Satiety Test Research Articles

The Formula of Jelly Drink Banana Fruit (Musa paradisiaca Typical) and Soybeans (Glycine max L. MERR) for Obesity

The diversity of food and beverage products is very important, especially for the needs of weight loss for obesesity. Therefore, the development of functional food sourced from local raw materials is needed. Therefore, the aim of this research is to find a jelly drink product formula made from bananas and soybeans for obesity sufferers. This research was a completely randomized design (CRD). Organoleptic tests on color, taste, aroma and texture parameters of three Jelly drink formula. The analysis of chemical and physical properties is obtained from the laboratory, and is followed by a test of satiety and desire to eat (desire to eat). Data analysis used descriptive statistical analysis and continued with Anova analysis. The results of this research found that the jelly drink formula (A) had the highest score of the jelly drink formula (B) and (C. The average test value of jelly drink formula (A) is higher than jelly drink formula (B) and (C). However, the chemical and physical properties tests between formula (A) and (B) and (C) have significant differences. Furthermore, formula (A) contains 24.27% ripe banana and soybeans, 1.45% carrageenan, 0.48% citric acid, and 0.97% tropicana slim sugar from a total of 206 grams of ingredients. Jelly drinks have the highest organoleptic value and nutritional content for suitable for obesesity. The results of the satiety test showed that 46.66 respondents felt full for 2.5 hours, and only 20 respondents felt full for 1.5 hours after consuming jelly drink products. Therefore, formula (A) can be as a functional food for obesity.

Low Vitamin D Levels in Patients with Symptoms of Gastroparesis: Relationships with Nausea and Vomiting, Gastric Emptying and Gastric Myoelectrical Activity

Patients with gastroparesis (Gp) often have diets deficient in calories, electrolytes, and vitamins. Vitamin D levels have been reported to be low in some patients with Gp but has not been systematically studied.AimsTo determine vitamin D levels and relationships among symptoms, gastric emptying and gastric myoelectrical activity (GMA) in patients with symptoms of Gp.Methods25-hydroxy-vitamin D was measured in patients at enrollment in the Gastroparesis Clinical Consortium Registry. Gastroparesis Cardinal Symptoms Index (GCSI), gastric emptying, and GMA before and after water load satiety test (WLST) were measured. GMA, expressed as percentage distribution of activity in normal and dysrhythmic ranges, was recorded using electrogastrography.ResultsOverall, vitamin D levels were low (< 30 ng/ml) in 288 of 513 (56.1%) patients with symptoms of Gp (206 of 376 (54.8%) patients with delayed gastric emptying (Gp) and 82 of 137 (59.9%) patients with symptoms of Gp and normal gastric emptying). Low vitamin D levels were associated with increased nausea and vomiting (P < 0.0001), but not with fullness or bloating subscores. Low vitamin D levels in patients with Gp were associated with greater meal retention at four hours (36% retention) compared with Gp patients with normal vitamin D levels (31% retention; P = 0.05). Low vitamin D in patients with normal gastric emptying was associated with decreased normal 3 cpm GMA before (P = 0.001) and increased tachygastria after WLST (P = 0.01).ConclusionsLow vitamin D levels are present in half the patients with symptoms of gastroparesis and are associated with nausea and vomiting and gastric neuromuscular dysfunction.

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.

A Randomized, Controlled Trial of Efficacy and Safety of Cannabidiol in Idiopathic and Diabetic Gastroparesis

Cannabis (delta-9-tetrahydrocannabinol), a nonselective cannabinoid-receptor agonist, relieves nausea and pain. Cannabidiol (CBD), a cannabinoid receptor 2 inverse agonist with central effects, also reduces gut sensation and inflammation. We compared the effects of 4 weeks of treatment with pharmaceutical CBD vs placebo in patients with idiopathic or diabetic (diabetes mellitus) gastroparesis. We performed a randomized, double-blinded, placebo-controlled study of CBD twice daily (Epidiolex escalated to 20 mg/kg/d; Jazz Pharmaceuticals, Dublin, Ireland) in patients with nonsurgical gastroparesis with delayed gastric emptying of solids (GES). Symptoms were assessed by the Gastroparesis Cardinal Symptom Index Daily Diary. After 4 weeks of treatment, we measured GES, gastric volumes, and Ensure (Abbott Laboratories, Abbott Park, IL) satiation test (1 kcal/mL, 30 mL/min) to assess volume to comfortable fullness and maximum tolerance. Patients underwent specific FAAH and CNR1 genotyping. Statistical analysis compared 2 treatments using analysis of variance including baseline measurements and body mass index as covariates. Among 44 patients (32 idiopathic, 6 diabetes mellitus type 1, and 6 diabetes mellitus type 2), 5 patients did not tolerate full-dose escalation; 3 withdrew before completing 4 weeks of treatment (2 placebo, 1 CBD); 95% completed 4 weeks of treatment and diaries. Compared with placebo, CBD reduced the total Gastroparesis Cardinal Symptom Index score (P= .008), inability to finish a normal-sized meal (P= .029), number of vomiting episodes/24 hours (P= .006), and overall symptom severity (P= .034). Patients treated with CBD had a higher volume to comfortable fullness and maximum tolerance and slower GES. FAAH rs34420 genotype significantly impacted nutrient drink ingestion. The most common adverse events reported were diarrhea (14 patients), fatigue (8 patients), headache (8 patients), and nausea (7 patients). CBD provides symptom relief in patients with gastroparesis and improves the tolerance of liquid nutrient intake, despite slowing of GES. gov NCT #03941288.

Characteristics and outcomes of patients with gastroparesis using enteral and/or exclusive parenteral nutrition.

Patients with gastroparesis (Gp) may need enteral nutrition (EN) or exclusive parenteral nutrition (PN). Among patients with Gp, we aimed to (1) identify the frequency of EN and exclusive PN use and (2) explore characteristics of patients using EN and/or exclusive PN compared with those using oral nutrition (ON), including changes over 48 weeks. Patients with Gp underwent history and physical examination, gastric emptying scintigraphy, water load satiety testing (WLST), and questionnaires assessing gastrointestinal symptoms and quality of life (QOL). Patients were observed 48 weeks. Of 971 patients with Gp (idiopathic, 579; diabetic, 336; post-Nissen fundoplication, 51), 939 (96.7%) were using ON only, 14 (1.4%) using exclusive PN, and 18 (1.9%) using EN. Compared with patients receiving ON, patients receiving exclusive PN and/or EN were younger, had lower body mass index, and had greater symptom severity. Patients receiving exclusive PN and/or EN had lower physical QOL but not mental QOL or Gp-related QOL scores. Patients receiving exclusive PN and/or EN ingested less water during WLST but did not have worse gastric emptying. Of those who had been receiving exclusive PN and/or EN, 50% and 25%, respectively, resumed ON at 48-week follow-up. This study describes patients with Gp requiring exclusive PN and/or EN for nutrition support, who represent a small (3.3%) but important subset of patients with Gp. Unique clinical and physiological parameters are associated with this subset and provide insight into the use of nutrition support in Gp.

AI-Derived Threshold Score of Intraabdominal Myoelectrical Activity Predicts Presence and Stage of Endometriosis with 100% Accuracy

Study Objective 1) Demonstrate non-invasive cutaneous Electroviscerography (EVG)-detected abnormal gastrointestinal myoelectrical activity (GMA) has 100% accuracy diagnosing endometriosis. 2) Demonstrate GMA-based artificial intelligence (AI)-derived formulae detects endometriosis regardless of hormonal suppression, surgical stage or symptoms. Design Prospective open-labeled study. Setting Clinical center for women's healthcare. Patients or Participants 50 women ages 17-45 with chronic abdominal pain, negative CT or MRI, and gastrointestinal endoscopy, scheduled for laparoscopy. Interventions Baseline EVG w/water load satiety test(WLST) and pain scores, followed by diagnostic laparoscopic surgery w/biopsy. Measurements and Main Results Response to EVG WLST identified specifically elevated GMA frequencies of 15-20(9.5 vs 2.2, p<0.001), 30-40(3.1 vs 0.8, p<0.001) and 50-60(1.1 vs 0.5,p<0.05) compared to known population normals and disease free subjects with abdominal pain. GMA-derived 2 stage Ai-determined threshold (AIET) was calculated to be >0.5, using linear regression of area under curve on first pass and age and pain scores in the second pass, demonstrated 100% selectivity and 100% specificity, respectively. All subjects exceeded AIET and had ASRM stages 1-4 at laparoscopy. AIET scores ranged 0.52 to 8.9, and escalated according to advancing surgical grade. Hormonal suppression did not affect diagnosis. Conclusion Endometriosis-specific abnormalities of GMA post-WLST predicts surgically detected endometriosis w/100% accuracy. AI GMA-derived threshold detects endometriosis with 100% sensitivity and specificity. Hormonal suppression, symptoms and surgical grade of endometriosis did not affect test accuracy. Variations in Ai-derived threshold scores may predict surgical stage of endometriosis. EVG represents an ideal test for the detection and screening of endometriosis. 1) Demonstrate non-invasive cutaneous Electroviscerography (EVG)-detected abnormal gastrointestinal myoelectrical activity (GMA) has 100% accuracy diagnosing endometriosis. 2) Demonstrate GMA-based artificial intelligence (AI)-derived formulae detects endometriosis regardless of hormonal suppression, surgical stage or symptoms. Prospective open-labeled study. Clinical center for women's healthcare. 50 women ages 17-45 with chronic abdominal pain, negative CT or MRI, and gastrointestinal endoscopy, scheduled for laparoscopy. Baseline EVG w/water load satiety test(WLST) and pain scores, followed by diagnostic laparoscopic surgery w/biopsy. Response to EVG WLST identified specifically elevated GMA frequencies of 15-20(9.5 vs 2.2, p<0.001), 30-40(3.1 vs 0.8, p<0.001) and 50-60(1.1 vs 0.5,p<0.05) compared to known population normals and disease free subjects with abdominal pain. GMA-derived 2 stage Ai-determined threshold (AIET) was calculated to be >0.5, using linear regression of area under curve on first pass and age and pain scores in the second pass, demonstrated 100% selectivity and 100% specificity, respectively. All subjects exceeded AIET and had ASRM stages 1-4 at laparoscopy. AIET scores ranged 0.52 to 8.9, and escalated according to advancing surgical grade. Hormonal suppression did not affect diagnosis. Endometriosis-specific abnormalities of GMA post-WLST predicts surgically detected endometriosis w/100% accuracy. AI GMA-derived threshold detects endometriosis with 100% sensitivity and specificity. Hormonal suppression, symptoms and surgical grade of endometriosis did not affect test accuracy. Variations in Ai-derived threshold scores may predict surgical stage of endometriosis. EVG represents an ideal test for the detection and screening of endometriosis.

Gastric myoelectrical activity based AI-derived threshold predicts resolution of gastroparesis post-pyloric balloon dilation.

A patient subset with gastroparesis (GP) has normal gastric myoelectrical activity (GMA) and pyloric dysfunction. (1) To determine pyloric balloon dilation (BD) effect on symptoms and gastric emptying in GP patients with normal 3 cycles per minute (cpm) GMA. (2) To demonstrate GMA-based artificial intelligence (AI)-derived formulae predict BD success at 10-12-month follow-up. Cohort subjects completed baseline electrogastrogram w/water load satiety test (WLST), solid-phase nuclear gastric emptying, Gastrointestinal Cardinal Symptom Index (ANMS GCSI-DD) and Leeds questionnaires. Subjects were divided into two groups based on response to the WLST. Group 1 (n = 26) with hypernormal/normal 3cpm GMA and Group 2 (n = 4) hyponormal/normal range 3cpm GMA, compared to healthy normals. All subjects underwent endoscopic pyloric BD. After 10-12months, gastric emptying and dyspepsia questionnaires were repeated to evaluate outcomes. Group 1 ANMS GCSI-DD scores improved from 2 points at baseline (BL) to 0 at follow-up (f/u) (p < 0.001); Group 2 ANMS GSCI-DD scores were 2 at BL and 1.6 at f/u (p = 0.25). Leeds scores improved (p < 0.001) only for Group 1. Group 1 gastric emptying improved (54.5% retained at 2h at BL vs. 12.2% at f/u, p < 0.001) in contrast to Group 2 patients (51.25% at BL vs. 56.25% at f/u, p = 0.252). Percentage 3cpm GMA decreased (41.1% at BL vs. 24.9% at f/u, p ≤ 0.005) in Group 1 versus Group 2 (15.3% at BL vs. 23.4% at f/u, p = 0.114). AI-derived GMA threshold (GMAT) of 0.59 predicted positive pyloric BD outcomes at 10-12months with sensitivity 96%, specificity 75%, and 93% correct classification. Pyloric BD improved symptoms and gastric emptying long term in patients with GP and hypernormal/normal 3cpm GMA. AI-derived GMAT predicted pyloric BD success. GMA post-WLST and GMAT are objective measures for improved selection and outcomes for endoscopic pyloric BD.

Cannabidiol for Functional Dyspepsia With Normal Gastric Emptying: A Randomized Controlled Trial.

Cannabidiol (CBD), a CBR2 agonist with limited psychic effects, antagonizes CB1/CB2 receptors. Allelic variation CNR1 (gene for CBR1) rs806378 and FAAH rs324420 were associated with altered gut motility and sensation. This study aimed to compare the pharmacodynamics and clinical effects of a 4-week treatment with pharmaceutical-grade CBD vs placebo and assess the interactions of FAAH and CNR1 gene variants on the effects of CBD in patients with functional dyspepsia (FD). We performed a randomized, double-blinded, placebo-controlled (1:1 ratio) study of CBD b.i.d. (20 mg/kg/d according to the US Food and Drug Administration escalation guidance) in FD patients with nondelayed gastric emptying (GE) at baseline. Symptoms were assessed by validated daily symptom diary (0-4 scale for upper abdominal pain, nausea, and bloating), weekly assessment of adequate relief, Leuven Postprandial Distress Scale (8 symptoms, adjectival scores rated 0-4 for severity), and quality of life (Short-Form Nepean Dyspepsia Index [average of 10 dimensions each on a 5-point scale]). After the 4-week treatment, all patients underwent measurements of GE of solids, gastric volumes, and Ensure nutrient satiation test. Statistical analysis compared 2 treatments for all endpoints and the effects of CBD in association with FAAH rs324420 and CNR1 rs806378. CBD and placebo effects on physiological functions and patient response outcomes were not significantly different. There were borderline CBD treatment-by-genotype interactions: rs806378 CNR1 with Leuven Postprandial Distress Scale ( P = 0.06) and GE solids ( P = 0.12). Approved doses of CBD used off-label do not relieve FD with normal baseline GE of solids or alter gastric motor functions and satiation. CBD treatment-by-gene interactions suggest potential benefits for postprandial distress with CNR1 rs806378 T allele.

Postprandial symptoms in patients with symptoms of gastroparesis: roles of gastric emptying and accommodation.

Patients often are evaluated for gastroparesis because of symptoms occurring with meals. Gastric emptying scintigraphy (GES) is used for gastroparesis diagnosis, although results are not well correlated with gastroparesis symptoms. The aim of this study is to assess relationships between gastroparesis symptoms, gastric emptying (GE), and gastric accommodation (GA). Patients with symptoms of gastroparesis completed the Patient Assessment of Upper GI Symptoms (PAGI-SYM) and recorded symptoms during GES and water load satiety test (WLST), an indirect assessment for GA. A total of 109 patients with gastroparesis symptoms were assessed. Symptom severity increased after GES meal for stomach fullness, belching, nausea, abdominal burning, and abdominal pain. There was no difference in symptoms after meal between patients with delayed (n = 66) and normal (n = 42) GE. Diabetic patients (n = 26) had greater gastric retention than idiopathic patients (n = 78), but idiopathic patients had greater postprandial nausea, stomach fullness, and abdominal pain. Water consumed during WLST averaged 421 ± 245 mL. Idiopathic patients had greater nausea scores during WLST than diabetic patients. In comparison to those with normal water consumption (≥238 mL; n = 80), patients with impaired water ingestion (<238 mL; n = 26) had increased stomach fullness, early satiety, postprandial fullness, and loss of appetite on PAGI-SYM. Patients with delayed and normal GE had similar symptom profiles during GES and WLST. Idiopathic patients had less gastric retention but more symptoms after GES meal and after WLST compared with diabetic patients. Patients with impaired water consumption during WLST had increased symptoms by PAGI-SYM. These data suggest that impaired GA, rather than GE, may be important in explaining postprandial symptoms in patients with symptoms of gastroparesis.NEW & NOTEWORTHY Patients with delayed and normal gastric emptying (GE) had similar symptom profiles during gastric emptying scintigraphy (GES). Idiopathic patients with symptoms of gastroparesis had less gastric retention by GES; but more symptoms after GES meal and after water load satiety test (WLST) compared with diabetic patients. In patients with symptoms of gastroparesis, symptoms after WLST increased with decreasing water consumption. Early satiety and loss of appetite were associated with decreased water consumption during WLST. Thus, impaired accommodation and perhaps visceral hypersensitivity are important in explaining postprandial symptoms in gastroparesis.

Association of Gastric Myoelectrical Activity With Ghrelin, Gastrin, and Irisin in Adults With Metabolically Healthy and Unhealthy Obesity.

Background and Objective: Functional disturbances of gastric myoelectrical activity (GMA) might exist in obesity. However, studies on its association with the gastric hormones in obesity phenotypes are lacking. The objective was to study the association of GMA with the serum levels of key gastric hormones in different obesity phenotypes. Methods: A total of 139 adults (31.00 ± 11.12 years) were classified into different metabolic phenotypes of obesity: 1) normal weight-lean (NWL group): BMI <25 kg/m2 and the fat-mass index (FMI) ≤9.7 kg/m2 in females and ≤6.3 kg/m2 in males; 2) metabolically obese normal weight (MONW group): BMI <25 kg/m2 and FMI >9.7 kg/m2 in females and >6.3 kg/m2 in males; 3) metabolically healthy obese (MHO group): BMI ≥25 and FMI ≤9.7 kg/m2 in females and ≤6.3 kg/m2 in males; and 4) metabolically unhealthy obese (MUO group): BMI ≥25 and FMI >9.7 kg/m2 in females and >6.3 kg/m2 in males. The GMA was measured at the baseline and post-prandial state using a multichannel electrogastrography with a water load satiety test. The average power distribution by the frequency region and the average dominant frequency were used for analysis. Anthropometric measurements and bioelectric impedance analysis were performed to calculate the FMI and fat-free mass index (FFMI). Serum levels of ghrelin, gastrin, and irisin were measured by ELISA kits according to the manufacturer’s protocol. Results: Compared to the NWL group, gastrin and ghrelin levels were significantly low in the MUO participants, while irisin was significantly high. The EGG showed significantly lower baseline and 20-min normogastria frequencies in the MHO and MUO groups. In the MHO group, baseline duodenal frequency was positively correlated with the gastrin level, while normogastria times were positively associated with the irisin level and negatively associated with the ghrelin level. In the MUO group, percentages of bradygastria frequencies at 10, 20, and 30 min were positively correlated with the BMI and FFMI. This bradygastria was correlated positively with the irisin level and negatively with the ghrelin level. Conclusion: The EGG patterns might be associated with obesity-related gastric hormones in different obesity phenotypes. EGG may be a promising clinical tool in obesity assessment. The association of the EGG patterns with hormonal levels needs further investigation for potential practical uses.

Satiety testing in diabetic gastroparesis: Effects of insulin pump therapy with continuous glucose monitoring on upper gastrointestinal symptoms and gastric myoelectrical activity.

Symptoms induced by caloric or non-caloric satiety test meals and gastric myoelectrical activity (GMA) have not been studied in patients with diabetic gastroparesis (DGP) before and after intense glucose management. Wedetermined the effects of continuous subcutaneous insulin infusion (CSII) with continuous glucose monitoring (CGM) on GI symptoms, volume consumed, and GMA induced by the caloric meal satiety test (CMST) and water load satiety test (WLST) in DGP. Forty-five patients with DGP underwent CMST and WLST at baseline and 24weeks after CSII with CGM. Subjects ingested the test meals until they were completely full. Visual analog scales were used to quantify pre- and postmeal symptoms, and GMA was recorded with cutaneous electrodes and analyzed visually and by computer. KEYRESULTS: At baseline and 24-week visits, nausea, bloating, abdominal discomfort, and fullness were immediately increased after CMST and WLST (Ps<0.01). The meal volumes ingested were significantly less than normal controls at both visits in almost one-third of the subjects. After the CMST, the percentage 3 cycle per minute GMA increased and bradygastria decreased compared with WLST (Ps<0.05). After treatment for 24weeks meal volumes ingested, postmeal symptoms and GMA were no different than baseline. CONCLUSIONS AND INFERENCES: (a) Satiety test meals elicited symptoms of nausea, bloating, and abdominal discomfort; (b) CMST stimulated more symptoms and changes in GMA than WLST; and (c) CSII with CGM for 24weeks did not improve symptoms, volumes ingested, or GMA elicited by the two satiety test meals in these patients with diabetic GP.Satiety tests in diabetic gastropresis are useful to study acutepostprandial symptoms and GMA, but these measures were not improved byintensive insulin therapy.

Obstructive Gastroparesis: Patient Selection and Effect of Laparoscopic Pyloroplasty

BackgroundFunctional obstructive gastroparesis is an understudied subtype of gastroparesis with normal 3 cycle per minute gastric myoelectrical activity that responds to botulinum toxin A injection and balloon dilation of the pylorus. AimsTo determine the effect of pyloroplasty on symptoms, weight, gastric emptying, and gastric myoelectrical activity in patients with gastroparesis and normal 3 cycle per minute gastric myoelectrical activity. MethodsTen patients (average age 36 years with gastroparesis and normal 3 cycle per minute gastric myoelectrical activity) who had at least two successful endoscopic pyloric therapies and then underwent pyloroplasty were identified. Electrogastrography with water load satiety test was performed to determine gastric myoelectrical activity. Gastric emptying was measured with 4-h scintigraphy. Key ResultsSix months after pyloroplasty, nine of ten patients reported improved symptoms and weight increased an average of 6.4 lb (p = 0.04). The average percentage of meal retained at 4 h decreased from 47% before to 16% after pyloroplasty (p < 0.01) and normalized in six patients. After pyloroplasty, the percent distribution of gastric myoelectrical activity power in the 3 cycle per minute range decreased at each measured interval compared with pre-pyloroplasty (p < 0.01). Conclusions(1) Pyloroplasty in these patients with obstructive gastroparesis improved gastric emptying and decreased 3 cycle per minute gastric myoelectrical activity, consistent with relief of functional gastric outlet obstruction. (2) Pyloric neuromuscular dysfunction is a key factor in delayed emptying in patients with functional obstructive gastroparesis.

Gastric Myoelectrical Activity and Autonomic Nervous System Abnormalities in Patients with Chronic Unexplained Nausea and Vomiting and in Patients with Gastroparesis

Background: Patients with chronic unexplained nausea and vomiting (CUNV) and Gastroparesis (GP) have similar symptoms, suggesting they share pathophysiological abnormalities along a continuum of disease.Objectives: To determine the incidence of gastric myoelectrical, accommodation dysfunction and autonomic abnormalities in patients with CUNV and GP.Methods: Outpatients with CUNV and GP who underwent standard 4-hr solid phase gastric emptying, upright tilt table test and electrogastrogram (EGG) recordings with water load satiety test (WLST) were identified from chart review. Subjects with normal emptying were in the CUNV group; those with delayed emptying were in the GP group. EGGs were recorded before and 30 minutes after the WLST and symptoms were recorded on a 100mm visual analog scale.Results: 44 patients (35 women and 9 men, ages 17-76 years) were identified: 24 had normal gastric emptying and CUNV and 20 had GP. Gastric dysrhythmias were found in 70% of CUNV and 69% of GP patients. Twenty percent of CUNV patients and 44% of GP patients ingested abnormally low volumes (&lt; 300mL) during the WLST. Nausea increased similarly after the WLST in the subjects with CUNV and GP (Ps &gt; 0.05). Postural orthostatic tachycardia syndrome (POTS) was diagnosed in 17% of CUNV patients and 20% of GP patients.Conclusions: Gastric myoelectrical and accommodation abnormalities and autonomic nervous system (ANS) dysfunctions frequently occur in subjects with CUNV and GP. These pathophysiological abnormalities support the idea that CUNV and GP occur along the same continuum of gastric neuromuscular dysfunction and may be targets for therapeutic approaches.&#x0D;

Idiopathic Dumping Syndrome in Patients Presenting with Chronic Unexplained Nausea

Introduction: Dumping syndrome is a well—known complication after gastric surgery. However, limited literature exists on idiopathic dumping syndrome. Our aim is to investigate the clinical characteristics of non—surgical patients with rapid gastric emptying who present with unexplained chronic nausea. Methods: A retrospective study was conducted on patients who had severe rapid gastric emptying, defined as gastric retention <30% at one hour during a four—hour isotope—labeled solid meal test. These patients were identified by chart review and were seen in a Neurogastroenterology Clinic at an academic institution between January 2011 and December 2017 for nausea and other unexplained gastrointestinal symptoms. Results: Forty—six patients were identified with severe rapid gastric emptying; sixteen were excluded due to previous gastric surgeries. The remaining thirty non—surgical patients (50% females, mean age 49 years, mean BMI 28) had a mean gastric retention of 19% (range 2% to 30%) at one hour. Thirteen (43%) had diabetes, and nine (30%) were insulin dependent. Six patients (20%) had a previous diagnosis of gastroparesis. All patients presented with unexplained nausea, fifteen (50%) had early satiety, and fifteen (50%) had bloating. Variations in bowel habits were reported as follows: 26% with diarrhea, 27% with constipation, 10% with diarrhea and constipation, and 27% with normal bowel movements. Sixteen (53%) patients had electrogastrogram tests: 69% had poor water load satiety test (ingested <557 mL in five min), 13% had tachygastria, 25% had bradygastria, 19% had mixed tachygastria and bradygastria, and 44% were normal. Five patients (17%) had positive breath tests for small bowel bacterial overgrowth. Conclusion: 1. Patients with severe idiopathic rapid gastric emptying may present with nausea and gastroparesis—like symptoms rather than vasomotor symptoms and diarrhea typically seen in postsurgical dumping syndrome; 2. Over half of the patients had risk factors for abnormal gastric motility, such as diabetes, poor water load satiety tests, and gastric dysrhythmias, which may contribute to altered emptying rates; 3. Physiological mechanisms underlying rapid gastric emptying warrants further investigations; and 4. Rapid gastric emptying should be considered in patients who present with chronic unexplained nausea without previous gastric surgeries.

Relationship of gastric emptying or accommodation with satiation, satiety, and postprandial symptoms in health.

The contributions of gastric emptying (GE) and gastric accommodation (GA) to satiation, satiety, and postprandial symptoms remain unclear. We aimed to evaluate the relationships between GA or GE with satiation, satiety, and postprandial symptoms in healthy overweight or obese volunteers (total n = 285, 73% women, mean BMI 33.5 kg/m2): 26 prospectively studied obese, otherwise healthy participants and 259 healthy subjects with previous similar GI testing. We assessed GE of solids, gastric volumes, calorie intake at buffet meal, and satiation by measuring volume to comfortable fullness (VTF) and maximum tolerated volume (MTV) by using Ensure nutrient drink test (30 ml/min) and symptoms 30 min after MTV. Relationships between GE or GA with satiety, satiation, and symptoms were analyzed using Spearman rank (rs ) and Pearson (R) linear correlation coefficients. We found a higher VTF during satiation test correlated with a higher calorie intake at ad libitum buffet meal (rs = 0.535, P < 0.001). There was a significant inverse correlation between gastric half-emptying time (GE T1/2) and VTF (rs = -0.317, P < 0.001) and the calorie intake at buffet meal (rs = -0.329, P < 0.001), and an inverse correlation between GE Tlag and GE25% emptied with VTF (rs = -0.273, P < 0.001 and rs = -0.248, P < 0.001, respectively). GE T1/2 was significantly associated with satiation (MTV, R = -0.234, P < 0.0001), nausea (R = 0.145, P = 0.023), pain (R = 0.149, P = 0.012), and higher aggregate symptom score (R = 0.132, P = 0.026). There was no significant correlation between GA and satiation, satiety, postprandial symptoms, or GE. We concluded that GE of solids, rather than GA, is associated with postprandial symptoms, satiation, and satiety in healthy participants.NEW & NOTEWORTHY A higher volume to comfortable fullness postprandially correlated with a higher calorie intake at ad libitum buffet meal. Gastric emptying of solids is correlated to satiation (volume to fullness and maximum tolerated volume) and satiety (the calorie intake at buffet meal) and symptoms of nausea, pain, and aggregate symptom score after a fully satiating meal. There was no significant correlation between gastric accommodation and either satiation or satiety indices, postprandial symptoms, or gastric emptying.

No impact of repeated extinction exposures on operant responding maintained by different reinforcer rates

Greater rates of intermittent reinforcement in the presence of discriminative stimuli generally produce greater resistance to extinction, consistent with predictions of behavioral momentum theory. Other studies reveal more rapid extinction with higher rates of reinforcers – the partial reinforcement extinction effect. Further, repeated extinction often produces more rapid decreases in operant responding due to learning a discrimination between training and extinction contingencies. The present study examined extinction repeatedly with training with different rates of intermittent reinforcement in a multiple schedule. We assessed whether repeated extinction would reverse the pattern of greater resistance to extinction with greater reinforcer rates. Counter to this prediction, resistance to extinction was consistently greater across twelve assessments of training followed by six successive sessions of extinction. Moreover, patterns of responding during extinction resembled those observed during satiation tests, which should not alter discrimination processes with repeated testing. These findings join others suggesting operant responding in extinction can be durable across repeated tests.

Chemical afferent vagal axotomy blocks re-intake after partial withdrawal of gastric food contents

Objectives: The aim of this study was to investigate the biological process by which animals regulate meal size. An experimental procedure for its study is to examine food re-intake after partial withdrawal of gastric food contents.Methods: The aim of the present experiments was to investigate the role of vagal afferents in food re-intake after perivagal administration of capsaicin, a neurotoxin that specifically damages weakly myelinated or unmyelinated vagal sensory axons.Results: In experiment 1, capsaicin-treated animals initially consumed higher amounts of food in comparison to controls (in first 24 hours) but their excess intake was compensated for in subsequent daily satiation tests. However, capsaicin treatment impaired the common short-term re-intake behavior observed in control rats after partial removal of gastric food nutrients, and the lesioned animals consumed significantly less food than had been withdrawn after completion of the initial meal; moreover, in this deficit condition, no counteraction was observed in subsequent repeated tests. This behavioral disturbance cannot be attributed to an indirect effect of capsaicin on gastric emptying volume, because the stomach contents were similar in both groups (Experiment 2).Discussion: These findings are discussed in terms of the critical role played by vagal afferents in rapid visceral adjustments related to short-term food intake, as also observed in other gastrointestinal regulatory behaviors that require immediate processing of visceral sensory information.

Peptide YY3-36 and glucagon-like peptide-1 in functional dyspepsia. Secretion and role in symptom generation

ABSTRACTObjective The role of peptide YY3-36 (PYY3-36), glucagon-like peptide-1 (GLP-1), and glucose homoeostasis in symptom development in functional dyspepsia (FD) is unclear. The aim was to investigate postprandial changes in plasma PYY3-36, GLP-1, glucose and insulin, and the relationship between PYY3-36, GLP-1, dyspeptic symptoms, and satiety measurements. Materials and methods Thirty-six patients with functional dyspepsia and 18 healthy controls consumed a liquid meal at two occasions. Firstly, a fixed amount of 250 mL (300 kcal) was consumed and gastric emptying was assessed using the paracetamol method. Secondly, participants drank 75 mL (90 kcal) per five min until maximal satiety. PYY3-36, GLP-1, glucose, and insulin concentrations were assessed. Satiety measures and dyspeptic symptoms were registered using visual analogue scales. Results Gastric emptying, glucose, PYY3-36, and GLP-1 concentrations were similar in patients and controls. Patients with epigastric pain syndrome had higher postprandial insulin levels. Patients reported more satiety, nausea, and pain. Area under the curve (AUC) for GLP-1 correlated positively to nausea in patients and negatively to nausea in controls during a single meal. AUC for PYY3-36 correlated similarly to sensation of fullness in the two groups; however, the correlation was negative for the single meal and positive for the satiety test. Conclusions In epigastric pain syndrome, postprandial insulin secretion seems to be increased. Neither GLP-1 nor PYY3-36 secretion is altered in functional dyspepsia, but postprandial GLP-1 secretion seems to correlate with nausea and PYY3-36 to the sensation of fullness, and therefore, these hormones might be involved in symptom generation.

Sensory‐enhanced beverages: Effects on satiety following repeated consumption at home

AbstractGrowing research suggests that a consumer's experience of satiety is influenced by information present at the time of, or before, food consumption. For example, making small modifications to the sensory characteristics of a high‐energy beverage (specifically thickness and creaminess) enhances its impact on subsequent satiety. Previous research has examined these sensory‐enhanced satiety effects in the laboratory but not in the ‘real world’. Therefore, the present study, using a cross‐over design, compared the effects of ‘real world’ consumption of two high‐energy versions of a beverage (sensory‐enhanced and unenhanced) and a low‐energy control beverage on satiety. Thirty‐four volunteers were provided with shelf‐stable dry powder mixes for the three test beverages, which varied in energy content and sensory characteristics, to which they added a commercially available juice. The volunteers prepared and consumed each beverage on eight occasions over a 3‐week period at home. Controlled satiety testing occurred in the laboratory either side of this exposure period. Focus groups were also conducted to assess consumer attitudes towards ‘enhanced satiety’ products and claims. Results of the satiety study indicate that appetite sensations and subsequent food intake were lower following consumption of the sensory‐enhanced high‐energy beverage relative to the unenhanced and control versions, and that these effects were maintained following repeated product consumption in the ‘real world’. The focus groups highlighted that consumers are aware of sensory and cognitive influences on satiety, though noted that dieting populations might benefit most from enhanced satiety products. Implications for further research and the role of satiety for consumers and manufacturers are discussed.

Commentary: Cafeteria diet impairs expression of sensory-specific satiety and stimulus-outcome learning.

Commentary: Cafeteria diet impairs expression of sensory-specific satiety and stimulus-outcome learning.