Gastric Half-emptying Time Research Articles

Comparing gastric emptying of cellulose nanocrystals with sodium alginate and pectin using a dynamic in vitro stomach model

Cellulose nanocrystals (CNC) are increasingly recognized for their potential in various applications, including packaging, cosmetics, and biomedical engineering. Due to their gelation properties influenced by pH and ionic strength, CNC could impact gastric emptying and satiety, beneficial for managing obesity and diabetes. This study investigated the gastric emptying of CNC (4 % and 8 %, w/w) in comparison with sodium alginate (2 %, w/w) and pectin (2 %, w/w), exploring the effect of divalent cations (Ca2+ and Mg2+) using a dynamic gastric digestion model. CNC, in the presence of Ca2+ and Mg2+, formed a high-viscosity gel network under gastric conditions, leading to delayed gastric emptying. While alginate formed strong gels with Ca2+, it did not significantly delay gastric emptying due to the poor water-holding capacity of its gel network. Pectin showed minimal impact on gastric emptying. Among the treatments, the half-time (t1/2) of gastric emptying for 8 % CNC with Ca2+ was observed to be the longest at 215.4 ± 23.7 min, compared to the shortest times observed with pectin at 15.1 ± 1.4 min. The results suggest that different mechanisms are involved in the gastric emptying effect of different dietary fibers, and CNC is more effective than alginate and pectin assisting in promoting gastric retention and aiding in the management of body weight. This study also introduced a novel application of the dynamic gastric digestion model for estimating digestion energy expenditure, providing insights into the impact of dietary fiber on gastric emptying and satiety enhancement.

Bariatric arterial embolization slows gastric emptying and improves postprandial glycaemia in obese dogs with impaired glucose tolerance.

To evaluate the effects of bariatric arterial embolization (BAE) on gastric emptying of, and the glycaemic response to, an oral glucose load in an obese canine model with impaired glucose tolerance. Eleven male dogs were fed a high-fat, high-fructose diet for 7 weeks before receiving BAE, which involved selective embolization of the left gastric artery (n = 5; 14.9 ± 0.8 kg), or the sham (n = 6; 12.6 ± 0.8 kg) procedure. Postprocedural body weight was measured weekly for 4 weeks. Prior to and at 4 weeks postprocedure, a glucose solution containing 13C-acetate was administered orally for evaluation of the gastric half-emptying time (T50) and the glycaemic response. The relationship between the changes in the blood glucose area under the curve over the first 60 minutes (AUC0-60min) and the T50 was also assessed. At 4 weeks postprocedure, BAE reduced body weight (BAE vs. the sham procedure: -5.7% ± 0.9% vs. 3.5% ± 0.9%, P < .001), slowed gastric emptying (T50 at baseline vs. postprocedure: 75.5 ± 2.0 vs. 82.5 ± 1.8 minutes, P = .021 in the BAE group; 73.8 ± 1.8 vs. 74.3 ± 1.9 minutes in the sham group) and lowered the glycaemic response to oral glucose (AUC0-60min at baseline vs. postprocedure: 99.2 ± 13.7 vs. 67.6 ± 9.8 mmol·min/L, P = .043 in the BAE group; 100.2 ± 13.4 vs. 103.9 ± 14.6 mmol·min/L in the sham group). The change in the glucose AUC0-60min correlated inversely with that of the T50 (r = -0.711; P = .014). In a canine model with impaired glucose tolerance, BAE, while reducing body weight, slowed gastric emptying and attenuated the glycaemic response to an oral glucose load.

Food passage following proximal gastrectomy with double-tract reconstruction and its effect on nutritional status in early gastric cancer: a prospective single-center cohort study.

Laparoscopic proximal gastrectomy with double-tract reconstruction (LPG-DTR) expectedly results in improved nutritional status and less body weight loss than conventional total gastrectomy in upper-third gastric cancer. This study aimed to investigate the food passage patterns following LPG-DTR and its effect on nutritional outcomes up to 1 year after surgery. This prospective cohort study recruited 10 patients with early gastric cancer scheduled for LPG-DTR. Nutritional indices and body composition were assessed every 3 months up to 12 months. Liquid and solid food transits were evaluated with fluoroscopic upper gastrointestinal study and radionuclide scintigraphy, respectively. At 12 months, patients exhibited a body weight loss of 14.5% ± 3.6%. The main passage routes for liquid and solid foods differed, primarily via the interposed jejunum for liquids, whereas via both tracts for solids. The median half-life of solid food emptying from the remnant distal stomach was 105.1 minutes (range, 50.8-2,194.2 minutes), and duodenal passage of solid food was noted in 9 of 10 patients. Those with gastric half-emptying time >3 hours demonstrated greater weight loss (19.5% ± 1.4% vs. 12.5% ± 1.1%, P = 0.024) and more pronounced reduction in serum albumin levels (-0.5 ± 0.3 g/dL vs. 0.0 ± 0.2 g/dL, P = 0.024) after 12 months. LPG-DTR demonstrated varying food passage patterns depending on the food contents and delayed solid food emptying from the remnant stomach was associated with more substantial weight loss.

Gastric emptying in newly diagnosed, treatment-naïve Han Chinese with type 2 diabetes and the impact of 4-week insulin pump therapy.

To evaluate gastric emptying (GE) and the glycaemic response to a 75-g oral glucose load in newly diagnosed, treatment-naïve Han Chinese with type 2 diabetes (T2D) before insulin pump therapy, after 4 weeks of insulin pump therapy, and 12-15 months after insulin pump therapy. Twenty participants with T2D (baseline glycated haemoglobin [± SD] 10.7% [± 1.2%] 93 [± 10] mmol/mol) ingested a 75-g glucose drink containing 150 mg 13C-acetate, to determine the gastric half-emptying time, and underwent assessment of plasma glucose and serum insulin, C-peptide and glucagon-like peptide-1 (GLP-1) over 180 min before and after 4 weeks of insulin pump therapy (discontinued for 48 h before re-assessment). Data were compared to those in 19 healthy participants matched for sex and age. After 12-15 months, GE was re-measured in 14 of the T2D participants. At baseline, participants with T2D exhibited substantially augmented fasting and post-glucose glycaemia, diminished insulin secretion, and more rapid GE (p < 0.05 each), but comparable GLP-1, compared to healthy participants. Following insulin pump therapy, insulin secretion increased, GLP-1 secretion was attenuated, fasting and post-glucose glycaemia were lower, and GE was slowed (p < 0.05 each). The slowing of GE in T2D participants was sustained over 12-15 months of follow-up. In newly diagnosed Han Chinese with T2D, GE is often accelerated despite poor glycaemic control and is slowed by short-term insulin pump therapy. The effect on GE is maintained for at least 12 months.

Gastric emptying of a glucose drink is predictive of the glycaemic response to oral glucose and mixed meals, but unrelated to antecedent glycaemic control, in type 2 diabetes.

Gastric emptying (GE), with wide inter-individual but lesser intra-individual variations, is a major determinant of postprandial glycaemia in health and type 2 diabetes (T2D). However, it is uncertain whether GE of a carbohydrate-containing liquid meal is predictive of the glycaemic response to physiological meals, and whether antecedent hyperglycaemia influences GE in T2D. We evaluated the relationships of (i) the glycaemic response to both a glucose drink and mixed meals with GE of a 75 g glucose drink, and (ii) GE of a glucose drink with antecedent glycaemic control, in T2D. Fifty-five treatment-naive Chinese adults with newly diagnosed T2D consumed standardised meals at breakfast, lunch and dinner with continuous interstitial glucose monitoring. On the subsequent day, a 75 g glucose drink containing 150 mg 13C-acetate was ingested to assess GE (breath test) and plasma glucose response. Serum fructosamine and HbA1c were also measured. Plasma glucose incremental area under the curve (iAUC) within 2 hours after oral glucose was related inversely to the gastric half-emptying time (T50) (r = -0.34, P = 0.012). The iAUCs for interstitial glucose within 2 hours after breakfast (r = -0.34, P = 0.012) and dinner (r = -0.28, P = 0.040) were also related inversely to the T50 of oral glucose. The latter, however, was unrelated to antecedent fasting plasma glucose, 24-hour mean interstitial glucose, serum fructosamine, or HbA1c. In newly diagnosed, treatment-naive, Chinese with T2D, GE of a 75 g glucose drink predicts the glycaemic response to both a glucose drink and mixed meals, but is not influenced by spontaneous short-, medium- or longer-term elevation in glycaemia.

Effects of corticotropin-releasing hormone on gastric electrical activity and sensorimotor function in healthy volunteers: a double-blinded crossover study.

Biopsychosocial factors are associated with disorders of gut-brain interaction (DGBI) and exacerbate gastrointestinal symptoms. The mechanisms underlying pathophysiological alterations of stress remain unclear. Corticotropin-releasing hormone (CRH) is a central regulator of the hormonal stress response and has diverse impact on different organ systems. The aim of the present study was to investigate the effects of peripheral CRH infusion on meal-related gastrointestinal symptoms, gastric electrical activity, and gastric sensorimotor function in healthy volunteers (HVs). In a randomized, double-blinded, placebo-controlled, crossover study, we evaluated the effects of CRH on gastric motility and sensitivity. HVs were randomized to receive either peripheral-administered CRH (100 µg bolus + 1 µg/kg/h) or placebo (saline), followed by at least a 7-day washout period and assignment to the opposite treatment. Tests encompassed saliva samples, gastric-emptying (GE) testing, body surface gastric mapping (BSGM, Gastric Alimetry; Alimetry) to assess gastric myoelectrical activity with real-time symptom profiling, and a gastric barostat study to assess gastric sensitivity to distention and accommodation. Twenty HVs [13 women, mean age 29.2 ± 5.3 yr, body mass index (BMI) 23.3 ± 3.8 kg/m2] completed GE tests, of which 18 also underwent BSGM measurements during the GE tests. The GE half-time decreased significantly after CRH exposure (65.2 ± 17.4 vs. 78.8 ± 24.5 min, P = 0.02) with significantly increased gastric amplitude [49.7 (34.7-55.6) vs. 31.7 (25.7-51.0) µV, P < 0.01], saliva cortisol levels, and postprandial symptom severity. Eleven HVs also underwent gastric barostat studies on a separate day. However, the thresholds for discomfort during isobaric distensions, gastric compliance, and accommodation did not differ between CRH and placebo.NEW & NOTEWORTHY In healthy volunteers, peripheral corticotropin-releasing hormone (CRH) infusion accelerates gastric-emptying rate and increases postprandial gastric response, accompanied by a rise in symptoms, but does not alter gastric sensitivity or meal-induced accommodation. These findings underscore a significant link between stress and dyspeptic symptoms, with CRH playing a pivotal role in mediating these effects.

Comparison of gastric emptying before and after treatment for subclinical hypothyroidism

Aim: The aim of this study was to evaluate the effect of levothyroxine treatment on dyspeptic symptoms and gastric emptying time in patients with subclinical hypothyroidism. Materials and Methods: Liquid gastric emptying scintigraphy was performed to detect the presence of gastroparesis in patients with dyspeptic complaints who were followed up with a diagnosis of subclinical hypothyroidism in the thyroid outpatient clinic. Those with specific hypothyroidism symptoms during their follow-up were treated with low dose (25 mg) levothyroxine for at least 6 months. Liquid gastric emptying scintigraphy test was performed again after treatment for those who continued to have dyspeptic complaints. Patients whose gastric emptying time was calculated using a liquid gastric emptying scintigraphy test before and after levothyroxine treatment were retrospectively examined. For testing, 18.5-37 MBq (0.5-1 mCi) 99m-TC nanocolloid was added to 300 ml of water. Late images were acquired at 30 minutes and one hour. The time activity curve was obtained. Results: Gastric emptying was normal in 13 (23.6%) patients in the liquid gastric emptying scintigraphy test performed before treatment. After treatment, gastric emptying half-time was normalized in 34 (81%) of 42 (76.4%) patients with a long gastric emptying half-time before treatment. In total, 47 patients had normal gastric emptying half-time values after treatment, and gastric emptying half-time was calculated to be long in 8 patients (14.5%). Conclusion: In our study, gastric emptying time was prolonged in 76.4% of patients with subclinical hypothyroidism, and in 81% of these patients, gastric emptying time was calculated within normal limits after LT4 treatment. Detection of prolongation of gastric emptying time due to the presence of gastroparesis in subclinical hypothyroidism cases followed up without treatment may be a guide in the prescription of treatment.

Rapid Gastric emptying in spontaneously hypertensive rats.

To assess the rate of gastric emptying in spontaneously hypertensive rats (SHR) and to evaluate rapid gastric emptying as a possible predisposing factor for hypertension. Rapid gastric emptying of carbohydrates, known to elevate postprandial serum glucose, has been reported to occur in many insulin-resistant states, including hypertension. SHR exhibit insulin resistance similar to human hypertensive patients. No prior studies have assessed gastric emptying of an oral glucose solution in SHR as compared with control Wistar Kyoto rats (WKY). Using scintigraphic imaging, gastric emptying of a physiologic, orally consumed glucose solution was assessed in 12 SHR and 12 control WKY at 5 weeks of age, prior to the development of hypertension, and at 12 weeks of age after hypertension was fully established. At 5 weeks, the gastric half-emptying time (GHET) was 67.8 ± 9.8 min for the SHR vs. 109.3 ± 18 ( P = 0.042) minutes for the WKY controls. At 12 weeks, the GHET was 37.29 ± 10.3 min for the SHR vs. 138.53 ± 37.6 ( P = 0.016) min for the WKY controls. Gastric emptying was significantly more rapid in the SHR before and after the development of hypertension. Even though SHR are known to have increased sympathetic activity associated with their development of hypertension, this increased sympathetic activity does not inhibit gastric emptying. SHR are a promising animal model for investigating therapeutic agents for treating hypertension aimed at slowing the rate of gastric emptying.

Milk coagulation and gastric emptying in women experiencing gastrointestinal symptoms after ingestion of cow's milk.

Gastrointestinal symptoms after drinking milk are often attributed to lactose intolerance or cow's milk allergy. However, some individuals without either condition still report gastrointestinal symptoms after drinking milk. This may be caused by gastric emptying (GE) rate or gastric protein coagulation. This study aimed to compare GE rate and protein coagulation after milk consumption between individuals reporting gastrointestinal symptoms and those without symptoms using a novel gastric MRI approach. Thirty women were included in this case-control study, of whom 15 reported gastrointestinal symptoms after drinking milk and 15 were controls. Participants underwent gastric MRI before and up to 90 min after consumption of 250 mL cow's milk. Gastric content volume and image texture of the stomach contents were used to determine GE and changes in the degree of coagulation. GE half-time did not differ between the groups (gastrointestinal symptom group 66 ± 18 min; control group 61 ± 14 min, p = 0.845). The gastrointestinal symptom group reported symptoms from 30 min onwards and rated pain highest at 90 min. The control group reported no symptoms. Image texture analyses showed a significantly higher percentage of coagulum and lower percentage of liquid in the group in the GI symptom group (MD 11%, 95% CI [3.9, 17], p = 0.003). Invitro data suggests that pH and proteolytic enzyme activity influence the coagulum structure. Gastric milk coagulation and emptied fraction of stomach content may differ between individuals experiencing symptoms after milk consumption, possibly due to differences in pH and proteolytic enzyme activity.

Ultrasonography findings in diabetes and diabetes gastroparesis: A meta-analysis

Background: The gold standard for diagnosis of diabetes gastroparesis (DG) is with gastric emptying scintigraphy (GES) examination. However, GES is not available in every healthcare center worldwide and the examination cost is rather expensive, unlike ultrasonography (USG) examination. This study aims to evaluate gastric changes monitored with USG in diabetes mellitus (DM) and DG. Methods: We performed searches from Google Scholar, PubMed, Science Direct, Proquest, and Scopus in April 30 – May 6, 2022. Random-effect approach on outcomes, standardized mean-difference (SMD) and 95%-confidence interval (CI) was assessed. Results: Compared to healthy control; (1) Antral cross-sectional area (CSA) in DM is bigger in fasting (SMD=1.25cm2; 95%CI, 0.79 to 1.71, I2=81%, P&lt;0.05) and postprandial (SMD=3.70 cm2; 95%CI, 1.45 to 5.34, I2=85%, P&lt;0.05). (2) Gastric emptying time (GET) is longer with DG (SMD=75.44min; 95%CI, 31.61 to 119.27, I2=97%) and in DM (SMD=35.54min; 95% CI, 11.49 to 59.60, I2=94%). (3) Gastric half-emptying time (GE50) were found to be longer in DM (SMD=20.73 min; 95%CI, 14.69 to 26.77, I2=60%, P&lt;0.05) and DG (SMD=7.46min; 95%CI, 5.06 to 9.86, I2=68.2%, P&lt;0.05). (4) Smaller gastric emptying rate (GER) in DG (SMD=-31.95%; 95%CI, -42.22% to -21.69%, I2=84%, P&lt;0.05) and DM (SMD=-16.14%; 95%CI, -30.88% to -1.39%, I2=78%, P&lt;0.05). (5) Less antral contraction in DG (SMD=-1.47; 95%CI, -2.61 to -0.33, I2=82%, P&lt;0.05). Conclusions: Patients with DM and DG have wider antral CSA, longer GET and GE50, reduced GER and reducing antral contraction. USG is useful for assessing gastric emptying in DM and DG. PROSPERO registration: CRD42022328695 (10/05/2022)

Bariatric endoscopic antral myotomy: first-in-human proof of concept of a novel therapeutic method to delay gastric emptying and induce weight loss

Bariatric endoscopic antral myotomy: first-in-human proof of concept of a novel therapeutic method to delay gastric emptying and induce weight loss

The contribution of cell wall integrity to gastric emptying and in vitro starch digestibility and fermentation performance of highland barley foods

Studies have shown that the structure, composition, and bioavailability of compounds in whole grains are affected by processing and the role of cells walls. In this study, the effects of different processing methods on highland barley, one of the mostly widely produced whole grains worldwide, were investigated. The processing methods applied were flaking-boiling (HB flake), sand-roasting (Puffed HB), and sand-roasting-milling (Tsamba). Results showed Puffed HB and Tsamba had higher levels of damaged starch content, starch short-range molecular order, and relative crystallinity than HB flake. The half-time of gastric emptying (t1/2) was the slowest for Tsamba (132.3 min) compared to HB flake (122.5 min) and Puffed HB (84.0 min), indicating the slowest gastric emptying rate, which could be attributed to its high viscosity of gastric digesta. After in vitro gastroduodenal digestion, Puffed HB exhibited the lowest starch digestibility and the least amount of β-glucan due to its less damaged cellular structure. Furthermore, Puffed HB resulted in a 21% and 18% higher in vitro production of total short-chain fatty acids than Tsamba and HB flake, respectively. Besides, undigested starch of Puffed HB after in vitro gastroduodenal digestion delayed in vitro fecal fermentation of β-glucan. Our study provided insight into the potential mechanisms of how cell wall integrity affected the gastric emptying, in vitro starch digestibility, and in vitro fecal fermentation of highland barley foods.

Deuterium body array for the simultaneous measurement of hepatic and renal glucose metabolism and gastric emptying with dynamic 3D deuterium metabolic imaging at 7 T.

Deuterium metabolic imaging (DMI) is a novel noninvasive method to assess tissue metabolism and organ (patho)physiology in vivo using deuterated substrates, such as [6,6'-2 H2 ]-glucose. The liver and kidneys play a central role in whole-body glucose homeostasis, and in type 2 diabetes, both hepatic and renal glucose metabolism are dysregulated. Diabetes is also associated with gastric emptying abnormalities. In this study, we developed a four-channel 2 H transmit/receive body array coil for DMI in the human abdomen at 7T and assessed its performance. In addition, the feasibility of simultaneously measuring gastric emptying, and hepatic and renal glucose uptake and metabolism with dynamic 3D DMI upon administration of deuterated glucose, was investigated. Simulated and measured B1 + patterns were in good agreement. The intrasession variability of the natural abundance deuterated water signal in the liver and right kidney, measured in nine healthy volunteers, was 5.6% ± 0.9% and 4.9% ± 0.7%, respectively. Dynamic 3D DMI scans with oral administration of [6,6'-2 H2 ]-glucose showed similar kinetics of deuterated glucose appearance and disappearance in the liver and kidney. The measured gastric emptying half time was 80 ± 10min, which is in good agreement with scintigraphy measurements. In conclusion, DMI with oral administration of [6,6'-2 H2 ]-glucose enables simultaneous assessment of gastric emptying and liver and kidney glucose uptake and metabolism. When applied in patients with diabetes, this approach may advance our understanding of the interplay between disturbances in liver and kidney glucose uptake and metabolism and gastric emptying, at a detail that cannot be achieved by any other method.

The ‘early’ postprandial glucagon response is related to the rate of gastric emptying in type 2 diabetes

Gastric emptying (GE) is a major determinant of the postprandial glycemic and insulinemic responses in health and type 2 diabetes (T2D). However, the effect of GE on the postprandial glucagon response, which is characteristically augmented in T2D, is unknown. This study examined the relationship between plasma glucagon and GE of a standardized mixed meal in individuals with well-controlled T2D. 89 individuals with T2D (HbA1c 6.6 ± 0.1%) consumed a mashed potato meal labeled with 100 µL 13C-octanoic acid between 0 and 5 min. Venous blood was sampled frequently over 4 h for measurements of blood glucose and plasma glucagon. The gastric half-emptying time (T50) was calculated by quantification of 13C in the breath. Blood glucose peaked at t = 90 min after the meal. Plasma glucagon increased to a peak at t = 30 min and then decreased to a nadir at t = 180 min. The T50 was 68.3 ± 1.6 min. The incremental area under the plasma glucagon curve between t = 0–30 min (glucagon iAUC0–30 min) was related inversely to the T50 (r = −0.23, P = 0.029), while the increase in blood glucose at t = 30 min was related directly to the plasma glucagon iAUC0–30 min (r = 0.25, P = 0.018). Accordingly, individuals with relatively faster GE exhibited higher postprandial glucagon and glucose levels (ANOVA: P<0.01 for each). In well-controlled T2D, the early postprandial glucagon response to a mixed meal is related to the rate of GE, and predictive of the initial glycemic response. These observations suggest that a reduction in plasma glucagon may contribute to the effect of dietary and pharmacological strategies which reduce postprandial glycemia in T2D by slowing GE.

Evaluation of postprandial symptoms in two different laparoscopic sleeve gastrectomy techniques using gastric emptying scintigraphy

Laparoscopic sleeve gastrectomy (LSG) is a frequently used procedure in the surgical treatment of obesity in recent years. However, surgeons have different opinions regarding the distance from the antrum to the pylorus. In addition, postprandial symptoms significantly affect the overall quality of life. Therefore, this study aimed to understand the relationship between postprandial symptoms with gastric emptying time and surgical procedures. Sixty patients who underwent LSG surgery were analyzed retrospectively and divided into two groups: antrum preserved (AP) and antrum resected (AR). The antral resection margin was 2 cm from the pylorus in 35 patients (AR group) and 6 cm in 25 patients (AP group). Semisolid gastric emptying scintigraphy (GES) was performed prospectively in both groups. Postprandial symptoms were standardized with a questionnaire. The relationship of symptoms with a half time of gastric emptying (GE T½), retention percentage at 30 and 60 minutes, lag phase, body mass index (BMI), and a decline in excess weight (% EWL), and antrum resection were investigated. The obtained results were compared between the two groups and with the control group. The study group comprised 60 patients (49 F/11 M, mean age: 40.3 ± 20.1 years, BMI 31.6 ± 8.1 kg/m2). The half-time of gastric emptying in the AR and AP groups (28.00 min ± 9.58, 28.24 min ± 11.90, respectively), percentage gastric retention at 30 and 60 minutes in the AR and AP groups (30 minutes: %44.37 ± 17.88, %40.52 ± 14.56 and 60 minutes: 17 ± 8.9, 19 ± 3.1) was significantly different compared with the control group, but no significant difference was observed between the study groups. In addition, there was no statistically significant difference between the AR and AP groups in postprandial symptom scores >9 (68.6%, 60%, P = 0.681), GER (77.1%, 64%, P = 0.253), and postoperative BMI (p = .397), % EWL (p = .975), and T lag phase (p = .332). In our study, the postprandial symptoms were not affected between two different surgical procedures in LSG.

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&amp;lt;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.

Tolerability, gastric emptying patterns, and symptoms during the Nottingham Test Meal in 330 secondary care non-diabetic dyspeptic patients.

Scintigraphy is used for overall assessment of gastric emptying. Adherence to an international consensus protocol is recommended to ensure quality; however, this has not been widely adopted because preparation of the "egg-beater" meal is inconvenient in clinical practice. In this report, we audit the tolerability and the results of gastric emptying scintigraphy with the 400 ml Tc-99 m-labeled liquid nutrient Nottingham Test Meal (NTM). Results from 330 consecutive adult, non-diabetic patients with dyspeptic symptoms referred for gastric scintigraphy were analyzed. Gastric half-emptying time (T50) and validated measurements of early- and late-phase gastric emptying were acquired. Postprandial sensations of fullness, bloating, heartburn, nausea, and epigastric pain were recorded using 100 mm visual analog scales (VAS) before and 0, 30, and 90 min after NTM ingestion. Results were compared with those previously obtained in healthy subjects. Almost all (98%) of the patients were able to consume the 400 ml NTM. Considering early- and late-phase gastric emptying, frequently observed patterns included normal early- with slow late-phase (25%) and fast early- with slow late-phase emptying (27%). Abnormal score of fullness and/ or dyspeptic symptoms were observed in 88% of dyspeptic patients. Abnormal fullness at T0 (after completed drink ingestion) was associated with slow late phase of gastric emptying, especially in women. Gastric scintigraphy with the NTM is simple to perform and well tolerated. Whether the identified abnormal gastric emptying patterns could predict different treatment outcome in patients with functional dyspepsia is the subject of ongoing prospective studies.

Intragastric injection of botulinum toxin A for weight loss: A systematic review and meta-analysis of randomized controlled trials.

Intragastric botulinum toxin A (BTA) injection is a potential treatment for weight reduction in obese patients. Current studies yielded conflicting results. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the efficacy of intragastric BTA injection for weight management. We searched several databases to identify RCTs evaluating intragastric BTA injections for obesity. We applied random-effects models for all meta-analyses due to heterogeneity in the included studies. The mean difference (MD) and 95% confidence interval (CI) were calculated for continuous outcomes. A total of 6 RCTs including 192 subjects met the inclusion criteria and were included for the meta-analysis. Although the pooled data from six studies showed no difference in the absolute weight loss between intragastric BTA injection and control, subgroup analysis showed a significantly decreased absolute weight after a BTA injection dose≥200U (MD, -2.04kg; 95% CI, -3.96 to -0.12) and after multiple injection regions in the stomach combined with diet control (MD, -4.44kg; 95% CI, -6.54 to -2.33kg) compared with the control. Regarding absolute weight loss, the impact of endoscopic ultrasound-guided injection and follow-up duration showed no difference. Intragastric BTA injection had a significant change in body mass index (MD, -1.25kg/m2 ; 95% CI, -2.18 to -0.32kg/m2 ) and prolonged gastric half-emptying time (MD, 11.37min; 95% CI, -3.69 to 19.06min). Intragastric BTA injection is effective for obesity treatment, and adequate doses (≥200U), multiple gastric injection regions, and combined diet control are crucial. However, given the small sample size and limited power, caution should be exercised.

Transpyloric propagation and liquid gastric emptying in children with foregut dysmotility.

Gastric emptying (GE) requires precise antropyloroduodenal coordination for effective transpyloric flow, the mechanisms of which are still unclear. We aimed to correlate gastric antral function assessed by antroduodenal manometry (ADM) with GE scintigraphy (GES) for liquid feeds in children with suspected gastrointestinal dysmotility. Children who underwent both ADM and GES over a five-year period were reviewed. ADM tracings were re-analyzed to assess antral frequency, amplitude, and motility index (MI) pre-prandially and postprandially. Transpyloric propagation (TPP) was defined as antegrade propagated antral activity preceding duodenal phase III of the migrating motor complex (MMC). TPP was defined as "poor" if occurring in <50% of all presented duodenal phases III. For GES, regions of interest over the whole stomach, fundus, and antrum were drawn to calculate GE half-time (GE-T1/2 ) and retention rate (RR) in each region at 1 and 2h. Forty-seven children (median age: 7.0years) were included. Twenty-two had PIPO, 14 functional GI disorders, and 11gastroparesis. Children with poor TPP had longer GE-T1/2 (113.0 vs 66.5min, p=0.028), higher RR of the whole stomach and fundus at 1h (79.5% vs 63.5%, p=0.038; 60.0% vs 41.0%, p=0.022, respectively) and 2h (51.0% vs 10.5%, p=0.005; 36.0% vs 6.5%, p=0.004, respectively). The pre-prandial antral amplitude of contractions inversely correlated with GE-T1/2 , RR of the whole stomach, and fundus at 2h. TPP during phase III of the MMC correlated with gastric emptying of liquid and its assessment on ADM might predict abnormalities in postprandial gastric function.

Activation of gastrointestinal ileal brake response with dietary slowly digestible carbohydrates, with no observed effect on subjective appetite, in an acute randomized, double-blind, crossover trial.

To test the hypothesis that oral ingestion of slowly digestible carbohydrates (SDCs) that reach the ileum triggers the ileal brake as indicated by delayed gastric emptying, reduced glycemic response, and decreased subjective appetite. The study was a five-arm, randomized, double-blind, crossover trial with a 1-week washout period between treatments (n = 20; 9 females, 11 males). Five treatments consisted of three SDC ingredients [raw cornstarch, isomaltooligosaccharide (IMO), sucromalt], and an IMO/sucromalt combination, shown in vitro to have slow and extended digestion profiles, and a rapidly digestible carbohydrate control (maltodextrin). Carbohydrates (26g) were incorporated into yogurt [300g total; carbohydrate (~ 77g), fat (~ 0.2g), and protein (~ 9g)] with closely matched energy content (346kcal) and viscosity (~ 30,000 cP). Outcomes were measured in a 4h postprandial period. Mean gastric half-emptying times were moderately though significantly increased for the raw cornstarch and IMO treatments (P < 0.05), but they could be sub-divided into larger effect responder (n = 11) and non-responder groups (n = 9). Longer time for glycemic response to return to baseline was associated with increased gastric half-emptying time in an exploratory subset of data removing gastric half-emptying times > 3.5h (P = 0.02). No significant differences in appetite ratings were observed. SDCs caused slower gastricemptying rate through activation of the ileal brake, as closely matched semi-solid yogurts were used and only rate of carbohydrate digestion differed. Extending glycemic response through consumption of SDCs was associated with triggering the ileal brake. ClinicalTrials.gov NCT03630445, August 2018, retrospectively registered.