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Nutrition in Clinical Practice :... Feb 2021Gastroparesis (GP) is commonly seen in hospitalized patients. Refractory vomiting and related dehydration, electrolyte abnormalities, and malnutrition are indications... (Review)
Review
Gastroparesis (GP) is commonly seen in hospitalized patients. Refractory vomiting and related dehydration, electrolyte abnormalities, and malnutrition are indications for hospital admission. In addition, tube feeding intolerance is a common sign of gastric dysmotility in critically ill patients. The diagnosis and management of GP in the hospital setting can be quite challenging. Diagnostic tests are often deferred because of patient intolerance of the oral meal for standard scintigraphy or severity of the primary disease. The diagnosis of GP is often established on the basis of clinical scenario and risk factors for gastric motor dysfunction. Medical therapy in GP is directed toward controlling nausea and vomiting by prokinetic and antinausea medications and correcting nutrition risks or treating malnutrition with nutrition therapy. Enteral nutrition is the preferred nutrition intervention for patients with GP. Delayed gastric emptying in critically ill patients has a negative impact on the timely delivery of enteral feeding and meeting the energy and protein goals. Measures to improve gastric tolerance or provide feeding beyond the stomach are often needed, since early enteral nutrition has been an important target of therapy for critically ill patients. This review will address the current understanding of the mechanisms of GP and feeding intolerance in critical illness, diagnostic workup, drug therapies, and interventions to improve the provision of enteral nutrition in hospital settings when gastric dysmotility is present or suspected.
Topics: Critical Illness; Enteral Nutrition; Gastric Emptying; Gastroparesis; Hospitals; Humans
PubMed: 33336872
DOI: 10.1002/ncp.10611 -
Expert Review of Gastroenterology &... Aug 2019: Gastroparesis is a chronic disorder of the stomach characterized by delayed gastric emptying without mechanical obstruction. Diabetes is the most commonly known cause... (Review)
Review
: Gastroparesis is a chronic disorder of the stomach characterized by delayed gastric emptying without mechanical obstruction. Diabetes is the most commonly known cause of gastroparesis. Management of diabetic gastroparesis involves lifestyle modifications, glycemic control, pharmacological drugs, and for refractory cases surgical treatments. Metoclopramide remains the only drug approved by the Food and Drug Administration for diabetic gastroparesis. The aim of this article is to provide a concise review of the pharmacology, clinical efficacy and tolerability of metoclopramide. : We searched PubMed using the key words 'metoclopramide', 'diabetic gastroparesis', and 'gastric emptying'. The relevant articles and their bibliography were reviewed. Metoclopramide acts on several different receptors; primarily as a dopamine receptor antagonist, both peripherally improving gastric emptying, and centrally resulting in an anti-emetic effect. Metoclopramide side effects, mostly related to its ability to cross the blood-brain barrier, include drowsiness, restlessness, hyperprolactinemia, and tardive dyskinesia (TD), a movement disorder that may be irreversible. : Metoclopramide carries a black box warning for use >12 weeks due to the risk of TD. However, gastroparesis patients experience chronic symptoms often requiring prolonged treatments. Physicians and patients look forward to FDA approval of new agents for gastroparesis with better efficacy and safety profile.
Topics: Diabetes Complications; Dopamine D2 Receptor Antagonists; Gastric Emptying; Gastroparesis; Humans; Metoclopramide; Treatment Outcome; Upper Gastrointestinal Tract
PubMed: 31314613
DOI: 10.1080/17474124.2019.1645594 -
Journal of Nuclear Medicine Technology Jun 2019
Review
Topics: Gastric Emptying; Humans; Radionuclide Imaging; Stomach
PubMed: 31167827
DOI: 10.2967/jnmt.117.227892 -
Diabetes Care Jun 2016The gastrointestinal tract plays a major role in the regulation of postprandial glucose profiles. Gastric emptying is a highly regulated process, which normally ensures... (Review)
Review
The gastrointestinal tract plays a major role in the regulation of postprandial glucose profiles. Gastric emptying is a highly regulated process, which normally ensures a limited and fairly constant delivery of nutrients and glucose to the proximal gut. The subsequent digestion and absorption of nutrients are associated with the release of a set of hormones that feeds back to regulate subsequent gastric emptying and regulates the release of insulin, resulting in downregulation of hepatic glucose production and deposition of glucose in insulin-sensitive tissues. These remarkable mechanisms normally keep postprandial glucose excursions low, regardless of the load of glucose ingested. When the regulation of emptying is perturbed (e.g., pyloroplasty, gastric sleeve or gastric bypass operation), postprandial glycemia may reach high levels, sometimes followed by profound hypoglycemia. This article discusses the underlying mechanisms.
Topics: Digestion; Eating; Gastric Emptying; Gastrointestinal Tract; Glucose; Homeostasis; Humans; Hyperglycemia; Incretins; Intestinal Absorption; Liver; Male; Nervous System Physiological Phenomena; Postprandial Period; Stomach
PubMed: 27222546
DOI: 10.2337/dc16-0351 -
Gastroenterology Clinics of North... Mar 2015Gastroparesis is a chronic symptomatic disorder of the stomach characterized by delayed emptying without evidence of mechanical obstruction. Symptoms of gastroparesis... (Review)
Review
Gastroparesis is a chronic symptomatic disorder of the stomach characterized by delayed emptying without evidence of mechanical obstruction. Symptoms of gastroparesis include nausea, vomiting, early satiety, postprandial fullness, and upper abdominal pain. The 3 main causes are diabetic, postsurgical, and idiopathic. Diagnosis is confirmed by demonstrating delayed gastric emptying. Gastric emptying rates measured by gastric motor testing generally correlate poorly with symptoms and quality of life in patients with gastroparesis. It may be appropriate to reconsider the definition of gastroparesis, recognizing it as a broader spectrum of gastric neuromuscular dysfunction.
Topics: Chronic Disease; Gastric Emptying; Gastroparesis; Humans
PubMed: 25667018
DOI: 10.1016/j.gtc.2014.11.001 -
Current Opinion in Endocrinology,... Feb 2019This review examines the hormonal regulation of gastric emptying, a topic of increasing relevance, given the fact that medications that are analogs of some of these... (Review)
Review
PURPOSE OF REVIEW
This review examines the hormonal regulation of gastric emptying, a topic of increasing relevance, given the fact that medications that are analogs of some of these hormones or act as agonists at the hormonal receptors, are used in clinical practice for optimizing metabolic control in the treatment of type 2 diabetes and in obesity.
RECENT FINDINGS
The major effects on gastric emptying result from actions of incretins, particularly gastric inhibitory polypeptide, glucagon-like peptide-1, and peptide tyrosine-tyrosine, the duodenal and pancreatic hormones, motilin, glucagon, and amylin, and the gastric orexigenic hormones, ghrelin and motilin. All of these hormones delay gastric emptying, except for ghrelin and motilin which accelerate gastric emptying. These effects on gastric emptying parallel the effects of the hormones on satiation (by those retarding emptying) and increase appetite by those that accelerate emptying. Indeed, in addition to the effects of these hormones on hypothalamic appetite centers and glycemic control, there is evidence that some of their biological effects are mediated through actions on the stomach, particularly with the glucagon-like peptide-1 analogs or agonists used in treating obesity.
SUMMARY
Effects of gastrointestinal hormones on gastric emptying are increasingly recognized as important mediators of satiation and postprandial glycemic control.
Topics: Appetite; Diabetes Mellitus, Type 2; Gastric Emptying; Gastrointestinal Hormones; Humans; Obesity; Satiation
PubMed: 30418188
DOI: 10.1097/MED.0000000000000448 -
Eksperimental'naia I Klinicheskaia... 2016The publication is based on a retrospective analysis of 344 radiological studies of the upper digestive tract and analysis of the literature. We propose the hypothesis...
The publication is based on a retrospective analysis of 344 radiological studies of the upper digestive tract and analysis of the literature. We propose the hypothesis of the gastric motility, based on the following points: 1) The gastric cardia is the intra-abdominal portion of the lower esophageal sphincter (LES). Its tone increases in response to the increasing pressure in the stomach. 2) in gastroesophageal reflux disease (GERD), the cardia cannot withstand the pressure and subsequently opens. Depending on the degree of insufficiency of the LES and the force applied during provocative test, angular deformity of the stomach appears, due to the shortening of LES as well as a downsizing of the gas bubble in the stomach; 3) Pyloric sphincter (PS) is a true sphincter. Evacuation from the stomach is the result of the opening of the PS due to increase of antral pressure above the "threshold" level; 4) The evacuation starts in the upright position, when the liquid chyme above PS creates hydrostatic pressure above the threshold; 5) When hydrostatic pressure is reduced below the threshold level or in the recumbent position the antral pressure is created by the clamping of deep peristaltic wave and formation of the closed antral cavity; 6) The portioned evacuation is provided in two ways; a) the volume of antral cavity corresponds to the volume of duodenal bulb; b) in upright position after filling of the duodenal bulb the postbulbar sphincter is closed, whereby the pressure in the bulb rises, which leads to a reflex contraction of the PS and cessation of the e stomach emptying.
Topics: Adolescent; Child; Child, Preschool; Female; Gastric Emptying; Humans; Infant; Male; Stomach
PubMed: 29889384
DOI: No ID Found -
Gastroenterology May 2020
Topics: Gastric Emptying
PubMed: 32084422
DOI: 10.1053/j.gastro.2020.02.026 -
Frontiers in Endocrinology 2020Oral levothyroxine sodium is absorbed in the small intestine, mainly in the jejunum and the ileum being lower the absorption rate at duodenal level. The time interval... (Review)
Review
Oral levothyroxine sodium is absorbed in the small intestine, mainly in the jejunum and the ileum being lower the absorption rate at duodenal level. The time interval between the ingestion of oral thyroxine and its appearance in the plasma renders unlike a gastric absorption of the hormone. However, several evidence confirm the key role of the stomach as a prerequisite for an efficient absorption of oral levothyroxine. In the stomach, in fact, occur key steps leading to the dissolution of thyroxine from the solid form, the process bringing the active ingredient from the pharmaceutical preparation to the aqueous solution. In particular, gastric juice pH, volume, viscosity, as well as gastric emptying time seem to be the most important limiting factors. These hypotheses are confirmed by the detection of an increased need for levothyroxine in patients with infection, chronic atrophic gastritis, gastroparesis, or in simultaneous treatment with drugs interfering with gastric acidic output. The aim of the present article is to focus on the knowledge of pathophysiologic events that determine the absorptive fate of traditional (tablet) and alternative thyroxine preparations (softgel capsule and liquid solution) in patients bearing gastric disorders.
Topics: Administration, Oral; Animals; Gastric Absorption; Gastric Emptying; Gastroparesis; Helicobacter Infections; Humans; Malabsorption Syndromes; Thyroxine
PubMed: 33584549
DOI: 10.3389/fendo.2020.621616 -
Critical Reviews in Food Science and... 2021Gastric emptying refers to a process in which the stomach discharges its contents into the small intestine to further digest and absorb nutrients. Understanding the... (Review)
Review
Gastric emptying refers to a process in which the stomach discharges its contents into the small intestine to further digest and absorb nutrients. Understanding the mechanisms of gastric emptying and relationships between food and individuals is of paramount importance for the design and manufacture of novel and healthy foods. For ethical and cost reasons, in vivo tests are not always possible. In vitro digestion models therefore play a key role in current exploration of gastric emptying. This review outlines the mechanisms and physiology of gastric emptying, including calories, viscosity, composition of the food, age and gender of the individual. In addition, recent progress on in vitro static and dynamic gastric digestion models and future research trends are included in this review.
Topics: Food; Gastric Emptying; Humans; Intestine, Small; Stomach; Viscosity
PubMed: 32602780
DOI: 10.1080/10408398.2020.1784841