Gastric Emptying Rate Of Liquids Research Articles

Preoperative liquid gastric emptying rate does not predict outcome after fundoplication

Aim of the studyPreoperative gastric emptying (GE) rate in patients with gastrointestinal reflux disease (GERD) was evaluated as a predictor of outcome after antireflux surgery. Methods and patientsGE was assessed using radionuclide scintigraphy and a standardized meal with cow's milk. GE half time (T1/2), patient demographics and GERD symptoms including vomiting (>4days/week), retching (>4days/week), prolonged feeding time (>3h/day), and discomfort after meals were recorded pre- and postoperatively. A standardized follow-up included a 24-h pH-monitoring and an upper gastrointestinal contrast study. Of 74 patients undergoing Nissen fundoplication between 2003 and 2009, 35 underwent a preoperative GE study. The remaining 39 patients were not examined owing to volume intolerance, cow's milk intolerance or allergy, inability to lie still, or parents refusing participation. Main resultsMedian age at fundoplication was 4.9 [range 1.1–15.4] years, and follow-up time was median 4.3 [1.9–8.9] years. GERD recurred in 7 (20%) patients. Preoperative T1/2 in the seven patients with recurrent GERD was median 45 [21–87] min compared to 44 [16–121] min in the 28 patients without recurrent GERD (p=0.92). There was no significant difference between the one third of patients with the slowest GE [T1/2 54–121min] and the remaining patients [T1/2 16–49min] regarding GERD recurrence or postoperative vomiting, retching, prolonged feeding time, or discomfort after meals. ConclusionPreoperative GE rate did not predict outcome after antireflux surgery, as slow GE was not associated with recurrent GERD or postoperative troublesome symptoms such as vomiting, retching, or meal discomfort.

What is the manner of gastric emptying after ingestion of liquids with differences in the volume under uniform glucose-based energy content?

We previously demonstrated that the gastric emptying rate of liquids chiefly depended on the total amount of calories (energy content) in a uniform volume. The aim of the present study was to examine the effects of different volumes of liquids with a uniform energy content on gastric emptying. Three types of test solutions were prepared with a uniform amount of calories (200kcal provided by glucose) and step-wise increments in volume (200ml, 400ml, and 600ml). The gastric volume of each solution was determined by ultrasound measurements of the gastric antral cross-sectional area after their ingestion by 8 healthy volunteers. The mean gastric volume decreased exponentially to nearly 0ml 70min after ingestion in the 200ml group, 90min in the 400ml group, and 100min in the 600ml group. Each gastric emptying curve converged with identical slopes on the graph when the points at which the gastric emptying curves of the 200ml and 400ml groups reached the zero point on the Y-axis (mean gastric volume) were shifted toward 110min on the X-axis (time scale). The volume of liquid ingested with a uniform glucose-based energy content is a critical determinant of liquid gastric emptying. The gastric emptying time may be predicted following the ingestion of an isocaloric liquid with any volume over a predefined range once a gastric emptying curve following the ingestion of a liquid has been plotted on a graph. UMIN000014930.

Pancreatic polypeptide stimulates mouse gastric motor activity through peripheral neural mechanisms.

Pancreatic polypeptide (PP) is supposed to be one of the major endogenous agonists of the neuropeptide Y4 receptor. Pancreatic polypeptide can influence gastrointestinal motility, acting mainly through vagal mechanisms, but whether PP acts directly on the stomach has not been explored yet. The aims of this study were to investigate the effects of PP on mouse gastric emptying, on spontaneous tone of whole stomach in vitro and to examine the mechanism of action. Gastric emptying was measured by red phenol method after i.p. PP administration (1-3nmol per mouse). Responses induced by PP (1-300mmolL-1 ) on gastric endoluminal pressure were analyzed in vitro in the presence of different drugs. Gastric genic expression of Y4 receptor was verified by RT-PCR. Pancreatic polypeptide dose-dependently increased non-nutrient liquid gastric emptying rate. In vitro, PP produced a concentration-dependent contraction that was abolished by tetrodotoxin, a neural blocker of Na+ voltage-dependent channels. The contractile response was significantly reduced by atropine, a muscarinic receptor antagonist, and by SR48968, an NK2 receptor antagonist, while it was potentiated by neostigmine, an inhibitor of acetylcholinesterase. The joint application of atropine and SR48968 fully abolished PP contractile effect. Reverse transcriptase-polymerase chain reaction analysis revealed the presence of Y4 receptor mRNA in mouse stomach with a greater expression in antrum than in fundus. The present findings demonstrate that exogenous PP stimulates mouse gastric motor activity, by acting directly on the stomach. This effect appears due to the activation of enteric excitatory neurons releasing acetylcholine and tachykinins.

Abdominal migraine in children: association between gastric motility parameters and clinical characteristics.

BackgroundApproximately 0.2–1 % of children suffers from abdominal migraine (AM). Pathophysiology of AM has not been adequately studied. This study evaluated gastric motility in children with AM.MethodsSeventeen children (6 boys), within an age range of 4–15 years, referred to a tertiary care paediatric unit, North Colombo Teaching Hospital Ragama, Sri Lanka, from 2007 to 2012, were screened. Those fulfilling Rome III criteria for AM were recruited after obtaining parental consent. None had clinical or laboratory evidence of organic disorders. Twenty healthy children (8 boys), with an age range of 4–14 years, were recruited as controls. Liquid gastric emptying rate (GE) and antral motility parameters were assessed using an ultrasound method.ResultsAverage GE (41.6 % vs. 66.2 %, in controls), amplitude of antral contractions (A) (57.9 % vs. 89.0 %) and antral motility index (MI) (5.0 vs. 8.3) were lower and fasting antral area (1.8 cm2 vs. 0.6 cm2) was higher in children with AM (p < 0.01). No significant difference in the frequency of antral contractions (F) (8.8/3 min vs. 9.3/3 min, p = 0.08) was found between the two groups. Scores obtained for severity of abdominal pain had a negative correlation with A (r = −0.55, p = 0.03). Average duration of abdominal pain episodes correlated with GE (r = −0.58, p = 0.02). Negative correlations were observed between duration of AM and A (r = −0.55), F (r = −0.52), and MI (r = −0.57) (p < 0.05).ConclusionsGE and antral motility parameters were significantly lower in children with AM. A significant correlation was found between symptoms and gastric motility. These findings suggest a possible role of abnormal gastric motility in the pathogenesis of AM.

Gastric emptying and antral motility parameters in children with functional dyspepsia: Association with symptom severity

Functional dyspepsia (FD) is an important gastrointestinal problem with obscure etiology. Abnormal gastric motility is suggested as a possible pathophysiological mechanism for symptoms. The main objective of this study was to assess gastric motility in Sri Lankan children with FD. Forty-one children (19 [46.3%] males, age 4-14 years, mean 7.5 years, SD 2.6 years) referred to the Gastroenterology Research Laboratory, Faculty of Medicine, University of Kelaniya, from January 2007 to December 2011, were screened. Those fulfilling Rome III criteria for FD were recruited. None had clinical or laboratory evidence of organic disorders. Twenty healthy children were recruited as controls (eight [40%] males, age 4-14 years, mean 8.4 years, SD 3.0 years). Liquid gastric emptying rate (GE) and antral motility parameters were assessed using an ultrasound-based method. Average GE (45.6% vs 66.2% in controls), amplitude of antral contractions (58.2% vs 89.0%) and antral motility index (5.1 vs 8.3) were lower and fasting antral area (1.5 cm(2) vs 0.6 cm(2)) was higher in patients with FD (P < 0.01). Frequency of antral contractions (8.8 vs 9.3) did not show a significant difference (P = 0.07). Scores obtained for severity of abdominal pain negatively correlated with GE (r = -0.35, P = 0.025). Children with FD, exposed to stressful events had higher fasting antral area (1.9 cm(2)) than those not exposed to stress (1.0 cm(2)) (P = 0.02). GE and antral motility parameters were significantly impaired in children with FD compared with controls. GE negatively correlated with severity of symptoms. This study points to disturbances in gastric motility as an etiological factor for FD.

Ultrasonographic Assessment of Liquid Gastric Emptying and Antral Motility According to the Subtypes of Irritable Bowel Syndrome in Children

Gastric motor abnormalities have been reported in adults with irritable bowel syndrome (IBS), commonly in constipation-predominant IBS (IBS-C); however, such studies are uncommon in children. Furthermore, differences of gastric motility have not been studied in children with different IBS subtypes. Seventy-six children (33 [43%] boys, age 4-14 years, mean 7.9 years, SD 3.0 years) fulfilling Rome III criteria for IBS and 20 healthy controls (8 [40%] boys, age 4-14 years, mean 8.4 years, SD 3.0 years) were recruited (diarrhea-predominant IBS=21, IBS-C=31, mixed IBS=19, and unsubtyped IBS=5). Liquid gastric emptying rate (GER) and antral motility were assessed using an ultrasound method. Average GER (43.8% vs 66.2% in controls), amplitude of antral contractions (56.4% vs 89%), and antral motility index (5.1 vs 8.3) were lower and fasting antral area (1.6 vs 0.6) was higher in patients with IBS (P<0.0001). Frequency of antral contractions F (8.9 vs 9.3) did not show a significant difference. Patients exposed to stressful events had a significantly lower GER, compared to those not exposed to such events (P=0.03). Gastric motility parameters had no correlation with severity of symptoms. GER (42.6%, 46.3%, 39.6%), fasting antral area (1.4 cm², 1.8 cm², 1.8 cm²), amplitude of antral contractions (53%, 58.9%, 51.8%), frequency of antral contractions (8.7, 8.9, 9.2), and antral motility index (4.7, 5.3, 4.8) were not different among diarrhea-predominant IBS, IBS-C, and mixed IBS (P>0.05). GER and antral motility parameters were significantly impaired in children with IBS compared with controls. GER and antral motility parameters were not different between IBS subtypes.

Delayed gastric emptying rates and impaired antral motility in children fulfilling Rome III criteria for functional abdominal pain

Gastric sensorymotor dysfunctions have been implicated in the pathophysiology of some functional gastrointestinal disorders, such as functional dyspepsia and irritable bowel syndrome. Therefore, we hypothesized that abnormal gastric emptying and impaired antral motility are possible underlying mechanisms of symptoms in children with functional abdominal pain (FAP). Hundred and two children [37 (36.3%) males, 4-14 years, mean 7.8 years, SD 2.7 years] fulfilling Rome III criteria for FAP were recruited for this study. An age and sex compatible group of healthy children (n = 20) were selected as controls [8 (40%) males, 4-14 years, mean 8.4 years, SD 3.0 years]. Liquid gastric emptying rate (GER) and antral motility parameters (amplitude of antral contractions, frequency of antral contractions and antral motility index) were assessed using a previously reported ultrasound method. Average GER (42.1% vs 66.2% in controls), amplitude of antral contractions (56.5% vs 89%), frequency of contractions per 3 min (8.5 vs 9.3), and antral motility index (4.9 vs 8.3) were significantly lower in patients with FAP compared with controls (P < 0.01). Fasting antral area was higher in patients (1.4 vs 0.6, P < 0.0001). GER negatively correlated with the scores obtained for severity of abdominal pain (r = -0.29, P = 0.004). Gastric emptying rate and antral motility parameters were significantly impaired in patients with FAP and GER negatively correlated with symptom severity. These findings highlight the possible role of gastrointestinal motility abnormalities in the pathophysiology of childhood FAP.

PTH-035 Assessment of gastric emptying and antral motility in different types of abdominal pain related functional gastrointestinal diseases: a paediatric study: Abstract PTH-035

Introduction Functional gastrointestinal disorders (FGD) are common among paediatric population. Abdominal pain related FGD are the most common subgroup found, of which irritable bowel syndrome is the most common. The exact mechanism of pain remains unclear in FGD. Visceral hypersensitivity and altered gastrointestinal motility are considered possible causes for abdominal pain and discomfort found in these children. Methods The main aim of this study was to evaluate the gastric emptying and antral motility in children and adolescents with abdominal pain related FGD. Hundred and fifty-five children referred to the Gastroenterology Research Laboratory who fulfilled Rome III criteria for abdominal pain related FGD (60 (38.5%) males, 4–14 years, mean 8.1 years, SD 2.6 years) and 20 healthy children without gastrointestinal symptoms (8 (40%) males, 4–15 years, mean 8.9 years, SD 2.7 years) were recruited. None had clinical or laboratory evidence of organic diseases. All subjects underwent ultrasonographic assessment of liquid gastric emptying rate (GE) and antral motility, using a previously reported method. Results Gastric motility parameters of children with FGD and controls are presented in the table. GE negatively correlated with the scores obtained for severity of symptoms in functional dyspepsia (FD) (r=−0.67, p Conclusion GE and antral motility parameters were significantly impaired in children with all types of abdominal pain related FGD. GE negatively correlated with symptoms in FD and FAP. Motility parameters were not significantly different between subtypes of IBS.

Erythromycin promotes gastric emptying during acute pain in volunteers

In this double-blind cross-over study, we assessed whether erythromycin infusion is effective as a prokinetic drug against gastroparesis from acute pain. The effect of erythromycin on gastric emptying (GE) was measured in seven volunteers subjected to a standardized acute painful stimulus. The GE rate for solids was measured using the octanoic acid breath test. An acetaminophen absorption test measured the GE rate for liquids. Five minutes after ingestion of a 13C-labeled meal, the subjects received in randomized order either a test (placebo and erythromycin groups) or a control (control group) stimulus consisting of repeated 1-min immersion of a hand into 4 degrees C (test) or 37 degrees C (control) water, with 15 s for recovery between immersions, for a total of 20 min. While the stimulus was applied, 250 mL saline (control and placebo groups) or 250 mg erythromycin (erythromycin group) was infused. Pain and stress were evaluated using visual analog scales, and standard hemodynamic values were recorded throughout the study. Our results show that acute stress decreased GE for solids, which was significantly accelerated in the erythromycin group in comparison with the placebo group. GE for liquids was similar in the three groups. We conclude that erythromycin is effective as a prokinetic drug for solids in acute painful situations.

Effects of indwelling nasogastric intubation on gastric emptying of a liquid marker in horses

To determine the effects of indwelling nasogastric intubation on the gastric emptying rate of liquid in horses. 6 healthy horses. Horses were assigned to treatment and control groups in a prospective randomized crossover study with a washout period of at least 4 weeks between trials. Acetaminophen (20 mg/kg) diluted in 1 L of distilled water was administered via nasogastric tube at time points of 0, 12, 30, 48, and 72 hours to evaluate the liquid-phase gastric emptying rate. In control horses, nasogastric tubes were removed after administration of acetaminophen. In horses receiving treatment, the tube was left indwelling and maintained for 72 hours. A 10-mL sample of blood was collected from a jugular vein immediately before and 20, 40, 60, 80, 100, 120, and 180 minutes after acetaminophen administration. Serum acetaminophen concentrations were measured by use of a colorimetric method. Peak serum acetaminophen concentration was significantly higher in the control group (38.11 microg/mL) than in the treatment group (29.09 microg/mL), and the time required to reach peak serum acetaminophen concentration was significantly shorter in the control group (22.79 minutes) than in the treatment group (35.95 minutes). Results indicated that indwelling nasogastric intubation has a delaying effect on the gastric emptying rate of liquids. Veterinarians should consider the potential for delayed gastric emptying when placing and maintaining an indwelling nasogastric tube for an extended period of time after surgery. Repeated nasogastric intubation may be better than maintenance of an indwelling tube in horses with ileus.

Erythromycin Promotes Gastric Emptying During Acute Pain in Volunteers

In this double-blind cross-over study, we assessed whether erythromycin infusion is effective as a prokinetic drug against gastroparesis from acute pain. The effect of erythromycin on gastric emptying (GE) was measured in seven volunteers subjected to a standardized acute painful stimulus. The GE rate for solids was measured using the octanoic acid breath test. An acetaminophen absorption test measured the GE rate for liquids. Five minutes after ingestion of a 13C-labeled meal, the subjects received in randomized order either a test (placebo and erythromycin groups) or a control (control group) stimulus consisting of repeated 1-min immersion of a hand into 4 degrees C (test) or 37 degrees C (control) water, with 15 s for recovery between immersions, for a total of 20 min. While the stimulus was applied, 250 mL saline (control and placebo groups) or 250 mg erythromycin (erythromycin group) was infused. Pain and stress were evaluated using visual analog scales, and standard hemodynamic values were recorded throughout the study. Our results show that acute stress decreased GE for solids, which was significantly accelerated in the erythromycin group in comparison with the placebo group. GE for liquids was similar in the three groups. We conclude that erythromycin is effective as a prokinetic drug for solids in acute painful situations.

Performance of the [13C]-acetate gastric emptying breath test during physical exercise.

The gastric emptying rate of liquids can be determined non-invasively using the [13C]-acetate breath test at rest. The aims of our study were to validate this test during physical exercise against the double-sampling method and to evaluate the time needed for intestinal absorption and the delay between absorption and appearance of 13CO2 in breath, both at rest and during exercise. Fifteen well-trained male subjects were investigated. Gastric emptying was determined simultaneously measuring the 13CO2 breath enrichment after intragastric administration of 0.5 L of carbohydrate solution with 150 mg of [13C]-acetate added and by the double-sampling technique (n = 9). In separate tests, 150 mg of [13C]-acetate was also applied intraduodenally and intravenously (n = 6), both at rest and during exercise. Time-to-peak (TTP) 13CO2 enrichment was determined using a curve fit and was considered as the parameter for gastric emptying. TTP enrichment derived from the breath test significantly correlated with the gastric emptying half-time obtained from the gastric aspirates. During exercise, median TTP enrichment values after intragastric, intraduodenal (i.d.) and intravenous (i.v.) administration of [13C]-acetate were 22.3, 10.3 and 5.4 min respectively. During exercise, i.d. and i.v. values were reached significantly earlier than at rest. The [13C]-acetate breath test can be used as a non-invasive method to determine relative gastric emptying rates of liquids during exercise, but the results are influenced by the rate of absorption and the time needed for subsequent oxidation of [13C]-acetate and exhalation of 13CO2.

Rapid gastric emptying of a liquid meal in long-term Type 2 diabetes mellitus.

Both delayed and accelerated gastric emptying rate (GER) have been reported in patients with diabetes mellitus. Delayed GER has been attributed to autonomic neuropathy in established diabetes but rapid GER was demonstrated in early Type 2 diabetes. The aim of the study was to investigate rapid gastric emptying in a group of people with long-duration Type 2 diabetes. GER of a radiolabelled liquid meal was studied scintigraphically in 20 Type 2 patients with a mean (+/-SEM) duration of diabetes 13 (+/-1) years. The 50% emptying time (t50) for the liquid meal was shorter in diabetic patients (29.6+/-2.1 min) than in controls (39.2+/-1.9 min; p<0.0005). Accelerated emptying (t50 value below the shortest t50 of controls) was evidenced in 14/20 patients and delayed emptying (t50 value exceeding the upper t50 of controls) in none. Patients with accelerated GER were comparable for BMI, diabetes duration, HbA1c and fasting glycaemia to those with normal GER. Rapid GER for liquids was found in the presence or absence of autonomic neuropathy. Seven of the patients with rapid emptying of the liquid meal were reassessed using a solid meal. Only one patient demonstrated rapid emptying of the solid meal, which was normal in 3 and delayed in 3 patients. In conclusion, accelerated GER can be found in long-term Type 2 diabetes but there is no concordance between GER of a liquid and a solid meal.

Guide for judicious use of the paracetamol absorption technique in a study of gastric emptying rate of liquids.

The paracetamol absorption technique, a widely used method for evaluating the gastric emptying rate of liquids, appears to be performed inappropriately, resulting from a lack of consideration of pharmacokinetics in paracetamol absorption. This review suggests that appropriate study designs and logical choice of the parameters for the rate of paracetamol absorption are the cornerstone of reliable investigation of gastric emptying using the paracetamol method.

Disturbed Gastric Motor Activity in Patients with Human Immunodeficiency Virus Infection

Background: Human immunodeficiency virus (HIV) infection is accompanied by a wide spectrum of disorders that affect the central and peripheral nervous system. Damage to the peripheral and central nervous system, including its autnnomic division, may become manifest at any stage of the disease. Methods: Twenty HIV-positive patients with abdominal complaints like dyspepsia, dysphagia, vomiting, and nausea underwent several function tests to determine oesophagcal motility, gastric motor and electric activity, and gastric emptying rate. The CDC (Center for Disease Control) classification was used to determine the stage of the disease, which varied from B2 to C3. Before gastric motility examinations all patients underwent endoscopy of the upper gastrointestinal (GI) tract, and none of them showed any morphologic changes of the stomach or oesophagus. Biopsy specimens taken during upper GI endoscopy did not show any histologic alterations of the gastric or oesophageal mucosa. Results: Manometry of the antrum showed an unchanged postprandial (after 200 ml liquid, caloric meal) motility index (MI) when compared with the fasting period (mean fed MI, 174 ± 43; mean fasting MI, 136 ± 51). The same was seen for frequency, amplitude, and duration of antral contractions. The electrogastrographic recordings showed basal rhythm of 3 cpm, and no significant changes of the electric pattern were observed postprandially. The amplitude of electric oscillations (power content) significantly increased postprandially when compared with the fasting period. The gastric emptying rate of liquids, measured by means of the 13C-acetatc breath test, was faster in HIV patients than in healthy controls. On the other hand, in HIV patients the scintigraphically determined emptying rate of solids was significantly delayed compared with the normal values. There were no significant differences in the oesophageal motility pattern with regard to the amplitude, duration, and propagation of peristaltic waves when compared with the values obtained from healthy volunteers. Conclusion: Our results suggest that HIV-associated visceral neuropathy may present already in relatively early stages of infection and may contribute to abdominal symptoms that occur frequently in these patients.

Relationship among acid secretion, antral distension, and liquid gastric emptying in active and healed duodenal ulcer.

The aim of this study was to assess the relationship between fasting antral distension and basal and maximal acid output and to examine the link between the gastric emptying rate of liquids and the amount of acid secretion. Twenty consecutive male patients with H. pylori-positive noncomplicated duodenal ulcer disease received a measurement of basal and maximal gastric acid secretion and underwent ultrasonographic (US) evaluation of fasting antral distension and gastric emptying of liquids on two separate days. Ten of these patients were studied again three months after ulcer healing. The width of the fasting antral area was not correlated with basal acid output, but a significant relationship was found between maximal acid output and fasting antral distension (r = 0.55; P = 0.012). No significant correlations were found between gastric emptying and gastric acid output. The gastric emptying rate, expressed as half-time gastric emptying and remaining liquid component at 60 min, was not influenced by basal or maximal acid output. After ulcer healing, no correlations were found between acid secretion, fasting antral distension, and gastric emptying rate. Our results suggest that in duodenal ulcer patients, fasting antral distension is not influenced by basal gastric secretion and that, on the contrary, a correlation exists between fasting antral distension and maximal acid output, but only in active duodenal ulcer. No relationship exists in both active and healed duodenal ulcer between gastric emptying and gastric acid secretion.

Influence of octreotide on the gastric emptying of solids and liquids in normal healthy subjects

The effects of octreotide on small intestinal and gall-bladder motility are well established. However, the influence of octreotide on the gastric emptying rate of both solids and liquids in normal healthy volunteers has never been studied. In nine healthy subjects, the gastric emptying rate of liquids and solids was studied in basal condition and 30 min after subcutaneous administration of 50 micrograms of octreotide, using the combined 14C-octanoic acid/13C-glycine breath test. To determine if the results were entirely due to alterations in gastric emptying, 14/13CO2 excretion rates of intraduodenally administered 14C-octanoic acid and 13C-glycine were measured in basal condition and after subcutaneous injection of octreotide. After subcutaneous injection of octreotide, the gastric emptying rate of solids was decreased in all but one subject, while the gastric emptying rate of fluids was decreased in all subjects. Nevertheless, 14/13CO2 excretion rates in the breath after intraduodenally administered 14C-octanoic acid and 13C-glycine, were similar in basal condition and after subcutaneous injection of octreotide. Subcutaneous injection of a single physiological dose of octreotide induces a marked delay in the gastric emptying of solids and liquids in young healthy volunteers. The combined 14C-octanoic acid/13C-glycine breath test is very well suited to demonstrate this effect, since the absorption and metabolism of octanoic acid and glycine remains unaltered after administration of octreotide.

Gastric emptying 16 to 26 years after treatment of infantile hypertrophic pyloric stenosis

Long-term follow-up was performed 16 to 26 years after conservative (group I, n = 18) and operative (group II, n = 38) treatment of 56 patients who had infantile hypertrophic pyloric stenosis (IHPS). The study encompassed the scintigraphic determination of gastric emptying rates for solids and liquids, an interview to obtain medical history and ascertain whether a current disorder of the upper gastrointestinal tract was present, and a clinical examination. Gastric emptying rates were measured on two different days for solids and liquids. The standard solid meal consisted of two scrambled eggs, two slices of toast, and 20 g of margarine. The gastric emptying rate for liquids was measured using 300 mL of apple juice. The scrambled eggs and apple juice were each marked with 2.2. MBq technetium 99m-sulphur-colloid. Two control collectives were used in this study; one group (physicans) served to create a reference curve for gastric emptying, and the other group, with the same age and gender distributions as those of the patients, served to evaluate the frequency of gastrointestinal complaints, by means of a questionnaire. There was no significant rate difference for gastric emptying between the patients treated conservatively or surgically and the controls. No association could be construed between the frequency of gastrointestinal symptoms or disorders and the gastric emptying rates for solids and liquids. The results presented here substantiate that clinically relevant disturbances of stomach motility after IHPS appear to be rare.

Reliability and interobserver variability of ultrasonographic measurement of gastric emptying rate

Scintigraphy and real-time ultrasound are valid techniques to measure parameters of gastric emptying. However, scintigraphy involves exposure to ionizing radiation, while the precision of real-time ultrasound has not been previously evaluated. The objectives of the present study were to determine the inter observer and day-to-day variability of liquid gastric emptying rate measured by real-time ultrasonography in healthy volunteers and to compare the gastric emptying rate of males and females. Twenty healthy volunteers had ultrasonographic measurement of gastric emptying rate after ingestion of 300 ml beef broth. Nine subjects had a concurrent assessment by a second observer. Nine subjects had two studies performed on different days by the same sonographer. The T1/2 for 20 subjects was 24.77 +/- 6.84 min with no difference between the half-emptying time for males (25.89 +/- 6.99 min) and females (24.02 +/- 6.94 min). The Pearson and intraclass correlation coefficients for observations made by two observers were 0.83 and 0.625, with a difference due to observer of 2.37 min +/- 5.26 (NS). The test-retest reliability across successive days was 0.136, representing considerable day-to-day variability within subjects. The variability between subjects was also large, explaining up to 79% of the total variance. We conclude that ultrasound is a useful method to evaluate gastric emptying with good interobserver agreement. Due to substantial day-to-day variability, sample sizes larger than previously suggested are required to demonstrate clinically important changes in gastric emptying rate in clinical trials.

The influence of the interdigestive migrating myoelectric complex on the gastric emptying of liquids

It is unknown how the interdigestive migrating motor complex influences the gastric emptying of liquids. Therefore, the gastric emptying rate of 50- and 200-mL volumes of phenol red solution were measured while monitoring contractile activity. Motor activity was recorded using a hydraulic manometric system and expressed as either the proximity of dosing time to time of appearance of phase III or as a motility index, defined as (contractile area)/(sampling interval time). After an initial lag period, emptying was log linear. With a 50-mL oral dose, the mean gastric emptying rate of the log-linear phase was successively faster during phase I (0.018 ± 0.003 min−1), phase II (0.083 ± 0.031 min−1), and late phase II/III (0.171 ± 0.066 min−1) (P < 0.05). Similarly, the mean lag time decreased successively with phases I, II, and late II/III (19.1 ± 12.4, 7.6 ± 5.6, and 3.8 ± 2.8 minutes, respectively). At a 200-mL oral dose, there was no difference in the emptying rate between phase I and phase II (0.104 ± 0.0014 vs. 0.110 ± 0.041 min−1), but the emptying rate during late phase II/III was significantly greater (0.236 ± 0.069 min−1); lag time was not dependent on phase. There was a statistical difference in the overall mean emptying rate between the 50- and 200-mL volumes. Also, during phase I, the emptying rate was faster for the 200-mL volume. This study shows a strong dependence of liquid gastric emptying rate and lag time on interdigestive antral motility, the emptying of small volumes being more dependent on motility phase than that of large volumes. Phase-related fluctuations in contractile activity can account for much of the reported variability in gastric emptying data. Furthermore, this study suggests that dose volume and interdigestive motor activity at the time of drug administration can affect absorption and onset of therapeutic response for some drugs.