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Digestive Diseases and Sciences Sep 2017Gastroparesis is a chronic, bothersome, and often disabling neuromuscular disorder of the upper gastrointestinal tract. The most frequently reported symptoms of... (Review)
Review
Gastroparesis is a chronic, bothersome, and often disabling neuromuscular disorder of the upper gastrointestinal tract. The most frequently reported symptoms of gastroparesis include nausea, vomiting, epigastric pain, early satiety, and unintentional weight loss. Etiologies of gastroparesis include diabetes, connective tissue disorders, prior infection, mesenteric ischemia, and post-surgical complications. The largest category of gastroparesis patients is comprised of those in whom no definitive cause can be identified (idiopathic gastroparesis). The individual and societal burden of gastroparesis is substantial. It considerably reduces patients' quality of life accompanied by a significant negative impact to the healthcare system. The current treatments of gastroparesis are less than ideal. Dietary modification may improve symptoms in patients with mild disease. Metoclopramide is the only medication currently approved for the treatment of gastroparesis; however, it is associated with adverse effects in a sizable proportion of patients. Other medications are frequently employed to treat symptoms of nausea and vomiting, although technically all are used off-label since they are not FDA approved for the treatment of gastroparesis. These data highlight the need to identify novel, more effective treatment options for this disabling disease. This review will provide a brief synopsis on the epidemiology, etiology, and impact of gastroparesis, discussing new therapeutic advances.
Topics: Animals; Digestive System Surgical Procedures; Electric Stimulation Therapy; Gastric Emptying; Gastrointestinal Agents; Gastroparesis; Humans; Stents
PubMed: 28721575
DOI: 10.1007/s10620-017-4679-7 -
Der Internist Jun 2015Gastroparesis is characterized by a constellation of upper gastrointestinal symptoms in association with delayed gastric emptying in the absence of mechanical outlet... (Review)
Review
Gastroparesis is characterized by a constellation of upper gastrointestinal symptoms in association with delayed gastric emptying in the absence of mechanical outlet obstruction from the stomach. Major symptoms are nausea, vomiting, early satiety or postprandial fullness, bloating, and abdominal or epigastric pain. Idiopathic, diabetic, and postsurgical causes represent the most common etiologies. Diagnostic procedures for the evaluation of gastroparesis comprise gastric emptying scintigraphy (gold standard), (13)C-octanoate breath testing, and a wireless motility capsule. Management of gastroparesis includes normalization of nutritional state, relief of symptoms, glycemic control, and improvement of gastric emptying. Medical treatment entails use of prokinetic drugs, which are currently the first-line therapy. Nausea and vomiting might be positively influenced by antiemetic drugs. Gastric electronic stimulation and surgical interventions should be used in well-defined patients and represent a therapeutic option in tertiary centers.
Topics: Antiemetics; Breath Tests; Diet Therapy; Gastric Emptying; Gastrointestinal Agents; Gastroparesis; Humans; Radionuclide Imaging; Terminology as Topic
PubMed: 25940143
DOI: 10.1007/s00108-014-3604-9 -
Neurogastroenterology and Motility May 2019Gastroparesis is a digestive syndrome characterized by delayed gastric emptying (GE) and by symptoms that are suggestive of gastroduodenal motor disorders. There are...
BACKGROUND
Gastroparesis is a digestive syndrome characterized by delayed gastric emptying (GE) and by symptoms that are suggestive of gastroduodenal motor disorders. There are three grades of gastroparesis of increasing severity: (a) mild gastroparesis; (b) compensated gastroparesis; and (c) gastric failure. GE abnormalities are partially related to symptom type and severity, and other mechanisms may be involved.
AIM
To investigate enteric dysmotility (ED) in patients with suspected gastroparesis.
METHODS
Patients with symptoms suggestive of gastroparesis were consecutively included in the study and underwent a C-octanoic acid GE breath test and small bowel manometry (SBM). Clinical features were recorded using predefined, validated questionnaires at entry.
KEY RESULTS
The study enrolled 88 patients (71 women; mean age: 37.8 ± 14.3 years). Gastric emptying was delayed in 25 patients (28.4%), and 70 patients (79.5%) presented small bowel motor abnormalities including bursts, abnormal activity fronts, inability to respond to meal ingestion, and hypocontractility. Gastric emptying was delayed in 24 of the 70 patients with ED (34.3% vs 5.5% of patients with normal SBM). Enteric dysmotility was detected in 24 of 25 patients (96%) with delayed GE. Patients with and without delayed GE showed similar moderate/severe gastroparesis manifestations, but patients with ED significantly more often had moderate/severe gastroparesis manifestations than patients with normal SBM (grade 1:14% vs 39%, grade 2:62% vs 56%, grade 3:24% vs 5%, respectively).
CONCLUSIONS AND INFERENCES
Enteric dysmotility was more frequent than delayed GE in patients with symptoms suggestive of gastroparesis. Gastroparesis severity was associated with small bowel motor abnormalities but not with delayed GE.
Topics: Adult; Breath Tests; Female; Gastric Emptying; Gastrointestinal Motility; Gastroparesis; Humans; Male; Manometry; Middle Aged
PubMed: 30773743
DOI: 10.1111/nmo.13562 -
World Journal of Gastroenterology May 2020Gastroparesis (Gp) is a chronic disease characterized by a delayed gastric emptying in the absence of mechanical obstruction. Although this condition has been reported... (Review)
Review
Gastroparesis (Gp) is a chronic disease characterized by a delayed gastric emptying in the absence of mechanical obstruction. Although this condition has been reported in the literature since the mid-1900s, only recently has there been renewed clinical and scientific interest in this disease, which has a potentially great impact on the quality of life. The aim of this review is to explore the pathophysiological, diagnostic and therapeutical aspects of Gp according to the most recent evidence. A comprehensive online search for Gp was carried out using MEDLINE and EMBASE. Gp is the result of neuromuscular abnormalities of the gastric motor function. There is evidence that patients with idiopathic and diabetic Gp may display a reduction in nitrergic inhibitory neurons and in interstitial cells of Cajal and/or telocytes. As regards diagnostic approach, 99-Technetium scintigraphy is currently considered to be the gold standard for Gp. Its limits are a lack of standardization and a mild risk of radiation exposure. The C13 breath testing is a valid and safe alternative method. C acid octanoic and the C Spirulina platensis recently approved by the Food and Drug Administration are the most commonly used diagnostic kits. The wireless motility capsule is a promising technique, but its use is limited by costs and scarce availability in many countries. Finally, therapeutic strategies are related to the clinical severity of Gp. In mild and moderate Gp, dietary modification and prokinetic agents are generally sufficient. Metoclopramide is the only drug approved by the Food and Drug Administration for Gp. However, other older and new prokinetics and antiemetics can be considered. As a second-line therapy, tricyclic antidepressants and cannabinoids have been proposed. In severe cases the normal nutritional approach can be compromised and artificial nutrition may be needed. In drug-unresponsive Gp patients some alternative strategies (endoscopic, electric stimulation or surgery) are available.
Topics: Antidepressive Agents, Tricyclic; Antiemetics; Cannabinoids; Capsule Endoscopy; Electric Stimulation Therapy; Endoscopy, Digestive System; Gastric Emptying; Gastroparesis; Humans; Metoclopramide; Severity of Illness Index; Stomach; Treatment Outcome
PubMed: 32476797
DOI: 10.3748/wjg.v26.i19.2333 -
Neurogastroenterology and Motility Dec 2022Gastroduodenal symptoms are highly prevalent, with underlying sensorimotor dysfunction contributing in many patients. Common symptoms include early satiation,... (Review)
Review
BACKGROUND
Gastroduodenal symptoms are highly prevalent, with underlying sensorimotor dysfunction contributing in many patients. Common symptoms include early satiation, postprandial fullness, epigastric bloating, pain or burning, nausea and vomiting, which collectively affect over 7% of adults. However, the clinical evaluation of these symptoms remains challenging, with current tests of gastric function remaining limited in their ability or availability to separate specific patient subgroups or guide-targeted care.
PURPOSE
In the current edition of Neurogastroenterology & Motility, Silver et al. present new data showing correlations between patterns of intragastric meal distribution and symptom profiles in a large series of patients undergoing gastric emptying scintigraphy. Studies of this type are important, as they motivate understanding beyond existing disease labels, and orient focus toward deeper mechanistic profiling. This brief review provides an overview of gastric sensorimotor function and profiles several current and emerging methods of clinical evaluation. Perspectives are provided on accommodation testing, gastric emptying, measuring gastric myoelectrical activity including new approaches, and antroduodenal manometry. Although gastric physiology is complex, recent progress has been encouraging, with the heterogenous pathophysiology of gastric symptoms continuing to be unraveled, and new techniques for evaluating gastric function and symptoms emerging.
CONCLUSIONS AND INFERENCES
Ongoing progress will now depend on continuing to accurately profile the underlying mechanisms of gastroduodenal disorders to identify specific disease phenotypes that inform care.
Topics: Humans; Gastric Emptying; Stomach Diseases; Nausea; Manometry; Dyspepsia
PubMed: 36371709
DOI: 10.1111/nmo.14489 -
The Journal of Nutrition Dec 2021When sufficient breast milk is not available, infant formula is often used as an alternative. As for digestion, gastric behavior of infant formula and breast milk have... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
When sufficient breast milk is not available, infant formula is often used as an alternative. As for digestion, gastric behavior of infant formula and breast milk have not been studied in detail.
OBJECTIVE
This study aimed to compare gastric emptying and intragastric behavior between breast milk and infant formula in vivo using MRI.
METHODS
In this randomized crossover study, 16 lactating mothers (age: 31.7 ± 2.9 y; time since giving birth: 9.3 ± 2 mo), underwent gastric MRI scans before and after consumption of 200 mL of infant formula or their own breast milk. MRI scans were performed after an overnight fast (baseline) and every 10 min up until 60 min following ingestion. Primary outcomes were gastric emptying measures and the secondary outcome was gastric layer volume over time. Differences between infant formula and breast milk in total gastric volume and layering volume were tested using linear mixed models.
RESULTS
Gastric emptying half-time was 5.1 min faster for breast milk than for infant formula (95% CI: -19.0 to 29.2) (n = 14). Within a subgroup (n = 12) with similar initial gastric volume (<20 mL difference), gastric emptying half-time was 20 min faster for breast milk (95% CI: 1.23-43.1). Top layer volume (n = 16) was 6.4 mL greater for infant formula than for breast milk (95% CI: 1.9-10.8). This effect is driven by t = 10 and t = 20 min postingestion.
CONCLUSIONS
When taking initial gastric volume into account, breast milk emptied faster than infant formula in women, which is in line with previous findings in infants. Infant formula showed a significantly larger top layer volume in the first 20 min after ingestion. MRI in adults may find application in studies assessing gastric behavior of infant formula.
Topics: Adult; Cross-Over Studies; Female; Gastric Emptying; Humans; Infant; Infant Formula; Infant, Newborn; Infant, Premature; Lactation; Milk, Human; Mothers; Pregnancy
PubMed: 34590118
DOI: 10.1093/jn/nxab295 -
Critical Reviews in Food Science and... 2023Viscosity is a property of most foods. The consumption of the high-viscosity food is associated with a variety of physiological responses, one of which is their ability... (Review)
Review
Viscosity is a property of most foods. The consumption of the high-viscosity food is associated with a variety of physiological responses, one of which is their ability to regulate gastric emptying and modulate postprandial glycemic response. Gastric emptying has been proven to be a key step affecting the digestion and absorption of food, whereas, the relationship between viscosity and gastric emptying is still far away from being understood. Here, we reviewed the factors that influence food viscosity and food viscosity changes during digestion. Besides, the effect of food viscosity on gastric emptying and food-viscosity-physiological response were highlighted. Finally, "quantitative relationship" of viscosity and gastric emptying was discussed. This review can contribute to the understanding that how food viscosity affects gastric emptying, and help for developing foods that could control satiety and manage body weight for the specific populations.
Topics: Gastric Emptying; Viscosity; Food; Chemical Phenomena; Satiation
PubMed: 34985365
DOI: 10.1080/10408398.2021.2024132 -
British Journal of Anaesthesia Aug 2021Gastric emptying may be delayed in patients with diabetes mellitus (DM). However, the incidence of full stomach in fasting patients with DM and their risk of pulmonary... (Review)
Review
BACKGROUND
Gastric emptying may be delayed in patients with diabetes mellitus (DM). However, the incidence of full stomach in fasting patients with DM and their risk of pulmonary aspiration under anaesthesia is not well understood.
METHODS
A scoping review was undertaken to map the literature on aspiration risk in DM. A search was conducted in seven bibliographic databases, including MEDLINE and Embase, for original articles that studied aspiration risk, gastric emptying, or gastric content and volume. Selection and characterisation were performed by two independent reviewers using a predefined protocol registered externally.
RESULTS
The search identified 5063 unique records, and 16 studies (totalling 775 patients with DM) were selected: nine studied gastric emptying and seven studied gastric content or volume. There were no studies reporting the incidence of aspiration in subjects with DM. All nine studies reported delayed emptying in patients with DM compared with healthy controls. Amongst the seven studies that compared gastric residual content/volume (GRV) in the perioperative period, five reported clinically negligible GRV in both patients with DM and controls, whereas two observed a higher incidence of 'full' stomach in patients with DM.
CONCLUSIONS
The evidence concerning the aspiration risk for surgical patients with DM is based on a limited number of studies, mostly unblinded, reporting physiological data on gastric emptying and gastric volume as surrogate markers of aspiration risk. Data on fasting gastric content and volume in patients with DM are limited and contradictory; hence, the true risk of aspiration in fasting patients with DM is unknown.
Topics: Anesthesia; Comorbidity; Diabetes Mellitus; Fasting; Gastric Emptying; Gastrointestinal Contents; Humans; Intraoperative Complications; Postoperative Complications; Respiratory Aspiration; Ultrasonography
PubMed: 34023055
DOI: 10.1016/j.bja.2021.04.008 -
Journal of Biomechanics Mar 2021Stomach is one of the most important organs in human gastro-track. To better understand the operation of human-stomach, the process of mixing and emptying of gastric...
Stomach is one of the most important organs in human gastro-track. To better understand the operation of human-stomach, the process of mixing and emptying of gastric contents is simulated using a numerical method. The numerical results confirm that a fast pathway is located close to the lesser curvature of the stomach when water is emptied. However, this fast pathway doesn't exist when the gastric contents are composed of water and food boluses with different properties. The muscle contractions enhance the mixing of light food boluses and water, while they have limited effects on heavy food boluses. As a result, the foods are distributed in layers; heavy food boluses are located in the bottom layer. Besides the gastric motility and high viscosity of foods, the food matrix made of heavy food particles is also important to the formation of the Magenstrasse (stomach road). The food matrix and the zone of wrinkles behave like a porous medium which has higher flow resistance to the light food particles than to the water, leading to faster emptying of water. The water is emptied along the stomach wall since the flow resistance in the stomach wrinkles is smaller than the one in the food matrix. This mechanism is supported by the numerical results, while it might interpret the phenomena observed in the experiments.
Topics: Food; Gastric Emptying; Humans; Muscle Contraction; Stomach
PubMed: 33588327
DOI: 10.1016/j.jbiomech.2021.110293 -
Journal of the Royal Society, Interface Jan 2023The amplitude and frequency of peristaltic contractions are two major parameters for assessing gastric motility. However, it is not fully understood how these parameters...
The amplitude and frequency of peristaltic contractions are two major parameters for assessing gastric motility. However, it is not fully understood how these parameters affect the important functions of the stomach, such as gastric mixing and emptying. This study aimed to quantify the effects of peristaltic amplitude and frequency on gastric mixing and emptying using computational fluid dynamics simulation of gastric flow with an anatomically realistic model of the stomach. Our results suggest that both the increase and decrease in peristaltic amplitude have a significant impact on mixing strength and emptying rate. For example, when the peristaltic amplitude was 1.2 times higher than normal, the emptying rate was 2.7 times faster, whereas when the amplitude was half, the emptying rate was 4.2 times slower. Moreover, the emptying rate increased more than proportionally with the peristaltic frequency. The nearest contraction wave to the pylorus and the subsequent waves promoted gastric emptying. These results suggest the importance of maintaining parameters within normal ranges to achieve healthy gastric function.
Topics: Gastric Emptying; Stomach; Peristalsis; Computer Simulation; Hydrodynamics; Gastrointestinal Motility
PubMed: 36596453
DOI: 10.1098/rsif.2022.0780