Gastric Emptying Rate Research Articles

Ameliorative Effect of Poria cocos -Yam Riched Rice Paste and Hericium erinaceus Biscuit on Rats with Functional Dyspepsia

Effect of rice paste based on Poria cocos-yam extract and biscuit riched in Hericium erinaceus extract on functional dyspepsia in rats were investigated. Functional dyspepsia rat mblished, and rats were randomly divided into model-, positive-, Poria cocos-yam extracts-(low, medium and high dose), rice paste-(low, medium and high dose), Hericium erainaceus extract-(low, medium and high dose), and biscuit-(low, medium and high dose) treated groups. The corresponding materials were orally administered for 14 days. The results showed that giving the four materials significantly(P<0.05) increased the body weight, feed intake, gastric emptying rate, small intestinal propulsion rate, serum motilin and gastrin levels, and significantly(P<0.05) reduced serum cholecystokinin level in rats with functional dyspepsia, with the colonic levels of acetic-, propionic-, butyric- and total short-chain fatty acids also increased. In summary, the four materials could effectively ameliorate the symptoms of functional dyspepsia in rats, while Poria cocos-yam extract and rice paste functioned better than Hericium erinaceus extract and biscuit, the extract exerted similar effect with the corresponding product, and the medium dose showed the best effect. The results of this study could provide data to support the development of products which improved gastrointestinal function and health.

Effect of DA-9701 on the Gastrointestinal Motility in the Streptozotocin-Induced Diabetic Mice.

Background: Compared to the general population, diabetic patients experience more frequent episodes of gastrointestinal (GI) motility dysfunction, owing to the disruption of functional innervations. DA-9701 is a new prokinetic agent formulated from the extracts of Pharbitidis semen and Corydalis tuber. Aim: To investigate the effect of DA-9701 on GI motility in an animal model of streptozotocin (STZ)-induced diabetes. Methods: Diabetes was induced in mice by intraperitoneal injection of STZ (40 mg/kg of body weight in 0.1 M citrate buffer) for 3 days. Diabetic mice were divided into four groups and administered DA-9701 in different doses (1, 3, and 10 mg/kg) or placebo for 2 weeks. Intestinal transit was assessed using charcoal meal movement. GI isometric contraction was measured by applying an isometric force transducer on a circular muscle strip of the antrum, ileum, and proximal colon of sacrificed mice. Gastric emptying rate was evaluated by measuring the dye percentage remaining in the stomach relative to the total dye amount recovered in a standardization group of mice. Results: Body weight and antral and small intestinal motility were less in diabetic mice than in control mice, and colonic motility was similar in both. DA-9701 showed a dose-dependent increase in the amplitude of spontaneous phasic contractions in the antrum, ileum, and colon in diabetic mice without influencing body weight or blood glucose levels. The degree of improvement was comparable between diabetic and control mice. Intestinal transit was significantly more delayed in diabetic mice than in controls (43 ± 7% vs. 67 ± 8%, p < 0.05); however, DA-9701 restored the delayed intestinal transit more effectively compared to placebo (75% vs. 50%). The gastric emptying rate was significantly more delayed in diabetic mice than in controls (43 ± 10% vs. 62 ± 12%, p < 0.05), and was improved by DA-9701 in a dose-dependent manner (50%, 55%, and 60% in mice treated with 1, 3, and 10 mg/kg of DA-9701, respectively, vs. 43% in placebo-treated and 60% in control mice). Conclusions: DA-9701 improved GI contractility without affecting blood sugar and body weight in diabetic mice. DA-9701 could improve the decreased GI motility and clinical symptoms in progressive diabetic patients.

Plasma GLP-1 Response to Oral and Intraduodenal Nutrients in Health and Type 2 Diabetes-Impact on Gastric Emptying.

Both gastric emptying and the secretion of glucagon-like peptide-1 (GLP-1) are major determinants of postprandial glycemia in health and type 2 diabetes (T2D). GLP-1 secretion after a meal is dependent on the entry of nutrients into the small intestine, which, in turn, slows gastric emptying. To define the relationship between gastric emptying and the GLP-1 response to both oral and small intestinal nutrients in subjects with and without T2D. We evaluated: (i) the relationship between gastric emptying (breath test) and postprandial GLP-1 levels after a mashed potato meal in 73 individuals with T2D; (ii) inter-individual variations in GLP-1 response to (a) intraduodenal glucose (4 kcal/min) during euglycemia and hyperglycemia in 11 healthy and 12 T2D, subjects, (b) intraduodenal fat (2 kcal/min) in 15 T2D subjects, and (c) intraduodenal protein (3 kcal/min) in 10 healthy subjects; and (iii) the relationship between gastric emptying (breath test) of 75 g oral glucose and the GLP-1 response to intraduodenal glucose (4 kcal/min) in 21 subjects (9 healthy, 12 T2D). The GLP-1 response to the mashed potato meal was unrelated to the gastric half-emptying time (T50). The GLP-1 responses to intraduodenal glucose, fat, and protein varied substantially between individuals, but intra-individual variation to glucose was modest. The T50 of oral glucose was related directly to the GLP-1 response to intraduodenal glucose (r = 0.65, P = 0.002). In a given individual, gastric emptying is not a determinant of the postprandial GLP-1 response. However, the intrinsic gastric emptying rate is determined in part by the responsiveness of GLP-1 to intestinal nutrients.

Structural changes in oat milk and an oat milk‒bovine skim milk blend during dynamic in vitro gastric digestion

In recent years, plant-based milk alternatives have become increasingly desirable because of their sustainability and proposed health benefits. There is a need to understand the behavior of plant-based milks during gastric digestion, including protein digestibility, structural changes, and macronutrient accessibility. The aim of this study was to investigate the gastric digestive behaviors of oat milk and an oat milk‒bovine skim milk blend (1:1, v/v), using an in vitro dynamic human gastric simulator. During gastric digestion with pepsin, the oat milk did not show significant changes in structure and physical stability. In contrast, the oat milk‒bovine skim milk blend formed coagulated, curd-like particles, which were induced by the action of pepsin on the milk proteins. The oat oil bodies were incorporated into the curd particles. This difference in gastric digestive behavior significantly altered the rate of gastric emptying. Coagulation of the oat milk‒bovine skim milk blend slowed the gastric emptying of macronutrients, leading to a delay in the release of protein and lipids into the small intestine compared with the oat milk. This study provides insight into the way the food structure modification during gastric digestion impacts nutrient delivery.

Efficacy and Safety of Mecobalamin Combined with Prokinetic Agents in the Treatment of Diabetic Gastroparesis: A Meta-Analysis.

Background:The aim of the present study was to systematically review the efficacy and safety of mecobalamin combined with prokinetic agents in diabetic gastroparesis (DGP).Methods:A variety of databases were searched from inception to Nov 2, 2018. RCTs of mecobalamin combined with prokinetic agents group (experimental group) versus prokinetic agents only group (control group) in DGP were included. RevMan 5.3 and Stata 12.0 were used to perform the meta-analysis. Finally, 24 RCTs with 1,878 patients were included.Results:The total efficacy rate was significantly higher in the experimental group (mecobalamin combined with prokinetic drugs) compared with the control group (prokinetic drugs alone) (P<0.001), and the improvement was observed regardless of the administration route. Furthermore, the treatment group exhibited a significantly improved gastric emption rate (P<0.001), motilin (P<0.001) and recurrence rate (P<0.001), and there was no statistical difference in the incidence of adverse reactions between two groups (P=0.49).Conclusion:Mecobalamin combined with prokinetic agents can significantly improve total efficacy rate and gastric emptying rate, decrease serum motilin and the recurrence rate without increasing adverse reactions in DGP. Thus, mecobalamin may can be used as a new therapeutic option for DGP.

Effect of electroacupuncture combined with Zhuang-medicine-thread moxibustion on silent information regulator-1/nuclear factor κB signaling pathway in gastric antrum of diabetic gastroparesis rats

To observe the effect of electroacupuncture (EA) combined with Zhuang-medicine-thread moxibustion on silent information regulator-1 (SIRT1)/nuclear factor kappa B (NF-κB) signal pathway and inflammatory factor expression in gastric antrum tissue of diabetic gastroparesis (DGP) rats, so as to explore its mechanism underlying improvement of DGP. Male SD rats were randomly divided into normal, model, medication, EA, Zhuang-medicine-thread moxibustion (moxibustion) and EA+moxibustion groups (n=12 per group). The DGP model was established by intraperitoneal injection of streptozotocin (STZ). Rats of the medication group were treated by gavage of 0.15 mg/mL mosapride citrate suspension. EA (10 Hz /50 Hz, 2 mA) or moxibustion (3 cones) or EA+moxibustion was applied to "Zhongwan"(CV12), bilateral "Neiguan"(PC6) and bilateral "Sanyinjiao"(SP6) of the related group for 20 min, once a day for 3 weeks. Blood glucose, gastric emptying rate and intestinal propulsion rate were measured. The levels of serum interleukin (IL)-6, IL-8, IL-10 and tumor necrosis factor-α(TNF-α) were detected by ELISA; the phosphorylation level of the phosphorylated inhibitor of nuclear factor κBα inhibitor (pIκ-Bα), the protein and mRNA expression of NF-κB p65 and SIRT1 in the gastric antrum tissue were detected by Western blot and real-time quantifitative PCR, respectively. (1) Compared with the normal group, the levels of blood glucose, serum IL-6, IL-8, TNF-α, and gastric pIκ-Bα and NF-κB p65 protein and mRNA expressions were significantly increased (P<0.01), and the gastric emptying rate, intestinal propulsion rate, serum IL-10 level, and SIRT1 protein and mRNA expressions were considerably decreased in the model group (P<0.01). (2) In contrast to the model group, the blood glucose in the EA, moxibustion and EA+moxibustion groups, serum IL-6, IL-8 and TNF-α levels in the 4 treatment groups, as well as NF-κB p65 protein expression in the medication and EA+moxibustion groups, and NF-κB p65 mRNA expression and pIκ-Bα protein and mRNA expression in the 4 treatment groups were significantly decreased (P<0.01, P<0.05); while the gastric emptying rate and intestinal propulsive rate and IL-10 content in the 4 treatment groups, and SIRT1 protein and mRNA expression in the medication and EA+moxibustion groups were obviously increased (P<0.05, P<0.01). (3) The effects of EA+moxibustion were significantly superior to those of simple EA and moxibustion in increasing gastric emptying rate, IL-10, SIRT1 protein expression (P<0.05, P<0.01), and in lowering IL-8 and TNF-α contents, pIκ-Bα protein and mRNA expression and NF-κB p65 mRNA expression (P<0.05, P<0.01). No significant differences were found among the 4 intervention groups in promoting the intestinal propulsive rate and among the EA, moxibustion and EA+moxibustion groups in lowering blood glucose (P>0.05). EA combined with Zhuang-medicine-thread moxibustion can effectively reduce the level of serum inflammatory factors and regulate SIRT1/NF-κB signal pathway in DGP rats, which may contribute to its function in improving gastrointestinal movement.

Effect of Total Starch and Resistant Starch in Commercial Extruded Dog Foods on Gastric Emptying in Siberian Huskies.

Simple SummaryGastric emptying is the release of nutrients from the stomach into the small intestine. The rate at which gastric emptying occurs may be associated with diabetes and obesity risk in humans and could help prevent weight gain in dogs. The largest portion of carbohydrates in pet diets is provided by various starches that are digested and absorbed at different rates. This study investigated the effects of common starch ingredients found in commercial dog foods on the gastric emptying rate in dogs. Dogs received each test diet once (4 total) and a glucose control twice in a randomized order, along with acetaminophen. Blood samples were taken once prior to meal consumption and at multiple time points after to determine acetaminophen concentrations. A mathematical model was used to estimate the rate of gastric emptying using postprandial acetaminophen concentrations. Overall, more gastric emptying occurred at a faster rate in dogs when fed the diet containing the highest fraction of starch ingredients resistant to canine digestion. These findings suggest that the inclusion of different starch sources may be associated with altered digestion and absorption of nutrients, which consequently affects gastric emptying rate. The link between carbohydrate sources and gastric emptying may provide a mechanism to prevent weight gain in dogs.Gastric emptying rate (GER) may impact diabetes and obesity in humans and could provide a method to reduce canine weight gain. Starch, the most common source of carbohydrates (CHOs) in pet food, is classified as rapidly or slowly digestible, or resistant to digestion. This study investigated starch source effects in commercial extruded dog foods on the GER of 11 healthy adult Siberian Huskies. Test diets were classified as traditional, grain-free, whole-grain, and vegan. Dogs received each diet once, a glucose control twice, and acetaminophen (Ac) as a marker for GER in a randomized, partially replicated, 6 × 6 Latin square design. Pre- and post-prandial blood samples were collected at 16 timepoints from −15 to 480 min. Serum Ac concentrations were assessed via standard spectrophotometric assays and fitted with a mathematical model to estimate parameters of GER. Parameter values were subjected to ANOVA, with period and treatment as fixed effects and dog as a random effect. More total emptying (p = 0.074) occurred at a faster rate (p = 0.028) in dogs fed the grain-free diet, which contained the lowest total starch (34.03 ± 0.23%) and highest resistant starch (0.52 ± 0.007%). This research may benefit future diet formulations to reduce the prevalence of canine weight gain.

S1406 A Retrospective Cohort Study to Evaluate the Differences Between Cohorts of Patients With Rapid Gastric Emptying

Introduction: Rapid gastric emptying (RGE) is defined as > 30% retention (> 70% emptying) of gastric contents at 1-hour on gastric emptying scintigraphy (GES). However, the clinical significance of mild to moderate increases in gastric emptying (30-69%) at 1-hour is unclear. RGE is commonly associated with dumping syndrome, although other diseases such as diabetes, autonomic neuropathies, and functional gastrointestinal disorders have also been implicated. The aim of this study is to further characterize the extent of rapid gastric emptying based on symptoms, co-morbid conditions, medications, and indications for GES. Methods: We identified a cohort of 258 adult patients (>18 years old) who underwent a 4-hour GES at a tertiary medical center with increased gastric emptying at 1-hour (≥ 30%). Patients with a history of esophageal or thoracic surgery were excluded. Patients were divided into cohorts at 1-hour emptying times (30-39%, 40-49%, 50-59%, 60-69% and > 70%). Demographics, medications, TSH and HgbA1c, and indications for testing were recorded. Additionally, we assessed whether the results of the GES led to a change in management. Results: The vast majority of the patients were in the 30-39% (n=131; 50.8%) or 40-49% (n=74; 28.7%) emptying cohorts. Only 10 (3.9%) patients met the previously define threshold of ≥ 70% emptying. The most common indications for gastric emptying studies were abdominal pain (25.6%), vomiting (33.7%), and nausea (39.1%), and there was no statistically significant difference among these indications across cohorts. Further, there was no difference in age, sex, BMI, comorbidities (including diabetes), medications, or subsequent management changes (medication change, dietary change, surgical intervention) across cohorts. Conclusion: In this retrospective cohort study of patients with increased gastric emptying at 1-hour on GES, only 4% of patients met the defined criteria for RGE (> 70% emptying at 1-hour). Over 2/3 of patients had mild-moderately increased gastric emptying (30-49% emptying). Interestingly, there were no significant differences among all study variables across cohorts of varying degrees of increased gastric emptying. The clinical significance of mild-moderately increased gastric emptying warrants further investigationTable 1-A.: Summary for Baseline and Clinical Characteristics Based on Different Gastric Emptying Rate Groups.Table 1-B.: Summary for Baseline and Clinical Characteristics Based on Different Gastric Emptying Rate Groups..

S1396 Glycosylated Hemoglobin Relation With Gastric Emptying Study in Gastroparesis

Introduction: Gastroparesis is a debilitating disorder which includes several upper abdominal symptoms and documented slow gastric emptying (AJG 2013; 108:18). Past studies have shown heterogenous results of correlations between the glycemic control and the gastric emptying study. We aim to study the association of glycosylated hemoglobin (HbA1c) with gastric emptying. Methods: We performed retrospective review of the patients diagnosed with diabetic gastroparesis between September 30th, 2009 and January 31st, 2020. The 99mTc sulfur labeled food study was used to diagnose gastroparesis. Gastric emptying of < 90% for solids at 240 minutes and < 95% for liquids at 60 minutes were identified as delayed gastric emptying. We examined the relationship of HbA1c levels with the rate of gastric emptying examined by various gastric emptying test. The cohort was further divided into HbA1c levels < 7% (good diabetes control), 7-9% (fair diabetes control) and >9% (poor diabetes control). Results: There were 129 patients (mean age 51.1 ± 14.2 years, 61.8% female, 64.1% white) with diabetic gastroparesis. The mean HbA1c level was 8.3 ± 2.2 %. We observed that the HbA1c levels were not associated with level of gastric emptying with either solid (r=-0.12, p=0.28) or liquid study (r=-0.15, p=0.17). The mean gastric emptying was 74.3 ± 20.9% for solids and 67.9 ± 23.6 % for liquids with good glycemic control, 70.8 ± 20.1 % for solids and 52.3 ± 31.1 % for liquids in patients with fair diabetes control and 64.4 ± 26.7 % for solids and 52.9 ± 31 % for liquids in the patients with poorly controlled diabetes mellitus. The level of glycemic control did not predict the percentage of solid gastric emptying (p=0.29) whereas there was trend towards inverse relation with liquids (p=0.09). Conclusion: There is no correlation between the HbA1c levels and gastric emptying time. The level of diabetes mellitus control does not predict the severity of gastroparesis at the time of diagnosis.Figure 1.: A. Correlation of HbA1c levels with liquid gastric emptying at 60 minutes, B. Correlation of HbA1c levels with solid gastric emptying at 240 minutes, C. Glycemic control category and gastric emptying studies (240 min solid and 60 min liquid).Table 1.: Patients’ characteristic and comparison of diabetic gastroparesis with diabetic non-gastroparesis.

The Influence of Stomach Back-Shu and Front-Mu Points on Insular Functional Connectivity in Functional Dyspepsia Rat Models.

Functional Dyspepsia (FD) is a common functional gastrointestinal disease, which can reduce the quality of life in patients. Prior research has indicated that insula is closely related to FD and that acupuncture can regulate the functional connectivity (FC) of FD. Therefore, we hypothesized that acupuncture on FD was effected through the insular pathway. To test our hypothesis, we performed electroacupuncture (EA) on FD rat models and then examined the FC between insula and other brain regions through resting-state functional magnetic resonance imaging (rs-fMRI). Seven-day-old male infant Sprague-Dawley (SD) rats were randomly divided into control group, FD model group, and FD acupuncture group, with twelve rats per group (n = 36). Upon establishing successful models, the FD acupuncture group was subjected to EA intervention using Stomach back-shu (BL-21) and front-mu (RN-12) points for ten consecutive days for durations of 20 minutes each day. After intervention, each group was subject to rs-fMRI. The digital image data obtained were analyzed using FC analysis methods. Subsequently, gastric ligation was performed to measure gastric emptying rates. Before EA intervention, the FD model group exhibited decreased functional connections between the insula and a number of brain regions. After EA intervention, FD acupuncture group exhibited increasing FC between insula and regions when compared to the FD model group, such as the primary somatosensory cortex (S1), hippocampal CA3 (CA3), polymorphic layer of dentate gyrus (PoDG), caudate putamen (CPu), and oral pontine reticular nuclei (PnO) (P < 0.05); decreasing FC was also exhibited between insula and regions such as the bilateral primary and secondary motor cortexes (M1/2), paraventricular hypothalamic nucleus (PVA), and limbic cortex (LC). These findings indicate that the effective treatment of FD using EA may be through regulating the abnormal FC between insula and several brain regions, in particular CA3, PoDG, and PVA.

Effect of Combination Therapy of Oral Famotidine with Mosapride on Intragastric pH and Gastric Emptying in Rats

Background/Aims: Studies in healthy humans have reported that the addition of mosapride to acid suppressants resulted in higher intragastric pH than acid suppressant administration alone. We investigated the effect of the addition of mosapride to famotidine on the intragastric pH and gastric emptying rate (GER) in rats.Materials and Methods: Sixty male Wistar rats were used in this study. Experimental groups were divided into control, famotidine-only, mosapride-only, and famotidine with mosapride (combination). The first experiment was performed in non-stressed rats. Mosapride was administered by oral gavage 1 hour before the meal, and famotidine was administered just before the meal. The rats were provided with food for 30 minutes. The intragastric pH was measured under isoflurane anesthesia, and the GER was measured after harvesting the stomach. In the stress experiment, rats were exposed to 1-hour restraint stress immediately after mosapride administration and subjected to the same process as in the experiment with the non-stressed rats.Results: The famotidine-only and combination groups showed significantly higher gastric pH levels than the control group in non-stressed (P&lt;0.01 and P&lt;0.001, respectively) and stressed (P&lt;0.001 and P&lt;0.001, respectively) rats. The combination group also showed significantly higher intragastric pH levels than the famotidine-only group in non-stressed (P&lt;0.01) and stressed (P&lt;0.05) rats. Additionally, combination groups showed a significantly higher GER than the famotidine-only group in non-stressed (P&lt;0.001) and stressed (P&lt;0.01) rats.Conclusions: The combination of mosapride with famotidine significantly increased intragastric pH compared to famotidine alone in the non-stressed and stressed rats.

The role of aspiration therapy and intragastric botulinum toxin A injection in obesity treatment

Aspiration therapy (AT) and intragastric injection of botulinum toxin A (gastric botox) are among the current endoscopic techniques used in the treatment of obesity. Both techniques have been preferred by patients and physicians due to their easy applicability, low risk of complications and reversibility. In this systematic review, it was aimed to assess the role of these techniques in obesity treatment. A comprehensive search of several databases including Cochrane Library, Web of Science and PubMed were conducted. Twenty-six clinical studies (10 studies on AT and 16 studies on gastric botox) were included. According to the obtained results, the effects of gastric botox on gastric emptying rate, appetite and weight loss have not been clarified yet. On the other hand, it is clear that AT is effective in weight loss. However, the complications that AT can cause (cardiac arrhythmia, hypokalemia, hypochloremic hypokalemic metabolic alkalosis) are more serious compared to gastric botox. AT can also cause some eating behavior disorders. Considering the physiological risks associated with AT, it may be important to support patients undergoing AT treatment with some supplements such as potassium chloride. Patients treated with AT should be periodically screened for eating disorders, in addition to medical monitoring. • The effect of gastric botox on weight loss has not been clarified yet. • Structure of pylorus is important in the success of gastric botox. • AT can cause cardiac arrhythmia, hypokalemia and hypochloremic metabolic alkalosis. • AT costs more than bariatric surgery in the long term. • Patients undergoing AT treatment may need supplements such as potassium chloride.

Effect of Right Position During and After Feeding on Gastric Residual Volume and Regurgitation Episodes Among Preterm Infants

Body position affects the gastric emptying rate and feeding regimen manipulation have been shown to affect the episodes of regurgitation. Aim: to investigate the effect of right position during and after on gastric residual volume and regurgitation episodes among preterm infants. Method: a quasi-experimental design was utilized. A convenient sample of 90 preterm infants on gavage feeding was randomly allocated into three groups (30 supine position, 30 right 1 position after feeding time and 30 right 2 position during and after feeding time). The study was conducted at Neonatal Intensive Care Unit (NICU) of El Manial and Pediatric University Hospital, Cairo University Hospitals. The following tool utilized to collect the required data: preterm infant's characteristics sheet and record for gastric residual volume, regurgitation episodes and feeding. Results: More than half of the preterm infants in supine and half of them in right1 and right 2 groups were males. There is no statistically significant difference in the mean gestational age of preterm infants in supine, right 1 and right 2 groups. The mean gastric residual for preterm infants in right 2 position is the least volume than in right 1 and supine positions. Conclusion: A highly statistically significant difference was found in the mean of gastric residual volume in supine, right 1 and right 2 positions at different feeding time. No significant difference was detected in occurrence of regurgitation between the three positions while the least occurrence of regurgitation in right 2 position when compared to other positions. Recommendation: The current study recommended that preterm infants could be placed in right side during and after gavage feeding.

PARAMETER ESTIMATION OF A SIMPLE, REALISTIC STOCHASTIC MODEL OF GASTRIC EMPTYING OF PELLETS UNDER FASTING CONDITIONS

This study is aimed to develop a parameter estimation procedure for a stochastic model of gastric emptying of pellets under fasting conditions of healthy subjects that represent the irregular decrements of gastric contents after administration of pellets. An algorithm for the identification of experimental subjects into subgroups based on their gastric emptying rates has been proposed. The parameter estimation procedure was performed with observational data of gastric emptying profiles of 19 subjects from the existing literature. The identification algorithm was validated through comparison against the original results, showing that seven subjects indicated slow gastric emptying and 12 subjects indicated fast emptying. After excluding one subject with gastric stasis, the optimal results obtained from this study classified subjects into three subgroups: two subjects with slow, five subjects with intermediate and 11 subjects with fast gastric emptying. The proposed parameter estimation procedure of the stochastic model is relatively easy to implement and can be used to analyze real patients’ data. The algorithm for identification of the gastric emptying dynamics in experimental subjects could provide useful information for further investigations of long-term energy balance forecasting.

Potential for Gut Peptide-Based Therapy in Postprandial Hypotension.

Postprandial hypotension (PPH) is an important and under-recognised disorder resulting from inadequate compensatory cardiovascular responses to meal-induced splanchnic blood pooling. Current approaches to management are suboptimal. Recent studies have established that the cardiovascular response to a meal is modulated profoundly by gastrointestinal factors, including the type and caloric content of ingested meals, rate of gastric emptying, and small intestinal transit and absorption of nutrients. The small intestine represents the major site of nutrient-gut interactions and associated neurohormonal responses, including secretion of glucagon-like peptide-1, glucose-dependent insulinotropic peptide and somatostatin, which exert pleotropic actions relevant to the postprandial haemodynamic profile. This review summarises knowledge relating to the role of these gut peptides in the cardiovascular response to a meal and their potential application to the management of PPH.

Effects of transcutaneous auricular vagus nerve stimulation on intestinal ligandins in a rat model of functional dyspepsia

ObjectiveTranscutaneous auricular vagus nerve stimulation (taVNS) can relieve the symptoms of functional dyspepsia (FD) and improve the quality of life of patients, however, the mechanism underlying this effect remains unclear. Therefore, this study aimed to investigate the effects of taVNS on the expression of intestinal mucosal ligandins. MethodsThis study was conducted on 24 specific Spathogen-free Sprague–Dawley rats (12 males and 12 females). The rat model of FD was established by tail-clip stimulation. After FD was established successfully, all rats were randomized to either the normal group (n = 6), model group (n = 6), taVNS group (n = 6), or sham-taVNS group (n = 6). After two weeks of the respective intervention, the score of their general conditions, 3 h food intake, gastric emptying rate, and the histology of gastric antrum tissues were observed to evaluate modeling success, and then the effect of taVNS was evaluated. Western blotting was used to assess the expression of the tight junction ligandins —ZO-1 and occludin—and the adhesion ligandin—β-catenin—in the duodenum. The effect of taVNs on the expression of intestinal mucosal barrier ligandins—ZO-1, occludin, and β-catenin—in FD rats was preliminarily investigated. ResultsWhen the model-induced period was finished, the manifestations of FD in the model group rats were mental exhaustion, reduced activities, decreased score of the general conditions, and decreased 3 h food intake, compared to the normal group rats. In addition, minimal eosinophil infiltration, without any mucosal erosion or ulcer, was observed in the gastric antrum mucosa. At the end of the study, the mental state of the FD rats improved, and their activities and gastric emptying rate increased in the taVNS group rats. Compared to the normal rats, the duodenal mucosa had less expression of the tight junction ligandins ZO-1 and occludin, but β-catenin expression remained unchangedin the model rats. The expression of the tight junction ligandins ZO-1 and occludin were increased in the duodenal mucosa of model rats after the taVNS intervention. ConclusionTaVNS can improve the gastric motility and mental state of rats with FD. It may play a therapeutic role by improving the expression of the tight junction ligandin ZO-1 and occludin in the duodenal mucosa, while also repairing the duodenal mucosal barrier.

United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on gastroparesis.

Gastroparesis is a condition characterized by epigastric symptoms and delayed gastric emptying (GE) rate in the absence of any mechanical obstruction. The condition is challenging in clinical practice by the lack of guidance concerning diagnosis and management of gastroparesis. A Delphi consensus was undertaken by 40 experts from 19 European countries who conducted a literature summary and voting process on 89 statements. Quality of evidence was evaluated using grading of recommendations assessment, development, and evaluation criteria. Consensus (defined as ≥80% agreement) was reached for 25 statements. The European consensus defined gastroparesis as the presence of symptoms associated with delayed GE in the absence of mechanical obstruction. Nausea and vomiting were identified as cardinal symptoms, with often coexisting postprandial distress syndrome symptoms of dyspepsia. The true epidemiology of gastroparesis is not known in detail, but diabetes, gastric surgery, certain neurological and connective tissue diseases, and the use of certain drugs recognized as risk factors. While the panel agreed that severely impaired gastric motor function is present in these patients, there was no consensus on underlying pathophysiology. The panel agreed that an upper endoscopy and a GE test are required for diagnosis. Only dietary therapy, dopamine-2 antagonists and 5-HT4 receptor agonists were considered appropriate therapies, in addition to nutritional support in case of severe weight loss. No consensus was reached on the use of proton pump inhibitors, other classes of antiemetics or prokinetics, neuromodulators, complimentary, psychological, or more invasive therapies. Finally, there was consensus that gastroparesis adversely impacts on quality of life and healthcare costs and that the long-term prognosis of gastroparesis depends on the cause. A multinational group of European experts summarized the current state of consensus on definition, symptom characteristics, pathophysiology, diagnosis, and management of gastroparesis.

Rapid Liquid Phase Gastric Emptying May Be The Harbinger Of Sustained Weight Loss After Laparoscopic Sleeve Gastrectomy

Study Contextual: 15-20 % Of laparoscopic sleeve gastrectomy patients need revisional surgery after LSG, because of inadequate weight loss. Aim: The aim of our study is, primarily to analyze the relationship between liquid-phase gastric emptying rate and weight loss, to find a parameter that may be the harbinger of successful weight loss after LSG. Methods: Patient records who have undergone laparoscopic sleeve gastrectomy were examined retrospectively. 44 Patients were included in the study. Preoperative weight and BMI, postoperative weight loss at first, third, and sixth months, surgical operation reports, preoperative and postoperative liquid-phase gastric emptying study values were mainly collected. Results: The male/ female ratio was 18/82. Mean age 38 (19-60), mean body mass index 48,1(40-66) kg/m² and mean (EWL%) 63,17±13,94 were found. Mean pre and post-operative gastric emptying half times were found to be (T½) 41,86 minute(min), T½ 6,82 min (p&lt;0.0001). Significant correlation was found between patients’ post-operative third and sixth month EWL% and post-operative T½ (p=0,020, p=0,032). Patients who have post-op gastric T½ above 10 min had decreased sixth-month EWL% significantly (p=0.03). Conclusion: Post-operative gastric emptying time (T½) may be a harbinger of weight loss after LSG.

Rapid, non-invasive measurement of gastric emptying rate using transcutaneous fluorescence spectroscopy.

Gastric emptying rate (GER) signifies the rate at which the stomach empties following ingestion of a meal and is relevant to a wide range of clinical conditions. GER also represents a rate limiting step in small intestinal absorption and so is widely assessed for research purposes. Despite the clinical and physiological importance of gastric emptying, methods used to measure GER possess a series of limitations (including being invasive, slow or unsuitable for certain patient populations). Here, we present a new technique based on transcutaneous (through-the-skin) fluorescence spectroscopy that is fast, non-invasive, and does not require the collection of samples or laboratory-based analysis. Thus, this approach has the potential to allow immediate reporting of clinical results. Using this new method, participants receive an oral dose of a fluorescent contrast agent and a wearable probe detects the uptake of the agent from the gut into the blood stream. Analysis of the resulting data then permits the calculation of GER. We compared our spectroscopic technique to the paracetamol absorption test (a clinically approved GER test) in a clinical study of 20 participants. Results demonstrated good agreement between the two approaches and, hence, the clear potential of transcutaneous fluorescence spectroscopy for clinical assessment of GER.

Effects of glucagon-like peptide-1 receptor agonists on secretions of insulin and glucagon and gastric emptying in Japanese individuals with type 2 diabetes: A prospective, observational study.

Aims/IntroductionDifferences in the glucose‐lowering mechanisms of glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) have been noted. Clarifying these differences could facilitate the choice of optimal drugs for individuals with type 2 diabetes and requires investigation in a clinical setting.Materials and MethodsA single‐arm, prospective, observational study was conducted to evaluate the effects of various GLP‐1RAs on postprandial glucose excursion, secretions of insulin and glucagon as well as on the gastric emptying rate. Participants were subjected to meal tolerance tests before and 2 weeks and 12 weeks after GLP‐1RA initiation. Effects on postprandial secretions of glucose‐dependent insulinotropic polypeptide (GIP) and apolipoprotein B48 were also investigated.ResultsEighteen subjects with type 2 diabetes received one of three GLP‐1RAs, i.e., lixisenatide, n = 7; liraglutide, n = 6; or dulaglutide, n = 5. While 12‐week administration of all of the GLP‐1RAs significantly reduced HbA1c, only lixisenatide and liraglutide, but not dulaglutide, significantly reduced body weight. Postprandial glucose elevation was improved by all of the GLP‐1RAs. Postprandial insulin levels were suppressed by lixisenatide, while insulin levels were enhanced by liraglutide. Postprandial glucagon levels were suppressed by lixisenatide. The gastric emptying rate was significantly delayed by lixisenatide, while liraglutide and dulaglutide had limited effects on gastric emptying. GIP secretion was suppressed by lixisenatide and liraglutide. Apolipoprotein B48 secretion was suppressed by all of the GLP‐1RAs.ConclusionsAll of the GLP‐1RAs were found to improve HbA1c in a 12‐week prospective observational study in Japanese individuals with type 2 diabetes. However, differences in the mechanisms of the glucose‐lowering effects and body weight reduction were observed.