volumes were evaluated using Spearman correlation. Whole stomach fed and accommodation volumes were significantly correlated with all gastric emptying times (10%, 25%, and 50%). Proximal stomach fed volumes were similarly associated with 50% and 75% proximal gastric emptying. Fed proximal gastric volume was associated with 50% and 75% whole gastric emptying. Fed proximal accommodation volume was associated with 50% gastric emptying. Fasting gastric volumes were not significant determinants of emptying rates. In conclusion, postprandial gastric accommodation is significantly associated with the rate of gastric emptying, with higher gastric volumes associated with prolongation of emptying. Novel methods to measure proximal gastric accommodation and correct for radioisotope upscatter are described.NEW & NOTEWORTHY In vivo human studies evaluated concurrently the volume of the stomach during fasting and after a solid and liquid meal using a new SPECT-based method. Although fasting gastric volumes did not impact the rates of gastric emptying, both postprandial and accommodation volumes of the whole and proximal stomach were significantly correlated with gastric emptying. Larger stomach volumes were associated with slower gastric emptying.

Gastric Motor Functions in Patients With Mood Disorders and Functional Gastroduodenal Symptoms.

Functional gastroduodenal symptoms (FGDSs) may result from perturbations in gastric emptying (GE) and gastric accommodation (GA), which are variably affected by acute stress. This study aimed to examine whether individuals who have both mood disorder and FGDS exhibit differences in GE and GA using standardized, validated, and reproducible noninvasive methods. Using a data retrieval program, 1554 individuals at a single center were identified after having undergone measurements of GE by scintigraphy of a 99mTc-radiolabeled egg (320 kcal, 30% fat meal) and GA by single-photon emission computed tomography to assess the underlying pathophysiology in FGDS. An extensive medical record review identified 267 of these individuals as having diagnoses of depression, anxiety, or comorbid anxiety/depression (CAD). Differences in GE and GA as related to the presence of anxiety or depressive disorders were analyzed using one-way analysis of variance on ranks and Mann-Whitney tests for the two-group comparisons. Sixty-three patients with anxiety, 134 with depression, and 70 with CAD were identified. GE at 1 hour was slower (p = .04) and GE at 2 hours numerically decreased (p = .07) for depression compared with anxiety. GA was diminished for CAD compared with anxiety (p = .04) and depression (p = .009). There were no differences in fasting gastric volume or GE at 4 hours. In this study examining GE and GA in anxiety and depressive disorders among patients with FGDS, the combined presence of anxiety and depression was associated with impaired GA compared with patients with depression or anxiety alone, and early GE seemed to be slower in those with depression compared with patients with anxiety.

Acute Effects of Red Chili, a Natural Capsaicin Receptor Agonist, on Gastric Accommodation and Upper Gastrointestinal Symptoms in Healthy Volunteers and Gastroesophageal Reflux Disease Patients.

The effects of chili on gastric accommodation (GA) in gastroesophageal reflux disease (GERD) patients have not been explored. Methods: In total, 15 healthy volunteers (HV) and 15 pH-positive non-erosive GERD (NERD) patients underwent single-photon emission computed tomography after ingesting 2 g of chili or placebo in capsules in a randomized double-blind crossover fashion with a one-week washout period. GA was the maximal postprandial gastric volume (GV) after 250 mL of Ensure® minus the fasting GV. Upper gastrointestinal symptoms were evaluated by using a visual analog scale. Results: NERD patients but not HV had significantly greater GA after chili compared to a placebo (451 ± 89 vs. 375 ± 81 mL, p < 0.05). After chili, the postprandial GVs at 10, 20, and 30 min in NERD patients were significantly greater than HV (10 min, 600 ± 73 vs. 526 ± 70 mL; 20 min, 576 ± 81 vs. 492 ± 78 mL; 30 min, 532 ± 81 vs. 466 ± 86 mL, all p < 0.05). In NERD, chili was associated with significantly less satiety, more severe abdominal burning (p < 0.05), and a trend of more severe heartburn (p = 0.06) compared to the placebo. In HV, postprandial symptoms after chili and placebo ingestion were similar (p > 0.05). Conclusions: Chili enhanced GA in NERD patients but not in HV. This suggests that the modulation of GA in NERD is abnormal and likely involves transient receptor potential vanilloid 1 (TRPV1) sensitive pathways.

Associations of gastric volumes, ingestive behavior, calorie and volume intake, and fullness in obesity.

Whereas gastric emptying significantly predicts calorie intake, the association between gastric capacity and satiation and satiety is unclear. To study the associations between gastric volumes and ingestive behaviors with satiation and satiety in obesity, 62 healthy adult obese patients (57 female) with no eating disorders underwent measurements of satiety, as determined by kilocalories of ingestion at a buffet meal, and satiation by volume to comfortable fullness (VTF) and maximum tolerated volume (MTV), while drinking Ensure (30 mL/min). Fasting and postprandial gastric volumes were measured by validated single-photon emission computed tomography. We also measured eating [Weight Efficacy Life-Style Questionnaire score (WEL)] and exercise behaviors associated with obesity. Spearman correlation-assessed relationships of measured traits and linear regression analysis to identify predictors of satiation or satiety. The participants were aged 38 ± 10.1 yr and the body mass index (BMI) 36.8 ± 4.8 kg/m2. Fasting gastric volume was significantly correlated with VTF (rs = 0.3, P = 0.03), but not with MTV or buffet meal kilocalorie ingestion. Regression analysis identified sex (P = 0.02, with males having significantly higher fasting gastric volume) and fasting gastric volume (0.04) as predictors of higher VTF. An increase in fasting gastric volume of 50 mL resulted in a 6-mL increase in VTF. Buffet meal intake was inversely related to the ability to resist the urge to eat; factors associated with ingestive behavior (increase in total WEL score) significantly correlated with satiety and gastric accommodation (P < 0.05). Gastric capacity during fasting is associated with calorie intake to the point of comfortable fullness; factors associated with ingestive behavior are associated with satiety and gastric accommodation.NEW & NOTEWORTHY Buffet meal intake was inversely related to the ability to resist the urge to overeat. Factors associated with ingestive behavior significantly correlated with satiety and gastric accommodation. Gastric capacity during fasting is associated with calorie intake to the point of comfortable fullness; factors associated with ingestive behavior are associated with satiety and gastric accommodation.

Comparison of fasting gastric volume using ultrasound in diabetic and non-diabetic patients in elective surgery: An observational study.

Background and Aims:Gastroparesis despite standard fasting in diabetic patients may increase the aspiration risk. This study aimed to compare fasting gastric volume (GV) of diabetic with non-diabetic patients scheduled for elective surgery using USG.Methods:This prospective observational study included 53 diabetic and 50 non-diabetic patients aged >18 years, American Society of Anesthesiologists' physical status I-III having similar fasting intervals. Before induction, using standard gastric scanning protocol, qualitative and quantitative assessments of gastric antrum in supine and right lateral decubitus (RLD) positions were performed with a curved array probe. USG grade, cross-sectional area (CSA) of the antrum and GV were calculated. The gastric antrum was classified as Grade 0, 1 or 2, signifying empty antrum, fluid in RLD position only and antral fluid in both supine and RLD positions, respectively.Results:In supine position, CC and AP diameters were 1.96 ± 0.41 cm and 0.9 ± 0.57 cm in control group and 2.28 ± 0.50 cm and 1.39 ± 0.44 cm in diabetic group, respectively. In RLD, CC was 2.28 ± 0.57 cm and AP was 1.24 ± 0.42 cm in control group as compared to CC 2.54 ± 0.56 cm and AP 1.82 ± 0.56 cm in diabetic group. The CSA of 2.57 ± 1.19 cm2 and 3.73 ± 1.61 cm2 in diabetic were significantly higher (P = 0.001) than 1.41 ± 0.55 cm2 and 2.30 ± 1.18 cm2 of control, in supine and RLD positions, respectively. GV was 4.20 ± 22.26 ml in control group and 9.15 ± 25.70 ml in diabetic group.Conclusion:Diabetic patients have higher gastric antral cross-sectional area and gastric volumes as observed by gastric ultrasound than the non-diabetic patients.

Effects of GLP-1 and Its Analogs on Gastric Physiology in Diabetes Mellitus and Obesity.

The processing of proglucagon in intestinal L cells results in the formation of glucagon, GLP-1, and GLP-2. The GLP-1 molecule becomes active through the effect of proconvertase 1, and it is inactivated by dipeptidyl peptidase IV (DPP-IV), so that the half-life of endogenous GLP-1 is 2-3min. GLP-1 stimulates insulin secretion from β cells in the islets of Langerhans. Human studies show that infusion of GLP-1 results in slowing of gastric emptying and increased fasting and postprandial gastric volumes. Retardation of gastric emptying reduces postprandial glycemia. Exendin-4 is a peptide agonist of the GLP-1 receptor that promotes insulin secretion. Chemical modifications of exendin-4 and GLP-1 molecules have been accomplished to prolong the half-life of GLP-1 agonists or analogs. This chapter reviews the effects of GLP-1-related drugs used in treatment of diabetes or obesity on gastric motor functions, chiefly gastric emptying. The literature shows that diverse methods have been used to measure effects of the GLP-1-related drugs on gastric emptying, with most studies using the acetaminophen absorption test which essentially measures gastric emptying of liquids during the first hour and capacity to absorb the drug over 4-6h, expressed as AUC. The most valid measurements by scintigraphy (solids or liquids) and acetaminophen absorption at 30 or 60min show that GLP-1-related drugs used in diabetes or obesity retard gastric emptying, and this is associated with reduced glycemia and variable effects on food intake and appetite. GLP-1 agonists and analogs are integral to the management of patients with type 2 diabetes mellitus and obesity. The effects on gastric emptying are reduced with long-acting preparations or long-term use of short-acting preparations as a result of tachyphylaxis. The dual agonists targeting GLP-1 and another receptor (GIP) do not retard gastric emptying, based on reports to date. In summary, GLP-1 agonists and analogs are integral to the management of patients with type 2 diabetes mellitus and obesity, and their effects are mediated, at least in part, by retardation of gastric emptying.

P.749 Combination extended-release Naltrexone/Bupropion causes significant weight loss without worsening psychiatric symptoms: pooled analysis from the contrave obesity research program

Liraglutide, a long-acting GLP-1 receptor agonist, is approved for treatment of obesity; however, the mechanisms of action of liraglutide are incompletely understood. We compared effects of liraglutide versus placebo on gastric motor functions, satiation, satiety, and weight in obese individuals over 16 weeks.We did a randomised, double-blind, placebo-controlled pilot trial at a single centre (Mayo Clinic, Rochester, MN, USA). Participants were randomly allocated (1:1) by a computer generated randomisation schedule with no stratification to receive subcutaneous liraglutide (3·0 mg) or placebo, with standardised nutritional and behavioural counselling. Allocation was concealed from participants and study investigators. Otherwise healthy, local residents aged 18–65 years with body-mass index (BMI) 30 kg/m2 or higher were included. Liraglutide or placebo was escalated by 0·6 mg/day each week for 5 weeks and continued until week 16. The primary outcome was change in gastric emptying (delay relative to baseline) of solids T1/2 (time taken for half the radiolabelled meal to empty from the stomach), measured at 5 weeks and 16 weeks in all patients who received at least one dose of study drug, with missing data imputed. Secondary outcomes included weight loss at weeks 5 and 16, satiation (volume to fullness and maximum tolerated volume), satiety, and fasting and postprandial gastric volumes at 16 weeks. This trial is registered with ClinicalTrials.gov, number NCT02647944, and is closed to new participants.Between Dec 18, 2015, and Sept 1, 2016, 40 adults were enrolled and randomly allocated (19 to the liraglutide group; 21 to the placebo group). Compared with placebo, liraglutide delayed gastric emptying of solids at 5 weeks (median 70 min [IQR 32 to 151] vs 4 min [–21 to 18]; p<0·0001) and 16 weeks (30·5 min [–11 to 54] vs −1 min [–19 to 7]; p=0·025). There was also significantly greater weight loss in the liraglutide group than in the placebo group (at 5 weeks: median 3·7 kg [IQR 2·8 to 4·8] vs 0·6 kg [–0·3 to 1·4], p<0·0001; at 16 weeks: 5·3 kg [5·2 to 6·8] vs 2·5 kg [0·1 to 4·2], p=0·0009). Satiation, as assessed by maximum tolerated volume at 16 weeks, was lower in the liraglutide group (median 750 mL [IQR 651 to 908]) compared with the placebo group (1126 mL [944–1185]; p=0·054). No significant differences were noted between groups in terms of volume to fullness, satiety, or fasting and postprandial gastric volumes at week 16. Post-hoc analysis showed that the T1/2 of gastric emptying of solids at 5 weeks correlated with change in weight loss at week 16 with liraglutide (Rs 0·567, p=0·018). Nausea was the most common adverse event in the liraglutide group (12 of 19) compared with placebo (four of 21).Effects of liraglutide on weight loss are associated with delay in gastric emptying of solids; measurement of gastric emptying (eg, at 5 weeks of treatment) may be a biomarker of responsiveness and may help to select individuals for prolonged treatment with this class of drug.US National Institutes of Health grant R56-DK67071.

Estimation of Gastric Volume Before Anesthesia in Term-Pregnant Women Undergoing Elective Cesarean Section, Compared With Non-pregnant or First-Trimester Women Undergoing Minor Gynecological Surgical Procedures.

Background:Traditionally, intubation of pregnant women has been performed using a rapid sequence induction. This is due to the classical concept that women with more than 18 weeks of pregnancy (mid-second trimester) are always considered to have an increased risk of aspiration due to a number of factors, regardless of the fasting duration. Rapid sequence induction is associated with a higher rate of adverse events.Aims:Our study aimed to illuminate the hypothesis that there is no difference in gastric volume between term-pregnant women and non-pregnant or first-trimester pregnant women who were undergoing minor gynecological surgical procedures. Accordingly, we measured gastric volume and content before anesthesia in term-pregnant women undergoing elective cesarean section, and to compare it with non-pregnant or first-trimester pregnant women who were undergoing minor gynecological surgical procedures.Methods:In this single-center prospective study, the gastric volume and content were assessed by abdominal ultrasound (AUS) just prior to the scheduled procedure. AUS was performed in the sagittal or para-sagittal plain in the upright position and the stomach content was estimated according to the antral circumferential area. Group 1 consisted of 50 term-pregnant women scheduled for cesarean section. Group 2 consisted of 45 non-pregnant or first-trimester pregnant women who were scheduled for minor gynecologic procedure.Results:Despite significant longer fasting time prior to the interventional procedure in the non-pregnant or first-trimester women group, there was no significant difference in gastric volume between term-pregnant and first-trimester pregnant women (3.2 ± 0.97 cm2 vs 3.2 ± 0.79 cm2; P = .97). Gastric volume was small in the two groups.Conclusion:Fasting gastric volume before cesarean section in term-pregnant women is small and is not different than in non-pregnant or first-trimester women undergoing minor gynecologic procedures. Ultrasound estimation of gastric volume is a reliable and easy-to-perform technique which might help in decision-making regarding the airway management prior to induction of anesthesia in pregnant women.

Characterization of Upper Gastrointestinal Symptoms, Gastric Motor Functions, and Associations in Patients with Diabetes at a Referral Center.

Our aim was to characterize upper gastrointestinal (UGI) symptoms and associations in individuals with diabetes mellitus (DM) who had undergone evaluation of gastric emptying (GE) and accommodation (GA) at a referral center. From the Mayo Clinic Rochester electronic medical records of adults with diabetes types 1 and 2 (DM1 and DM2) evaluated between January 1997 and December 2015, we extracted demographics, UGI symptoms, current medications, treatments for diabetes, GE solids by scintigraphy, GA by single photon emission computed tomography (SPECT), and diabetes complications. We compared subgroups with delayed (GE at 2 h <25% or GE at 4 h <75%), rapid (GE at 1 h > 35%), and normal GE, as well as reduced (<428 mL) and normal GA. We reviewed 108 patients (60.2% females, median age 49.0 years). Overall, 71.3% had DM2; one-third of these were insulin dependent and had fairly well-controlled diabetes (median HbA1c 6.7% (IQR 6.2; 7.9)). Manifestations of diabetic triopathy (peripheral neuropathy, nephropathy, and retinopathy) were uncommon at presentation with UGI symptoms. Nausea was the most common symptom (80.6%). There were single or combined GE (total 56%: rapid in 37%, slow in 19%) and GA (total 39%) abnormalities; there was normal GA and GE in 28%; 40.3% of the DM2 patients had accelerated GE at 1 h. GE at 1 h is associated with nausea/vomiting, and fasting gastric volume is associated with bloating. Among referred diabetic patients with UGI symptoms, GE and GA testing identifies potential targets for individualizing treatment and avoidance of empirical trials for the 28% with no disturbance of GE and GA.