Intragastric Meal Distribution Research Articles

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

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

Prognostic Value of Pre-Operative Intragastric Meal Distribution in Gastric Emptying Scintigraphy for Long-Term Success of Gastric Peroral Endoscopic Myotomy in Gastroparesis

Background and aimsGastric emptying scintigraphy (GES) is the gold standard for the diagnosis of gastroparesis. However, data are lacking regarding the prognostic value of pre-operative intragastric meal distribution during GES, in patients undergoing gastric peroral endoscopic myotomy (GPOEM) for gastroparesis. This study investigated the association of GES morphologic parameters and the long-term clinical success of G-POEM. MethodsThis retrospective study included patients who underwent G-POEM for refractory gastroparesis in a tertiary center with preoperative GES data. Intragastric meal distribution was measured using the proximal to distal count ratio (PDCR) at 0, 1, 2 and 4 hours (h), and the retention index (RI) was calculated. Clinical success was defined as a decrease of at least 50% in the post-G-POEM Gastroparesis Cardinal Symptom Index (GCSI) total score. ResultsIn total, 77 patients were included with a mean follow-up of 40.14 months. Clinical success was observed in 54.55% of patients. The RI was not associated with clinical success. Only PDCR at 0h (PDCR0) was associated with clinical success. In univariate analysis, the median PDCR0 was 6.0 (IQR 5.59) in patients with clinical success and 4.29 (IQR 4.51) in patients with clinical failure (p=0.019). In multivariate analysis, PDCR0 > 5.25 was associated with clinical success (HR = 4.36 [1.55;12.26], p=0.00524). ConclusionsThis study suggests that in patients with gastroparesis, High PDCR0 value (suggestive for a preferential fundic meal distribution) during preoperative GES is associated with long-term clinical response to G-POEM.

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

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

Gastric sensorimotor function and its clinical measurement.

Gastroduodenal symptoms are highly prevalent, with underlying sensorimotor dysfunction contributing in many patients. Common symptoms include early satiation, postprandial fullness, epigastric bloating, pain or burning, nausea and vomiting, which collectively affect over 7% of adults. However, the clinical evaluation of these symptoms remains challenging, with current tests of gastric function remaining limited in their ability or availability to separate specific patient subgroups or guide-targeted care. In the current edition of Neurogastroenterology & Motility, Silver et al. present new data showing correlations between patterns of intragastric meal distribution and symptom profiles in a large series of patients undergoing gastric emptying scintigraphy. Studies of this type are important, as they motivate understanding beyond existing disease labels, and orient focus toward deeper mechanistic profiling. This brief review provides an overview of gastric sensorimotor function and profiles several current and emerging methods of clinical evaluation. Perspectives are provided on accommodation testing, gastric emptying, measuring gastric myoelectrical activity including new approaches, and antroduodenal manometry. Although gastric physiology is complex, recent progress has been encouraging, with the heterogenous pathophysiology of gastric symptoms continuing to be unraveled, and new techniques for evaluating gastric function and symptoms emerging. Ongoing progress will now depend on continuing to accurately profile the underlying mechanisms of gastroduodenal disorders to identify specific disease phenotypes that inform care.

Proximal and distal intragastric meal distribution during gastric emptying scintigraphy: Relationships to symptoms of gastroparesis.

Total gastric retention (TGR) from gastric emptying scintigraphy (GES) is used for diagnosing gastroparesis (Gp), but correlates poorly with patients' symptoms. Regional intragastric meal distribution (RIMD) can also be assessed from GES. This study classified patients' meal distribution as proximal or distal to relate RIMD to symptoms of Gp. GES studies in patients (n=193) and control subjects (n = 21) were selected for RIMD analysis. Patients completed Patient Assessment of Upper Gastrointestinal Symptoms (PAGI-SYM) for symptom severity before GES. TGR was analyzed using % TGR, and RIMD used a proximal/distal gastric count ratio (PDCR). Results were classified as proximal or distal RIMD at 0, 1, 2, and 4h postprandially based on their PDCR being above or below the median value of the patients. Patients with delayed GE and immediate post-meal ingestion distal distribution had more severe early satiety and regurgitation. Distal distribution at 1h had more severe early satiety and loss of appetite compared to proximal distribution. Patients with delayed GE and proximal distribution at 4h had more severe nausea, retching, and vomiting compared to 4h distal distribution. Severely delayed 4h proximal distribution had more nausea than severely delayed 4h distal distribution. Increased early distal IMD in patients with delayed GE was associated with regurgitation and early satiety whereas increased late proximal IMD was associated with nausea, retching, and vomiting. Differentiating proximal from distal meal distribution patterns helps to relate symptoms to gastric dysfunction and may be helpful for directing therapy.

Regional gastric emptying and gastric contractile activity in functional dyspepsia: new approach optimizing the consensus protocol

Consensus protocol organizes gastric emptying scintigraphy (GES). There is low adherence to the protocol, and its applicability is reduced due to poor connection between retention and functional disorders. To optimize the consensus protocol, we added a dynamic acquisition and quantification of distinct parameters for healthy and dyspeptic subjects. Fourteen patients with functional dyspepsia (FD) and 20 healthy volunteers were undergone GES. The dynamic acquisition was added to the activity versus time curve composed of 4-time points (0, 60, 120, and 240 min) preconized. A dynamic set of 3060 images (1 Hz) were acquired between immediate and 60 min static images. Regions of interest were drawn to divide the stomach internally, and two gastric segmentations (similar areas and incisura) were adopted for all quantification of global GE and contractile parameters. Gastric retention at 4-time points preconized was not enough to identify differences between FD and healthy volunteers (R² = 0.99; p ˂ 0.0009). Retention percentage of test meal in the proximal stomach employing segmentation, T1/2, MGET and lag phase analysis were higher in dyspeptic compared to healthy volunteers. Impaired intragastric meal distribution was observed in FD by similar areas (p &lt; 0.02) and incisura (p &lt; 0.001). Reduction in the amplitude of contraction from the proximal region (p ˂ 0.015 and p ˂ 0.003) was observed in FD segmentation by similar areas and incisura, respectively. Impaired proximal stomach was observed in functional dyspepsia due to the insertion of dynamic acquisition proposed by consensus. Our approach can strengthen the consensus protocol and makes it capable of recognize and classify some diseases.

Global and Regional Gastric Emptying Parameters: Establishment of Reference Values and Comparison of Different Camera View Methods.

Purpose of the Study:The purpose of the study is to establish the reference values of global and regional gastric emptying parameters (GEPs) using a standard vegetarian meal acceptable to the Indian population and compare the values derived on different camera view methods.Materials and Methods:Thirty-six consecutive healthy subjects with age ≥18 years underwent gastric emptying scintigraphy using anterior, posterior, and left anterior oblique (LAO) views. GEP was derived based on decay corrected counts in regions of interest defined on the whole and proximal stomach. Counts in the anterior and posterior view images were used to derive GEP based on geometric mean (GM) method. Comparison of GEP among different camera view methods was done with Friedman test and post hoc Wilcoxon signed-rank test after Bonferroni correction. Reference values were derived based on percentiles.Results:Rapid gastric emptying based on GM method was defined as percent retention <20% at 1 h while delayed emptying as percent retention >40% and >5% at 2 h and 4 h, respectively. The reference range of half-time of gastric emptying was 23–109 min. The reference value of intragastric meal distribution at time t = 0 was >64%, while the reference range of retention index was 0.7–1.3. Although the overall distribution of GEP derived on different camera view methods could be statistically significant (P < 1.00), the small differences in the derived reference values are likely to be of no clinical significance.Conclusion:The reference values of GEPs established in this study can be generalized for the Indian population and may be applied to aid in clinical decision making. We recommend the GM method as the preferred method, although single view method (LAO preferred over anterior) can also be an acceptable alternative.

Gastric accommodation: Physiology, diagnostic modalities, clinical relevance, and therapies.

Gastric accommodation is an essential gastric motor function which occurs following ingestion of a meal. Impaired gastric fundic accommodation (IFA) is associated with dyspeptic symptoms. Gastric accommodation is mediated by the vagal pathway with several important physiologic factors such as duodenal nutrient feedback playing a significant role. IFA has been described as a pathophysiologic factor in several gastrointestinal disorders including functional dyspepsia, diabetic gastropathy, post-Nissen fundoplication, postsurgical gastrectomy, and rumination syndrome. Modalities for gastric accommodation assessment include gastric barostat, intragastric meal distribution via scintigraphy, drinking tests (eg, water load), SPECT, MRI, 2D and 3D ultrasound, and intragastric high-resolution manometry. Several treatment options including sumatriptan, buspirone, tandospirone, ondansetron, and acotiamide may improve symptoms by increasing post-meal gastric volume. Our aim is to provide an overview of the physiology, diagnostic modalities, and therapies for IFA. A literature search was conducted on PubMed, Google Scholar, and other sources to identify relevant studies available until December 2020. Gastric accommodation is an important gastric motor function which if impaired, is associated with several upper gastrointestinal disorders. There are an increasing number of gastric accommodation testing modalities; however, each has facets which warrant consideration. Evidence regarding potentially effective therapies for IFA is growing.

Gastroparesis versus dyspepsia by intragastric meal distribution: new diagnostics and definitions ahead

Gastroparesis often presents a challenge to the practicing gastroenterologist. Postprandial symptoms with nausea and vomiting may not only lead to nutritional and metabolic consequences, but also significant disruption of social activities that often center around food. The treatment options that affect gastric function are limited and often disappointing. The female predominance, the mostly idiopathic and idiosyncratic nature of the illness, often with some common psychiatric co-morbidity, parallels other functional disorders of the gastrointestinal tract. These parallels have provided the rationale for studies investigating alternative diagnostic features of the gastric emptying test as employed in the clinical setting. Hence, not only the regular cut-offs of 60% or 10% gastric retention of a meal at 2 and 4 h, but also a new concept, the intragastric meal distribution at time 0 (IMD0) is now introduced as a plausible diagnostic feature that should be more aligned with the patients’ symptoms as they appear in close connection with the meal. Impaired gastric accommodation with absence of fundic relaxation followed by dumping of the meal into antrum is suggested to be diagnostic for functional dyspepsia and gastroparesis. The diagnostic cut-off is considered when more than 57% of the meal is distributed to the distal part of the stomach immediately on food intake. This new diagnostic feature of the gastric emptying profile lend support to better understanding of the patients’ symptoms and provides a new basis for pharmacological treatment options in gastroparesis that may provide an improved quality of life in affected individuals.

Gastric accommodation measurements by single photon emission computed tomography and two-dimensional scintigraphy in diabetic patients with upper gastrointestinal symptoms.

To compare estimates of gastric accommodation (GA) with single photon emission computed tomography (SPECT) to measurements based on intragastric meal distribution immediately post-meal ingestion (IMD0 ). We evaluated 108 diabetics with upper gastrointestinal (UGI) symptoms who had undergone gastric emptying of solids (GE) by scintigraphy and GA measurements by SPECT. Immediately after ingestion of a 99m Tc-labeled egg meal (time 0), we estimated IMD0 as radioactive counts or area of the proximal half of the stomach on two-dimensional images. Gastric volume (GV) during fasting and after 300mL Ensure® was measured by SPECT to quantify accommodation volume (AV) or postprandial to fasting volume ratio (GVR). From the measured proximal gastric area, we estimated the volume of proximal stomach (4/3×π×r3 ). We performed regression analyses to assess relationships between IMD0 and GA (AV) and GVR. There was a significant correlation between area and radioactivity counts in the proximal stomach (r=0.67, P<0.001); however, there was considerable interpersonal variation [bias 0.20 (95% CI -0.07, 0.47)]. There were no significant correlations between total GV or AV or VR by SPECT and measurements using IMD0 : proximal gastric counts, area, and estimated volume as continuous variables of dichotomized patient groups, based on published cutoff values. There were no significant differences in total gastric area or the IMD0 parameters (% area or % radioactive counts) between those with and without UGI symptoms except for fullness and satiety. Intragastric meal distribution immediately post-meal ingestion is not significantly correlated with GA measurement by SPECT.

Enhanced Gastric Emptying Scintigraphy to Assess Fundic Accommodation Using Intragastric Meal Distribution and Antral Contractility.

Gastric emptying scintigraphy (GES) as now commonly performed measures only total gastric emptying. Intragastric meal distribution (IMD) immediately after meal ingestion (t = 0 min) (IMD0) can assess fundic accommodation, and dynamic antral contraction scintigraphy (DACS) can assess antral motility. Our goals were to incorporate IMD and DACS into GES, compare IMD0 using gastric division into anatomic proximal and distal halves versus more physiologic separation of the antrum from the proximal stomach using DACS, and establish reference values. Methods: Healthy subjects (n = 20) underwent GES using a solid-liquid meal. DACS (1 frame/3 s) was performed for 20 min after each static imaging time. IMD0 was measured using both semiautomated software to divide the gastric long axis into anatomic halves and Fourier analysis to identify antral pixels with phasic contractions. Results: Using halving of the stomach, IMD0 averaged 0.75 ± 0.15 (SD). Using phasic contractions to define the antrum, mean IMD0 was 0.85 ± 0.14 (P = 0.004). Sustained antral contractions started at a mean of 11.24 ± 12.98 min after meal ingestion and originated in the gastric midbody with a starting location at 40.5% ± 10.8% from the distal to the proximal stomach along its long axis. Antral frequency and ejection fraction peaked 30 min after meal ingestion at 3.30 ± 0.71 contractions per minute and an ejection fraction of 30.3% ± 13.69%, when mean antral filling peaked at 36.7% ± 14%. Maximum antral contraction speed was 3.54 ± 0.90 mm/s at 60 min after meal ingestion. Gastric retention was 39.8% ± 12.8% at 2 h and 5.8% ± 6.0% at 4 h. Conclusion: Addition of DACS to GES permits physiologic characterization of both fundic accommodation and antral contractility to supplement routine GES.

Sa1552 - Solid Meal Gastric Retention and Intragastric Meal Distribution in the Assessment of Patients Referred for Clinical Gastric Emptying Scintigraphy

Sa1552 - Solid Meal Gastric Retention and Intragastric Meal Distribution in the Assessment of Patients Referred for Clinical Gastric Emptying Scintigraphy

Sa1553 - Normal Integrated Gastric Motility: Assessing Intragastric Meal Distribution, Antral Contractility, and Emptying with Scintigraphy

Sa1553 - Normal Integrated Gastric Motility: Assessing Intragastric Meal Distribution, Antral Contractility, and Emptying with Scintigraphy

Intragastric Meal Distribution During Gastric Emptying Scintigraphy for Assessment of Fundic Accommodation: Correlation with Symptoms of Gastroparesis.

Impaired fundic accommodation (FA) limits fundic relaxation and the ability to act as a reservoir for food. Assessing intragastric meal distribution (IMD) during gastric emptying scintigraphy (GES) allows for a simple measure of FA. The 3 goals of this study were to evaluate trained readers' (nuclear medicine and radiology physicians) visual assessments of FA from solid-meal GES; develop software to quantify GES IMD; and correlate symptoms of gastroparesis with IMD and gastric emptying. Methods: After training to achieve a consensus interpretation of GES FA, 4 readers interpreted FA in 148 GES studies from normal volunteers and patients. Mixture distribution and κ-agreement analyses were used to assess reader consistency and agreement of scoring of FA. Semiautomated software was used to quantify IMD (ratio of gastric counts in the proximal stomach to those in the total stomach) at 0, 1, 2, 3, and 4 h after ingestion of a meal. Receiver-operating-characteristic analysis was performed to optimize the diagnosis of abnormal IMD at 0 min (IMD0) with impaired FA. IMD0, GES, water load testing, and symptoms were then compared in 177 patients with symptoms of gastroparesis. Results: Reader pairwise weighted κ-values for the visual assessment of FA averaged 0.43 (moderate agreement) for normal FA versus impaired FA. Readers achieved 84.0% consensus and 85.8% reproducibility in assessing impaired FA. IMD0 based on the division of the stomach into proximal and distal halves averaged 0.809 (SD, 0.083) for normal FA and 0.447 (SD, 0.132) (P < 0.01) for impaired FA. On the basis of receiver-operating-characteristic analysis, the optimal cutoff for IMD0 discrimination of normal FA from impaired FA was 0.568 (sensitivity, 86.7%; specificity, 91.7%). Of 177 patients with symptoms of gastroparesis, 129 (72.9%) had delayed gastric emptying; 25 (14.1%) had abnormal IMD0 Low IMD0 (impaired FA) was associated with increased early satiety (P = 0.02). Conclusion: FA can be assessed visually during routine GES with moderate agreement and high reader consistency. Visual and quantitative assessments of FA during GES can yield additional information on gastric motility to help explain patients' symptoms.

Su1548 - Intragastric Meal Distribution (IMD) During Routine Gastric Emptying Scintigraphy (GES) to Better Relate Symptoms of Gastroparesis to Abnormal Gastric Motility

Su1548 - Intragastric Meal Distribution (IMD) During Routine Gastric Emptying Scintigraphy (GES) to Better Relate Symptoms of Gastroparesis to Abnormal Gastric Motility

The effect of body position on postprandial perceptions, gastric emptying, and intragastric meal distribution: An ultrasonographic study in reclining healthy subjects

Objective. Postprandial dyspepsia is common and may be associated with abnormal intragastric distribution of food. We aimed to determine the effect of body position on gastric emptying, meal distribution, and postprandial perceptions in healthy subjects. Material and methods. Eight adolescents (4 females and 4 males aged 14 years) were investigated using three-dimensional ultrasonography. The subjects were studied twice in a random order: once in the right lateral recumbent (RLR) position and once in the left lateral recumbent (LLR) position. Postprandial perceptions, gastric volumes, and antral areas were recorded immediately after the ingestion of 500 ml of a low-caloric meat soup over 4 min, and at 10 and 20 min following the meal. Results. Postprandial perceptions (epigastric pain, nausea, and fullness) were more pronounced in the RLR position compared to the LLR position, particularly at the end of the meal ingestion (p < 0.01). Gastric volumes were significantly smaller in the RLR position compared to the LLR position at 10 min (p < 0.01) and 20 min (p < 0.05). Antral areas were significantly wider in the RLR position compared to the LLR position at 10 min (p < 0.05) and 20 min (p < 0.01). Conclusion. Postprandial perceptions are more pronounced, gastric emptying is faster, and antral area is wider in the RLR position compared to the LLR position. The results suggest that lying on the left side after a meal may be a measure to reduce postprandial dyspeptic sensations.

Influence of sumatriptan on gastric accommodation and on antral contraction in healthy subjects assessed by ultrasonography

Oral sumatriptan administration has been reported to delay gastric emptying after liquid meals. The aim of this study was to determine whether delayed gastric emptying is caused by enhanced gastric accommodation, impaired antral contractions, or both using ultrasonography. Ten healthy volunteers were enrolled in this randomized two-way crossover study. After overnight fasting, the subjects received the liquid meal 60 min after ingesting a 50 mg sumatriptan tablet with 50 mL of water or 50 mL of water alone (control). The cross-sectional area of the proximal stomach was measured in a supine position after every 100 mL. The frequency and amplitude of the antral contractions were measured in a slightly backward sitting position. The intragastric distribution of the liquid meal was assessed by calculating the proximal stomach/distal stomach ratio (prox/distal ratio). The cross-sectional area after drinking 100, 200, and 300 mL of the liquid meal (oral sumatriptan vs control) was 34.49 vs 15.11 cm(2) (P = 0.0051), 48.00 vs 30.61 cm(2) (P = 0.0166), and 58.67 vs 47.19 cm(2) (P = 0.0125), respectively. There was no significant difference in the amplitude of contractions, contraction cycle, motility index, and prox/distal ratio (97.15 vs 97.93%, P = 0.0745; 19.42 vs 19.5 s, P= 0.8590; and 887.58 vs 889.22, P = 0.5751; 9.75 vs 8.41, P = 0.8785; respectively). Oral sumatriptan administration enhanced gastric accommodation after the ingestion of liquid nutrients, but had no significant effect on antral contractions or intragastric distribution in healthy subjects.

Assessment of Gastric Accommodation by SPECT

Assessment of Gastric Accommodation by SPECT

The effects of sedation on gastric emptying and intra-gastric meal distribution in critical illness

The effects of sedation on gastric emptying and intra-gastric meal distribution in critical illness

Reproducibility of energy intake, gastric emptying, blood glucose, plasma insulin and cholecystokinin responses in healthy young males

Gastric emptying, as well as intragastric meal distribution, and gastrointestinal hormones, including cholecystokinin (CCK), play an important role in appetite regulation. The evaluation of gastrointestinal factors regulating food intake is commonly performed in healthy, lean, young male participants. It has, however, been suggested that there is a marked interindividual variability in the effects of nutrient 'preloads' on energy intake in this group. Whether there is significant intraindividual variation in acute energy intake after a nutrient preload, and, if so, how this relates to day-to-day differences in gastric emptying and gastrointestinal hormone release, is unclear. The purpose of the present paper is to evaluate the hypothesis that energy intake after a nutrient preload would be reproducible and associated with reproducible patterns of gastric emptying, intragastric distribution and gastrointestinal hormone release. Fifteen healthy men (age 25 (sem 5) years) consumed a glucose preload (50 g glucose in 300 ml water; 815 kJ) on three occasions. Gastric emptying and intragastric meal distribution (using three-dimensional ultrasound), blood glucose, plasma insulin and CCK concentrations and appetite perceptions were evaluated over 90 min, and energy intake from a cold buffet-style meal was then quantified. Energy intake was highly reproducible within individuals between visits (intraclass correlation coefficient, ri = 0.9). Gastric emptying, intragastric meal distribution, blood glucose, plasma insulin and CCK concentrations and appetite perceptions did not differ between visits (ri>0.7 for all). In healthy males, energy intake is highly reproducible, at least in the short term, and is associated with reproducible patterns of gastric emptying, glycaemia, insulinaemia and CCK release.