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The purpose of this study was to characterize intestinal myoelectrical activity along the small intestine and investigate its responses to test meals with different glycemic index at different locations. Sixteen rats were implanted with electrodes in the serosal surface of the duodenum, jejunum, and ileum. Intestinal myoelectrical activities were recorded from these electrodes for 30 min in the fasting state and 3 h after four kinds of meals with different glycemic index, together with the assessment of blood glucose. The results were as follows: 1) in the fasting state, the percentage of normal intestinal slow waves (%NISW) showed no difference; however, the dominant frequency (DF), power (DP), and percentage of spike activity superimposed on the intestinal slow wave (NS/M) were progressively decreased along the entire small intestine; 2) regular solid meal and Ensure solicited no changes in any parameters of intestinal myoelectrical activity; whereas glucose and glucose + glucagon significantly altered the %NISW, DF, DP, and NS/M, and the effects on the proximal intestine were opposite to those in the distal intestine; and 3) postprandial blood glucose level was significantly correlated with %NISW along the entire small intestine. We found that that, in addition to the well-known frequency gradient, there is also a gradual decrease in the DP and spikes along the small intestine in the fasting state. Glucose and hyperglycemic meals inhibit myoelectrical activities in the proximal small intestine but result in enhanced but more dysrhythmic intestinal myoelectrical activities. There is a significant negative correlation between the normality of intestinal slow waves and blood glucose.

The purpose of this investigation was to review our experience with our comprehensive esophagogastrointestinal transit study in the first 229 patients. This scintigraphic study analyzes the motility of the entire gut, from the esophagus through the rectosigmoid colon. Methods: Data were reviewed for our first 2 y of experience with this examination (184 women and 45 men aged 20–79 y [mean ± SD, 44 ± 16 y]). Patients were referred with symptoms suggestive of a motility disorder. They first swallowed (111)In-diethylenetriaminepentaacetic acid in water for the esophageal-swallow study and then 300 mL for a 30-min (111)In water-only study, followed by 120 mL of (111)In water simultaneously with the solid standardized (99m)Tc egg-substitute meal. Images and quantification were obtained for esophageal transit, water-only gastric emptying, water-with-solid gastric emptying, small-bowel transit, and colonic transit. Results: Of the 229 patient studies, 45 (20%) were normal. The remaining 184 (80%) had at least 1 region of dysmotility, for a total of 336 regions of abnormal motility. A single region of dysmotility was seen in 92 patients (50%), 2 regions in 50 (27%), 3 regions in 26 (14%), 4 regions in 12 (7%), and 5 regions in 4 (2%). There was a poor correlation between the results of the water-only study and water with the solid meal. Three different patterns of delayed colonic transit were seen. Patient symptoms were often not predictive of the scintigraphic findings. Conclusion: This study highlights the frequent occurrence of dysmotility in more than 1 region of the gastrointestinal tract in patients with a suspected motility disorder and the frequent concurrence of both upper- and lower-tract dysmotility in the same patients. It provides information to referring physicians regarding which motility disorders may be causing the patient symptoms, why the patient is or is not responding to the present therapy, and if and what additional workup and therapy may be needed.

Background/Aims The role of esophageal motility in determining gastroesophageal reflux disease (GERD) severity has not been completely evaluated. A few studies have investigated high-resolution manometry (HRM) patterns during solid swallows. The present study evaluates the HRM patterns of non-erosive reflux disease (NERD) patients during both liquid and solid swallows and their correlation with the severity of GERD. Methods In 23 NERD patients and 15 healthy volunteers (HVs) HRM was performed during a standard solid meal in a seated position, followed by 24-hour impedance-pH monitoring. Results Of the 31 patients, 10 showed a pathological acid exposure time (AET; NERD patients), 13 a normal pH profile with positive symptom association probability (SAP; reflux hypersensitivity patients), and 8 normal AET and SAP (functional heartburn patients). Mean distal contractile integral and distal latency values, in all patient groups and HVs, were significantly higher during solid swallows. In the group of 10 NERD patients, the number of large breaks of the esophageal peristalsis was 16 out of 100 liquid swallows (16%) and 31 out of 171 solid swallows (18%). Fourteen out of 100 liquid swallows (14%) and 25 out of 171 solid swallows (15%) resulted ineffective. Mean reflux clearing time at multichannel intraluminal impedance-pH was 17.6 ± 3.7 seconds. NERD patients presented, during solid swallows, a significantly higher proportion of large peristaltic breaks and of ineffective swallows than reflux hypersensitivity and functional heartburn patients. Conclusion HRM during solid swallows reveals motor abnormalities, undetected during liquid swallows, which might be involved in delaying reflux and acid clearance in patients with GERD. (J Neurogastroenterol Motil 2019;25:68-74)

Background Meal-related symptoms are common in paediatric functional dyspepsia (FD). There are only a small number of paediatric studies assessing mechanisms for meal-related symptoms, and these have not utilized Rome IV criteria. The aim of the current study was to assess gastric myoelectric and autonomic nervous system (ANS) responses to both liquid and solid meals in youth with Rome IV-defined FD. Methods In healthy controls (N = 14) and youth with FD (N = 12), we recorded electrocardiograph (to assess heart rate variability; HRV) and electrogastrograph (EGG) signals before and after two test meals, one liquid and one solid. EGG parameters and HRV were assessed for the entire pre- and postprandial periods and in short time intervals. Additionally, liquid gastric emptying was assessed utilizing a 13 C-acetate breath test. Key results During the EGG, the dominant power increased with both meals in controls but not patients with FD. During HRV assessment, the low frequency to high frequency ratio was higher after the liquid meal in controls, despite being similar preprandial, as compared to patients with FD. In controls, both standard deviation of normal to normal waves (SDNN) and root mean square of successive ECG R peaks (R-R interval) differences (rMSSD) increased after the liquid meal (but not after the solid meal) in controls but not patients with FD. Conclusions and inferences Youth with Rome IV-defined FD lacks the normal postprandial EGG dominant power response or autonomic nervous system response following a liquid meal. The latter appears to indicate a lack of ANS flexibility.

Summary The effects of effortful swallowing and solid meal ingestions on heart rate variability (HRV) have been examined previously. The effects of spontaneous saliva swallowing on short-term HRV and reliability of HRV analysis have not been studied before. The effect of saliva swallowing on HRV analyses parameters [meanRRI, SDNN (standard deviation of normal-to-normal), LF (low frequency), HF (high frequency) powers, LH/HF] and the reliability of LF and HF powers were investigated by frequency, time–frequency and intraclass correlation coefficient (ICC) analyses. Electrocardiogram and swallowing signal that obtained from an electronic stethoscope placed on the necks of subjects were recorded simultaneously from 30 healthy and young volunteers in sitting position during 15 min. Spontaneous swallowing has been shown to significantly alter some HRV parameters (SDNN, LF power and LF/HF ratio). Time-frequency analysis results showed that the contribution of saliva swallowing to LF (1–58%) and HF (2–42%) powers could change significantly depending on the number of swallowing. The ICC of the LF and HF powers for the successive 5-min signal segments were found 0·89, 0·92, respectively. These values decreased to 0·73 and 0·90 in the subjects with more swallowing rate. When the analyses were made for 2-min signal periods, these values decreased to 0·63 and 0·67. We concluded that spontaneous saliva swallowing can change HRV parameters. We have also seen that changes in swallowing rate and use of short signal segments may reduce the reliability of HRV analyses.

BC Combo is a co-formulation of prandial insulin lispro (25%) and basal insulin glargine (75%) with a rapid “prandial“ insulin component and prolonged flat “basal“ component compared to LMx. In this study the effects of BC Combo on PPG vs. LMx and G+L were investigated. Thirty-nine T2DM subjects (mean±SD age 60.8±7.5 years and HbA1c 7.97±0.6%) were randomized to receive the three insulin combinations immediately before a standardized solid meal test (MMT, 20% protein 30% fat 50% carbohydrates) in a double-blind, double-dummy, cross-over design. The individual insulin dose was the same for each visit day (mean 0.62 U/kg). BC Combo demonstrated improved PPG compared to LMx (Figure, reduction ∆AUCBG,0-2h of 18%, p=0.0009) and G+L (reduction ∆AUCBG,0-2h of 10%, p=0.0450). The proportion of subjects experiencing documented symptomatic hypoglycemic events (plasma glucose In conclusion, BC Combo demonstrated superior PPG control in T2DM subjects with numerically fewer subjects experiencing symptomatic hypoglycemia compared to both LMx and separate G+L. Disclosure T. Heise: Research Support; Self; ADOCIA, Boehringer Ingelheim GmbH, Dance Biopharm, Eli Lilly and Company, Janssen Research & Development, MedImmune, Merck Sharp & Dohme Corp., Mylan, Nordic Bioscience, Novo Nordisk A/S, Poxel SA, Roche Diagnostics Corporation, Saniona, Sanofi, Senseonics, Zealand Pharma A/S. Advisory Panel; Self; Novo Nordisk A/S, Mylan. Speaker's Bureau; Self; Dexcom, Inc., Eli Lilly and Company, Novo Nordisk A/S, Sanofi. L. Plum-Moerschel: None. C. Mégret: Employee; Self; ADOCIA. Stock/Shareholder; Self; ADOCIA. T. Herbrand: None. V. Vacher: Employee; Self; ADOCIA. E. Anastassiadis: None. O. Klein: None. M. Gaudier: Employee; Self; ADOCIA. Stock/Shareholder; Self; ADOCIA. O. Soula: Board Member; Self; ADOCIA. Stock/Shareholder; Self; ADOCIA. Employee; Spouse/Partner; ADOCIA. S. Glezer: Stock/Shareholder; Self; Sanofi. Stock/Shareholder; Spouse/Partner; Sanofi. Employee; Self; ADOCIA, Novo Nordisk Inc.. Employee; Spouse/Partner; Pfizer Inc., Teva Pharmaceutical Industries Ltd.. Stock/Shareholder; Spouse/Partner; Teva Pharmaceutical Industries Ltd.. B. Alluis: None. G. Meiffren: Employee; Self; ADOCIA. Stock/Shareholder; Self; ADOCIA.

The gastric emptying study provides a comprehensive assessment of gastric function and motility using a standardized meal-and-imaging protocol. View this table: TABLE 1 Medications to Discontinue 48–72 h Before Gastric Emptying Scintigraphy ([1][1],[3][2]) View this table: TABLE 2

To corroborate the hypothesis that mastication affects the motivation to get food, we examined the effects of dietary consistency on the development of meal anticipation in locomotor activity of rats subjected to restricted daily feeding (RF), in which food supply was restricted to a fixed time each day. RF of both liquid and solid meals produced anticipatory locomotor activity. However, the strength of the activity in rats subjected to RF of liquid meal was lower than that in rats subjected to RF of solid meal. These results suggest that the feeding-associated circadian oscillation that developed by feeding with liquid meal is less potent than that in the case of feeding with solid meal. Furthermore, mastication for digesting solid meal might be one of the factors that determine the strength of the feeding-associated circadian oscillation.

Background: The clinical use of Magnetic Resonance Imaging (MRI) for investigating gastric motor function in dyspepsia is limited, largely due to protocol complexity, cost and limited availability. In this study, we explore the feasibility of a sub 60-minute protocol using a water challenge to assess gastric emptying, motility and accommodation in a cohort of Ehlers-Danlos Syndrome-Hypermobility type (EDS-HT) patients presenting with dyspepsia.Methods: Nine EDS-HT patients (mean age 33, range: 26-50 all female) with a history of dyspepsia were recruited together with nine-matched controls. Subjects fasted for 6 hours prior to MRI. A baseline anatomical and motility scan was performed after which the subjects ingested 300 mL water. The anatomical and motility scans were then repeated every 10 minutes to a total of 60 minutes. Gastric emptying time, motility, and accommodation were calculated based on the observations of two observers for each EDS-HT subject and compared to their matched control using paired statistics.Key Results: Median motility increase following the water challenge was lower in EDS-HT subjects (11%, range: 0%-22%) compared to controls (22%, range: 13%-56%), P=.03. Median gastric emptying time was non-significantly decreased in EDS-HT subjects (12.5 minutes, range: 6-27) compared to controls (20 minutes, range: 7-30), P=.15. Accommodation was non-significantly reduced in EDS-HT subjects (56% increase, range: 32%-78%) compared to healthy controls (67% increase, range: 52%-78%), P=.19.Conclusions & Inferences: This study demonstrates the feasibility of a water challenge MRI protocol to evaluate gastric physiology in the clinical setting. Motility differences between EDS-HT and controls are worthy of further investigation.

Gastric emptying scintigraphy (GES) using a solid meal is often recommended for the evaluation of gastroparesis. However, some patients cannot tolerate the standardized egg-white sandwich (EWS) solid meal and an alternative meal is needed.The aim of this study was to compare GES, regional gastric emptying, and gastric contractility using a liquid nutrient meal (LNM; Ensure Plus(®)) to those using EWS.Twenty healthy volunteers underwent GES using EWS and LNM on separate days. Gastric emptying was measured using scintigraphy and with a wireless motility capsule (WMC; SmartPill(®)).The gastric emptying half-time with LNM was similar to that with EWS (1.41 ± 0.11 vs 1.52 ± 0.08 h; P = 0.28) and the two were significantly correlated (r = 0.53; P = 0.017). There were time-related differences in gastric emptying of the LNM compared to EWS: in the first hour, gastric retention of EWS was slightly greater than that of LNM, whereas at 3 and 4 h, gastric retention of EWS was slightly less than that of LNM. Regionally, the percentage retention of the meal in the proximal stomach was greater for EWS than for LNM at 0.5 h. WMC gastric emptying times and gastric contractility for the two meals were not significantly different.Overall gastric emptying of the LNM was similar to that of the EWS meal. The LNM empties without a lag phase and takes slightly longer to empty from the distal stomach, likely due to its higher fat content. These differences are likely due to early accommodation with retention of solids in the proximal stomach and the need for trituration of solids. We conclude that this LNM can serve as an alternative to the conventional solid EWS for GES.

Despite the rapid development of minimally invasive surgery, the treatment of esophageal lesions remains controversial. Giant esophageal leiomyoma could be removed once diagnosed, but its operative method is not quite the same as esophageal leiomyoma of small size. We report a case of giant esophageal leiomyoma and review published cases of giant leiomyomas in the past 10 years. A 29-year-old man was admitted to the clinic for the complaints of 2-month history of dysphagia and discomfort. Radiologic and endoscopic findings suggested esophageal lesion in the muscular layer. The VATS enucleation was performed to relieve the patient's symptoms. The patient started oral intake on the 1st postoperative day, with following solid meal. The postoperative course was uneventful, and the patient was discharged on the 8th postoperative day.

Objective: This cross-sectional descriptive study examined the role of parental premarital counselling and socio-demographic characteristics on the prevalence of sickle cell gene among 82 apparently healthy under-two children.Methods: Subjects were recruited from under-two children attending child welfare clinic at Nnamdi Azikiwe University Teaching Hospital, Nnewi, South-East, Nigeria.Results: More than half of their mothers were aware of their hemoglobin phenotype (64.6%) and that of their husbands (53.6%). In about half of the families (52.4%), the parents had a premarital counselling intervention against sickle cell disease (SCD). Among the 44 families where parents were aware of their phenotype before marriage, only one couple (2.3%) was at risk of having an offspring with SCD. None of the subjects had SCD and the prevalence of sickle cell trait (SCT) among them was 22%. Premarital counselling intervention in families seemed to increase the prevalence of SCT when compared to those not counselled but this was not statistically significant (p = 0.30). The lower prevalence of SCT among children of more educated women suggests that educational status may affect the distribution of the sickle cell gene in the population.Conclusion/Recommendation: Premarital counselling and screening may be effective in reducing the prevalence of SCD but the higher prevalence of SCT among the population where this intervention occurred portends an ominous sign for the future. Integration of malaria eradication and competent genetic counselling, with avoidance of discrimination against people with SCT or SCD, into screening programmes are essential for reducing the burden and impact of SCD.Keywords: Sickle cell gene, sickle cell disease, prevalence, premarital screening, counselling

The use of ultrasound equipment in routine clinical evaluation of the gastrointestinal tract is still standby. Objective: to show an alternative application of ultrasound technique for monitoring peristalsis and gastric emptying through an executable routine implemented in LabVIEW. Methods: an ultrasound equipment (Medison SONACE 800 SE) was used in ten healthy subjects and four patients; dominant peristalsis frequency and gastric emptying were measured after fasting nights of the patients; subjects ingested, first 300 mL of water and then a solid meal (240 kCal). Results: the video acquisition in M mode and imaging processing were performed in a LabVIEW platform, as long as digital signal processing was carried out in matlab 2008a; peristaltic frequency of 2.4 cpm (cycles per minute) and a half time of the gastric emptying around 35 s were found. Discussion: these findings are congruent with similar evaluations of GI tract obtained by using the gold standard technique. So, ultrasound technique is now an alternative procedure for gastric evaluation with the advantage that patients are free of ionizing radiation, and these equipments are amply available in the world hospitals.

The gold standard technique for measuring gastric emptying is scintigraphy using radiolabeled test meals. Recently, a standardized radiolabeled solid meal has been proposed and adopted by many centers. There is still a need for alternative meals, and several such meals with demonstrated radiolabel stability have been evaluated in small numbers of subjects. Updated radiation dosimetry associated with these meals has been calculated for adult males and adult females with normal gastrointestinal transit as well as transit abnormalities.

The purpose of the present study was to determine whether a protein-rich beverage leads to a differential response in appetite, satiety and subsequent energy intake compared with an energy- and macronutrient-matched solid version in young people. A total of fifteen adolescents (eight girls and seven boys; age 14 (sem 1) years, BMI percentile 79 (sem 4) %) randomly completed two testing days that included protein-rich (PR) breakfast meals (38 % of energy as protein, 48 (sem 2) g/meal) provided as a solid (S) or beverage (B). Breakfast was 24 % of estimated daily energy needs (2146 (sem 96) kJ/meal). Perceived appetite and satiety responses were collected over 5 h followed by an ad libitum lunch buffet. The PR-S meal led to greater reductions in 4 h postprandial appetite ( − 6221 (sem 1171) mm × 240 min) v. the PR-B meal ( − 3570 (sem 957) mm × 240 min; P v. the PR-B meal (all comparisons, P v. PR-B meals. The PR-S meal led to approximately 480 kJ less energy consumed at the ad libitum lunch buffet (1418 (sem 222) kJ) v. the PR-B meal (1900 (sem 326) kJ; P v. a solid meal.

Aim: To study whether eradication of Helicobacter pylori (H. pylori) in patients with functional dyspepsia affects gastric emptying (GE) and concomitantly relieves their clinical symptoms. Material and methods: Eighteen H. pylori-positive patients suffering from functional dyspepsia were recruited. At entrance and two weeks after successful H. pylori eradication they filled in a questionnaire examining the intensity of dyspeptic symptoms and underwent measurement of GE of a 378 kcal solid test meal labelled with 75 μl of 13C-octanoic acid. Normative values of GE were obtained in 12 healthy controls. Results: Helicobacter pylori eradication was attained in 17 patients. The duration of the lag phase (T_Lag) of the GE did not change after the eradication (mean ± SD 144.5 ±23.2 min) vs. before the eradication (152.1 ±27.6 min). On the other hand, the gastric half emptying time (T1/2) increased statistically significantly from 207.1 ±33.5 min before eradication to 229.5 ±49.4 min (p = 0.0217). Considering the whole patient group, the H. pylori eradication did not significantly affect the dyspeptic symptoms. It was established, however, that the deterioration of the score for fullness or satiety was dependent on the increase in the T_Lag. Also the aggravation of pain, burning or satiety was related to the prolongation of the T1/2. Conclusions: 1) Eradication of H. pylori in patients with functional dyspepsia prolongs the gastric half emptying time of a solid meal without eliciting a significant symptomatic improvement. 2) The worsening of dyspeptic symptoms may be related to sluggish gastric emptying. Streszczenie Cel: Ustalenie, czy eradykacja Helicobacter pylori (H. pylori) u chorych z dyspepsją czynnościową wplywa na szybkośc oprozniania zolądka (gastric emptying – GE) i zlagodzenie towarzyszących objawow klinicznych. Material i metody: W badaniu wzielo udzial 18 chorych z infekcją H. pylori cierpiących na dyspepsje czynnościową. W czasie wlączania do badania oraz 2 tyg. po skutecznej eradykacji wypelniali oni kwestionariusz mający na celu określenie nasilenia objawow dyspeptycznych oraz zostali poddani pomiarowi GE z posilku stalego o wartości energetycznej 378 kcal z dodatkiem 75 μl 13C-kwasu oktanowego. Wartości normatywne kinetyki GE wyznaczono u 12 zdrowych osob. Wyniki: Eradykacje H. pylori uzyskano u 17 chorych. Czas trwania fazy opoźnienia GE (T_Lag) nie zmienil sie po eradykacji (średnia ± SD 144,5 ±23,2 min) w porownaniu z czasem przed eradykacją (152,1 ±27,6 min). Polokres GE (T1/2) natomiast zwie k szyl sie statystycznie znamiennie z 207,1 ±33,5 min przed eradykacją do 229,5 ±49,4 min po eradykacji (p = 0,0217). Biorąc pod uwage calą grupe chorych, eradykacja H. pylori nie wplynela znamiennie na objawy dyspeptyczne. Wykazano jednak, ze pogorszenie punktacji w skali oceny uczucia pelności lub wczesnej sytości zalezalo od wzrostu dlugości T_Lag, podczas gdy zwiekszenie odczucia bolu, pieczenia i pelności od wydluzenia T1/2. Wnioski: 1) Eradykacja H. pylori u chorych z dyspepsją czynnościową wydluza polokres oprozniania zolądka z pokarmow stalych, nie wywierając znamiennego wplywu na zmniejszenie objawow. 2) Pogorszenie objawow dyspeptycznych moze sie wiązac ze zwolnionym oproznianiem zolądka.

BACKGROUND: Small bowel manometry is a diagnostic test available only in a few specialized referral centers. Its exact place in the management of refractory symptoms is controversial. METHODS: The records of all patients who underwent 24-hour ambulatory duodenojejunal manometry over a 6-year period were retrospectively reviewed. We studied the clinical indications for small bowel manometry, and reviewed the impact of manometric findings on the clinical outcome. One hundred and forty-six studies were performed in 137 patients (46M, 91F) with a mean age of 44.9 ± 15.7 years. Mean follow-up duration was 15.1 ± 22.6 months. Appropriate endoscopic, radiological and gastric scintigraphy studies were performed in all patients prior to small bowel manometry. Criteria for abnormal motor activity were based on Bharucha's classification. KEY RESULTS: The indications for small bowel manometry were chronic abdominal pain (n = 43), slow-transit constipation (n = 17), refractory gastroparesis (n = 16), chronic diarrhea (n = 7), recurrent episodes of subocclusion (n = 16), postsurgical evaluation (n = 36), suspicion of gut involvement in systemic disease (n = 9), and unexplained nausea (n = 2). The most common finding was a normal 24-hour ambulatory small bowel manometry (n = 113). Thirty-three studies yielded abnormal findings which included extrinsic neuropathy (n = 6), intrinsic neuropathy (n = 18), intestinal myopathy (n = 2), and subocclusion (n = 7). Ambulatory small bowel manometry excluded a generalized motility disorder in 77% and had a significant impact on the subsequent clinical course in 23%. CONCLUSIONS & INFERENCES: Ambulatory small bowel manometry is a useful and safe diagnostic tool to complement traditional investigative modalities in patients with severe unexplained abdominal symptoms. ispartof: NEUROGASTROENTEROLOGY AND MOTILITY vol:30 issue:9 ispartof: location:England status: published

The medical literature states that solid gastric-emptying studies are more sensitive for the detection of gastroparesis than are liquid studies; thus, liquid studies are rarely required. However, we have seen patients with normal solid but delayed liquid emptying. The purpose of this investigation was to determine whether a study of clear liquid gastric empting has added value for the diagnosis of gastroparesis over a study of solid emptying alone. Methods: A total of 101 patients underwent both solid and liquid gastric-emptying studies, acquired sequentially on the same day. A 30-min (1-min frames) liquid study (300 mL of water with 7.4 MBq [0.2 mCi] of 111In-diethylenetriaminepentaacetic acid) was followed by a standardized 4-h solid-meal study (a 99mTc-sulfur colloid–labeled egg-substitute sandwich meal). Emptying was quantified as a best-fit exponential emptying rate (T1/2) for liquids and percentage emptying at 4 h for solid empting. Thirty healthy volunteers underwent a study of clear liquid emptying to establish normal values. The results of the liquid and solid studies were compared. 111In liquid downscatter into the subsequent 99mTc solid meal results was analyzed. Results: The upper range of normal for clear liquid emptying (T1/2) for healthy volunteers was 22 min (mean ± 3 SDs) and 19 min (mean ± 2 SDs). Of 101 patients, delayed emptying was found in 36% of liquid and 16% of solid studies. Of all patients with normal solid emptying, 32% had delayed liquid emptying. 111In downscatter into the 99mTc window was not generally significant. Conclusion: For the detection of gastroparesis, a 30-min study of clear liquid gastric-emptying has considerable added diagnostic value over a study of solid emptying alone.

Background Information about the extent of carbohydrate digestion and fermentation is critical to our ability to explore the metabolic effects of carbohydrate fermentation in vivo. We used cooked (13)C-labelled barley kernels, which are rich in indigestible carbohydrates, to develop a method which makes it possible to distinguish between and to assess carbohydrate digestion and fermentation. Materials and methods Seventeen volunteers ingested 86 g (dry weight) of cooked naturally (13)C enriched barley kernels after an overnight fast. (13)CO(2) and H(2) in breath samples were measured every half hour for 12 h. The data of (13)CO(2) in breath before the start of the fermentation were used to fit the curve representing the digestion phase. The difference between the area under curve (AUC) of the fitted digestion curve and the AUC of the observed curve was regarded to represent the fermentation part. Different approaches were applied to determine the proportion of the (13)C-dose available for digestion and fermentation. Results Four hours after intake of barley, H(2)-excretion in breath started to rise. Within 12 h, 24-48% of the (13)C-dose was recovered as (13)CO(2), of which 18-19% was derived from colonic fermentation and the rest from digestion. By extrapolating the curve to baseline, it was estimated that eventually 24-25% of the total available (13)C in barley would be derived from colon fermentation. Conclusion Curve fitting, using (13)CO(2)- and H(2)-breath data, is a feasible and non-invasive method to assess carbohydrate digestion and fermentation after consumption of (13)C enriched starchy food.

We assessed the impact of a prolonged lipase inhibition upon gastric emptying (GE) and orocecal transit time (OCTT) of a 355-kcal low-fat solid meal.In double-blind manner, 40 obese women BMI30 kg/m2, randomly allocated into two equal groups, took orally t.i.d. 120 mg orlistat or placebo during 8 weeks of a weight-reducing management. At randomization and after 2 months, GE was measured simultaneously with OCTT by means of a 13C-octanoic acid and a hydrogen breath test, respectively. Lipolytic activity was evaluated with a 13C-mixed triglyceride breath test (13C-MTGBT).A profound lipase inhibition by orlistat was confirmed by a 79.5% +/- 16.9% reduction of the cumulative 6-h 13C recovery with 13CMTGBT. GE remained unchanged either in the orlistat (T1/2, 188 +/- 35 min start versus 198 +/- 36 min end) or the placebo (T1/2, 191 +/- 35 min start versus 180 +/- 39 min end) group. OCTT increased from 208 +/- 54 min to 271 +/- 64 min (P0.01) after orlistat treatment and did not change significantly (216 +/- 76 vs. 234 +/- 72 min) in the placebo group.No adverse effect on the GE and a moderate prolongation of the OCTT of a low-fat solid meal is to be expected under a prolonged treatment with orlistat at a typical dosage regimen.

The effect of three different meal constituents, solid, semisolid and liquid, on gastric pH, recorded in the proximal and distal stomach, was evaluated in a prospective study of 20 normal volunteers. The solid and liquid were ingested together as one meal and the semisolid as another. Simultaneous recordings of the rate of gastric emptying of the isotopically labelled meal constituents and the gastric pH were made. The rate of gastric emptying was more rapid for the liquid and semisolid constituents (t1/2= 35.6, range 9.8–103.3 min and 47.4, range 33.5–120 min, respectively) than for the solid meal constituent (t1/2= 72.0, range 45.0–103.8 min), P < 0.01. Both the combined meal of solid and liquid and the semisolid meal produced a higher pH response in the proximal stomach than in the distal stomach (5.2, range 2.4–6.1 vs 2.9, range 0.8–5.3 and 5.9, range 4.3–6.6 vs 4.3, range 1.1–5.9), P < 0.01. There were significant correlations between the rate of gastric emptying of all three meal constituents and the decline phase in the gastric pH recorded at both the proximal and distal probes, P < 0.01 (Pearson's correlation). The strongest correlations were found between the rate of gastric emptying and the gastric pH recorded in the proximal stomach. The decline phase of gastric pH followed the emptying of semisolid more closely than the emptying of either solid or liquid.

PURPOSE To assess the gastric emptying pattern of a standardized solid meal in patients with non-ulcer dyspepsia by using scintigraphic techniques. METHODS Results for the half-emptying time for solids (T1/2) and percent clearance of solid meal at 60 min (C60) of patients (n=35) having non-ulcer dyspepsia according to Rome II criteria were compared with age- and sex-matched controls (n=28). Gastric emptying was studied by using egg omelette labelled with Tc tin colloid. Data acquisition was done using two protocols: dynamic acquisition was performed for the first 100 min and then static acquisition was carried out for up to 4 h. T1/2 and C60 were calculated from the computer-generated time-activity curve. RESULTS The normal range of T1/2 was 29-88 min (mean+/-2 SD) among the control group. The mean T1/2 of the patient group was 160.1+/-96.1 min (P

5-hydroxytryptamine mechanisms in mediating the effects of small intestinal glucose on blood pressure and antropyloroduodenal motility in older subjects. Am J Physiol Gastrointest Liver Physiol 293: G692-G698, 2007. First published August 9, 2007; doi:10.1152/ajpgi.00199.2007.-Postprandial hypotension is an important clinical problem, particularly in the elderly. 5-Hydroxy-tryptamine(3) (5-HT3) mechanisms may be important in the regulation of splanchnic blood flow and blood pressure (BP), and in mediating the effects of small intestinal nutrients on gastrointestinal motility. The aims of this study were to evaluate the effects of the 5-HT3 antagonist granisetron on the BP, heart rate (HR), and antropyloroduodenal (APD) motility responses to intraduodenal glucose in healthy older subjects. Ten subjects (5 male, 5 female, aged 65-76 yr) received an intraduodenal glucose infusion (3 kcal/min) for 60 min (t = 0-60 min), followed by intraduodenal saline for a further 60 min (t = 60-120 min) on 2 days. Granisetron (10 mu g/kg) or control (saline) was given intravenously at t = -25 min. BP (systolic and diastolic), HR, and APD pressures were measured. Pressure waves in the duodenal channel closest ("local") to the infusion site were quantified separately. During intraduodenal glucose, there were falls in systolic and diastolic BP and a rise in HR (P

The (13)C-octanoic acid breath test is widely used for evaluating gastric emptying of solids. Since the results of this test are influenced by multiple factors such as the time required to grind the solid meal into smaller particles, the gastroduodenal transport time of the ground meal, and the time required for bowel drug absorption and drug dispersion, the administration of a test meal by the oral route alone cannot result in an accurate measurement of the complicated process of emptying the stomach of solids. The aim of the present study was to evaluate each phase of gastric emptying of solids by varying the administration route of the test meal. Six healthy male volunteers (mean age: 33.2 yr) participated in the study. The test meal consisted of a bowl of rice topped with a mixture of boiled chicken and eggs admixed with 100 mg of (13)C-octanoic acid (total: 273 kcal). All subjects were given the test meal by each of the following three methods: 1. Normal oral intake of the test meal, 2. Feeding of the ground test meal through a nasogastric tube, 3. Feeding of the ground test meal through a duodenal tube. For each set of examinations, the mean residence time (MRT), half-emptying time (T(1/2)), gastric emptying coefficient (GEC), lag phase (L-breath), and measured maximum (13)C excretion time (Tmax-measured) were calculated. The data was analyzed to determine the time for each phase of gastric emptying as follows: mean grinding time (MGT) = MRT(oral) - MRT(nasogastric), mean gastroduodenal transport time (MGDTT) = MRT(nasogastric) - MRT (nasoduodenal). Data was expressed as the mean +/- SE. The values of the parameters of MGT were 0.82 +/- 0.50 hr (MRT), 0.64 +/- 0.18 hr (T(1/2)), 0.51 +/- 0.24 hr (L-breath), -0.45 +/- 0.30 hr (GEC), and 49.2 +/- 8.0 min (Tmax-measured). The values of the parameters of MGDTT were 0.87 +/- 0.38 hr (MRT), 0.26 +/- 0.29 hr (T(1/2)), 0.92 +/- 0.36 hr (L-breath), 0.55 +/- 0.23 hr (GEC), and 63.33 +/- 8.16 min (Tmax-measured). The times required for the drug absorption and disposition were 1.60 0.20 hr (MRT), 1.03 +/- 0.24 hr (T(1/2)), 0.10 +/- 0.08 hr (L-breath), 3.72 +/- 0.46 hr (GEC), and 19.67 +/- 2.11 min (Tmax-measured). By varying the administration route of a test meal containing (13)C-octanoic acid, we may be able to assess each phase of the emptying of gastric solids in detail, thus leading to a better understanding of gastroduodenal motility.

Patients with medically complex conditions undergoing repair of large or recurrent hernia of the abdominal wall are at risk for early postoperative hyperglycemia, which may serve as an early warning for delays in recovery and for adverse outcomes.To evaluate postoperative serum glucose level as a predictor of outcome after open ventral hernia repair in patients with major medical comorbidities.We performed a retrospective medical record review of 172 consecutive patients who underwent open ventral hernia repair at Penn State Milton S. Hershey Medical Center, an academic tertiary referral center, from May 1, 2011, through November 30, 2013. We initially identified patients by medical complexity and repair requiring a length of stay of longer than 1 day.Postoperative recovery variables, including time to the first solid meal, length of stay, total costs of hospitalization, and surgical site occurrence.Postoperative serum glucose values were available for 136 patients (79.1%), with 130 (95.6%) obtained within 48 hours of surgery. Among these patients, Ventral Hernia Working Group grade distributions included 8 patients with grade 1, 79 with grade 2, 41 with grade 3, and 8 with grade 4. Fifty-four patients (39.7%) had a postoperative glucose level of at least 140 mg/dL, and 69 patients (50.7%) required insulin administration. Both outcomes were associated with delays in the interval to the first solid meal (glucose level, ≥140 vs140 mg/dL: mean [SD] delay, 6.4 [5.3] vs 5.6 [8.2] days; P = .01; ≥2 insulin events vs2: 6.5 [5.5] vs 5.4 [8.4] days; P = .02); increased length of stay (glucose level, ≥140 vs140 mg/dL: mean [SD], 8.0 [6.0] vs 6.9 [8.2] days; P = .008; ≥2 insulin events vs2: 8.3 [6.1] vs 6.5 [8.4] days; P .001); increased costs of hospitalization (glucose level, ≥140 vs140 mg/dL: mean [SD], $31 307 [$20 875] vs $22 508 [$22 531]; P .001; ≥2 insulin events vs2: $31 943 [$22 224] vs $20 651 [$20 917]; P .001); and possibly increased likelihood of surgical site occurrence (glucose level, ≥140 vs140 mg/dL: 37.5% [21 of 56 patients] vs 22.5% [18 of 80 patients]; P = .06; ≥2 insulin events vs2: 36.4% [24 of 66 patients] vs 21.4% [15 of 70 patients]; P = .06). Not all patients with diabetes mellitus developed postoperative hyperglycemia or needed more intense insulin therapy; however, 46.4% of the patients who developed postoperative hyperglycemia were not previously known to have diabetes mellitus, although most had at least 1 clinical risk factor for a prediabetic condition.Postoperative hyperglycemia was associated with outcomes in patients in this study who underwent complex ventral hernia repair and may serve as a suitable target for screening, benchmarking, and intervention in patient groups with major comorbidities.

This study assessed whether liquid carbohydrate-protein (C+P) supplements, ingested early during recovery, enhance muscle glycogen resynthesis versus isoenergetic liquid carbohydrate (CHO) supplements, given early or an isoenergetic solid meal given later during recovery (PLB).Two hours after breakfast (7.0 kcal.kg; 0.3 g.kg P, 1.2 g.kg C, 0.1 g.kg F), six male cyclists performed a 60-min time trial (AMex). Pre- and postexercise, vastus lateralis glycogen concentrations were determined using nMRS. Immediately, 1 h, and 2 h postexercise, participants ingested C+P (4.8 kcal.kg; 0.8 g.kg C, 0.4 g.kg P), CHO (4.8 kcal.kg; 1.2 g.kg C), or PLB (no energy). Four hours postexercise, a solid meal was ingested. At that time, C+P and CHO received a meal identical to breakfast, whereas PLB received 21 kcal.kg (1 g.kg P, 3.6 g.kg C, 0.3 g.kg F); energy intake during 6 h of recovery was identical among treatments. After 6 h of recovery, measurement and cycling protocols (PMex) were repeated.Absolute muscle glycogen utilization was 18% greater (Por= 0.05) during AMex (C+P: -42.75+/-5.24 mmol.L; CHO: -37.08+/-7.59 mmol.L; PLB: -53.78+/-11.59 mmol.L; P=0.302) relative to PMex (C+P: -38.40+/-4.37 mmol.L; CHO: -31.16+/-3.78 mmol.L; PLB: -40.33+/-1.47 mmol.L; P=0.292), but there were no differences between groups. During 6 h of recovery, muscle glycogen resynthesis was greater in C+P (+ 28.62+/-2.10 mmol.L) versus CHO (+ 22.20+/-1.19 mmol.L, Por= 0.05) or PLB (+18.50+/-7.67 mmol.L, Por= 0.05). Cycling performance was similiar (P=0.282) among treatments during both AMex (C+P: 37.61+/-0.63 km; CHO: 37.03+/-0.60 km; PLB: 37.24+/-0.34 km) and PMex (C+P: 36.31+/-0.83 km; CHO: 36.38+/-0.80 km; PLB: 35.34+/-0.45 km).C+P supplements, given early after exercise, enhance glycogen resynthesis relative to CHO and PLB. However, this does not influence performance in this type of exercise bout.

Objective The physiological range of gastric emptying in healthy children has not previously been documented. The aim of this study was to establish the range of normal gastric emptying in children aged between 5 and 10 years with a Tc 99m–labelled solid meal acceptable to most of the children. Methods A list of 7 child-friendly foods was compiled. Thirty-one children aged 5 to 10 years completed a questionnaire, ranking their favourite food choices. A volume survey, to decide the weight of solid meal for the study, was carried out in 20 children. After ethical approval, gastric emptying was monitored in healthy children aged 5 to 10 years with a 99m Tc-labelled solid meal selected by the methodology given hereinabove. Geometric mean counts were obtained from anterior and posterior gamma camera images, and data were used to produce normal emptying curves. In each case, a T 1/2 gastric emptying time (time taken to empty half the stomach contents) was calculated. Results The overall preference was a chocolate Technecrispy cake, and the volume survey suggested a 30-g weight for the study. Twenty-four subjects consumed the meal and completed the study. The mean T 1/2 gastric emptying time was 107.2 minutes (2 SD; range, 54.6-159.8 minutes). Conclusions Chocolate Technecrispy cake was acceptable to most healthy children between 5 and 10 years of age and gave mean T 1/2 gastric emptying time of 107.2 minutes. This meal can now be used for paediatric patients with transit problems.

Noninvasive imaging has been developed to measure gastric volumes. The relationship between gastric emptying and volume postprandially is unclear. The aims were to 1) develop a 3-dimensional (3D) single photon emission-computed tomography (SPECT) method to simultaneously measure gastric volume and emptying postprandially, 2) describe the course of gastric volume change during emptying of the meal, and 3) assess a 3D method measuring gastric emptying. In 30 healthy volunteers, we used 111In-planar and 99mTc-SPECT imaging to estimate gastric emptying and volume after a radiolabeled meal. A customized analysis program of SPECT imaging assessed gastric emptying. A Bland-Altman plot assessed the performance of the new SPECT analysis compared with planar analysis. Gastric volume postprandially exceeds the fasting volume plus meal volume. The course of volume change and gastric emptying differ over time. Higher differences in volumes exist relative to fasting plus residual meal volumes at 15 min (median 763 vs. 568 ml, respectively, P < 0.001), 1 h (median 632 vs. 524 ml, P < 0.001), and 2 h (median 518 vs. 428 ml, P < 0.02), in contrast to similar volumes at 3 h (median 320 vs. 314 ml, P = 0.85). Analysis of SPECT imaging accurately measures gastric emptying compared with planar imaging with median differences of 1% (IQR −2.25 to 2.0) at 1 h, 1% (−3.25 to 2.25) at 2 h, and −2.5% (−4 to 0) at 3 h. Gastric volume exceeds meal volume during the first 2 postprandial hours, and simultaneous measurements of gastric volume and emptying can be achieved with a novel 3D SPECT method.

Background Small intestinal and oro-cecal transit time (OCTT) is determined for clinical diagnostics and research purposes. Experimental protocols used vary with respect to the inclusion of a subsequent meal during the test period. This study was conducted to elucidate whether the ingestion of a subsequent meal during the test period influences the OCTT of the test meal. Materials and methods The OCTT of a liquid test meal, measured with the lactose-[C-13]ureide breath test, was compared between four groups of healthy volunteers (n = 36) who consumed the subsequent meal at different time points. Also, the OCTT was determined twice in eight subjects; a subsequent meal was ingested after 180 min (test A) and after 360 min (test B). Results An apparently meal-related increase in median OCTT was observed. The OCTT of the eight volunteers measured in test A (210; 210-349 median; quartiles) was significantly shorter than that found in test B (345; 300-375 min, P = 0.016). As result of the ingestion of the subsequent meal at 180 min the OCTT was shortened by 90; 64-116 min in 7/8 subjects. Conclusion These data indicate that the ingestion of a subsequent meal affects the OCTT of a liquid test meal. This phenomenon could be explained by the increased intestinal motility in response to a meal, and should be taken into account when designing protocols for measurements of the OCTT and in the interpretation of small intestinal absorption studies.

Scintigraphy and the 13C-octanoic acid breath test are both applied to assess gastric emptying. Using the 13C-octanoic acid breath test, excretion curves show 13C excretion immediately after ingestion of a solid egg meal, in contrast with scintigraphy where gastric emptying is observed after a lag phase. The aim of our study was to investigate whether transpyloric flow occurs during and directly after meal ingestion. Therefore, transpyloric flow was measured during and after ingestion of an egg meal labeled with 13C-octanoic acid, using Doppler ultrasonography. The breath test was performed simultaneously, with samples taken at regular intervals. The first emptying episode was observed 6.9 (3.9–16.2) min after start of meal ingestion. A significant relation between recovery of 13C and total duration of gastric emptying during the first 20 min was observed (partial correlation coefficient r = 0.80, p < 0.001). In conclusion, transpyloric flow starts during ingestion of a solid egg meal and results in detectable excretion of 13C.

The study of gastric emptying rate of solids using radiopaque indigestible solid markers has been a poorly employed technique because some kinds of markers do not leave the stomach at the same time as the meal but during the interdigestive migrating motor complex (IMMC). The aim of this study was to evaluate whether markers of particular shape and size can be successfully employed for this purpose.Twenty-eight non-ulcer dyspeptic (NUD) patients and 20 healthy volunteers received a standard solid meal (790 Kcal) together with 20 small polyethylene radiopaque cylinders (5 mm x 2 mm in diameter). Gastric emptying rate was evaluated by ultrasound while the emptying of markers was simultaneously followed by X-rays using a brilliance intensifier.Final emptying time (FET = time when the antrum area returns to fasting size) of digestible solids was 355+/-35 min in NUD patients versus 265+/-20 min in controls (P0.001). The gastric emptying curve of digestible solids correlated with emptying of markers both in NUD patients (r= +0.96) and in controls (r= +0.93).The assessment of gastric clearance of radiopaque cylinders of 2 mm x 5 mm in size is a reliable tool for the study of gastric emptying rate of digestible solids. This is a readily available and easily performed test in any radiology unit.