Paracetamol Absorption Technique Research Articles

Association of glucagon-like peptide-1 receptor agonist treatment with gastric residue in an esophagogastroduodenoscopy.

Previous studies have reported that the glucagon-like peptide-1 receptor agonist (GLP-1RA) delays gastric emptying, and gastric emptying was assessed by the 13 C breath test or paracetamol absorption technique. However, neither of them is clinically familiar in real-world clinical practice. The purpose of the present study was to investigate the association between GLP-1RA treatment and gastric residue in an esophagogastroduodenoscopy. This study was a matched pair case-control study. The study population consisted of 1,128 individuals with diabetes who had esophagogastroduodenoscopy at our clinic between July 2020 and June 2022. To account for differences in characteristics, such as age, sex, insulin treatment and glycated hemoglobin, we carried out a one-to-one nearest neighbor propensity score matching analysis between diabetes patients with and without GLP-1RA treatment. After matching, we compared the presence of gastric residue in an esophagogastroduodenoscopy by the McNemar test between patients with and without GLP-1RA treatment. After the propensity score matching, we selected 205 pairs. In the propensity score-matched comparison, the proportion of gastric residue was statistically significantly higher in the GLP-1RA treatment group (0.49% vs 5.4%, P=0.004). The details of GLP-1RA prescribed for the 11 patients with gastric residue were liraglutide once daily 1.8 mg (n=2), dulaglutide once weekly 0.75 mg (n=5), semaglutide once weekly 0.5 mg (n=2) and semaglutide once weekly 1.0 mg (n=2). GLP-1RA treatment is associated with gastric residue in an esophagogastroduodenoscopy in patients with diabetes.

Normal gastric emptying time of a carbohydrate-rich drink in elderly patients with acute hip fracture: a pilot study

BackgroundGuidelines for fasting in elderly patients with acute hip fracture are the same as for other trauma patients, and longer than for elective patients. The reason is assumed stress-induced delayed gastric emptying with possible risk of pulmonary aspiration. Prolonged fasting in elderly patients may have serious negative metabolic consequences. The aim of our study was to investigate whether the preoperative gastric emptying was delayed in elderly women scheduled for surgery due to acute hip fracture.MethodsIn a prospective study gastric emptying of 400 ml 12.6% carbohydrate rich drink was investigated in nine elderly women, age 77–97, with acute hip fracture. The emptying time was assessed by the paracetamol absorption technique, and lag phase and gastric half-emptying time was compared with two gender-matched reference groups: ten elective hip replacement patients, age 45–71 and ten healthy volunteers, age 28–55.ResultsThe mean gastric half-emptying time in the elderly study group was 53 ± 5 (39–82) minutes with an expected gastric emptying profile. The reference groups had a mean half-emptying time of 58 ± 4 (41–106) and 59 ± 5 (33–72) minutes, indicating normal gastric emptying time in elderly with hip fracture.ConclusionThis pilot study in women with an acute hip fracture shows no evidence of delayed gastric emptying after an orally taken carbohydrate-rich beverage during the pre-operative fasting period. This implies no increased risk of pulmonary aspiration in these patients. Therefore, we advocate oral pre-operative management with carbohydrate-rich beverage in order to mitigate fasting-induced additive stress in the elderly with hip fracture.Trial registrationClinicalTrials.gov NCT02753010. Registered 17 April 2016, retrospectively.

Does Adding Milk to Tea Delay Gastric Emptying?

Hillyard, S.*†; Cowman, S.†; Ramasundaram, R.†; Seed, P. T.‡; G., O’Sullivan† Author Information

Does adding milk to tea delay gastric emptying?

BackgroundMany preoperative fasting guidelines suggest that hot tea or coffee with milk added should be considered similar to solid food, allowing an interval of 6 h before commencing anaesthesia. There is little evidence to support these instructions, with recent guidelines undecided on the issue. This study aimed to establish whether there was a clinically significant delay in gastric emptying associated with adding a modest amount of milk to tea. MethodsThis randomized controlled crossover study was conducted in 10 healthy volunteers. The paracetamol absorption technique and real-time ultrasound measurement of the cross-sectional area of the gastric antrum were used to assess gastric emptying after ingestion of 300 ml of black tea or 300 ml of tea with milk (250 ml black tea plus 50 ml of full fat milk). ResultsThe mean difference in the time to reach the peak paracetamol concentration (tmax) was −8 min [95% confidence interval (CI) −23.1 to 7] in favour of tea with milk. Ultrasound assessment indicated that the geometric mean of the half-time to gastric emptying (T1/2) after tea without milk was 22.7 (95% CI 12.7–40.9) min and after tea with milk 23.6 (95% CI 13.5–41.0) min (ratio 1.04) (95% CI 0.47–2.29). ConclusionsThis study demonstrated no difference in gastric emptying times when a modest amount of milk was added to tea. These findings suggest that it may be acceptable to allow patients to add a small quantity of milk to their tea or coffee and follow the same fasting restrictions applied to clear fluids.

How useful is paracetamol absorption as a marker of gastric emptying? A systematic literature study.

Functional dyspepsia is a common disorder in primary care and gastroenterology units; however, the pathophysiology is poorly understood. Delayed gastric emptying is present in nearly 40% of patients. We evaluated the validity of the paracetamol absorption test in comparison with scintigraphy for gastric emptying assessment. Studies comparing scintigraphy with paracetamol absorption were selected through a structured Medline search. A correlation coefficient between scintigraphy and paracetamol absorption over 0.6 was considered good, between 0.45 and 0.6 intermediate, and below 0.45 poor. Feasibility was assessed by studying the administration of paracetamol, frequency of blood sampling, duration of the test period, and parameters used in the analysis. Thirteen studies were identified, eight (127 subjects) found a good correlation between scintigraphy and paracetamol absorption, two studies (28 subjects) found a moderate correlation, and three (25 subjects) found no correlation. Parameters used were area under the curve (N = 9), fixed-time concentrations (N = 6), concentration-max (N = 4) and time-to-concentration-max (N = 5). Repetitive blood samples ranged from 6 to 20 samples. The durations were 1.5-8 h. In conclusion, the paracetamol absorption technique generally correlates well to scintigraphy of liquid phase gastric emptying. The execution and outcome parameters however need further standardization to optimize its' value for clinical use and research purposes.

Evaluation of standard haemodynamic tests of autonomic function and HbA1c as predictors of delayed gastric emptying in patients with type 1 diabetes mellitus.

We examined the relation between chronic glycaemic control (using glycosylated haemoglobin), haemodynamic autonomic function and rate of gastric emptying in 16 patients with type 1 diabetes mellitus. Gastric emptying was measured using a paracetamol absorption technique. Parameters of gastric emptying include area under the plasma paracetamol concentration time curve. Patients were classified as diabetic autonomic neuropathy positive or negative using five standardized haemodynamic reflex tests. Area under the plasma paracetamol concentration time curve in the neuropathy positive (10.36 (4.5) mmol.-1. min) and negative (9.84 (3.0) mmol.-1. min) groups were similar (.P.=0.42) using unpaired Student's.t. -tests. Glycosylated haemoglobin concentration and area under the plasma paracetamol concentration time curve (.n.=16) demonstrated a Pearson's correlation co-efficient of 0.24. Neither tests of haemodynamic autonomic function, nor concentration of glycosylated haemoglobin, are predictive of diabetic gastroparesis.

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

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

Effect of anxiety on the rate of gastric emptying of liquids

The efficacy of preoperative fasting is reduced in the presence of any factor which delays gastric emptying. We examined the association between anxiety and gastric emptying in adult patients undergoing elective surgery. Immediately before operation, 21 patients completed both a Spielberger state trait inventory (used to quantify current anxiety state (STAIs) and anxiety predisposition (STAIt)), and the Amsterdam preoperative anxiety and information scale (used to quantify anxiety and need for information). Gastric emptying was measured using the paracetamol absorption technique. Four to 10 weeks later, gastric emptying and STAI were measured again. Patients were more anxious before than after operation (STAIs = mean 35.4 (SD 10.9) and 25 (4.1), respectively; P = 0.0004). Neither anxiety state (P = 0.40) nor measures of anxiety relative to anxiety predisposition (P = 0.86) influenced gastric emptying (as measured by area under the paracetamol absorption-time curve). This contrasts with previous findings that anxiety in patients with low anxiety predisposition scores delays gastric emptying.

An evaluation of gastric emptying times in pregnancy and the puerperium.

In a controlled study, gastric emptying was measured during the three trimesters of pregnancy and after delivery, using an indirect paracetamol absorption technique. The peak plasma paracetamol concentration, time to reach the peak, and the area under the plasma paracetamol concentration-time curve, were determined. As compared to nonpregnant controls, there were no significant differences in the gastric emptying times of women in the three trimesters of pregnancy and of mothers from 18 h after delivery onwards. Gastric emptying was significantly delayed in mothers within 2 h after delivery (p < 0.01); median (range) values of peak paracetamol concentration, time to reach the peak and the area under the paracetamol concentration-time curve for this group were 12.5 (0.2-30.5) mg.l-1, 120 (30-120) min and 3.8 (0.1-16.6) mg.l-1 x h respectively, and 20.8 (8.6-64.5) mg.l-1, 40 (10-120) min and 13.5 (5.5-28.8) mg.l-1 x h respectively, for the nonpregnant control group (p < 0.01). Repeated measurements of gastric emptying in these women on the second postpartum day showed no significant delay.