Gastric Emptying Of Solid Meal Research Articles

Whole Gut Transit Scintigraphy for the Assessment of Patients with Symptoms of Chronic Constipation.

Whole gut transit scintigraphy (WGTS) can detect delayed colonic transit (CT), different types of CT delays, and assess upper GI tract transit. To delineate the frequency of different types of CT patterns in patients with chronic constipation (CC), determine the relationship between these CT patterns and upper GI tract transit abnormalities, and assess how symptoms relate to different colonic transit patterns. Retrospective review of patients who had WGTS for CC. Patients completed a modified PAGI-SYM questionnaire to assess symptoms. Patients ingested a standard solid (Tc-99m egg sandwich)-liquid (In-111 water) meal to assess solid meal gastric emptying (GE), liquid GE, small bowel transit (SBT), and geometric center of colonic activity at 24, 48, and 72h. One hundred and eighty six patients underwent WGTS. Main symptoms were constipation (41%), nausea (24%), and bloating (22%). CT assessment showed 32% of patients had normal transit, 31% colonic inertia (CI), 28% functional rectosigmoid obstruction (FRS0), and 9% generalized slow colonic transit (GSCT). GE was delayed in 36%; more commonly in CI and FRSO. SBT was delayed in 19%; more commonly in GSCT and CI. Patients with CI had less bowel movements per week whereas patients with normal CT had more bm/week. In this series of patients with symptomatic constipation, WGTS assessment showed delayed colonic transit in 68% of patients, with 31% having colonic inertia, 28% a functional rectosigmoid obstruction pattern, and 9% generalized delay in colonic transit. Abnormalities in GE and SBT were present in 36 and 19%. WGTS is helpful to document delayed colonic transit (CT), assess the pattern of the delay in CT, and determine if there are upper GI transit abnormalities.

Assessment of Small-bowel and Colonic Transit on Routine Gastric Emptying Scintigraphy: Establishment of Reference Values.

The primary objective was to establish the reference values for small-bowel and colonic transit within the context of the routine standard solid meal gastric emptying scintigraphy (GES). The secondary objective was to compare the small-bowel and colonic transit between the anterior view and geometric mean methods. Twenty-nine healthy controls underwent routine GES, with additional imaging at 24 h if feasible. Small-bowel transit was assessed using the index of small-bowel transit (ISBT), calculated as the ratio of terminal ileal reservoir counts to total abdominal counts at 4 h. Colonic transit was evaluated using the colonic geometric center (CGC) by dividing the large bowel into four segments, with an additional fifth segment accounting for the eliminated counts. Reference values were established based on the fifth percentile or mean ± 1.96 standard deviations. Rapid small-bowel transit was visually determined. Paired Samples t-test or Wilcoxon signed-rank test, as applicable, was used to compare the small-bowel and colonic transit between the anterior view and geometric mean methods. For comparing small-bowel and colonic transit between females and males, the Independent samples t-test or Mann-Whitney U-test was applied, as appropriate. The correlation between age and small-bowel and colonic transit was assessed using Spearman's rank correlation analysis. The reference value for small-bowel transit using the geometric mean method was established as ISBT >37% at 4 h, whereas rapid small-bowel transit was defined as the first visualization of activity in the cecum-ascending colon within 2 h. For colonic transit, the reference range was established as CGC 2.8-4.4 at 24 h. Comparing the anterior view and geometric mean methods, there were no significant differences in ISBT and CGC values (P ≥ 0.125). Gender did not affect small-bowel and colonic transit in both methods (P ≥ 0.378), and age showed no significant correlations (P ≥ 0.053). This study determined the reference values for small-bowel and colonic transit in the Indian population using routine GES, avoiding the need for additional complex procedures. The results may be generalized to the Indian population, emphasizing the importance of assessing small-bowel and colonic transit in patients with normal gastric emptying parameters to enhance gastrointestinal transit evaluation.

RF24 | PSUN116 Once-weekly semaglutide delays a late phase gastric emptying of solid meal measured by repeated scintigraphic imaging in obese women with PCOS

Abstract Background GLP-1 agonism have the potential to affect gastric emptying (GE), yet the reports for subcutaneous semaglutide, currently the most effective GLP-1 RA approved for weight management, remain inconclusive. It has been demonstrated that once-weekly semaglutide either had no effect on GE or it delayed GE only within the first hour, without late phase retention. Notably, those conclusions were made by an indirect method of estimation of GE through ingestion, absorption and determination of plasma level of paracetamol. Furthermore, in most previous studies with once weekly semaglutide, GE has been evaluated as a part of the composite outcome. The indirect method with paracetamol was shown to be appropriate for evaluation of kinetics of liquid meals, whereas it might lead to inaccurate estimation of late phase GE. Scintigraphic evaluation is considered as a reference method for the purpose. Aim This is the first study that evaluates the effect of once weekly subcutaneous semaglutide on late phase GE of a solid meal by scintigraphy in obese women with PCOS without other comorbidities as a primary outcome. Materials and Methods A single-blind, placebo-controlled trial was conducted in 20 women with PCOS and obesity, without diabetes and other comorbidities, randomized to once weekly subcutaneous semaglutide 1 .0 mg (S) or placebo (P) for 8 weeks. Gastric emptying was assessed by scintigraphy after ingestion of 99mTC colloid in pancake labelled with radiopharmaceutical that maintained a stable binding within gastric environment by scintigraphy using sequential static imaging and dynamic acquisition. Estimation of GE was obtained by repeated imaging of remaining 99mTC activity (RA) at fixed time intervals over 4 hours and the half time (T1/2) of gastric emptying had been calculated. Additionally, we evaluated anthropometric, metabolic, hormonal and appetite parameters. Results At 30 min after ingestion significant difference in RA was observed between semaglutide group and placebo (92.5% in S vs. 89% in P (p=0,05)) and persisted throughout the observation period up to 4 hour (37% in S vs. 0% in P (p=0,002)). T1/2 was significantly longer in S as compared to P (171 min vs 118 min, respectively (p<0.001)). In addition, semaglutide led to significant decrease in weight, waist and neck circumference, HbA1c and androgen levels. Subjective ratings of appetite suppression correlated with T1/2. Conclusion Once weekly semaglutide 1.0 mg resulted in a significant late-phase retention of solid meal measured by repeated scintigraphic imaging. This effect correlated with appetite suppression and likely contributed to weight loss. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m., Sunday, June 12, 2022 1:18 p.m. - 1:23 p.m.

Once-weekly semaglutide delays a late phase gastric emptying of solid meal measured by repeated scintigraphic imaging in obese women with PCOS

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Functional dyspepsia in children: A study of pathophysiological factors.

Functional dyspepsia (FD) is common in children, and treatment targeted towards the altered pathophysiology can improve outcome. We evaluated FD children for abnormality of gastric accommodation and emptying, psychological stressors (PS), Helicobacter pylori (HP) infection, and post-infectious FD. Diagnosis of FD was based on ROME III criteria. Clinical evaluation including dyspeptic symptom scoring and assessment for PS was performed. Satiety drink test for gastric accommodation, gastroscopy with biopsy for HP infection, and solid meal gastric emptying were performed. Sixty-seven healthy children were enrolled for assessing PS and satiety drink test. Fifty-five FD children (33 boys, age 12 [6-18] years) with symptoms for 4 (2-48) months and dyspeptic score of 5 (1-13) were enrolled. PS were more common in FD than in controls (46/55 vs 9/67; P<0.001). Median satiety drink volume was 360mL (180-1320mL); no patients had satiety drink volume of <5th centile of healthy children. The frequency (98% vs 85%; P=0.01) and severity (65 [10-175] vs 50 [5-130]; P<0.001) of postprandial symptoms were higher in FD than in controls. Of the postprandial symptoms, pain (20.3% vs 0%; P=0.000) was present only in FD. Delayed gastric emptying was present in 6.5%, HP infection in 11%, and post-infectious FD in 13% cases. Etiological factor was identified in 87% children, with 20% having multiple factors. Abnormality of gastric sensorimotor function is seen in one-fourth of FD cases. HP infection and post-infectious FD are present in 11% and 13% cases, respectively.

National survey of gastric emptying studies in the UK.

This study was undertaken to investigate the extent of variation in meals, radiopharmaceuticals and methodology used for gastric emptying studies in the UK. Overall, 178 nuclear medicine departments across the UK were contacted by telephone and the gastric emptying protocol was requested. In all, 128 (72%) performed routine gastric emptying studies; 83 protocols were received. Liquid meal gastric emptying: 15 departments performed liquid gastric emptying either as a dual isotope technique (27%) or as a separate test using Tc-diethylenetriamine pentacetic acid (53%) or Tc-colloid (20%). The radiopharmaceutical was administered in a variety of liquid mediums including water, orange juice/squash or milk. Although dynamic acquisition was most often used for liquid gastric emptying (60%), significant number of departments used static images (40%). Solid meal gastric emptying: Tc was the radioisotope most predominantly used for solid meals (98%). Tc-colloid was the most commonly used radiopharmaceutical (38%), followed by macroaggregated albumin (25%) and diethylenetriamine pentacetic acid (23%). Egg-based meals are most popular (59%) followed by porridge (27%) that was also used as an alternative to egg in some departments. Alternative meals (cooked meals, ready meals, All-Bran, Weetabix, etc.) were used in 22% of the surveyed departments. Patient preparation and positioning: There was a wide range in patient preparation and methodology used. Patients fasted between 2 and 12 h for the test. Overall, 55% departments acquire images with patient sitting or standing. Although 45% of the departments acquired images supine, most allowed patients to stand or walk in between the images, and only 22% performed the entire test with patient supine. Acquisition parameters: 58% of departments used intermittent static images with intervals ranging from 5 to 15 min, followed by hourly static images of up to 4 h. Twenty-five per cent of departments used dynamic acquisition images. Seventeen per cent of departments used a combination with early dynamic study followed by static images. Normal ranges: There was a wide variation in the normal ranges used for reporting. Most departments used 50% emptying time to assess gastric function. The maximum normal range values for solid gastric emptying ranged from 60 to 120 min, with four departments relying on the percentage of activity remaining at 4 h (normal<10%). Liquid gastric emptying also had a wide range of values for the normal range. The most commonly used range for liquid gastric emptying was 40-60 min. There is a wide variation in radiopharmaceuticals, meals and the methodology used for gastric emptying studies. Solid meal gastric emptying is performed universally by all the departments, while relatively few performed liquid meal gastric emptying. Our survey shows that egg-based meals are most prevalent, followed by a porridge meal. Intermittent static imaging is also the most popular method of imaging. In view of this audit, it would be prudent to establish a protocol for solid meal gastric emptying on the basis of the most commonly used meals and methods that may then be universally acceptable. We propose to undertake a study to establish normal ranges for these meals (egg meal and porridge), using the most accepted imaging methodology in an attempt to establish a standardized normal range and acquisition method for solid gastric emptying studies in the UK.

Evaluation of Gastric Emptying by Transabdominal Ultrasound after Oral Administration of Semisolid Cellulose-Based Gastric Ultrasound Contrast Agents

Many previous studies have found that transabdominal ultrasound may allow precise measurement of gastric emptying of liquid meals. However, the clinical use of this technique has been hampered by the limitation that transabdominal ultrasound might not accurately measure gastric emptying of solid meals. It is more important to measure gastric emptying of solids instead of liquids, as gastric emptying of solids is more often delayed than gastric emptying of liquids in gastric motility disorders. Recently, transabdominal ultrasound after oral administration of a cellulose-based gastric contrast agents (TUS-OSCA) has been suggested to be effective in initial screening of gastric lesions. The aim of this study was to explore the accuracy of TUS-OSCA in the evaluation of gastric emptying of a semisolid meal. Twenty healthy young patients (10 males and 10 females aged 25.5 ± 2.5 y) were studied. Concurrent measurements of gastric emptying by scintigraphy and TUS-OSCA were performed after ingestion of 350 mL semisolid ultrasound agent labeled with 20 MBq 99mTc-sulfur colloid. There was no significant difference in the overall curves for gastric emptying time between scintigraphy and TUS-OSCA. There was a good correlation between the gastric 50% emptying times determined by scintigraphy (89.4 ± 1.8 min) and TUS-OSCA (92.5 ± 1.7 min). The correlation coefficient was r = 0.922 (p = 0.000). Current results indicate that TUS-OSCA is accurate, and the results are similar to those obtained by scintigraphy for gastric emptying of a semisolid meal.

Simultaneous Blood Glucose Monitoring During Gastric-Emptying Scintigraphy May Identify Unsuspected Abnormalities.

A retrospective study of 197 patients was performed to evaluate utility of simultaneous fingerstick glucose monitoring during standardized solid meal gastric-emptying scintigraphy (GES). We hypothesized the unlabeled carbohydrate components of the standardized meal often empty at different rates than the labeled egg protein component and that simultaneous glucose monitoring may identify rapid carbohydrate gastric emptying. Patients were classified as normal, rapid, or delayed gastric emptying from the standardized solid egg meal GES criteria. Further subcategorization was made based on postprandial glycemic excursions above baseline at 30/60 minutes and was delineated as elevated (>75 mg/>85 mg/dL), normal, or diminished (<30 mg/dL) glucose excursion. Of the 197 patients, solid gastric-emptying rates for 105 were normal, delayed in 54, and rapid in 25 patients, and 13 patients had initially delayed emptying 1 or 2 hours with normal emptying by 4 hours. Of the 105 patients with normal gastric emptying, 58 had elevated, 47 normal, and none had diminished glucose excursions. Of the 54 patients with delayed gastric emptying, 26 had elevated, 16 had normal, and 12 had diminished glucose excursions. Nine patients with normal or delayed gastric emptying but elevated glycemic excursions returned for a liquid glucose GES. In contrast to their standardized GES results, all 9 had rapid emptying with elevated glycemic excursions. Simultaneous blood glucose monitoring with standardized GES protocols may provide a marker for contradictory findings of rapid gastric emptying of the unlabeled carbohydrate component in the standardized meal and may contribute to unexplained postprandial gastrointestinal symptoms. The additional insights provided by fingerstick glucose monitoring are inexpensive, easy to perform and may provide for new approaches to management of patient's gastrointestinal symptoms.

Moderate‐Intensity Treadmill‐Training and Functional Changes in Solid Meal Gastric Emptying in a Rodent Model

PURPOSEExercise has long been known for the beneficial effects on numerous systems within the body; it improves cardiovascular function, improves brain functioning and memory, reduces adipose tissue lowering the risk of obesity and associated disorders. But the overall effect of exercise on the gastrointestinal (GI) tract remains unresolved. Patients suffering from GI dysfunction are frequently prescribed physical activity to improve their symptoms. Yet, physical activity has also been shown to provoke GI disturbances including diarrhea, abdominal pain, and gastroesophageal reflux. These GI disturbances commonly occur after bouts of prolonged or high‐intensity exercise, and the GI disturbance frequency is twice as high during running compared to other endurance sports. The effects of upper GI function following exercise are diverse; studies have reported increases, decreases, or no changes in gastric emptying (GE) rate following treadmill‐training. We hypothesize that exercise contributes to beneficial effects on the upper GI tract, like other systems, by altering peripheral and central signaling mechanisms regulating gastric motility. By gaining a greater understanding of the relationship between exercise and gastric functioning, exercise may serve a putative role as medicine in treating a number of upper GI‐related health disorders and dysfunctions (e.g. gastroparesis).METHODSIn this study, we evaluated the effects of moderate‐intensity treadmill‐training (66.6% VO2 max) on GE rate in rats. Male Wistar rats were exercised (n = 8) or placed (n = 8; control) on a treadmill five days week−1 for 8 weeks. Baseline, mid‐point, and final GE measurements were conducted throughout the study. On the days of the GE experiment, rats were fasted overnight with unlimited access to water, and then placed into individual chambers where GE was indirectly measured. Baseline air measurements were collected before the fasted rats received 1g of pancake containing 5μL of the stable isotope [13C]‐octanoic acid. The exhaled breath was collected and analyzed to determine the [13C]‐ to [12C]‐ carbon dioxide ratio.RESULTSBody mass increased over the duration of the study by 41%; however, there were no significant differences between exercise and control rats (325.40±3.11 vs. 325.99±3.06g; p&gt;0.05). Food intake remained similar between exercise and control rats (23.23±0.20 vs. 23.19±0.20; p&gt;0.05). Not surprisingly, mean energy intake (MEI; kcal/100g/day) also revealed no significant differences between exercise and control rats (28.99±0.50 vs. 28.90±0.55; p&gt;0.05). There was no significant difference in GE between the exercise and control group gastric emptying coefficient (5.10±1.37 vs 5.04±0.40; p&gt;0.05).CONCLUSIONModerate‐intensity treadmill‐training for 8‐weeks has no significant effect on anthropometric factors. Interestingly, however, as body mass and food intake increased, MEI decreased. We have validated that moderate‐intensity treadmill running has no significant effect on gastric emptying function but structural adaptations may be occurring prior to functional detection.Support or Funding InformationResearch &amp; Professional Development Grant (Gettysburg College Provost), Cross‐Disciplinary Science Institute at Gettysburg College (X‐SIG), X‐SIG Student Supply GrantThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Rapid Gastric Emptying: An Under-Recognized Clinical Entity?

Introduction: Rapid gastric emptying (RGE) is defined as less than 30% retention of gastric contents at 1 hour of solid meal, gastric emptying scintigraphy (GES). Given the infrequent nature of this phenomenon, most studies regarding RGE have been relatively small. There is a paucity of data concerning the clinical profile of patients with rapid emptying, and even less regarding recognition of RGE as a distinct clinical entity. In this retrospective analysis, we attempted to characterize the clinical profile of RGE, and determine if RGE was recognized by the clinician. Methods: Patients over the age of 18 who underwent solid meal gastric-emptying scintigraphy (GES) at Cleveland Clinic from January 2011 to September 2012 and from May 2014 to December 2015 were included. GES was performed using the standardized protocol of oral ingestion of 1 mCi of Tc-99m sulfur colloid mixed with an egg meal followed by imaging over the abdomen obtained in the anterior and posterior projections at 0, 1, 2 and 4 hours. Records of patients with RGE were reviewed for demographic and clinical data. Results: 305/3641 (8.7%) of patients undergoing GES had RGE. Of these, 82.6% were noted to be symptomatic. Clinical characteristics and associated diseases are detailed in Table 1. Findings included an association with diabetes, autonomic dysfunction and functional gastrointestinal disorders. Additionally, RGE was found in patients who had previously undergone fundoplication or lung transplantation. Of note, 30.2% of patients with RGE were on opiates when GES was performed. RGE was acknowledged by the ordering physician in just 17 cases (5.6%). Therapies offered included the 5HT1a agoinst buspirone, neuromodulators, anti-emetics, or dietary modification.Table: Table. Patient characteristics and associated diseasesConclusion: While rapid gastric emptying was found in 8.7% of patients undergoing gastric emptying scan, it was rarely acknowledged by the clinician. RGE was found in patients with many disorders more commonly thought to be associated with gastroparesis, including opiate use. Further research regarding pathogenesis and treatment of rapid gastric emptying is warranted.

E‐Poster Presentations – A2) Gastric and Duodenal

E‐Poster Presentations – A2) Gastric and Duodenal

PTU-177 Diabetic gastroparesis- a review of clinical practice in county durham

<h3>Introduction</h3> Diabetic gastroparesis represents a significant health burden not only for patients and their families but also for health care systems.¹Treatment guidelines for gastroparesis are limited²and evidence base for effectiveness of current treatment modalities is lacking. <h3>Method</h3> This study aims to evaluate patients with diabetic gastroparesis, assess disease burden and response to therapy. The diabetes database was used to identify patients, epidemiological and clinical data acquired from electronic pt records. A quality of life index³(QoLI) and Gastroparesis Cardinal Symptom Index⁴(GPCSI) questionnaire was completed. <h3>Results</h3> 40 pts identified but 7 excluded due to moving away (5), not consenting for participation (1) or dying (1). Median age 48 yrs (21–85), 61% female. 73% had Type 1 diabetes mellitus, duration of diabetes 18 yrs (2–53). BMI = 26.7 (16.2–40) kg/m². 39% nonsmokers, 21% current smokers. 82% of patients had one or more diabetes related complications. Median duration of diabetes before diagnosis 11.5 yrs (0–43). The cohort had 65 hospital admissions in the preceding 12 mths, median of 1 (0–15) per pt. 332 outpatient clinic visits were recorded. In those with T1DM, 33% had subcutaneous insulin infusion (CSII), while 67% of those with T2DM were receiving insulin. Diabetes was stable in 30% of pts. Nausea and vomiting were the most prominent symptoms in 97% of patients. Other symptoms included bloating (61%), early satiety (30%), constipation (33%) and diarrhoea (21%). Diagnosis was confirmed by scintigraphic single phase solid meal gastric emptying studies in 88%. 64% adopted life style modifications with 43% reporting sustained benefit. Prokinetic medications tried included: metoclopramide (58%), domperidone (76%), prochlorperazine (12%) and erythromycin (33%) with less than half of patients experiencing lasting benefit. Prucalopride was used in 11%. Pyloric injection with Botulinum toxin A was carried out in 15% with 20% reporting lasting benefit. Gastric electric stimulator was inserted in 8 (24%) patients 2 of whom had maintained benefit while rest of patients lost benefit within few month of device insertion. Surgical procedures were required in 3 (9%) pts. QoLi and GPCSI scores showed no correlation with glycaemic control or diabetes stability. <h3>Conclusion</h3> Diabetic patients with gastroparesis have increased health needs and multiple complications. Majority of treatments have only transient benefit, which tend to wane off. There was no correlation between duration of diabetes, diabetes control or diabetes stability and QoLI or GPCSI scores. A multi disciplinary appraoch is needed to manage these patients and new treatments need to be developed for long term benefits. <h3>Disclosure of interest</h3> A. Aldibbiat: None Declared, E. Nash: None Declared, C. Sinclair: None Declared, P. Praveen: None Declared, P. Peter: None Declared, A. Dhar Grant/ Research Support from: Carefusion UK, Consultant for: Takeda Pharmaceuticals, Speaker Bureau of: Falk Pharmaceuticals, Covidien.

Diabetes-Induced Gastric Visceral Hypersensitivity is Mediated by Activation of MAP Kinase That Modulates Transient K + Current in Rat Dorsal Root Ganglia Neurons

intact rats and on fundic muscularis externa from both groups of rats. Results: Neonatal inflammatory insult significantly suppressed the contractile response of circular muscle strips from the fundus of rats to ACh (10-6 to 10-2 M) in adulthood vs. controls. The gastric emptying of a solid meal in FD rats in 90 minutes (57±6 %) was slower than in controls (66±9 %, p<0.05). Similar induction of colonic inflammation by TNBS in 6-week-old adult rats did not show these effects 6 to 8 weeks later, compared with age-matched controls. Real time PCR and western blotting showed that the expression of MLCK mRNA (31± 9 % of control, p<0.01) and protein (51+7 % of control, p<0.01), were significantly suppressed in FD rats. The protein and mRNA expressions of other cell signaling proteins α1C-subunit of L-type Ca2+ channels, Gαq and 20 kDa regulatory light chain (RLC20) were not affected in FD rats. The intensity of phosphorylation of RLC20 by the activation of MLCK determines the amplitude of smooth muscle contraction. The intensity of phosphorylation of RLC20 in response to ACh was lower in FD vs. controls. The analysis of MLCK promoter showed no CpG islands. However, we found six regions in the mylk1 promoter (-3460/-3408; -3180/3141; -2156/-2101; -1176/-1136; -890/-831; -436/-366) that contain more than 5% of 5'CG-3' content, which may serve as methylation targets. One of these regions (-3,180/-3,141) contains the binding motifs of the SRF and SP1 transcription factors, while another region (-890/-831) contains the binding motif of the CREB transcription factor. Methylation-specific PCR showed significantly increased methylation of the DNA segment -890/-831 containing the recognition sequence of CREB transcription factor 1-week after the neonatal inflammatory insult, which persisted into adulthood. Conclusions: Neonatal inflammatory insult during the vulnerable stage of neonatal development methylates a specific region of the mlck1 gene promoter to suppress the critical cell signaling protein MLCK, which reduces the reactivity of gastric fundus smooth muscle cells to ACh, resulting in delayed gastric emptying of solid meals in adulthood.

M2013 Cyclic Vomiting Syndrome: Quantitative Pedigree Analysis for Maternal Inheritance Patterns in Adults and Children

(18 male, age 28±10), with postprandial fullness, bloating, belching, nausea, epigastric pain, early satiety and vomiting being reported by 85, 70, 70, 56, 67, 48 and 19 % of the patients, respectively; systematic analysis revealed that such pattern of symptoms was quite stable along the times. Although severity was gradually reducing for the majority of the symptoms, only the proportion of patients reporting moderate or severe belching were significantly reduced at 12 months (70 vs. 12 %, p<0.05). At baseline, delayed gastric emptying and impaired satiety testing were present in 60% and 85% of the patients with a similar percentage at 6 months (58 and 90%, respectively). Conclusions: We showed that at least 20% of prospectively evaluated patients with acute gastroenteritis develop and maintain dyspeptic symptoms after the resolution of the acute phase. In these patients symptoms severity was gradually reducing, but still persistent up to 1 year. Persistent delayed gastric emptying of solid meal and impaired gastric accommodation are putative mechanisms involved in symptoms generation.

M2011 Mechanisms of Burn-Induced Impairment in Gastric Slow Waves and Emptying in Rats

Giovanni Sarnelli, Francesco De Giorgi, Elisabetta Atteo, Daniela Viscardi, LetiziaVozzella, Rosario CuomoBackground and aims: Functional bowel disorders may follow acute intestinal infection. Asingle, large, retrospective study showed that a subset of dyspeptic patients had a historyof gastroenteritis. No data are however currently available in patients with prospectivelyidentified postinfectious dyspepsia (PD). Our aim was to characterize frequency, symptomsevolution and underlying mechanisms of functional dyspepsia, up to 12 months after acutegastroenteritis. Subjects and Methods: A total of 150 consecutive patients with undergoingacute gastroenteritis were screened and followed-up for 1 month. In patients with symptomspersistence upper GI endoscopy, gastric emptying study (13C-octanoic acid breath test) andsatiety testing (as a surrogate of gastric fundus accommodation) were performed. Patternand severity of dyspeptic symptoms were scored at 3, 6 and 12 months by standardizedquestionnaire. Gastric emptying and satiety testing were repeated at 6 months. Patients withprevious diagnosis of FGIDs or organic disease at endoscopy were excluded. Cut-off valuesfor normal gastric emptying rate and meal-induced satiety (120 min and 890 kcal, respect-ively) were obtained on 20 age/sex matched healthy subjects. Results: At baseline no signsof infection by common pathogens were found in the majority of the patients, except thangiardia lamblia and salmonella tiphy in 3 and 1 patients, that were respectively treated andfollowed up. Persistence of dyspeptic symptoms at 1 month was observed in 31 subjects(18 male, age 28±10), with postprandial fullness, bloating, belching, nausea, epigastric pain,early satiety and vomiting being reported by 85, 70, 70, 56, 67, 48 and 19 % of the patients,respectively; systematic analysis revealed that such pattern of symptoms was quite stablealong the times. Although severity was gradually reducing for the majority of the symptoms,only the proportion of patients reporting moderate or severe belching were significantlyreduced at 12 months (70 vs. 12 %, p<0.05). At baseline, delayed gastric emptying andimpairedsatietytestingwerepresentin60%and85%ofthepatientswithasimilarpercentageat 6 months (58 and 90%, respectively). Conclusions: We showed that at least 20% ofprospectively evaluated patients with acute gastroenteritis develop and maintain dyspepticsymptoms after the resolution of the acute phase. In these patients symptoms severity wasgradually reducing, but still persistent up to 1 year. Persistent delayed gastric emptyingof solid meal and impaired gastric accommodation are putative mechanisms involved insymptoms generation.

P.31 FREQUENCY, SYMPTOMS EVOLUTION AND PATHOPHYSIOLOGICAL CORRELATES IN PROSPECTIVELY IDENTIFIED PATIENTS WITH POSTINFECTIOUS DYSPEPSIA

Background and aim: Functional bowel disorders may follow acute intestinal infection. A single, retrospective study showed that a subset of dyspeptic patients had a history of gastroenteritis. No data are available in patients with prospectively identified postinfectious dyspepsia (PD). We aimed to characterize frequency, symptoms evolution and underlying mechanisms of functional dyspepsia after acute gastroenteritis. Material and methods: A total of 150 consecutive patients with undergoing acute gastroenteritis were screened and followed-up for 1 month (m). In patients with symptoms persistence upper GI endoscopy, breath test-based gastric emptying study and satiety testing (to estimate gastric fundus accommodation) were performed. Pattern and severity of symptoms were scored at 3, 6 and 12 m by standardized questionnaire. Gastric emptying and satiety testing were repeated at 6 m. Patients with previous diagnosis of FGIDs or organic disease were excluded. Normal values of gastric emptying rate and meal-induced satiety (120 min and 890 kcal, respectively) were obtained on 20 age/sex matched healthy subjects. Results: At baseline no signs of infection were found in the majority of the patients, except than giardia lamblia and salmonella tiphy in 3 and 1 patients. Persistence of dyspeptic symptoms at 1 m was observed in 31 subjects (18 male, age 28±10), with postprandial fullness, bloating, belching, nausea, epigastric pain, early satiety and vomiting being reported by 85, 70, 70, 56, 67, 48 and 19% of the patients, respectively; systematic analysis revealed that such pattern of symptoms was quite stable along the times. Although severity was gradually reducing for the majority of the symptoms, only patients reporting severe belching were significantly reduced at 12 m (70 vs. 12%, p<0.05). At baseline, delayed gastric emptying and impaired satiety testing were present in 60% and 85% of the patients with a similar percentage at 6 m (58 and 90%, respectively). Conclusions: We showed that at least 20% of prospectively evaluated patients with acute gastroenteritis develop and maintain dyspeptic symptoms after the resolution of the acute phase. In these patients symptoms severity was gradually reducing, but still persistent up to 1 year. Persistent delayed gastric emptying of solid meal and impaired gastric accommodation are putative mechanisms involved in symptoms generation. # C. Functional disorders 1. Dyspepsia

Effects of Proton Pump Inhibitors on Gastric Emptying: A Systematic Review

The proton pump inhibitor (PPI) is widely used for the treatment of gastroesophageal reflux disease, peptic ulcer diseases, and functional dyspepsia. The pathogenesis of these acid-related and/or functional upper gastrointestinal disorders is potentially associated with abnormal gastric emptying. To date, variable effects of PPIs on gastric emptying have been reported. Therefore, it is relevant to gather and analyze published information on this topic. A systematic literature search has been performed, showing that the delaying effect of PPIs on gastric emptying of solid meals is consistent, whereas the effect of PPIs on the emptying of liquids is inconsistent. The underlying mechanisms whereby PPIs may affect gastric emptying have been discussed, most of which still remain hypothetic. Gastric emptying of solids involves a process of peptic hydrolysis. PPIs impair the hydrolytic digestion by inhibiting acid-dependent peptic activity, thereby delaying the solid emptying. Gastric emptying of liquids largely depends on volume and energy density of intragastric contents. PPIs variably modify the volume and the energy density by reducing gastric fluid secretion, thereby modifying the liquid emptying in an unpredictable manner. Hypergastrinemia has been considered to delay gastric emptying, but it seems of minor importance in the regulation of gastric emptying during PPI use. The delayed emptying of solids due to PPI therapy may have clinical implications in the management of gastroesophageal reflux disease, functional dyspepsia, as well as diabetes.

Gastric Emptying

Gastric Emptying

Predictors of Gastric Myoelectrical Activity in Type 2 Diabetes Mellitus

Previous studies have clearly demonstrated the delayed gastric emptying of solid meals in diabetics, whereas their gastric myoelectrical activity, which primarily determines gastric motility, has not yet been fully confirmed. This study aimed to clarify the characteristics and potential predictors of gastric myoelectrical activity in type 2 diabetics. Twenty-eight diabetics and 18 healthy controls participated. Duodenal biopsy sample was used for reverse transcription-polymerase chain reaction to evaluate cholecystokinin and motilin mRNA contents. Electrogastrography was performed before and after the test meal, and was assessed in terms of dominant frequency; dominant frequency instability coefficient; and the percentage of bradygastria, normogastria, and tachygastria. Over the entire recording period, dominant frequency was significantly lower, and dominant frequency instability coefficient and the percentage of bradygastria were significantly higher in diabetics than in controls. In diabetics, the multiple regression analysis demonstrated that dominant frequency instability coefficient and the percentage of tachygastria in the fasting period were dependent on fasting plasma glucose level and HbA1c, respectively. Moreover, dominant frequency over the entire period and the postprandial percentage of bradygastria were significantly associated with body mass index; the fasting percentage of bradygastria and postprandial dominant frequency instability coefficient were associated with fasting serum leptin level; the postprandial percentage of bradygastria was also associated with cholecystokinin mRNA content. Gastric myoelectrical activity in type 2 diabetics is impaired on dominant frequency, dominant frequency instability coefficient, and the percentage of bradygastria and predicted by body mass index, fasting serum leptin level, and cholecystokinin mRNA content besides the glycemic status.

Rabeprazole delays gastric emptying of a nutrient liquid

It is generally considered that gastric acid suppression delays gastric emptying of solid meals because gastric hypoacidity impairs peptic digestion and antral triturition. Rabeprazole is one of the most potent acid suppressants. We conducted this cross-over study to investigate if rabeprazole delays gastric emptying of liquid nutrients, for which peptic digestion is unnecessary. On two randomized occasions, 13 healthy male volunteers underwent the (13)C-acetate breath test following ingestion of a 300 kcal-liquid meal. On one occasion, they had received 20 mg rabeprazole for the preceding 2 days and 1 h before the test. On another, they took no pretreatment. Based on 4 h breath samples, the half (13)CO(2) excretion time (t(1/2b)) and the time of maximal excretion (t(max)) were calculated as overall measures of gastric emptying. In addition, time profiles of gastric emptying were generated using the Wagner-Nelson analytical method, which creates the gastric emptying curve as accurately as the scintigraphy. Rabeprazole significantly prolonged t(max) but unchanged t(1/2b). The gastric emptying profiles showed that rabeprazole evoked a segmental slowing of gastric emptying during 0.5-1.25 h of post-meal ingestion. Rabeprazole suppresses gastric emptying of a liquid nutrient 0.5 h after meal ingestion. We have speculated that: (i) rabeprazole delays gastric emptying via a mechanism other than acid-pepsin maldigestion; and (ii) rabeprazole may intensify the post-gastric feedback regulation system (>0.5 h of post-meal).