Postprandial Symptoms Research Articles

Association between nutritional status assessed by body mass index and Crohn's disease phenotype: A Nation-wide analysis

Background & aimsIncidence of obesity and Crohn's disease (CD) is increasing globally. Therefore, understanding any associations between adiposity and disease phenotype is crucial. We aimed explore the relationship between nutritional status measured by body mass index (BMI) and phenotypes of CD using a large national recallable data set. MethodsUsing National Institute for Health and Care Research-IBD Bioresource data base, we retrospectively assessed the relationship between BMI and stenosing CD by logistic regression. BMI was the primary variable of interest; CD behaviour was the dependent variable; stenosing CD was the primary outcome. Confounders were adjusted for in a multivariate model. Results8797 patients diagnosed between 1942 and 2020 were included. Mean overall BMI was 26.3 kg/m2 (SD5.5). 52.7 % had a BMI ≥25 kg/m2 (mean 30.2 kg/m2, SD 4.5). Majority had inflammatory CD (62.9 %) followed by stenosing (25.1 %) and penetrating CD (12 %). Stenosing and penetrating phenotypes were more common in the <25 kg/m2 BMI group (50.7 %, 50.3 % respectively) p < 0.001. Colonic disease location was more common (27.8 % vs 24.3 %, p = 0.001) in patients with high BMI. On univariate analysis, stenosing disease was positively associated with ileal disease location, disease duration, previous surgery, use of infliximab, ustekinumab, vedolizumab, adalimumab and azathioprine but negatively associated with BMI (OR 0.98, 95%CI [0.968–0.99]). On multivariate analyses, BMI remained negatively associated with stenosing CD (OR 0.98, 95%CI [0.97–0.99]); ileal disease location (OR 3.69, 95%CI [3.22–4.24]), adalimumab (OR 1.47, 95%CI [1.30–1.66]), ustekinumab usage (OR 1.51, 95%CI [1.14–2.01] and azathioprine (OR 1.35, 95%CI [1.19–1.53]). ConclusionsAfter multivariate analyses, BMI, ileal disease location and biologic use was negatively associated with a stenosing disease phenotype. This might reflect a change in eating behaviour due to persistent postprandial symptoms related to stenosing disease. Large longitudinal studies are needed to investigate any possible temporal relationship between the obesogenic state and intestinal fibrosis.

Postprandial Symptoms in a Mixed-Meal-Test after Bariatric Surgery - Clinical Experience and a Critical Review of Dumping Syndrome Definition and Management.

Introduction Despite recent attempts to reach a consensus on the diagnostic criteria and treatment of Dumping Syndrome (DS) after bariatric surgery, many questions about the clinical applicability and significance of standardized provocation tests remain unanswered. The objective of this study is to retrospectively evaluate a mixed-meal-test (MMT) based on general nutritional recommendations after bariatric surgery and its clinical value in diagnosing DS. Methods The MMT contained 15.5g of protein, 10g of fat, 20.7g of carbohydrates, and 3.1g of dietary fiber, totaling 241 kcal. Symptoms based on the Sigstad Score, along with blood sugar, hematocrit, pulse rate, and blood pressure, were collected as primary readouts. The analysis included 58 MMTs from 56 patients who reported postprandial symptoms indicative of DS and were referred to the clinic by surgeons or general practitioners. Results Although all individuals reported significant symptoms at home, the MMT showed a positive symptom score (Sigstad Score ≥7) in only 16 cases (28%). Neither a heart rate increase &gt;10 BPM nor the 3% hematocrit increase suggested as cut-offs for early DS by the consensus paper were associated with the Sigstad Score or individually reported symptoms. None of the participants had a glucose decrease below 50 mg/dl; one fell below 60 mg/dl and 14 fell below 70 mg/dl. A blood glucose decrease below 70 mg/dl was not associated with symptoms. Conclusion The MMT showed that only a minority of patients reported classical DS symptoms under controlled conditions. Changes in hematocrit, heart rate, and blood sugar decrease below 70mg/dl did not help to predict symptoms in the individuals studied. The data, in the context of existing evidence, suggest that provocation tests have little value in clinical practice and that DS as a clinical entity after bariatric surgery should be reevaluated.

Assessment of Gastric Remnant Activity, Symptoms, and Quality of Life Following Gastric Bypass.

While most gastric bypass patients recover well, some experience long-term complications, including nausea, abdominal pain, food intolerance, and dumping. This study aimed to evaluate symptoms and quality of life (QoL) in association with the residual activity of the remnant stomach. Patients undergoing gastric bypass and conversion-to-bypass were recruited. The Gastric Alimetry® System (Auckland, NZ) was employed, comprising a high-resolution electrode array, wearable reader, and validated symptom logging app. The protocol comprised 30-min fasting baseline, a 218-kCal meal stimulus, and 4-h of post-prandial recordings. Symptoms and QoL were evaluated using validated questionnaires. Remnant gastric electrophysiology evaluation included frequency, BMI-adjusted amplitude, and Gastric Alimetry Rhythm Index (GA-RI, reflecting pacemaker stability), with comparison to validated reference intervals and matched controls. Thirty-eight participants were recruited with mean time from bypass 46.8 ± 28.6months. One-third of patients showed moderate to severe post-prandial symptoms, with patients' median PAGI-SYM 28 ± 19 vs controls 9 ± 17 (p < 0.01); PAGI-QOL 37 ± 31 vs 135 ± 22 (p < 0.0001). Remnant gastric function was markedly degraded shown by undetectable frequencies in 84% (vs 0% in controls) and low GA-RI (0.18 ± 0.08 vs 0.51 ± 0.22 in controls; p < 0.0001; reference range > 0.25). Impaired GA-RI and amplitude were correlated with worse PAGI-SYM and PAGI-QOL scores. One-third of post-bypass patients suffered significant upper GI symptoms with reduced QoL. The bypassed remnant stomach shows highly deranged electrophysiology in-situ, reflecting disuse degeneration. These derangements correlated with QoL; however, causality is not implied by the present study.

8202 Retrospective Analysis of Mixed-Meal Testing in People with Suspected Spontaneous Post-Prandial Hypoglycemia

Abstract Disclosure: N. Sankaran: None. R. Jalleh: None. C. Bischoff: None. C. Marathe: None. Introduction: While there is no consensus on the optimal confirmatory test for postprandial hypoglycemia, guidelines suggest evaluation with a mixed meal test that is most likely to provoke symptoms of hypoglycemia as nominated by the patient. However, studies evaluating post-bariatric surgery hypoglycemia indicate that meals with a lower carbohydrate content are less likely to be associated with postprandial hypoglycemia. It is hypothesized that a greater carbohydrate load may result in an excessive second-phase insulin response resulting in hypoglycemia. We evaluated the outcomes of consecutive mixed meal tests in individuals with suspected spontaneous postprandial hypoglycemia and the relationship with the percentage carbohydrate content of the test meal. Methods: We retrospectively analysed the data of 103 unselected patients who were referred to undergo a 5-hour mixed meal test following an overnight fast, between the years 2010 - 2023 at the Royal Adelaide Hospital. Correlations were determined using a linear regression model and Student’s t-test was used to compare the mean carbohydrate meal content in those with and without postprandial hypoglycemia. Outcomes: Outcomes that were measured included post-meal blood glucose, plasma insulin, plasma C-peptide levels and the macronutrient composition of the meal. Subjective reporting of symptoms during the test were also noted and correlated with the symptoms included in the Edinburgh Hypoglycemia Score. Results: 33/103 participants were excluded as they had previously undergone islet cell transplant or bariatric surgery. Out of the remaining 70 participants referred for confirmatory MMT testing, 51 were female and 19 were male. The ages of the participants ranged from 16 to 74, with the median age of 40 years. 9 participants (6 females and 3 males) had abnormal results with glucose below 3.0mmol/L. 34 participants experienced hypoglycemia with glucose levels recorded below 4.0mmol/L during the test. There was no difference in carbohydrate content consumed (61.1g, P=0.30) or percentage carbohydrate (64.5%, P=0.17) in the group without postprandial hypoglycemia compared with those with postprandial hypoglycemia (carbohydrate content 67.9 g, 69.6% carbohydrate). No correlation could be identified between the percentage of carbohydrate content of the meal with the glucose nadir (P=0.75), peak insulin concentration (P=0.99) or peak C-peptide concentration (P=0.40). The percentage of carbohydrate content of the meal was neither associated with hypoglycemia (P=0.17) or symptoms (P=0.41). Conclusion: On mixed meal testing, postprandial symptoms and hypoglycemia does not correlate with either carbohydrate load or the percentage carbohydrate content of the nominated meal. Presentation: 6/1/2024

Efficacy of Semaglutide in Reactive Hypoglycemia Related to Dumping Syndrome after Bariatric Surgery.

Postprandial hypoglycemia induced by Dumping Syndrome (DS) represents a side effect of bariatric surgery linked to glucose-dependent hyperinsulinemia, which can cause serious symptoms 2-3 hours after the meal hypoglycemia. This clinical case shows the effectiveness of semaglutide, a long-acting GLP1 receptor agonist, in one patient previously subjected to gastric bypass (GBP), with persistent late postprandial hypoglycaemic symptoms occurring after surgery. A female patient, 31 years old, subjected to GBP 10 years earlier, with the diagnosis of diabetes, was admitted to our unit for persistent post-prandial reactive hypoglycemia, confirmed by Flash Glucose Monitoring (FGM) FreeStyle. The patient was intolerant to metformin, had been treated with acarbose with poor results. HbA1c 7.9%. Acarbose was suspended, and semaglutide was started sc at increasing doses, 0.25 mg/week for 1 month and subsequently 0.5 mg/week. After the first few weeks, symptoms of DS were significantly reduced with improvement of the daily glycemic profile and disappearance of hypoglycemic events. The time-below range, time spent with blood glucose <70 mg/dl, decreased by 12% to 4% during treatment with semaglutide 0.25 mg/week, up to 1% with a dose of 0.5 mg/week. The effect of the drug on reducing hypoglycemic episodes was persistent for up to 8 months. Treatment of post-bariatric reactive hypoglycemia includes nutritional therapy, the use of glucosidase inhibitors, and somatostatin analogues. The use of short-acting GLP-1RA analogues has also recently been reported. In our patient, therapy with semaglutide s.c. significantly reduced episodes of reactive hypoglycemia with an improvement in the quality of life.</p>.

Air Swallowing and Breathing Exercises Reduce the Severity of Acute Gastroesophageal Reflux Symptoms and Give a Clue into the Role of Oxygen in Digestion: A Case Report with Extended Discussion

A case is reported where a patient, after using a tooth whitening gel containing the active ingredient hydrogen peroxide over 2 days, found that the expected onset of postprandial gastroesophageal reflux symptoms (RS) did not occur. Hydrogen peroxide can also be formed when oxygen in air dissolves in water contained in the gut lumen and so the role of oxygen, rather than potentially toxic hydrogen peroxide, was investigated as a treatment for RS. Air swallowing can provide oxygen to the gut lumen, and breathing exercises can supply oxygen from the blood to the gut epithelium. Air swallowing and breathing exercises (ASBE) were performed as required over 34 days, and it was found that a single ASBE session (3-8 ASBE over 30 seconds) brought temporary relief from RS over 1-2 hours. Up to 3 sessions of ASBE were required and resolved RS over 74% of days, reducing the need to take antacid tablets. To understand the impact oxygen could have on RS, the oxidation potential for oxygen, calculated as mmol electrons/100 ml (2-3 breaths) of swallowed air, was calculated and compared to the reported values for the antioxidant content of various foods. It was found that 100 ml of swallowed air has the potential to oxidize 1 serving of coffee, red wine, or orange juice, known refluxogenic or trigger foods that can cause RS. Based on the finding that ASBE can reduce RS and a brief review of the role oxygen plays in digestion, a hypothetical oxygen model for digestive reflux was proposed. For the model, the reflux of digesting food to the more oxygenated esophageal regions is triggered by refluxogenic foods high in antioxidants that react with oxygen in the lumen to create an inadequate supply necessary for aerobic digestion, resulting in gastroesophageal reflux. As the ASBE did not resolve all RS, with ≈26% remaining unresolved, the oxygen supply was considered only a part of the complex digestive reflux mechanism.

Double-blind, randomized, 8-week multicenter study of the efficacy and safety of STW 5-IIversus placebo in functional dyspepsia.

Herbal products are widely used to treat patients with disorders of gut brain interaction but clinical efficacy and safety data for treatments lasting >4 weeks are widely lacking. We evaluated the efficacy and safety of 8 weeks of treatment with the herbal combination product STW 5-II for patients with functional dyspepsia (FD) meeting Rome II criteria. We also conducted a post hoc analysis including patients meeting Rome IV criteria for FD and evaluated the effect of the G-protein beta 3 (GNB3) subunit polymorphism (C825T) on therapeutic response. This multicenter, placebo-controlled, double-blind study included 272 FD patients meeting Rome II criteria in the intention-to-treat cohort and 266 meeting Rome IV criteria. We used the validated Gastrointestinal Symptom Score (GIS) to assess GI symptoms, defining response rate as the proportion of patients with ≥50% GIS improvement in at least three of four assessments. After 8 weeks, the response rate was significantly higher in the STW 5-II group versus placebo (61.2% vs 45.1%, P = 0.008). Mean GIS non-significantly improved with STW 5-II treatment (7.9 ± 4.41 vs 6.7 ± 4.91 with placebo; P = 0.07). In the Rome IV subgroup analysis, STW 5-II yielded a better response rate (P = 0.01) versus placebo and greater postprandial distress symptom improvement (P = 0.04) versus placebo. Safety parameters did not differ between groups, and GNB3 status was not linked with therapeutic response. STW 5-II is efficacious, with no observed safety signals at up to 8 weeks of treatment in patients with FD meeting Rome II or IV criteria.

Air Swallowing and Breathing Exercises Reduce the Severity of Acute Gastroesophageal Reflux Symptoms and Give a Clue into the Role of Oxygen in Digestion: A Case Report with Extended Discussion

A case is reported where a patient, after using a tooth whitening gel containing the active ingredient hydrogen peroxide over 2 days, found that the expected onset of postprandial gastroesophageal reflux symptoms (RS) did not occur. Oxygen in air dissolves in water contained in the gut lumen to form hydrogen peroxide, and so the role of oxygen, rather than potentially toxic hydrogen peroxide, was investigated as a treatment for RS. Air swallowing can provide oxygen to the gut lumen, and breathing exercises can supply oxygen from the blood to the gut epithelium. Air swallowing and breathing exercises (ASBE) were performed as required over 34 days, and it was found that a single ASBE session (3-8 ASBE episodes over 30 seconds) brought temporary relief from RS over 1-2 hours. Up to 3 sessions of ASBE were required and resolved RS over 74% of days, reducing the need to take antacid tablets. To understand the impact oxygen could have on RS, the oxidation potential for oxygen, calculated as mmol electrons/100 ml (2-3 breaths) of swallowed air, was calculated and compared to the reported values for the antioxidant content of various foods. It was found that 100 ml of swallowed air has the potential to oxidize 1 serving of coffee, red wine, or orange juice, known refluxogenic or trigger foods that can cause RS. Based on the finding that ASBE can reduce RS and a brief review of the role oxygen plays in digestion, a hypothetical oxygen model for digestive reflux was proposed. For the model, the reflux of digesting food to the more oxygenated esophageal regions is triggered by refluxogenic foods high in antioxidants that react with oxygen in the lumen to create an inadequate supply necessary for aerobic digestion, resulting in gastroesophageal reflux. As the ASBE did not resolve all RS, with ≈26% remaining unresolved, the oxygen supply was considered only a part of the complex digestive reflux mechanism.

Binge eating symptomatology in adolescents with polycystic ovary syndrome

Several factors may contribute to binge eating behaviors in PCOS. However, findings are contradictory and studies in the adolescence are limited. We aimed to evaluate the eating attitudes of adolescents with PCOS and the possible etiological factors underlying the association between PCOS and binge eating symptomology. Between 2019 and 2022, 46 newly diagnosed adolescents with PCOS and 56 controls matched for age and BMI z-score were included. The Eating Disorder Examination Questionnaire, Three Factor Eating Questionnaire-R18, and a questionnaire assessing postprandial reactive hypoglycemia symptom severity were given. Binge eating symptomology, in terms of over, uncontrolled, and emotional eating, were more prevalent in the PCOS group. Uncontrolled, emotional, and binge eating were positively correlated with postprandial reactive hypoglycemia symptom score. Overeating was also associated with clinical hyperandrogenism. Improving the disease outcome and reducing the future complications requires early recognition and management of emotional and uncontrolled eating behaviors in adolescents with PCOS.

Clinical Practice Guidelines for the Diagnosis and Management of Hereditary Fructose Intolerance.

Hereditary fructose intolerance or hereditary fructosemia is an autosomal recessive metabolic disorder caused by a loss of function in the aldolase B gene. This disorder affects 1 in 20,000 people, constituting a rare disease with a favorable prognosis through adherence to a fructose-free diet. Despite dietary management, chronic pathology may manifest, underscoring the importance of early diagnosis to mitigate adverse effects. However, early detection of the disease poses significant challenges. Our aim was to compile pertinent information on the differential diagnosis of this pathology based on patient symptoms, facilitating the development of a diagnostic algorithm for early identification. A systematic review adhering to PRISMA guidelines was conducted on empirical studies from PubMed, encompassing a total of 35 studies. Individuals with fructose intolerance may acutely experience postprandial symptoms such as hypoglycemia, vomiting, and abdominal distension. Despite proper treatment, chronic complications such as fatty liver, Fanconi syndrome, growth deficiency, and irritable bowel syndrome may arise. The proposed diagnostic algorithm aims to minimize these adverse processes. Understanding the pathogenesis enables prompt diagnosis and prevention of chronicity. Establishing continuity of care from pediatric to adult medicine is crucial, and disseminating information to non-pediatric endocrinologists is imperative for managing this rare disease.

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.

HPB P28 Continuous glucose monitoring improves the diagnosis of insulinoma and surveillance after endoscopic ablation therapy

Abstract Background Insulinomas are the most common functioning pancreatic neuroendocrine tumours (PNET) and are classically diagnosed according to Whipple’s triad. The gold-standard diagnostic test (72 hour fasting glucose/C-peptide) is difficult for patients, and risks mis-diagnosing patients who only experience post-prandial symptoms. Moreover, the advent of endoscopic ablative techniques means that confirming successful treatment can be challenging when compared with surgical resection. This study aimed to investigate the value of continuous glucose monitoring (CGM) to: a) confirm the diagnosis of insulinoma; b) guide symptom management whilst awaiting definitive treatment; and c) as a surveillance tool in patients electing for non-surgical interventions. Methods A 61-year-old healthy male presented with post-prandial sweating, vacant episodes and reduced exercise tolerance which resolved upon consuming glucose. Computed Tomography demonstrated a 2cm exophytic hypervascular lesion in the pancreatic body, consistent with a NET, and correlated with an Octreotide avid lesion upon SPECT/CT. Overnight fasting glucose/c-peptide was not confirmatory. The target glucose range was defined as 4.0-9.9 mmol/L and critical hypoglycaemia as ≤2.9mmol/L. Data from CGM were analysed (Time in range and critical hypoglycaemia [Chi2]; glycaemic control and glycaemic variability [T-test]) during diagnosis, in the first week post-ablation, and the recovery phase beyond 3 weeks. Results Data from 22,008 glucose levels were analysed over a 90 day period. Time in range during diagnosis was 67.25%, 82.8% (p&amp;lt;0.0001) post-ablation, and 98.9% (P&amp;lt;0.0001) during recovery. Critical hypoglycaemia occurred in 5.2% of measurements during diagnosis, 1.9% (p&amp;lt;0.0001) post-ablation, and 0.1% (p&amp;lt;0.0001) during recovery. Glucose levels (mean [SD] mmol/L) were 4.4 (0.47) during diagnosis, 4.9 (0.29) (p=0.0001) post-ablation, and 5.7 (0.42) (p&amp;lt;0.0001) during recovery. Glycaemic variability (mean [SD] %CV) was 19.4 (5.09) during diagnosis, 20.17 (5.60) post-ablation (p=0.630), and 11.3 (5.53) (p&amp;lt;0.0001) during recovery. Temporal changes identifying post-prandial hypoglycaemia during diagnosis, and resolution during recovery, are illustrated (Figure 1). Conclusions CGM has utility to accurately diagnose insulinoma when standard tests are negative, and to improve quality of life by alerting patients to life-threatening critical hypoglycaemia. As parenchymal preserving non-operative therapies increase in popularity, especially for patients with small PNETs, sensitive, reliable, and acceptable surveillance techniques are required in order to confirm treatment success and monitor for recurrence. Proactive engagement with commissioning and regulatory bodies is necessary in order to harness the potential from emerging technologies, so that PNET patients can benefit in a similar manner as those with type 1 Diabetes Mellitus.

Modern aspects of managing patients with non-erosive reflux disease

A review of current data on the management of patients with non-erosive reflux disease (NERD) was made. Diagnosis of gastroesophageal reflux disease (GERD) is based on symptom analysis, endoscopic evaluation of the esophageal mucosa, objective evidence of gastric contents reflux into the esophagus during pH-impedancemetry, and response to therapeutic intervention. Treatment for GERD should include weight loss if overweight, lifestyle modification, and dietary modification. Current consensus recommends starting NERD treatment with once-daily proton pump inhibitors (PPIs), but only 50% of patients with this pathology respond to such therapy. Incomplete response to PPIs is a reason to increase the dose of PPI and add Gaviscon to treatment to neutralize the post-prandial “acid pocket”. Gaviscon is especially effective in patients with postprandial or nocturnal symptoms and in those with hiatal hernia. The mechanism of action of Gaviscon is based on the formation of an alginate “raft” on the surface of the gastric contents, which neutralizes the acid and blocks its pathological effect to esophageal mucosa. A modern meta-analysis on the NERD treatment, which included 23 studies and 10,735 patients, showed the efficacy of Gaviscon monotherapy comparable to PPIs in treatment for 4 weeks. The combination of a PPI with Gaviscon offers the opportunity to optimize response to treatment in NERD patients with an incomplete response to PPIs monotherapy. The Russian Gastroenterological Association thinks that alginates can be used both as monotherapy for mild clinical variants of NERD and in complex treatment regimens for various GERD variants.

Long-Term Outcomes of Pylorus-Preserving Gastrectomy for Early Gastric Cancer.

In the short term, pylorus-preserving gastrectomy (PPG) has been reported to have advantages over distal gastrectomy (DG) with regard to postprandial symptoms and dumping syndrome. We aimed to evaluate the quality of life after PPG for early gastric cancer in the long term in comparison to that after DG. Twenty-six patients who underwent gastrectomy (11 PPG, 15 DG) for early gastric cancer at Osaka University Hospital participated and were followed for more than 4years. Body weight changes, nutritional status, dual-phase scintigraphy findings, endoscopic survey results, and questionnaire responses after gastrectomy were examined. There were significantly lower ratios of weight changes in PPG than in DG, 5years after surgery. There were no differences in the clinicopathological characteristics, nutritional parameters, questionnaire responses, and endoscopic findings between the two groups. Based on gastric scintigraphy, although the gastric emptying of liquids showed similar curves in the two groups, gastric emptying of solids was significantly slower in the PPG group than in the DG group (P = .039). PPG had advantages with regard to long-term outcomes over DG in terms of weight maintenance and the prevention of rapid gastric emptying. PPG might be efficient in patients with early gastric cancer.

Non-diabetic hypoglycaemia

Hypoglycaemia is diagnosed by the presence of symptoms of hypoglycaemia, documented low plasma glucose (often less than 50 mg/dl) at the time of symptoms, and recovery of symptoms by correction of glucose. If plasma glucose is normal at the time of symptoms, causes other than hypoglycaemia should be considered. If hypoglycaemia has been documented, the cause of hypoglycaemia should be investigated. Only after documentation of spontaneous endogenous insulin secretion causing hypoglycaemia should we proceed with localization of the tumor. Surgery will cure hypoglycaemia in about 90% of patients with insulinoma. Dumping syndrome can cause postprandial symptoms in people who have had upper gastrointestinal (GI) surgery (and rarely without surgery). The symptom complex in dumping syndrome includes the ones caused by GI stretching and GI hormones, or hypoglycaemia, or both. Dumping syndrome often needs to be managed by dietary interventions with or without pharmacotherapy.

Postprandial effect of gastrointestinal hormones and gastric activity in patients with irritable bowel syndrome

Altered gut regulation, including motor and secretory mechanisms, is characteristic of irritable bowel syndrome (IBS). The severity of postprandial symptoms in IBS patients is associated with discomfort and pain; gas-related symptoms such as bloating and abdominal distension; and abnormal colonic motility. The aim of this study was to assess the postprandial response, i.e., gut peptide secretion and gastric myoelectric activity, in patients with constipation-predominant IBS. The study was conducted on 42 IBS patients (14 males, 28 females, mean age 45.1 ± 15.3 years) and 42 healthy participants (16 males, 26 females, mean age 41.1 ± 8.7 years). The study assessed plasma gut peptide levels (gastrin, CCK—Cholecystokinin, VIP—Vasoactive Intestinal Peptide, ghrelin, insulin) and gastric myoelectric activity obtained from electrogastrography (EGG) in the preprandial and postprandial period (meal–oral nutritional supplement 300 kcal/300 ml). Mean preprandial gastrin and insulin levels were significantly elevated in IBS patients compared to the control group (gastrin: 72.27 ± 26.89 vs. 12.27 ± 4.91 pg/ml; p < 0.00001 and insulin: 15.31 ± 12.92 vs. 8.04 ± 3.21 IU/ml; p = 0.0001), while VIP and ghrelin levels were decreased in IBS patients (VIP: 6.69 ± 4.68 vs. 27.26 ± 21.51 ng/ml; p = 0.0001 and ghrelin: 176.01 ± 88.47 vs. 250.24 ± 84.55 pg/ml; p < 0.0001). A nonsignificant change in the CCK level was observed. IBS patients showed significant changes in postprandial hormone levels compared to the preprandial state—specifically, there were increases in gastrin (p = 0.000), CCK (p < 0.0001), VIP (p < 0.0001), ghrelin (p = 0.000) and insulin (p < 0.0001). Patients with IBS showed reduced preprandial and postprandial normogastria (59.8 ± 22.0 vs. 66.3 ± 20.2%) compared to control values (83.19 ± 16.7%; p < 0.0001 vs. 86.1 ± 9.4%; p < 0.0001). In response to the meal, we did not observe an increase in the percentage of normogastria or the average percentage slow-wave coupling (APSWC) in IBS patients. The postprandial to preprandial power ratio (PR) indicates alterations in gastric contractions; in controls, PR = 2.7, whereas in IBS patients, PR = 1.7, which was significantly lower (p = 0.00009). This ratio reflects a decrease in gastric contractility. Disturbances in the postprandial concentration of gut peptides (gastrin, insulin and ghrelin) in plasma may contribute to abnormal gastric function and consequently intestinal motility, which are manifested in the intensification of clinical symptoms, such as visceral hypersensitivity or irregular bowel movements in IBS patients.

Gastroesophageal reflux disease in conditions of chronic stress. Review with own observation

It is known that 20 to 42% of patients receiving a proton pump inhibitor for the treatment of gastroesophageal reflux disease do not respond satisfactorily to it. This condition is called refractory gastroesophageal reflux disease. To achieve a therapeutic effect, it is advised to use H2‑receptor antagonists, alginates, baclofen or antidepressant therapy in complex treatment. Recent years, solutions containing sodium alginate have been widely used. These drugs reduce the severity and frequency of heartburn when used postprandially as adjunctive therapy to proton pump inhibitors in patients with gastroesophageal reflux disease. The alginates, available in the US and European markets, differ, with the latter containing higher concentrations of alginate, possibly contributing to higher efficiency. This is supported by some researchers reporting rapid efficacy for both postprandial and nocturnal symptoms in patients with refractory gastroesophageal reflux disease. Given the absence of significant side effects, it is advised to use alginates as an addition to proton pump inhibitors, taking into account the availability, as well as the preferences of the doctor and patient.&#x0D; The article presents modern scientific data on a widespread Gastroenterological disease — GERD in the context of the impact of stress factor on its course. The analysis was performed of the recent investigations, aimed at the study of the mechanisms of traumatic effect of psychosocial and psychoemotional stress on the functional activity of the upper gastrointestinal tract. The results of the study of the role of anxiety‑phobic and depressive disorders because of prolonged exposure to stressors were analyzed. The author presented data of his own research, which clearly demonstrated a significant increase of frequency and level of anxiety and depression under wartime stress. It has been established that combination of gastroesophageal reflux disease with anxiety and depression exacerbates the clinical manifestations of the disease and reduces the effectiveness of treatment, which requires an individual approach to the choice of therapeutic measures. It is advisable to use antacids and alginic acid preparations, as well as methods of psychological correction, along with proton pump inhibitors or instead of them.

Colloid gastric emptying with SPECT-CT after oesophagectomy.

Scintigraphic analysis of gastric motility uses the rate of gastric emptying by measuring radioactivity remaining in the stomach at pre-defined points in time. It helps to assess unresolved symptoms of functional gastrointestinal disorders such as gastroparesis. Delayed gastric emptying can occur in post-oesophagectomy patients. Squamous cell carcinoma of the esophagus is a common indication for oesophagectomy. In such patients presenting with post-prandial symptoms of bloating, nausea or vomiting, colloid scintigraphy can play a vital role in evaluation of their symptoms. We present an interesting image of a post-oesophagectomy patient with persistent gastric dilatation suspected of delayed gastric emptying.

Novel insights in the pathophysiology and management of functional dyspepsia.

Functional dyspepsia is a common functional gastrointestinal disorder with bothersome symptoms in the upper abdomen without an organic lesion that is likely to explain the complaints. Traditionally, changes in gastric physiology were held responsible for the symptoms, including delayed gastric emptying, impaired gastric accommodation and hypersensitivity to distension. However, gastric sensorimotor disturbances correlated only poorly to symptom severity and treatments targeting these abnormalities are not very effective. In the last decade, the duodenum has been identified as a key integrator in the pathophysiology of functional dyspepsia with an impaired barrier function and immune activation with a particular role for eosinophils and mast cells. Moreover, changes in the duodenal microbiota were associated to dyspeptic symptoms and eosinophil counts. PPIs – still the first line treatment for functional dyspepsia – have been shown to reduce symptoms through anti-inflammatory effects in the duodenum, similar to their effect in eosinophilic esophagitis. Finally, specific probiotic strains were effective in improvement of postprandial symptoms, most likely through an anti-inflammatory effect as demonstrated by reduced Th17 signaling. These novel insights in pathophysiology and treatment provide novel hope for patients with this challenging condition.

The relationship between fermentable carbohydrates and post-prandial bowel symptoms in patients with functional bowel disorders.

A low fermentable oligosaccharide, disaccharide, monosaccharide, and polyols (FODMAP) diet alleviates symptoms of irritable bowel syndrome (IBS). We aimed to investigate the relationship between habitual FODMAP intake and post-prandial bowel symptoms in adults with IBS, functional diarrhoea (FD), or constipation (FD) (functional bowel disorders), and in healthy adults (controls). 292 participants (173 with functional bowel disorders and 119 controls) completed a food and symptom times diary. Estimated meal portion sizes were entered into the Monash FODMAP Calculator to analyse FODMAP content. Wilcoxon and ANOVA tests were used to investigate the relationship between FODMAP intake and post-prandial bowel symptoms. IBS participants experienced more post-prandial bowel symptoms compared to participants with other functional bowel disorders or controls. Meals associated with abdominal pain contained on average increased excess fructose (0.31 g vs. 0.18 g, p < 0.05), sorbitol (0.27 g vs. 0.10 g, p < 0.01), and total FODMAP (3.46 g vs. 2.96 g, p < 0.05) compared to meals not associated with pain. Abdominal swelling was associated with increased sorbitol (0.33 g vs. 0.11 g, p < 0.01), and total FODMAP (3.26 g vs. 3.02 g, p < 0.05) consumption. Abdominal bloating was associated with increased galacto oligosaccharide consumption (0.18 g vs. 0.14 g, p < 0.05). These findings support the role of FODMAP in post-prandial bowel symptom onset, however, the amount and type of FODMAP triggering symptoms vary between individuals. Future research should investigate the relationship between the effect of individual FODMAP consumption on post-prandial bowel symptoms for each subtype, the interaction of FODMAP with differing functional bowel disorders and whether longitudinally symptoms and dietary intake are stable.