Semisolid Meal Research Articles

410. THE RELATIONSHIP BETWEEN GASTRIC CONDUIT EMPTYING, FUNCTIONAL ANATOMY AND PERISTALSIS: A DETAILED ANALYSIS USING DYNAMIC MAGNETIC RESONANCE IMAGING

Abstract Background Gastric conduit peristalsis post oesophagectomy is an important mediator of conduit emptying and consequently gastrointestinal symptoms and quality of life. The relationship between anatomical variations of the conduit, peristaltic function and transpyloric flow are incompletely defined. We aimed to analyse gastric conduit function using dynamic MRI to evaluate functional anatomy, quantify peristaltic function and measure emptying. Methods Eighteen patients with gastric conduit reconstruction post oesophagectomy and 12 controls with normal gastric anatomy were recruited. Dynamic and static sequences of MRI following ingestion of a semi solid meal were obtained. Peristalsis variables including Gastric Motor Index (GMI - Velocity x Amplitude) were measured at 4 time points throughout the MRI, and volume scans were taken at the beginning and end of the 20-minute scanning period. Nuclear Scintigraphy conduit emptying studies were obtained from 17/18 (94%) of patients. Quality of Life questionnaire data was collected. Results Nine (50%) conduits demonstrated coordinated peristalsis, 3(16.7%) had no measurable peristalsis and 6 (33.3%) had incoordinate peristalsis. Regarding conduits vs controls, there was no difference in peristaltic wave frequency (5 vs 5/90 seconds) or GMI (35.45 vs 36.5, p=0.61), but emptying was decreased (0.10% vs 15% p=0.01). Acute angulation of the conduit was associated with a slower emptying half time (444 vs 127 min, p=0.025). Conduit width and location of the pylorus relative to the hiatus made no significant difference to peristalsis or emptying. Quality of life scores were significantly better in controls compared with conduits. Conclusion Although coordinate peristalsis was present in many conduits, it did not appear to be a key mediator of conduit emptying. Conduit shape and location within the mediastinum significantly affected emptying. These data demonstrate that construction of the conduit at the index operation may be a key factor in long term function and reducing gastrointestinal symptoms. Dynamic MRI is a promising research and diagnostic tool to assess conduit function due to its capacity to accurately delineate the key elements of conduit function.

Surface mapping of gastric motor functions using MRI: a comparative study between humans and rats.

The stomach's ability to store, mix, propel, and empty its content requires highly coordinated motor functions. However, current diagnostic tools cannot simultaneously assess these motor processes. This study aimed to use magnetic resonance imaging (MRI) to map multifaceted gastric motor functions, including accommodation, tonic and peristaltic contractions, and emptying, through a single noninvasive experiment for both humans and rats. Ten humans and 10 Sprague-Dawley rats consumed MRI-visible semisolid meals and underwent MRI scans. We used a surface model to analyze MRI data, capturing the deformation of the stomach wall on ingestion or during digestion. We inferred muscle activity, mapped motor processes, parcellated the stomach into functional regions, and revealed cross-species distinctions. In humans, both the fundus and antrum distended postmeal, followed by sustained tonic contractions to regulate intragastric pressure. Peristaltic contractions initiated from the distal fundus, including three concurrent wavefronts oscillating at 3.3 cycles/min and traveling at 1.7 to 2.9 mm/s. These motor functions facilitated linear gastric emptying with a 61-min half-time. In contrast, rats exhibited peristalsis from the midcorpus, showing two wavefronts oscillating at 5.0 cycles/min and traveling at 0.4 to 0.9 mm/s. For both species, motility features allowed functional parcellation of the stomach along a midcorpus division. This study maps region- and species-specific gastric motor functions. We demonstrate the value of MRI with surface modeling in understanding gastric physiology and its potential to become a new standard for clinical and preclinical investigations of gastric disorders at both individual and group levels.NEW & NOTEWORTHY A novel MRI technique can visualize how the stomach accommodates, mixes, and propels food for digestion in humans and animals alike. Digital models of gastric MRI reveal the functional maps, organization, and distinction of the stomach across individuals and species. This technique holds the unique potential to advance basic and clinical studies of functional gastric disorders.

Early steps of an alternative test meal for gastric emptying scintigraphy

Background/Aim. Gastric emptying (GE) scintigraphy provides a physiologic and noninvasive measurement of GE. Although GE scintigraphy has been standardized, preparing a meal is still complex and not practical in daily routine. The aim of the study was to prepare a simple, practical, and easily standardizable semisolid meal and investigate its role in estimating the GE function in of rabbits. Methods. In the first part of the study (basal condition), the mixture of the macroaggregated albumin (MAA) labeled with 37 MBq (1 mCi) of technetium-99m (99mTc) and 40 g of barium sulfate (1g/mL) was applied to animals via a nasogastric catheter. A series of images (frame/min, 60 min) in the anterior and posterior projections were dynamically acquired, and the motion was corrected after the radiopharmaceutical application. A few days later, the same rabbits were scanned under the same protocol after a 1 mg atropine injection to simulate gastroparesis condition. Eleven rabbits were included according to inclusion and exclusion criteria, and a total of twenty-two imaging data sets were analyzed for quantification. Results. In the basal study, total counts of the mixture decreased from 87,800.83 ? 12,622.76 to 42,733.14 ? 6,591.53 at 30 min and to 13,684.19 ? 1,774.90 at 60 min, and these decreases were statistically significant (p = 0.003). Emptying percentages were 51.39 ? 0.78% at 30 min and 84.32 ? 1.56 at 60 min and were statistically significant (p = 0.003). After intravascular atropine sulfate injection, total counts of the mixture decreased from 84,508.78 ? 11,871.48 to 64,995.18 ? 9,298 at 30 min and to 53,507.17 ? 7,258.98 at 60 min, and these decreases were statistically significant (p = 0.003). Emptying percentages were 23.10 ? 1.11% at 30 min and 36.63 ? 1.42 at 60 min and were statistically significant (p = 0.003). The difference between basal and post-atropine sulfate gastric emptying percentage at 30th (p = 0.003) and 60th (p = 0.003) min was statistically significant. Conclusion. The meal, used in this study, is non-nutrient, fatty-free, and semisolid and is easy to prepare and administer. Due to its semisolid nature, it offers a chance to evaluate the quantification of regional and total GE as well as the separate roles of the fundus and antrum.

Expected Values of Esophageal Transit and Gastric Emptying Scintigraphy Post-uncomplicated Sleeve Gastrectomy.

Sleeve gastrectomy (SG) results in significant anatomical and physiological alterations of the esophagus and stomach, including food tolerance. Currently, there is no consensus on the parameters of abnormal esophageal transit and gastric emptying in this population. We describe standardized esophageal transit and gastric emptying protocols, and define expected values following an uncomplicated SG. In 43 asymptomatic post-SG patients with optimal weight loss, a standardized liquid and semi-solid (oatmeal) esophageal transit study, plus a 90-min semi-solid gastric emptying study with dynamic 5-s image acquisition to assess gastroesophageal reflux, was performed. Gastric emptying half-time and retention rate was calculated. Esophageal transit and reflux were graded by visual inspection of images. Thirty-one female and 12 male patients participated: mean age 49.0±10.7 years, pre-operative BMI 47.6±7.0 kg/m2, excess weight loss 58.8±26.0% at median follow-up of 7.4 months. The standardized semi-solid meal and liquid preparations were well tolerated. Delays in esophageal transit of liquid and semi-solid boluses were infrequent (7.0% and 16.3% respectively). Deglutitive reflux of both semi-solids and liquids was common (48.8% and 32.6%). The median semi-solid gastric emptying half-time was 21.0 min. A large proportion of substrate transited into the small bowel on initial image acquisition (median 39.1%). Reflux events during gastric emptying were common (median 5.0 events, 12.7% of image acquisition time). Rapid gastric emptying with asymptomatic deglutitive and post-prandial gastroesophageal reflux events are common following SG. We have defined the expected values of standardized esophageal transit and gastric emptying scintigraphy specifically tailored to SG patients.

A Comparison of Intermittent and Continuous Exercise Bouts at Different Intensities on Appetite and Postprandial Metabolic Responses in Healthy Men.

Exercise intensity affects many potential postprandial responses, but there is limited information on the influence of exercise modality. Therefore, the aim of this study was to investigate if the nature of exercise at two different intensities would affect gastric emptying rate (GER), appetite and metabolic responses following ingestion of a semi-solid meal. Twelve healthy men completed, in a random order, four 60-min cycles at 60% VO2peak (MOD), 40% VO2peak (LOW) and in a continuous (CON) or intermittent (INT) manner. INT consisted of 20 × 1-min exercise bouts with 2-min rest breaks. INT and CON were matched for total work output at each intensity. GER of the post-exercise meal was measured for 2 h using the 13C-breath method. Blood glucose, substrate utilisation and appetite ratings were measured at regular intervals throughout all trials and 24-h energy intake (EI) post-trials was assessed. GER-Delta over Baseline (DOB) was lower (p < 0.05) on MOD-INT vs. MOD-CON from 30–120 min post-meal. Blood glucose was higher mid-exercise (p < 0.05) on MOD-INT vs. MOD-CON. Although post-exercise LOW-CON was significantly higher than LOW-INT (p < 0.05), blood glucose was also higher 30-min post-meal ingestion on both CON trials compared to INT (p < 0.001). No interaction effect was observed for perceived appetite responses 2 h after meal ingestion (all p > 0.05). 24-h post-trial EI was similar between LOW-CON vs. LOW-INT (p > 0.05), although MOD-INT vs. MOD-CON 3500 ± 1419 vs. 2556 ± 989 kCal: p < 0.001 was elevated. In summary, MOD-INT exercise delays GER without stimulating perceived appetite in the 2 h period after meal ingestion, although EI was greater in the 24-h post-trial.

Trimebutine Maleate Monotherapy for Functional Dyspepsia: A Multicenter, Randomized, Double-Blind Placebo Controlled Prospective Trial.

Background and Objectives: Functional dyspepsia (FD) is one of the most common functional gastrointestinal disorders; it has a great impact on patient quality of life and is difficult to treat satisfactorily. This study evaluates the efficacy and safety of trimebutine maleate (TM) in patients with FD. Materials and Methods: A multicenter, randomized, double-blind, placebo controlled, prospective study was conducted, including 211 patients with FD. Participants were randomized to receive TM 300 mg twice per day (BID, 108 patients) or placebo BID (103 patients) for 4 weeks. The Glasgow Dyspepsia Severity Score (GDSS) was used to evaluate the relief of dyspepsia symptoms. Moreover, as a pilot secondary endpoint, a substudy (eight participants on TM and eight on placebo) was conducted in to evaluate gastric emptying (GE), estimated using a 99mTc-Tin Colloid Semi Solid Meal Scintigraphy test. Results: Of the 211 patients enrolled, 185 (87.7%) (97 (52.4%) in the TM group and 88 (47.6%) in the placebo group) completed the study and were analyzed. The groups did not differ in their demographic and medical history data. Regarding symptom relief, being the primary endpoint, a statistically significant reduction in GDSS for the TM group was revealed between the first (2-week) and final (4-week) visit (p-value = 0.02). The 99 mTc-Tin Colloid Semi Solid Meal Scintigraphy testing showed that TM significantly accelerated GE obtained at 50 min (median emptying 75.5% in the TM group vs. 66.6% in the placebo group, p = 0.036). Adverse effects of low to moderate severity were reported in 12.3% of the patients on TM. Conclusion: TM monotherapy appears to be an effective and safe approach to treating FD, although the findings presented here warrant further confirmation.

Acceleration of Gastric Emptying and Improvement of GERD Outcome After Laparoscopic Sleeve Gastrectomy in Non-diabetic Obese Patients.

Obesity has become a pandemic nowadays. Bariatric surgery is increasingly performed to manage obesity. Currently, laparoscopic sleeve gastrectomy (LSG) is a widely accepted procedure given its feasibility and efficacy. Previous studies revealed conflicting results regarding the change of gastric emptying following sleeve gastrectomy. The primary aim of the present study is to assess gastric motor function by gastric emptying scintigraphy in a cohort of non-diabetic patients undergoing laparoscopic sleeve gastrectomy (LSG) for treatment of severe obesity. This prospective observational study included 100 obese, non-diabetic patients attending the surgery clinic at Cairo University Hospitals and Al Azhar University Hospitals. LSG was performed following a standardized protocol, with no complications observed. All patients had gastric emptying scintigraphy done through a standard semisolid meal (250kcal), marked with 0.5 mCiTc 99, pre-operatively and 3months after LSG. The mean age was 38.71years (9.2) and males comprised 57% of the cohort. The body mass index, low-density lipoproteins, and glycated hemoglobin declined significantly at 3-month postsurgery. The scintigraphy study revealed a significantly reduced percent retention at equivalent time points 3months after LSG. In addition, the percent of patients suffering from GERD decreased significantly after LSG. Gastric emptying becomes faster after LSG in morbidly obese non-diabetic patients. GERD symptoms improve after surgery.

The Effects of a High Fiber Beta Glucan Talbina Meal on Emotional Well-being Among Syrian Refugees in Metropolitan Detroit (P08-076-19)

ObjectivesThe on-going Syrian War has affected Syrians’ mental health, causing anxiety, depression, stress, and mood disturbances. Barley β- glucan is a soluble fiber and its benefits for mental health have been reported in the literature. This study was designed to assess the possible therapeutic effects of β-glucan supplementation as a natural remedy for emotional disturbance control/prevention using a traditional Islamic homestyle meal, “Talbina”, a semi-solid meal made from ground whole grain, hulled barley (Hordeum vulgare). MethodsA single-blind randomized crossover design was conducted in free-living, stressed Syrian refugees using barley flour (active, AC) for 28 days and rice flour (placebo, PL) for 14 days as part of a breakfast. Subjects (14 females and 9 males, mean age: 41 ± 10 yrs) with normal-to-mild depression and anxiety scores were recruited from the Islamic Center of Detroit. More than 60% of the subjects self-rated their general health as good or very good. Only 4.3% reported poor mental health, and nearly 60% of the subjects reported having at least one non-communicable disease. Arabic validated self-administered questionnaires: The Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS), and The Profile of Mood States-short form (POMS-SF) were used to measure anxiety and depression states, stress, and mood, respectively. Body weight and height data were also collected. ResultsSubjects without depression showed a reduction in body mass index (BMI) at the end of the AC phase compared to the PL phase while depressed subjects showed an increase in BMI. The difference between these groups was significant (−.5 ± .5 kg/m2 vs .2 ± .8, P = 0.04). The results showed no differences in anxiety, depression, stress and mood scores between the AC and PL phases. ConclusionsThe findings of this study showed no significant improvement in emotional well-being, depression, or stress levels by eating Talbina. But the subjects with anxiety were benefited significantly by taking part in this study regardless of the key ingredients of their meals. These findings suggest that refugee communities need further social support. Future studies should be conducted with a higher dosage of β-glucan for a longer duration and with a larger sample size to examine the beneficial effects of β-glucan. Funding SourcesThe Department of Nutrition and Food Science at Wayne State University and the Department of Clinical Nutrition at Umm Al-Qura University.

The Effect of Glucose or Fructose Added to a Semi-solid Meal on Gastric Emptying Rate, Appetite, and Blood Biochemistry.

The ingestion of fructose is of interest due to previously reported differences in gastrointestinal, appetite, and metabolic effects when compared to glucose ingestion when ingested in liquid solution. The aim of this study was to examine these variables when fructose and glucose are added to a semi-solid meal. Seven healthy male participants completed three experimental trials involving the ingestion of 300 mL of semi-skimmed milk mixed with 40 g of instant porridge mix (CON) and with the addition of either 40 g of glucose (GLU) or fructose (FRU). Subjective feelings of appetite were assessed for 2 h after ingestion with blood samples collected at regular intervals. Gastric emptying rate was assessed using the 13C breath test method. Half emptying time was not different between trials (CON = 159 ± 51 min; GLU = 197 ± 46 min; FRU = 198 ± 67 min: P = 0.117). No differences were observed for any subjective measurements of appetite (P > 0.05) while blood glucose was elevated (P < 0.05) 20 min after ingestion on both GLU and FRU with this tending to be higher on GLU than FRU. FRU resulted in greater (P < 0.05) blood lactate concentrations than on the other trials. The results of this study demonstrate that gastric emptying rate of glucose and fructose is similar when ingested in a semi-solid meal. In addition, there is little difference in appetite response between these sugars, however, there are some differences in metabolic response which deserve further study.

Evaluation of Gastric Emptying by Transabdominal Ultrasound after Oral Administration of Semisolid Cellulose-Based Gastric Ultrasound Contrast Agents

Many previous studies have found that transabdominal ultrasound may allow precise measurement of gastric emptying of liquid meals. However, the clinical use of this technique has been hampered by the limitation that transabdominal ultrasound might not accurately measure gastric emptying of solid meals. It is more important to measure gastric emptying of solids instead of liquids, as gastric emptying of solids is more often delayed than gastric emptying of liquids in gastric motility disorders. Recently, transabdominal ultrasound after oral administration of a cellulose-based gastric contrast agents (TUS-OSCA) has been suggested to be effective in initial screening of gastric lesions. The aim of this study was to explore the accuracy of TUS-OSCA in the evaluation of gastric emptying of a semisolid meal. Twenty healthy young patients (10 males and 10 females aged 25.5 ± 2.5 y) were studied. Concurrent measurements of gastric emptying by scintigraphy and TUS-OSCA were performed after ingestion of 350 mL semisolid ultrasound agent labeled with 20 MBq 99mTc-sulfur colloid. There was no significant difference in the overall curves for gastric emptying time between scintigraphy and TUS-OSCA. There was a good correlation between the gastric 50% emptying times determined by scintigraphy (89.4 ± 1.8 min) and TUS-OSCA (92.5 ± 1.7 min). The correlation coefficient was r = 0.922 (p = 0.000). Current results indicate that TUS-OSCA is accurate, and the results are similar to those obtained by scintigraphy for gastric emptying of a semisolid meal.

The Effect of Exercise Intensity on Gastric Emptying Rate, Appetite and Gut Derived Hormone Responses after Consuming a Standardised Semi-Solid Meal in Healthy Males.

This study investigated the acute circulating gut hormone, appetite and gastric emptying rate responses to a semi-solid meal following exercise at different intensities. Twelve men completed three trials in a randomised-crossover design, consisting of continuous cycling at 70% O2Peak (HIGH), 40% O2Peak (LOW) or rest (CONTROL). Baseline samples were collected after an overnight fast before undertaking the 60 min exercise or rest period, followed by 30 min rest before consumption of a standardised semi-solid meal (~242 kcal). During the 2 h postprandial period, gastric emptying rate of the meal was examined using the 13C-breath test method, appetite was measured using visual analogue scales, and serum concentrations of acylated ghrelin, pancreatic polypeptide, peptide YY, glucagon-like peptide-1, insulin, glucose, triglycerides, total cholesterol and non-esterified fatty acids were assessed. Subjective appetite response was not different between trials (p > 0.05). Half emptying time of the meal was 89 ± 13, 82 ± 8 and 94 ± 31 min on CONTROL, LOW and HIGH, respectively (p = 0.247). In healthy un-trained adult males, responses to exercise at intensities of 70% and 40% O2Peak did not differ to a non-exercise control for measurements of subsequent gastric emptying, circulating gut hormone response or appetite. These results suggest that exercise intensity has little effect on post-exercise appetite response to a semi-solid meal.

The effect of high β-glucan flour incorporation into instant rice porridge on satiety and energy intake

Soluble dietary fibres such as oat β-glucan have been suggested to increase gastrointestinal viscosity to improve appetite regulation and reduce subsequent food intake. However, a paucity of research regarding the appetite-regulating effects of β-glucan in semisolid test meals exists. The aim of this study was to examine the appetite-regulating effects of instant rice porridge enriched with oat β-glucan on postprandial satiety and 24-h prospective energy intake. In a crossover, single blind study design, seventeen healthy volunteers consumed instant rice porridge enriched with 1g oat β-glucan and control rice porridge. Appetite ratings at baseline and during the 210min following the consumption of test meals were recorded using visual analog scales (VAS). Food diaries were used to record dietary intake prospectively over a 24-h period. No significant differences between treatments were observed in hunger, fullness, satiety, desire to snack and capacity to eat. However, consumption of the β-glucan enriched porridge resulted in a significant reduction (p = 0.026) in energy intake (1715kJ) in the post-meal 24-h period. Low doses of high-viscosity β-glucan-rich flour in a semisolid meal appeared to decrease prospective energy intake over 24h, with no postprandial effects on appetite regulation within 210min.

Effect of Cinnamon Addition to an High-Sugar Meal on the Postprandial Blood Glucose Response of Healthy Subjects

Background: Previous studies suggest that cinnamon can reduce postprandial glycaemia through enhance insulin sensitivity in healthy adults. The aim of this study was to study the effect of cinnamon (C. burmannii) addition to a high-sugar semi-solid food on the postprandial blood glucose response on non-diabetic subjects and to characterize the antioxidant activity of this meal. Methods: Twenty four non-diabetic participants were included in a randomized clinical trial and assigned in two groups: Group A (reference meal) or group B (test meal). The blood glucose concentration was measured before the ingestion of the meals and at 30, 60, 90 and 120 minutes after the start of the meal. The test meal used consisted of 100 g of mousse mixed with 3 g of cinnamon. Chemical analysis was performed to quantify total phenolic content (Folin-Ciocalteu method) and antioxidant activity (Ferric Reducing Antioxidant Potential assay- FRAP). Results: The postprandial blood glucose levels AUCs slightly increased with the addition of 3 g of C. burmannii. However, the statistical analysis revealed that differences on AUCs and postprandial blood glucose values, between groups, were not significant. Chemical analysis showed that addition of C. burmannii (3g) to the mousse, increased the total phenolic content and the antioxidant activity. Conclusions: The results provide evidence that inclusion of cinnamon in the mousse increased the phenolic content and the antioxidant activity of a semi-solid high-sugar meal, and did not improve glucose response in healthy subjects.

Dairy food structures influence the rates of nutrient digestion through different in vitro gastric behaviour

The purpose of this study was to investigate in vitro the extent to which specific food structures alter gastric behaviour and could therefore impact on nutrient delivery and digestion in the small intestine. Results obtained from a specifically developed gastric digestion model, were compared to results from a previous human study on the same foods. The semi-dynamic model could simulate the main gastric dynamics including gradual acidification, lipolysis, proteolysis and emptying. Two dairy-based foods with the same caloric content but different structure were studied. The semi-solid meal comprised a mixture of cheese and yogurt and the liquid meal was an oil in water emulsion stabilised by milk proteins. Our findings showed similar gastric behaviour to that seen previously in vivo. Gastric behaviour was affected by the initial structure with creaming and sedimentation observed in the case of liquid and semi-solid samples, respectively. Lipid and protein digestion profiles showed clear differences in the amount of nutrients reaching the simulated small intestine and, consequently, the likely bioaccessibility after digestion. The semi-solid sample generated higher nutrient released into the small intestine at an early stage of digestion whereas nutrient accessibility from liquid sample was delayed due to the formation of a cream layer in the gastric phase. This shows the strong effect of the matrix on gastric behaviour, proteolysis and lipolysis, which explains the differences in physiological responses seen previously with these systems in terms of fullness and satiety.

J-pouch versus Roux-en-Y reconstruction after gastrectomy: functional assessment and quality of life (randomized trial).

PurposeThe aim of this study was to evaluate the quality of life and functional emptying of J-pouch versus Roux-en-Y reconstruction after total gastrectomy for malignancy.MethodsThis study was designed as a prospective, nonblinded, randomized, parallel clinical trial (Trial Number: MN Ostrava, 200604). With informed consent, patients undergoing gastrectomy for malignancy were randomized to J-pouch or Roux-en-Y reconstruction. The time taken for a test semisolid meal labeled with 99mTc-sulfur colloid to exit the reconstructed parts was measured by dynamic scintigraphy 1 year after resection. Quality of life was measured using the Eypasch questionnaire at the same time as functional emptying assessment. This trial was investigator-initiated.ResultsIn all, 72 patients were included into the study. The time taken for the test meal to exit the postgastrectomy reconstruction was 16.5±10.0 minutes (mean ± standard deviation) in the Roux-en-Y group and 89.4±37.8 minutes in the “J-pouch” group; the difference was statistically significant (P<0.001). Emptying of the J-pouch appeared to be a linear decreasing function compared to the exponential pattern seen in the Roux-en-Y group. The quality of life measurement showed scores of 106±18.8 points (mean ± standard deviation) in the Roux-en-Y group compared to 122±22.5 points in the J-pouch group; the difference was statistically significant (P=0.0016). There were no important adverse events.ConclusionAfter total gastrectomy, a J-pouch reconstruction empties more slowly and is associated with higher quality of life compared to Roux-en-Y reconstruction. Whether these two observations have a direct causative link remains unanswered.

Calorie restriction and not glucagon-like peptide-1 explains the acute improvement in glucose control after gastric bypass in Type 2 diabetes.

To compare directly the impact of glucagon-like peptide-1 secretion on glucose metabolism in individuals with Type 2 diabetes listed for Roux-en-Y gastric bypass surgery, randomized to be studied before and 7 days after undergoing Roux-en-Y gastric bypass or after following a very-low-calorie diet. A semi-solid meal test was used to investigate glucose, insulin and glucagon-like peptide-1 response. Insulin secretion in response to intravenous glucose and arginine stimulus was measured. Hepatic and pancreatic fat content was quantified using magnetic resonance imaging. The decrease in fat mass was almost identical in the Roux-en-Y gastric bypass and the very-low-calorie diet groups (3.0±0.3 and 3.0±0.7kg). The early rise in plasma glucose level and in acute insulin secretion were greater after Roux-en-Y gastric bypass than after a very-low-calorie diet; however, the early rise in glucagon-like peptide-1 was disproportionately greater (sevenfold) after Roux-en-Y gastric bypass than after a very-low-calorie diet. This did not translate into a greater improvement in fasting glucose level or area under the curve for glucose. The reduction in liver fat was greater after Roux-en-Y gastric bypass (29.8±3.7 vs 18.6±4.0%) and the relationships between weight loss and reduction in liver fat differed between the Roux-en-Y gastric bypass group and the very-low-calorie diet group. This study shows that gastroenterostomy increases the rate of nutrient absorption, bringing about a commensurately rapid rise in insulin level; however, there was no association with the large post-meal rise in glucagon-like peptide-1, and post-meal glucose homeostasis was similar in the Roux-en-Y gastric bypass and very-low-calorie diet groups. (Clinical trials registry number: ISRCTN11969319.).

Refeeding improves blood glucose and gastric emptying responses to a mixed-nutrient meal in anorexia nervosa

Gastric emptying (GE) is an important determinant of postprandial blood glucose (BG), yet GE is delayed in anorexia nervosa (AN). This study aimed to characterise relationships between GE (13C-octanoate breath test), and BG responses to, a mixed-nutrient semi-solid meal in 22 female adolescent AN inpatients on admission (BL) and following 1 (W1) and 2 weeks (W2) of refeeding, and in 17 age-matched healthy controls (HC). Compared with HC, BL GE was markedly delayed in AN (BL:192±21, HC:310±40%/hr, P<0.01). At W2, GE was faster (W2:297±34), and no longer different from HC. Fasting BG did not differ between AN and HC, however, BG did not rise postprandially in AN at BL (BL:635±14, HC:803±29 mmol/L.min-1, P<0.01). At W2, BG increased postprandially in AN, yet remained lower than in HC (W2:713±18, P<0.05). There was a moderate correlation between GE and BG in HC (R2=0.643, P<0.01), but not in AN. In conclusion, GE of, and BG response to, a mixed-nutrient meal are markedly impaired in untreated AN, and nutritional rehabilitation may partially restore the gut responses to nutrients. This study highlights the need to elucidate the mechanisms underlying altered postprandial BG responses in AN and the importance of clinical monitoring of BG during refeeding.

Su1436 Central Versus Peripheral Sites of Action of New Ghrelin Agonists on Gastrointestinal Prokinetic Activity

Background: Gastric dysmotility including delayed gastric emptying and decrease the electrical activity of the stomach is common in patients with long-standing diabetes mellitus (DM). These DM patients, some of them are diagnosed as diabetic gastroparesis, have several upper gastrointestinal (GI) symptoms such as nausea, vomiting, bloating and abdominal pain. However, the relationship between gastric dysmotility and GI symptoms has not been investigated well. Aim: The aim of this study was to identify the relationship between gastric motility measures and upper GI symptoms in patients with long-standing DM. Methods: We enrolled 22 long-standing DM patients (13 females, 9 males; aged 33-80 years) with more than 10 years duration of DM, and 15 matched healthy controls (9 females, 6 males; aged 26-74 years). All DM patients were receiving insulin treatment, and had at least one history of diabetic neuropathy, retinopathy or nephropathy. Gastric motility was evaluated with cutaneous recorded electrogastrography (EGG) and gastric emptying of a semi-solid meal, using 13C-octanoic acid breath testing. Upper GI symptoms were quantified in all patients by questionnaire. Results: Compared with the healthy controls, the DM patients showed a significant lower percentage of normogastria (2to 4 cpm slow wave) in both fasting and postprandial state with a lower power ratio (postprandial peak power / fasting peak power) in EGG. Both half-emptying time and lag time in 13C-acetic acid breath testing were higher in DM patients than in healthy controls, indicating that gastric emptying was significantly delayed in the former in overall analysis. Fifteen patients demonstrated abnormalities of either gastric myoelectric activity or gastric emptying (group A), and 7 had normal gastric motor function (group B). Sixteen of 22 (72.7%) patients had some kind of upper GI symptoms. The number of patients who had some GI symptoms was 13 in group A versus 3 in group B. No significant correlation was observed between gastric emptying parameters and HbA1C values. Conclusion: The patients with long-standing DM showed gastric dysmotility, including impaired gastric myoelectrical activity and delayed gastric emptying. Gastric dysmotility appear to be an important factor in the generation of upper GI symptoms in patients with long-standing DM. The relationship between gastric motility and upper gastrointestinal symptoms

Su1435 The Role of Insulin and IGF-I Signaling Passway in Renovation of Interstitial Cells of Cajal Promoted by Gastric Electrical Stimulation in Streptozotocin-Induced Diabetic Rats

Background: Gastric dysmotility including delayed gastric emptying and decrease the electrical activity of the stomach is common in patients with long-standing diabetes mellitus (DM). These DM patients, some of them are diagnosed as diabetic gastroparesis, have several upper gastrointestinal (GI) symptoms such as nausea, vomiting, bloating and abdominal pain. However, the relationship between gastric dysmotility and GI symptoms has not been investigated well. Aim: The aim of this study was to identify the relationship between gastric motility measures and upper GI symptoms in patients with long-standing DM. Methods: We enrolled 22 long-standing DM patients (13 females, 9 males; aged 33-80 years) with more than 10 years duration of DM, and 15 matched healthy controls (9 females, 6 males; aged 26-74 years). All DM patients were receiving insulin treatment, and had at least one history of diabetic neuropathy, retinopathy or nephropathy. Gastric motility was evaluated with cutaneous recorded electrogastrography (EGG) and gastric emptying of a semi-solid meal, using 13C-octanoic acid breath testing. Upper GI symptoms were quantified in all patients by questionnaire. Results: Compared with the healthy controls, the DM patients showed a significant lower percentage of normogastria (2to 4 cpm slow wave) in both fasting and postprandial state with a lower power ratio (postprandial peak power / fasting peak power) in EGG. Both half-emptying time and lag time in 13C-acetic acid breath testing were higher in DM patients than in healthy controls, indicating that gastric emptying was significantly delayed in the former in overall analysis. Fifteen patients demonstrated abnormalities of either gastric myoelectric activity or gastric emptying (group A), and 7 had normal gastric motor function (group B). Sixteen of 22 (72.7%) patients had some kind of upper GI symptoms. The number of patients who had some GI symptoms was 13 in group A versus 3 in group B. No significant correlation was observed between gastric emptying parameters and HbA1C values. Conclusion: The patients with long-standing DM showed gastric dysmotility, including impaired gastric myoelectrical activity and delayed gastric emptying. Gastric dysmotility appear to be an important factor in the generation of upper GI symptoms in patients with long-standing DM. The relationship between gastric motility and upper gastrointestinal symptoms

Molecular weight of barley β-glucan does not influence satiety or energy intake in healthy male subjects

Previous studies have shown the ability of high molecular weight barley β-glucan with increased viscosity to attenuate glycemic response, gastric emptying and in vitro starch digestion. The main objective of this study was to investigate the effect of molecular weight of barley β-glucan in a semisolid meal on energy intake and subjective feelings of hunger, fullness, desire to eat and prospective food consumption in healthy male subjects. In a randomised, controlled, crossover trial, 23 healthy male subjects (BMI 24.2 ± 2.5 kg/m2) tested soups equivalent to 25 g available carbohydrate containing high or low molecular weight barley β-glucan (~3 g) as preload after a standard breakfast. The viscosity of soup with high molecular weight β-glucan was 350 Pa·s whereas the soup with low molecular weight β-glucan had a viscosity of 100 Pa·s. Appetite ratings before and for two hours after consumption of β-glucan soups and subsequent ad libitum energy intake at lunch were recorded and compared with a control soup with no β-glucan. There was no significant difference in food intake at the ad libitum meal or for the remainder of the day following consumption of the three test foods (p > 0.05). Similarly, there were no significant differences (p > 0.05) in hunger, fullness, desire to eat or prospective food consumption following β-glucan soups. The current study provides evidence that the molecular weight of barley β-glucan may not impact on perceived feelings of hunger or food intake at the current dose and viscosity.