Gastric Accommodation Research Articles

Herbal Amara extract induces gastric fundus relaxation via inhibition of the M2 muscarinic receptor.

Impaired gastric accommodation is one of the most frequent symptoms of functional dyspepsia. The safety and efficacy of conventional treatments remain to be proven and alternative herbal therapies have been proposed to alleviate gastrointestinal symptoms. This preclinical study examined the role of herbal Amara extract (containing Artemisia absinthium, Centaurium erythraea, Cichorium intybus, Gentiana lutea, Juniperus communis, Achillea millefolium, Peucedanum ostruthium, Salvia officinalis, and Taraxacum extracts) on gastric (fundus) accommodation and the possible implication of muscarinic receptors in its regulation. The effect of Amara extract on fundus motility was investigated in organ baths of smooth muscle strips isolated from the fundus of guinea pigs, and the role of the muscarinic receptor pathway was evaluated using functional and radioligand binding assays in cell lines expressing the M2 or M3 muscarinic receptor. Amara extract inhibited carbachol-induced contraction of guinea pig smooth muscle strips in a dose-dependent manner. This relaxant effect was not affected by the M3 antagonist J-104129. Amara extract also inhibited M2, but not M3, receptor activity in CHO-K1 cells (IC50 219 μg mL-1), and specifically bound the M2 receptor (IC50 294 μg mL-1). Of the nine herbal components of Amara extract, Juniperus communis, P. ostruthium, and Salvia officinalis inhibited M2 receptor activity (IC50 32.0, 20.8, and 20.1 μg mL-1, respectively), and P. ostruthium was sufficient to reverse carbachol-induced exvivo contraction of guinea pig fundic smooth muscles. Amara extract relaxes gastric smooth muscles by inhibiting the M2 muscarinic receptor. This study suggests the potential benefit of Amara extract for patients with impaired gastric accommodation.

Determination of fundic accommodation in gastric emptying scintigraphy. Evaluation of its clinical usefulness

AimGastric emptying scintigraphy is used to assess patients with symptoms of dyspepsia or gastroparesis. An alteration of fundus accommodation may explain these symptoms. The aim of this study was to determine the accommodation in gastric emptying scintigraphy studies performed in our institution. Material and methods50 patients (43 children) referred for gastric emptying assessment were evaluated. After fasting for 8 h, and following international guidelines, egg labeling was performed with 37 mBq of [99mTc]Tc-DTPA and administration of standardized food. Areas of interest were defined in the stomach at different times, and the corresponding retention percentages were calculated. Considering the image at time zero, gastric accommodation was qualitatively and quantitatively assessed, calculating the ratio between proximal stomach counts and total counts. ResultsOf the 50 patients studied, 32 had normal emptying, 10 had slowed emptying and 8 had accelerated emptying. Within the group of patients with normal emptying, 8 had altered accommodation (25%) and another 8 in the group with abnormal emptying (44%). Applying the ROC curve analysis to quantitative values, the most appropriate cut-off value was 0.785 with p < 0.001, sensitivity 82.4% and specificity 100%. ConclusionGastric emptying scintigraphy in addition to determining motility, made it possible to assess both qualitatively and quantitatively the distribution of the radiotracer in the stomach and thus, indirectly, the accommodation in the fundus. It provided added diagnostic information in a simple manner, without protocol changes and allowing more specific treatments to be assessed.

Randomized, crossover trial: comparing the effects of standardized egg-white meal and Vital® on global gastric emptying parameters and intragastric meal distribution in healthy Asian participants.

Measurements of gastric emptying and accommodation for alternative test-meal protocol during gastric emptying scintigraphy (GES), such as high-calorie nutrient drinks, are not fully established. We aimed to compare the effects of standardized egg-white meal (EWM) versus high-calorie nutrient drink (Vital®; Abbott Laboratories) on global GES parameters and intragastric meal distribution at immediate scan (IMD0h). Of 84 screened participants, 60 asymptomatic healthy Asian population (38 females; 24.0±1.5years; 23.8±2.6kg/m2) were recruited in this 2×2 (AB/BA) crossover trial. Participants were randomized to a 4-h GES with 99mTc-radiolabeled EWM (~255.8kcal), followed by a 200mL Vital® (300kcal), or vice versa, separated by a 2-week washout period. Global meal retention (GMR), power-exponential model emptying parameters (half-emptying [T1/2], lag phases [Tlag2%, Tlag5%, Tlag10%]), and IMD0h were determined and compared. GMRs for both test meals were within the international standard references for solid GES. Compared to EWM, Vital® exhibited significantly lower GMRs (faster emptying) from 0.5 to 3h (all P<0.001) but comparable at 4h (P=0.153). Similar observations were found for the model-based T1/2 and the different Tlag thresholds (all P<0.001). Furthermore, IMD0h was found to be lower with Vital®, indicating lower gastric accommodation (faster antral filling) immediately post-ingestion (P<0.001). Both test meals showed significant moderate-to-strong positive associations at the late-phase GE (GMR 2-4h, T1/2) (all P<0.05). Overall, Vital® is an acceptable alternative test meal to the EWM for GES; however, exercise caution when interpreting early-phase GE. The normative values for global GES parameters and IMD0h are also established.

Determinación de la acomodación fúndica en gammagrafía de vaciamiento gástrico. Valoración de su utilidad clínica

AimGastric emptying scintigraphy is used to assess patients with symptoms of dyspepsia or gastroparesis. An alteration of fundus accommodation may explain these symptoms. The aim of this study was to determine the accommodation in gastric emptying scintigraphy studies performed in our institution. Material and methods50 patients (43 children) referred for gastric emptying assessment were evaluated. After fasting for 8hours, and following international guidelines, egg labeling was performed with 37 mBq of [99mTc]Tc-DTPA and administration of standardized food. Areas of interest were defined in the stomach at different times, and the corresponding retention percentages were calculated. Considering the image at time zero, gastric accommodation was qualitatively and quantitatively assessed, calculating the ratio between proximal stomach counts and total counts. ResultsOf the 50 patients studied, 32 had normal emptying, 10 had slowed emptying and 8 had accelerated emptying. Within the group of patients with normal emptying, 8 had altered accommodation (25%) and another 8 in the group with abnormal emptying (44%). Applying the ROC curve analysis to quantitative values, the most appropriate cut-off value was 0.785 with p<0.001, sensitivity 82.4% and specificity 100%. ConclusionGastric emptying scintigraphy in addition to determining motility, made it possible to assess both qualitatively and quantitatively the distribution of the radiotracer in the stomach and thus, indirectly, the accommodation in the fundus. It provided added diagnostic information in a simple manner, without protocol changes and allowing more specific treatments to be assessed.

Extensive scintigraphic gastric motor function testing with concurrent symptom recording predicts prospectively measured daily dyspeptic symptoms.

Absent "organic" disease, dyspeptic symptoms may arise from abnormal gastric sensation, accommodation, motility or emptying (GE). Extensive gastric sensorimotor evaluation is rarely undertaken because testing is prolonged, invasive, poorly tolerated or unavailable. To investigate whether gastric antral motor function, evaluated with scintigraphy, predicts GE. To explore whether motor testing with symptom recording predicts day-to-day symptoms in patients with dyspepsia. GE was determined using a scintigraphic solid-meal protocol (296 kcal, 35% fat). Antral motility was estimated from 10 min of scintigraphic time-activity curves acquired 40 min after meal consumption. An antral motility index (MI) was derived from contraction amplitude and frequency. Intra-gastric distribution of the meal on scintograms at 1 h (IGD1) was determined. Meal-induced symptoms were evaluated by questionnaire. Patients completed the Gastroparesis Cardinal Symptom Index Daily Diary (GCSI-DD) for 14 days. Twelve healthy participants and 23 prospectively recruited patients completed the study. Nine patients had delayed, and 2 had rapid, GE. In univariate analysis MI explained 42% of GE half-time. In multivariate analysis MI and GE half-time explained 25% of the variance in meal-induced symptoms. While scintigraphic evaluation of gastric motor function with symptom recording explained 80% of the variance in the GCSI-DD, meal-induced symptoms were the only significant predictor. However, among patients with delayed GE, MI, GE half-time, IGD1, and meal-induced symptoms all significantly predicted GCSI-DD. Antral motility predicts GE. In exploratory analyses, only meal-induced symptoms predicted daily symptoms among patients with dyspepsia. However, motor function also predicted symptoms in patients with delayed GE.

A Case Report on Acotiamide’s Role in De-Prescribing PPI – An Offbeat Approach

Proton pump Inhibitors (PPI) are the commonest over the counter medications which are abused. Its prescribed even for minor gastric events and patients tend to take it for indefinite periods.PPI abuse can lead to wide range of toxic events like nephritis, osteoporosis, cardiac events, Clostridium infections, vitamin malabsorption. There are not many reports on management of pantaprazole abuse. Acotiamide is a drug which enhances acetylcholine release from enteric neurons through muscarinic receptor antagonism and acetylcholinesterase (AchE) inhibition, thereby enhancing gastric emptying and gastric accommodation. Here I am presenting a 36-year-old female with daily pantaprazole or omeprazole 40mg intake. She came for quitting the PPIs and was successfully managed with acotiamide and gradual tapering of the PPI.International Journal of Human and Health Sciences Vol. 08 No. 02 Apr’24 Page: 212-214

Gastric accommodation: pathogenetic role and clinical significance

The article presents a literature review of modern Russian and foreign publications devoted to the study of gastric accommodation. It has been shown that accommodation of the proximal stomach plays an important role in its adaptation to food intake. This process is carried out in two stages with the participation of parasympathetic and paracrine regulation; the effects of nutrients when they enter the duodenum also play an important role. Methods for assessing gastric accommodation include gastric barostat, gastric scintigraphy with food load, drinking tests, single-photon emission computed tomography, magnetic resonance imaging and ultrasound examination of the stomach, intragastric manometry. Violation of gastric accommodation leads to an excessive increase in intragastric pressure and the occurrence of symptoms most often found in functional dyspepsia, gastroesophageal reflux disease and diabetic gastropathy. Approaches to the treatment of gastric accommodation disorders are at the development stage, the possibilities of diet therapy, pharmacological and non-drug correction are being discussed.

Assessing impaired gastric accommodation in children with functional constipation using the water load test.

This study aimed to evaluate gastric accommodation in pediatric patients with functional constipation using the water load test. This was a cross-sectional case-control study. Herein, the water load test results of children aged >4 years with functional constipation referred to a Pediatric Gastroenterology Outpatient Clinic (functional constipation group) were compared with those of a control group (without functional constipation or chronic abdominal pain) recruited from two public schools. Clinical manifestations outlined in the Rome IV criteria were used to diagnose functional constipation. Water load tests were performed after 3 h of fasting. For the test, the participants were asked to drink as much water as possible in 3 min. A total of 36 patients and 77 students were included in the functional constipation and control groups, respectively. There was no significant difference in age between the groups (8.6 ± 2.3 years and 8.8 ± 1.8 years in the functional constipation and control groups, respectively). The water load test showed intake volumes of 390 ± 245 mL and 528 ± 219 mL in the functional constipation and control groups, respectively (p = 0.001). The maximum volume in the water load test correlated with the 24 h daily intake of energy (rS = +0.42, p = 0.012), protein (rS = +0.48, p = 0.004), and water (rS = +0.39, p = 0.020) only in the group with functional constipation. According to the water load test, gastric accommodation was impaired in children with severe functional constipation. The impairment of gastric accommodation in children with severe functional constipation is related to food intake.

Mechanisms involved in the muscle relaxing effects of STW 5 in guinea pig stomach.

The herbal preparation STW 5 ameliorates functional dyspepsia partly by relaxing smooth muscle of the proximal stomach, thus improving gastric accommodation. We explored the unknown pathways responsible for this effect by testing targets known to modulate gastric smooth muscle relaxation. STW 5-induced relaxation of smooth muscle strips from guinea pig gastric corpus before and after pharmacological interventions were recorded with force transducers in an organ bath. ORAI1 mRNA expression was tested in the proximal stomach. Blockade of Ca2+-activated K+ and Cl- channels, voltage-gated L- or T-type Ca2+ channels, TRPA1-, TRPV1-, adenosine or 5-HT4 receptors, antagonizing ryanodine receptors, inhibiting cyclooxygenase or sarcoplasmic reticulum calcium ATPase did not affect STW 5-evoked relaxation. Likewise, protein-kinase A or G were not involved. However, the relaxation evoked by STW 5 was significantly reduced by phorbol-12-myristat-13-acetat, an activator of protein-kinase C, by 2- aminoethyldiphenylborinate, an inhibitor of the IP3 receptor-mediated Ca2+ release from the sarcoplasmic reticulum or by SKF-96365, a nonselective store-operated calcium entry (SOCE) blocker. Furthermore, the mixed TRPC3/SOCE inhibitor Pyr3, but not the selective TRPC3 blocker Pyr10, reduced the effect of STW 5. Finally, BTP2, a potent blocker of ORAI-coupled SOCE, almost abolished STW 5-evoked relaxation. Expression of ORAI1 could be demonstrated in the corpus/fundus. STW 5 inhibited SOCE, most likely ORAI channels, which are modulated by IP3- and PKC-dependent mechanisms. Our findings impact on the design of drugs to induce muscle relaxation and help identify phytochemicals with similar modes of actions to treat gastrointestinal disturbances.

Dispepsia: etiopatogenia, manifestaciones clínicas, diagnóstico y tratamiento

Dyspepsia is a set of symptoms originating in the gastroduodenal region. The term is complex and difficult to define; some symptoms are confused or overlap with other diseases. The main symptoms are burning or pain in the epigastrium, postprandial fullness, and early satiety. It is classified as organic or functional according to the origin of the symptoms. The pathophysiology of the latter is multifactorial, involving multiple factors such as slowing of gastric emptying, visceral hypersensitivity, or gastric accommodation, among others. It is an important disease with a significant prevalence in the population (20%) that generates high costs and an impact on patients’ quality of life. In order to diagnose it, it is essential to rule out an organic nature in patients with alarm symptoms by means of an oral panendoscopy. In the absence of these symptoms, the first step is to detect and treat Helicobacter pylori infection. If symptoms persist afterwards, first-line treatment is acid suppressant medications followed by tricyclic antidepressants and prokinetic agents.

Yoga Therapy in Functional Dyspepsia. A Narrative Review.

Functional dyspepsia (FD) is a common upper gastrointestinal disorder, characterized by bothersome epigastric pain or burning, fullness after meals or early satiety. The precise pathophysiology remains incompletely understood but may include the role of disordered gut-brain communication leading to disturbances in gastro-duodenal physiological functioning. Even if there are several pharmacological treatment options, it is a chronic and relapsing disorder with persistent symptoms that makes its management difficult. Yoga is a fast-spreading complementary and alternative medicine (CAM) specialty, that has gained attention in the medical field for its ability to address the physical, emotional, mental and social aspects of health and disease. Various other CAM therapies are being used for FD with varying efficacy. However, apart from one research study that used yoga therapy on abdominal pain related functional gastrointestinal disorders in children which included a few FD cases as well (11.6%), no other study using yoga therapy has been done in FD as per our best knowledge. Therefore, in the present review, we have summarized the current scientific understanding of the probable effects of yoga on the pathophysiological mechanisms involved in FD (gastric motility, fundic accommodation, hypersensitivity, duodenal inflammation, psychological distress and gut-brain dysfunction). The literature suggests yoga can have a beneficial role in the management of FD. However, rigorous research and clinical trials are required to confirm the same.

Electrophysiology, molecular modelling, and functional analysis of the effects of dietary quercetin and flavonoid analogues on Kir6.1 channels in rat stomach fundus smooth muscle

Flavonoids, ubiquitously distributed in the plant world, are regularly ingested with diets rich in fruit, vegetables, wine, and tea. During digestion, they are partially absorbed in the stomach. The present work aimed to assess the in vitro effects of quercetin and ten structurally related flavonoids on the rat gastric fundus smooth muscle, focussing on ATP-dependent K+ (Kir6.1) channels, which play a central role in the regulation of resting membrane potential, membrane excitability and, consequently, of gastric motility. Whole-cell currents through Kir6.1 channels (IKir6.1) were recorded with the patch-clamp technique and the mechanical activity of gastric fundus smooth muscle strips was studied under isometric conditions. Galangin ≈ tamarixetin > quercetin > kaempferol > isorhamnetin ≈ luteolin ≈ fisetin > (±)-taxifolin inhibited pinacidil-evoked, glibenclamide-sensitive IKir6.1 in a concentration-dependent manner. Morin, rutin, and myricetin were ineffective. The steric hindrance of the molecule and the number and position of hydroxyl groups on the B ring played an important role in the activity of the molecule. Molecular docking simulations revealed a possible binding site for flavonoids in the C-terminal domain of the Kir6.1 channel subunit SUR2B, in a flexible loop formed by residues 251 to 254 of chains C and D. Galangin and tamarixetin, but not rutin relaxed both high K+- and carbachol-induced contraction of fundus strips in a concentration-dependent manner. Furthermore, both flavonoids shifted to the right the concentration-relaxation curves to either pinacidil or L-cysteine constructed in strips pre-contracted by high K+, rutin being ineffective. In conclusion, IKir6.1 inhibition exerted by dietary flavonoids might counterbalance their myorelaxant activity, affect gastric accommodation or, at least, some stages of digestion.

Erratum

Gastrointestinal symptoms related to antireflux surgery are result of either an incompetent gastroesophageal valve, a supra-therapeutic valve or other complications of anti-reflux surgery such as decreased gastric accommodation, rapid gastric emptying, gastroparesis, paraesophageal hernia, or exacerbation of another undiagnosed motility disorder. Here, we reviewed a diagnostic approach for these symptoms which starts with detailed history and a tailored approach in use of diagnostic tests and empirical treatment to aid in diagnosis. In treatment for these symptoms, a conservative approach with lifestyle modifications should be employed first and repeat surgical procedure should be reserved as the last option. Of the emerging endoscopic therapies for symptoms refractory to medical therapy, gastric per-oral endoscopic myotomy is effective in improving gastric emptying and related symptoms.

Clinical Efficacy and Mechanism of Transcutaneous Neuromodulation on Functional Dyspepsia.

Prokinetics and proton pump inhibitors are first-line drugs for functional dyspepsia (FD) patients. However, no available treatment is effective for most FD patients, and the pathogenesis is still unclear. The purpose of this study was to investigate the therapeutic effect of transcutaneous neuromodulation (TN) on FD and its potential mechanisms. Fifty-seven FD patients were enrolled in the study and randomly divided into 3 groups (TN Neiguan (PC6) group, TN Zusanli (ST36) group, and sham TN group) that received corresponding treatment respectively for 4 weeks. Then, all the patients enrolled received TN PC6 combined with ST36 treatment for another 4 weeks. Dyspepsia symptom questionnaire, Medical outcomes study item short form health survey (SF-36), Hospital Anxiety and Depression Scale were used to assess the severity of symptoms. Gastric accommodation, gastric emptying rate, and related parameters of electrogastrogram were used to assess the pathophysiological mechanism of FD. The possible gastrointestinal hormonal mechanism involved was assessed by detecting serum ghrelin, neuropeptide Y, and vasoactive intestinal peptide. The possible duodenal inflammation mechanism involved was assessed by detecting duodenal mucosa. TN treatment reduced the dyspepsia symptom score ( P <0.05) and improved the quality of life. After TN treatment, the gastric accommodation ( P <0.01), the gastric emptying rate ( P <0.01), and the percentages of preprandial ( P <0.05) and postprandial ( P <0.05) gastric slow waves (GSW) were increased. The proportions of preprandial ( P <0.05) and postprandial ( P <0.05) gastric electrical rhythm disorder were reduced. The double acupoint combination therapy further enhanced the therapeutic effect of single acupoint. In addition, the levels of ghrelin ( P <0.001) and neuropeptide Y ( P <0.001) were significantly increased, the level of vasoactive intestinal peptide ( P <0.001) was significantly decreased, and the total number of mast cells ( P <0.001) in the duodenal bulb was significantly decreased after double acupoints combination therapy. TN treatment significantly improves the dyspepsia symptoms of FD patients and their quality of life. TN treatment increases the percentage of normal GSW, reduces the proportion of gastric electrical rhythm disorder, and improves the gastric accommodation and gastric emptying rate. The therapeutic effect of TN may be caused by regulating gastrointestinal hormone secretion and alleviating local inflammatory responses in duodenum. In addition, the improvement of TN on GSW was closely related to the decrease of bradygastria.

Impaired gastric accommodation in patients with postprandial distress syndrome type of functional dyspepsia assessed by 2D ultrasonography.

The pathophysiology of postprandial distress syndrome includes impaired gastric accommodation, hypersensitivity to gastric distension and delayed gastric emptying. 2D-ultrasonography is one of the methods to assess gastric accommodation by measuring proximal gastric area and we evaluated its role in calculating proximal gastric area and thus assessing gastric accommodation in Indian patients with postprandial distress syndrome. In a hospital-based comparative analysis, proximal gastric area was measured with 2D-ultrasonography of postprandial distress syndrome(PDS) patients and compared with healthy controls. Five readings were measured every fiveminutes till 25minutes after 400mL of vegetable soup. The Patient Assessment of Upper Gastrointestinal Disorders-Quality of Life (PAGI-QOL score) and diets aggravating PDS symptoms were studied through detailed questionnaires. Sample size was calculated at 80% study power and alpha error of 0.05 to be 30 subjects in each group. The mean age of patients (18 males) vs. 30 healthy controls (25 males) was 40.8 ± 11.50years vs. 36.37 ± 7.58, respectively, (p = 0.084). Proximal gastric area was significantly lower in patients versus healthy controls at fiveminutes (22.54 ± 2.77 vs. 30.66 ± 2.55 cm2), 10minutes (23.03 ± 2.45 vs. 31.10 ± 2.06 cm2), 15minutes (23.06 ± 2.27 vs. 30.31 ± 2.11 cm2), 20minutes (22.21 ± 2.31 vs. 29.73 ± 1.71 cm2) and 25minutes (22.02 ± 2.33 vs. 28.39 ± 1.55 cm2); p < 0.001 at all intervals of time, indicating impaired gastric accommodation. The QOL was poor in all patients with PDS with mean PAGI-QOL score of 31.30 ± 15.05, median of 30, minimum score of 12 and maximum score of 66. Measurement of proximal gastric area with 2D-ultrasonography is simple and non-invasive. Proximal gastric area in patients was lower than controls, indicating impaired gastric accommodation. Poor quality of life was universal in patients with postprandial distress syndrome.

The role of gastric function in control of food intake (and body weight) in relation to obesity, as well as pharmacological and surgical interventions.

The objectives of this review are to summarize the role of gastric motor functions in the development of satiation (defined broadly as postprandial fullness) and satiety (reduced appetite or postponing desire to eat after a meal) and their impact on weight change. The specific topics are the methods of measurement of gastric emptying and accommodation and their impact on food intake, satiation, and satiety. A second focus contrasts bariatric surgery to endoscopic gastroplasty that alter gastric emptying and incretin responses in markedly divergent manners. The hormone, GLP-1, retards gastric emptying and increases gastric accommodation through vagally-mediated effects. Indeed, these effects provide the basis for the association of altered gastric emptying in the appetite and weight loss responses to pharmacological interventions particularly by those acting on receptors of incretin agonists such as liraglutide and the dual agonists, tirzepatide and cotadutide, all of which retard gastric emptying. In fact, retardation of gastric emptying and gastrointestinal adverse effects have been shown to contribute in part to the weight loss in response to this class of pharmacological agents. The motor functions of the stomach are relevant to postprandial fullness and to interventions aimed at weight loss in people with obesity.

Imaging in Gastroparesis: Exploring Innovative Diagnostic Approaches, Symptoms, and Treatment.

Gastroparesis (GP) is a chronic disease characterized by upper gastrointestinal symptoms, primarily nausea and vomiting, and delayed gastric emptying (GE), in the absence of mechanical GI obstruction. The underlying pathophysiology of GP remains unclear, but factors contributing to the condition include vagal nerve dysfunction, impaired gastric fundic accommodation, antral hypomotility, gastric dysrhythmias, and pyloric dysfunction. Currently, gastric emptying scintigraphy (GES) is considered the gold standard for GP diagnosis. However, the overall delay in GE weakly correlates with GP symptoms and their severity. Recent research efforts have focused on developing treatments that address the presumed underlying pathophysiological mechanisms of GP, such as pyloric hypertonicity, with Gastric Peroral Endoscopic Myotomy (G-POEM) one of these procedures. New promising diagnostic tools for gastroparesis include wireless motility capsule (WMC), the 13 carbon-GE breath test, high-resolution electrogastrography, and the Endoluminal Functional Lumen Imaging Probe (EndoFLIP). Some of these tools assess alterations beyond GE, such as muscular electrical activity and pyloric tone. These modalities have the potential to characterize the pathophysiology of gastroparesis, identifying patients who may benefit from targeted therapies. The aim of this review is to provide an overview of the current knowledge on diagnostic pathways in GP, with a focus on the association between diagnosis, symptoms, and treatment.

Relationships among intragastric meal distribution during gastric emptying scintigraphy, water consumption during water load satiety testing, and symptoms of gastroparesis.

Gastric emptying scintigraphy (GES) measures total gastric retention after a solid meal and can assess intragastric meal distribution (IMD). Water load satiety test (WLST) measures gastric capacity. Both IMD immediately after meal ingestion [ratio of proximal gastric counts after meal ingestion to total gastric counts at time 0 (IMD0)] and WLST (volume of water ingested over 5 min) are indirect measures of gastric accommodation. In this study, IMD0 and WLST were compared with each other and to symptoms of gastroparesis to gauge their clinical utility for assessing patients with symptoms of gastroparesis. Patients with symptoms of gastroparesis underwent GES to obtain gastric retention and IMD0, WLST, and filled out patient assessment of upper GI symptoms. A total of 234 patients with symptoms of gastroparesis were assessed (86 patients with diabetes, 130 idiopathic, 18 postfundoplication) and 175 (75%) delayed gastric emptying. Low IMD0 <0.568 suggesting initial rapid transit to the distal stomach was present in 8% and correlated with lower gastric retention, less heartburn, and lower volumes consumed during WLST. Low WLST volume (<238 mL) was present in 20% and associated with increased severity of early satiety, postprandial fullness, loss of appetite, and nausea. Low IMD0 is associated with less gastric retention and less heartburn. Volume of water consumed during WLST, while associated with IMD0, has associations with early satiety, postprandial fullness, loss of appetite, and nausea. Thus, IMD0 and WLST appear to overlap somewhat in their assessment of gastric physiology in adults with symptoms of gastroparesis but relate to different dyspeptic symptoms.NEW & NOTEWORTHY IMD0 and WLST were assessed for their clinical utility in assessing patients with symptoms of gastroparesis. Low IMD0 is associated with less gastric retention and less heartburn. Volume of water consumed during WLST, while associated with IMD0, has associations with early satiety, postprandial fullness, loss of appetite, and nausea. IMD0 and WLST appear to overlap somewhat in their assessment of gastric physiology in adults with symptoms of gastroparesis but relate to different dyspeptic symptoms.

Symptoms Evaluation After Anti-Reflux Surgery—GI Perspective

Gastrointestinal symptoms related to antireflux surgery are result of either an incompetent gastroesophageal valve, a supra-therapeutic valve or other complications of anti-reflux surgery such as decreased gastric accommodation, rapid gastric emptying, gastroparesis, paraesophageal hernia, or exacerbation of another undiagnosed motility disorder. Here, we reviewed a diagnostic approach for these symptoms which starts with detailed history and a tailored approach in use of diagnostic tests and empirical treatment to aid in diagnosis. In treatment for these symptoms, a conservative approach with lifestyle modifications should be employed first and repeat surgical procedure should be reserved as the last option. Of the emerging endoscopic therapies for symptoms refractory to medical therapy, gastric per-oral endoscopic myotomy is effective in improving gastric emptying and related symptoms.

Anti-inflammatory effect of hyperbaric oxygen in the treatment of peptic ulcer disease: review

OBJECTIVE: Based on the analysis of literature data, highlight the mechanisms of anti-inflammatory action of hyperbaric oxygenation (HBO) in peptic ulcer of the stomach and duodenum (PUS and D).MATERIALS AND METHODS: The subject of study was scientific publications on the use of hyperbaric oxygenation (GBT) in treatment (PUS and D). The search was carried out on the international databases Elibrary, Pub Med, Scopus, Google Scholar from 1980–2022. A total of 38 literature sources were selected, of which at least 60% were published within the last five years. RESULTS: The effectiveness of the therapeutic effect of HBO (ulcer healing rate) in PUS and D depends on the location and size of the ulcer defect on the wall of the stomach or duodenum. At the moment, there is no conclusive data on the optimal number of HBO sessions required to achieve the maximum therapeutic effect in the treatment of PUS and D. DISCUSSION: The leading link in hyperoxic sanogenesis in this pathology is the anti-inflammatory effect of hyperbaric oxygen (HBO2), which is realized by: a) through stimulation of mucocyte formation; b) through regulation of HBO2 qualitative composition of mucocyte secretion; c) by stimulating the formation of bicarbonates by additional cells and increasing the sensitivity of these cells to their endogenous stimulant -solar acid (HCl); d) through the effect of HBO2 on gastrin formation (HCl stimulant), as well as on the diffusion of HCl from the gastric lumen into its capillary network. Together, this leads to a rapid cessation of pain syndrome, which creates conditions for the elimination of dyspeptic syndrome. This is realized through the restoration of the myoelectric activity of the stomach wall and duodenum, the regulation of the myogenic tone of their walls, as well as the elimination of the violation of gastric accommodation in the conditions of HBO. CONCLUSION: The anti-inflammatory effect of HBO2 in the treatment of PUS and D allows us to consider hyperbaric oxygenation as an integral part of the treatment of ulcerative lesion of the upper gastrointestinal tract.