Measurement Of Gastric Emptying Research Articles

Gastric emptying in patients with insulin dependent diabetes mellitus and bioavailability of thioctic acid-enantiomers

The objective of this study was to determine the impact of prolonged gastric emptying in patients with insulin dependent diabetes mellitus (IDDM) on the bioavailability of the R(+)- and S(−)-thioctic acid (TA) enantiomers. Gastric emptying time (GET) was assessed in 30 healthy volunteers and 22 patients with IDDM using sequential ultrasonography after a standardized solid-liquid test meal. Pharmacokinetics and absolute bioavailability ( F) of the TA-enantiomers were studied using a randomized, open two-way crossover design with administrations of oral and intravenous single doses of 200 mg rac-TA. GET in healthy subjects was 134.7±21.6 min, the normal range was calculated from 88.3 to 181.1 min. The mean GET in all IDDM patients was significantly prolonged (178.2±28.1 min; P<0.001). Only 50% of the patients ( n=11) were found to have normal GET (group A), the other half of the population ( n=11) were considered to have delayed GET (group B). Mean GET values were 156.9±21.5 in group A ( P=0.028) and 199.4±13.9 min in group B, respectively, suggesting that gastric motility is significantly different from non-diabetic controls even in patients with apparently normal gastric emptying. Times to peak plasma concentrations ( t max) of both TA-enantiomers were similar in both groups and thus, unrelated to measures of gastric emptying. In contrast, maximum concentrations ( C max) and area-under-the-curve values (AUC) of both enantiomers were reduced by about 30% in patients with delayed GET. Although these differences resulted in statistical significance for the AUC of both enantiomers ( P<0.05), linear regression analysis showed only modest correlation between GET and the extent of TA-enantiomer absorption ( r 2=0.31 and 0.22 for R(+)-/ S(−)-TA, respectively). The study suggests that prolonged gastric emptying is frequently present in IDDM. Delayed gastric emptying, however, does not substantially affect the rate and extent of absorption of both TA-enantiomers.

The effect of octreotide on gastric emptying at a dosage used to prevent complications after pancreatic surgery: a randomised, placebo controlled study in volunteers

Background—Octreotide is used in many centres to prevent complications after pancreatic surgery. Delayed gastric emptying is a another complication occurring in around 30% of patients after pancreatoduodenectomy (PD) and causes...

Measurement of gastric emptying by intragastric gamma scintigraphy.

Gastric emptying is usually measured in animals and humans by dilution/sampling or external scintigraphy. These methods are either time consuming or require expensive equipment. The capacity of a miniature gamma counter positioned in the stomach to measure emptying of liquid and solid meals was evaluated. In eight conscious pigs fitted with gastric and duodenal cannulae, gastric emptying of saline (500 mL), dextrose (20%, 500 mL), porridge (300 g) and scrambled eggs (300 g), all labelled with 3.5 MBq 99mTC, was evaluated. When positioned in the antrum the probe was unable to quantify gastric emptying. In contrast, measurements of the fractional emptying of saline over 4-min periods by the probe positioned in the corpus and quantification of radioactivity in the duodenal effluent correlated closely (r = 0.88, P < 0.05). Gastric emptying (50% emptying time) of saline and both solid meals measured by the probe was not significantly different from quantification of the duodenal effluent volume. No difference was observed also for the dextrose meal but only while gastric acid secretion was suppressed by omeprazole. We conclude that an intragastric gamma counter permits measurement of gastric emptying of homogeneous meals provided meal stimulation of gastric secretion was not extensive. This was possible probably by monitoring emptying from the proximal stomach.

Nitric oxide produced by inducible nitric oxide synthase delays gastric emptying in lipopolysaccharide-treated rats.

Endotoxin induces nitric oxide synthase (NOS), resulting in relaxation of gastric smooth muscle. The authors examined the effect of NO produced in response to lipopolysaccharide (LPS) treatment on gastric emptying in rats, and they also examined the effects of a selective inhibitor of inducible NOS (iNOS), aminoguanidine, and a suppressor of iNOS gene expression, dexamethasone. Male Wistar rats weighing 200-250 g were used. LPS-treated rats received LPS (0.2-10 mg/kg) diluted in physiologic saline intraperitoneally. Before and at different intervals up to 8 h after administration of LPS, measurements of gastric emptying were performed in groups of 3-5 rats, by determining the amount of phenol red remaining in the stomach 20 min after intragastric instillation. In additional group of LPS (2 mg/kg)-treated rats, the gastric fundus was isolated 6 h after administration, and the tension changes in response to L-arginine, a substrate for NOS, and electrical transmural stimulation (3 Hz, 5 s) were recorded isometrically. (1) Gastric emptying was delayed by pretreatment with LPS in a dose- and time-dependent fashion (reduction from 68 +/- 12% to 22 +/- 7% with a dose of 2 mg/kg for 6 h). Aminoguanidine (50 mg/kg) or dexamethasone (5 mg/kg) partially inhibited the delay (to 39 +/- 4% or to 40 +/- 10%, respectively). (2) L-arginine (0.1 mM) produced a relaxation (28 +/- 2% reduction in active tension) in the gastric fundus strips isolated from LPS-treated rats but not from LPS-untreated rats. The relaxation was inhibited by aminoguanidine (1 mM). In contrast, the relaxation response to the electrical stimulation was not affected by aminoguanidine (0.1-1 mM). The present study suggests that NO, probably produced by iNOS, is one of the factors involved in the delay of gastric emptying in the LPS-treated rats and probably in those with sepsis.

Relation between postprandial satiation and antral area in normal subjects

The factors influencing appetite in humans are poorly understood. There is a weak relation between appetite and gastric emptying in normal subjects. Recent studies have shown that fasting and postprandial antral areas increase in patients with functional dyspepsia compared with normal subjects. We evaluated the hypothesis that antral area, and hence antral distention, is a significant determinant of postprandial fullness. Fourteen normal subjects had simultaneous measurements of gastric emptying by scintigraphy and antral area by ultrasound after ingestion of 350 mL 20% glucose. Fullness and hunger were assessed by visual analog scales. Measurements of the gastric-emptying half time (t1/2) by scintigraphy and ultrasound were not significantly different (129.6 +/- 11.8 min compared with 115.6 +/- 11.4 min). Fullness increased (P < 0.001) and hunger decreased (P < 0.001) after the drink. Both fullness and the magnitude of the increase in fullness after the drink were related to antral area (r > 0.56, P < 0.05), the increase in antral area (r > 0.59, P < 0.05), and the scintigraphic content of the distal stomach (r > 0.57, P < 0.05), but not to the ultrasound or scintigraphic t1/2 values. In contrast, hunger and the magnitude of the decrease in hunger after the drink were not related to either antral area, the increase in antral area, or the rate of gastric emptying. We conclude that postprandial fullness, but not hunger, was closely related to antral distention in normal subjects.

A new method to measure gastric emptying in conscious dogs: a validity study and effects of EM523 and L-NNA.

A new method for measurement of gastric emptying without the use of radioisotope markers has been developed in dogs. A test meal was given after measurement of its freeze-dried weight, and 1-ml duodenal samples were collected through an indwelling tube at 15-min intervals, and their absolute weight was measured. The duodenum was continuously perfused with phenolsulfonphthalein to determine the recovery of each sample. Three different calorie or fat-enriched meals were administered with 100 ml saline containing polyethylene glycol as a liquid marker. The results showed that increasing the calorie load of, and adding fat to, the test meal proportionally delayed gastric emptying of the solid phase. Utilizing this method, it was found that EM523, an erythromycin derivative, accelerated the gastric emptying of solids, whereas N(omega)-nitro-L-arginine (L-NNA) markedly delayed the gastric emptying of both solids and liquids. In conclusion, this freeze-drying method is a reliable technique for measuring the gastric emptying of the solid phase in dogs.

A model of gastric emptying using paracetamol absorption in intensive care patients.

To describe the range and factors which may affect gastric emptying in the ICU patient. Validation sample. The adult Intensive Care Unit (ICU) of a teaching hospital. Twenty-seven ICU patients, aged 18-65 years were studied within 3 days of their ICU admission. All patients had normal hepatic and renal chemistry and had no contraindications to enteral feeding. The area under the concentration curve from 0-60 min (AUC60) of a paracetamol absorption test was used as the measure of gastric emptying. The variables of the presence or absence of bowel sounds, volume of gastric aspirate ( > 50 ml or < 50 ml), an estimated risk of death (ROD), an APACHE II score calculated 24 h before the study, a pHi measurement, the use of dopamine (2.5-5 microg/kg, yes or no) and of opioids were included in a multiple regression analysis. Using Pearson correlation, AUC60 was positively correlated with the estimated ROD (r = 0.50, p < 0.05). There was a statistically significant difference in the mean AUC60 between those patients who did, and those who did not, receive dopamine (t = 3.06, p < 0.005). On multiple regression analysis the only variable which was significantly associated with AUC60 was estimated ROD, which accounted for 25% of the variance in AUC60. The results suggest that there is a wide range in gastric emptying in critically ill patients. The results may be due to the case mix of the patients. The use of dopamine may adversely affect gastric emptying and requires further investigation in the ICU patient. Prediction of gastric emptying is difficult in these patients and further investigation is necessary in order to improve our understanding of this process.

Postprandial cholecystokinin release and gastric emptying in patients with bulimia nervosa

This study was designed to investigate the biological underpinnings of the observed deficit in satiety in patients with bulimia nervosa. Eight women with bulimia nervosa and 10 age- and weight-matched control subjects consumed three laboratory meals consisting of 200, 400, and 600 g of a radiolabeled liquid meal. For 1 h after each meal, blood samples were obtained at 10-min intervals for measurement of cholecystokinin concentration and gastric emptying was measured. Subjects also completed perceptual rating scales at 10-min intervals. Compared with control subjects, patients with bulimia nervosa showed a blunting of postprandial cholecystokinin release, particularly with larger meal sizes, as well as delayed gastric emptying. Increasing meal size was associated with increased desire to binge eat in patients but not in control subjects. These data lend support to a model in which increased gastric capacity, perhaps resulting from repeated binge eating, gives rise to delayed gastric emptying and blunted postprandial cholecystokinin release, leading to an impaired satiety response, which tends to perpetuate the illness.

131I-labeled bovine serum ablum: A valuable marker for solid in the measurement of gastric emptying

131I-labeled bovine serum ablum: A valuable marker for solid in the measurement of gastric emptying

Observations on the patterns of 24-hour energy expenditure changes in body composition and gastric emptying in head-injured patients receiving nasogastric tube feeding.

Although intolerance to nasogastric feeding is commonly observed after head injury, quantitative measurements of gastric emptying are lacking. Concepts about energy requirements are limited by the lack of long-term measurements of total energy expenditure. Six male subjects with severe head injury had their gastric emptying measured by the phenol red technique. N and energy balances were measured by classic balance techniques, which included continuous indirect calorimetry for up to 24 hours (days 3 to 5). Measurements of body composition were made on days 3 to 5 and 12 to 19 (4 subjects only). The subjects lost a mean of 9.8 kg of which 2.3 kg was estimated to be due to fat (equivalent to -14 g N/d and -1690 kcal/d). On days 3 to 5, basal metabolic rate (BMR) was 130% to 135% of predicted. The low dietary intake (650 kcal and 4.2g N/d) was associated with negative energy (-1710 +/- 520 kcal/d) and N balances (-19 +/- 5 g N/d). Gastric emptying was delayed twofold (days 3 to 5) compared with controls (p < .001) and was associated with significant regurgitation of feed into the mouth (16 of 31 saliva samples contained glucose at a concentration of > 0.5 mmol/L compared with control values of < 0.2 mmol/L. The large negative energy balance in the subjects studied was largely due to the inadequate nasogastric feeding, which was associated with a twofold reduction in the rate of gastric emptying and frequent regurgitation of feed. The large negative N balance and the high contribution of protein oxidation to total energy expenditure (25% to 28%) was predominantly due to the injury sustained and immobility. An increase in BMR is not necessarily associated with increased total energy expenditure or energy requirements.

Role of antral intramural neural pathways in control of gastric emptying in the pig.

1. The role of antral intramural pathways in the control of antropyloric motility and gastric emptying was evaluated in five conscious pigs equipped with chronic gastric and duodenal cannulae. Neural pathways were divided by transection and re-anastomosis of the antrum 2 cm proximal to the pylorus. Concurrent measurements of gastric emptying, transpyloric flow and antropyloric motility were performed before and 6 weeks after surgery. 2. Antral transection retarded gastric emptying, only 36% of 1000 ml saline being emptied in 30 min compared with 62% before transection. Transection did not alter the number of transpyloric flow pulses (22.0 +/- 4.0 cf. 24.4 +/- 3.2 pre-transection), but reduced (P < 0.01) the volume of flow pulses substantially (8.6 +/- 0.4 cf. 18.7 +/- 1.5 ml pre-transection). 3. Antral transection was associated with a reduction in the rate of distal antral pressure waves (P < 0.05), but no alteration in the rate of phasic low level pressurization of the entire gastric content by gastric contractions (gastric common cavity pressure waves). However, transection was associated with a significant (P < 0.05) shortening of the interval between the onset of gastric common cavity pressure waves, and the onset of lumen-occlusive pyloric pressure waves generated by the same contraction sequence (3.2 +/- 0.3 cf. 7.9 +/- 0.6 s). 4. Transection did not alter the inhibition of antral pressure waves, stimulation of localized pyloric pressure waves, and retardation of gastric emptying produced by infusion of 25% dextrose into the duodenum. 5. These studies suggest that antral intramural nerves regulate the emptying of liquids from the stomach by modulating the timing of pyloric closure in relation to phasic gastric antral and corpus contractions. 6. Distal antral intramural neural pathways do not appear to play a major role in the suppression of antral motor activity produced by duodenal glucoreceptors.

Nizatidine accelerates gastric emptying of a solid meal in rats.

Nizatidine, a new histamine-2-receptor antagonist, stimulates gastrointestinal motility in dogs and gastric emptying of liquids in rats. Effect of nizatidine on gastric emptying of a solid meal was investigated using a novel gastric emptying model in rats. Male Wistar rats (weighing 200-300 g) were supplied with powdered food containing 30 w/w% barium 14 hr before the beginning of the experiment and x-ray photography of rat stomach was taken under light ether anesthesia. Gastric emptying was assessed by percentage of a decrease in area 30 min after drug was injected intraperitoneally. There was a positive correlation between the area of the gastric outline and the weight of the gastric contents (r = 0.94, P < 0.01). Ether anesthesia itself did not affect gastric emptying. Nizatidine increased gastric emptying dose-dependently (emptied percentage; vehicle: 4.9 +/- 1.5%, 1 mg/kg: 7.2 +/- 0.4%, 3 mg/kg: 10.4 +/- 2.0%, 10 mg/kg: 16.7 +/- 4.9%, 30 mg/kg: 25.7 +/- 7.4%). N-Desmethyl nizatidine (NDM) also stimulated gastric emptying, but nizatidine S-oxide, cimetidine, an famotidine had no significant effects on gastric emptying. Nizatidine and neostigmine, but not NDM, at a subthreshold dose accelerated gastric emptying treated with a low dose of acetylcholine (0.1 mg/kg). Atropine (2 mg/kg, -30 min) did not modulate the gastroprokinetic action of nizatidine, but blocked that of NDM. These findings suggest that this noninvasive method may allow measurement of gastric emptying of solids accurately and that nizatidine and NDM facilitate gastric emptying probably mediated by a direct and/or an indirect (acetylcholinesterase inhibition) cholinergic mechanism.

Evaluation of a non-invasive test for the measurement of gastric emptying during exercise using a stable isotope technique

Evaluation of a non-invasive test for the measurement of gastric emptying during exercise using a stable isotope technique

Highly variable gastric emptying in patients with insulin dependent diabetes mellitus.

Some diabetic patients--particularly those with nausea and vomiting--frequently have evidence of delayed gastric emptying while other diabetic patients may in fact exhibit accelerated gastric emptying. Whether the presence or absence of symptoms of upper gastrointestinal dysfunction correlated with objective measures of gastric emptying in insulin dependent diabetic subjects was investigated. Twenty one insulin dependent diabetic patients underwent a solid phase gastric emptying scintiscan using in vivo labelled chicken liver. Thirteen patients had symptoms suggestive of gastrointestinal dysfunction (nausea, vomiting, early satiety, or constipation), while eight patients had no gastrointestinal symptoms. Eleven patients had orthostatic hypotension. All patients had been diabetic since childhood or adolescence. As a group, the diabetic patients showed a half time (T50) of gastric emptying (mean (SD) 150.0 min (163.7) that was not significantly different from that of 12 healthy control subjects (148.1 min (62.4)). Those diabetic patients without gastrointestinal symptoms and without orthostatic hypotension, however, showed a gastric emptying half time (70.1 min (41.6)) that was significantly faster than that of the control subjects. Conversely, those diabetic patients with nausea, vomiting, and early satiety (or early satiety alone) showed T50 values that were significantly greater than those of the diabetic patients without these symptoms. No correlation was found between the T50 value and the duration of diabetes, the fasting blood glucose at the time of study, or the respiratory variation in heart rate (E:I ratio). These observations indicate that highly variable rates of gastric emptying occur in insulin dependent diabetic patients, and that accelerated gastric emptying may occur in diabetic patients who have no symptoms of gastrointestinal dysfunction.

Scintigraphic and ultrasonographic measurement of gastric emptying - relationship to appetite

Scintigraphic and ultrasonographic measurement of gastric emptying - relationship to appetite

Emptying of radioopaque markers as a measure of gastric emptying

Emptying of radioopaque markers as a measure of gastric emptying

The [ 13C]acetate breath test accurately reflects gastric emptying of liquids in both liquid and semisolid test meals

Background/Aims: The current standard for gastric emptying studies are radioactive isotope methods. [ 13C]breath tests have been developed as a nonradioactive alternative. The aim of this study was to validate a [ 13C]acetate breath test as a measure of gastric emptying of the liquid phase both in liquid and semisolid test meals by simultaneous radioscintigraphy. Methods: Thirty-five patients with dyspeptic symptoms and 20 healthy volunteers were tested using a semisolid oatmeal or a liquid test meal. Both test meals were labeled by 150 mg sodium [ 13C]acetate and (in patients) by 45 MBq 99mTc-albumin colloid. Half-time of gastric emptying was calculated after curve fitting of the 13C exhalation to a modified power exponential function. 99mTc-albumin emptying was measured by conventional radioscintigraphy. Results: The half-emptying times for the [ 13C]acetate breath test closely correlated to those measured by radioscintigraphy both for semisolids ( r = 0.87) and liquids ( r = 0.95). The time of maximum 13CO 2 exhalation was itself a reliable parameter compared with the half-emptying times obtained by scintigraphy ( r = 0.85 for semisolids; r = 0.94 for liquids). Conclusions: The [ 13C]acetate breath test is a reliable and noninvasive tool for the analysis of gastric emptying rates of liquid phases without radiation exposure.

Applied Potential Tomography in the Measurement of Gastric Emptying in Infants

SummaryThe aim of this study was to investigate the feasibility of using applied potential tomography (APT), a noninvasive and nonradioactive method, to measure the rate of gastric emptying in preterm babies and infants &lt;3 months old. APT, a form of electrical impedance tomography, creates tomographic images of tissue resistivity to a small electrical current and has been used to study gastric emptying in adults. The rate of gastric emptying of 53 preterm infants and 29 term infants was measured. The test feed was either milk (formula milk or expressed breast milk) or Dioralyte (a commercial rehydration solution). When a nasogastric tube was present, the results obtained by APT were validated by comparing the volume of feed estimated to be present with the volume that could be aspirated. All infants completed the investigation without any problems. APT demonstrated a slower rate of emptying of milk feeds than Dioralyte and showed that milk and Dioralyte feeds in preterm babies emptied at a similar rate to feeds in term infants. In validation studies, gastric emptying has been observed in 44 of 47 studies, and this finding was confirmed by aspiration of the nasogastric tube. Applied potential tomography is a safe, noninvasive method for measuring gastric emptying in small infants.

Measurement of gastric emptying and gastric motility by magnetic resonance imaging (MRI)

Hitherto it has been impossible to measure noninvasively gastric emptying and motility from multiple regions of the stomach in humans. We describe the development of a novel methodology to achieve this using magnetic resonance imaging (MRI). Initial validation studies performed in five healthy volunteers demonstrated similar gastric emptying curves and secretion rates after ingestion of 10% dextrose labeled with [Gd]DOTA, assessed by MRI ([Gd]DOTA as meal marker) and a simultaneous double-indicator technique. Comparison between MRI and scintigraphy in five patients also gave similar results. Application of newer MRI technology allowing a series of coronal scans 1.2 sec apart permitted quantification of wall motion in the proximal and distal stomach in seven healthy volunteers. These results indicate that MRI provides new insights into the mechanisms responsible for both normal and disordered emptying.

Measurement of gastric emptying in infants with pyloric stenosis using applied potential tomography : S. Nour, Y. Mangnall, J.A.S. Dickson, et al. Arch Dis Child 68:484–486, (April), 1993

Measurement of gastric emptying in infants with pyloric stenosis using applied potential tomography : S. Nour, Y. Mangnall, J.A.S. Dickson, et al. Arch Dis Child 68:484–486, (April), 1993