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Journal of Nuclear Medicine Technology Mar 2016Although not as well standardized as gastric emptying (GE) scintigraphy, esophageal transit scintigraphy, if performed in a comprehensive manner including both... (Review)
Review
Although not as well standardized as gastric emptying (GE) scintigraphy, esophageal transit scintigraphy, if performed in a comprehensive manner including both quantitative and qualitative analysis of single- and multiple-swallow studies, is clinically useful when expertise in esophageal manometry is not available or not tolerated and when esophageal manometry or barium videofluoroscopy results are equivocal or nondiagnostic. GE scintigraphy has undergone much-needed standardization. Both solid and liquid GE studies play an important role in assessing patients with upper gastrointestinal symptoms. Because measurement of simple total GE is often not sufficient to explain patient symptoms, there is a need to expand the analysis of GE scintigraphy to include the separate roles of the fundus and antrum and to include the complex interactions the stomach has with other organ systems.
Topics: Esophagus; Gastric Emptying; Gastrointestinal Transit; Humans
PubMed: 26940447
DOI: 10.2967/jnumed.112.114314 -
Neurogastroenterology and Motility May 2023Gastroparesis is a complex, challenging gastrointestinal disorder presenting with upper gastrointestinal symptoms, especially nausea and vomiting, with significant... (Review)
Review
BACKGROUND
Gastroparesis is a complex, challenging gastrointestinal disorder presenting with upper gastrointestinal symptoms, especially nausea and vomiting, with significant impact on patients' quality of life. After ruling out mechanical obstruction, it is essential to identify delay in gastric emptying for definitive diagnosis. The most common causes are idiopathic (no identified etiology), diabetes mellitus, and postsurgical status. Management of gastroparesis focuses on dietary modifications and treatment directed to symptom relief. Unfortunately, approximately one-third of patients are refractory to pharmacological therapy, and the effectiveness of the few nonpharmacological options has been questioned.
PURPOSE
Extensive review of the literature identifies several uncertainties or controversies regarding the differential diagnosis based on the spectrum of symptoms, the lack of availability of reliable diagnostic test, and questions regarding effective therapeutic options. In this review, we discuss ten controversies regarding gastroparesis: clinical presentation, diagnosis, overlap syndromes, pathophysiology, etiology, as well as pharmacological and nonpharmacological therapeutic options. In addition, we briefly review studies exploring pathological, inflammatory, and molecular disturbances affecting the intrinsic neuromuscular elements that may be involved in the pathophysiology of gastroparesis and may constitute possible therapeutic targets in the future. Finally, we tabulate future research opportunities to resolve these controversies in the management of patients with gastroparesis.
Topics: Humans; Gastroparesis; Quality of Life; Gastric Emptying; Diabetes Mellitus; Diagnosis, Differential
PubMed: 36371704
DOI: 10.1111/nmo.14494 -
Current Opinion in Clinical Nutrition... Mar 2015During critical illness, enteral nutrition remains central to clinical care and an understanding of gut dysfunction is therefore important. Contemporary data have... (Review)
Review
PURPOSE OF REVIEW
During critical illness, enteral nutrition remains central to clinical care and an understanding of gut dysfunction is therefore important. Contemporary data have contributed to our knowledge in this area and this review will concentrate on recently published studies.
RECENT FINDINGS
It is difficult to precisely measure gastric emptying and nutrient absorption as part of routine clinical care. However, techniques for the measurement of these parameters for research purposes have been refined, studied and validated. These methodologies allow the evaluation of novel treatments that modulate gastric emptying. Quantification and an understanding of the mechanisms of nutrient malabsorption may facilitate the development of therapeutic agents to improve absorption and/or formulae, which are more readily absorbed, thereby improving nutritional and clinical outcomes.
SUMMARY
Improved understanding of gut pathophysiology in critical illness provides opportunities for the development and testing of novel and targeted treatment strategies, with the objective to improve clinical outcomes in this group.
Topics: Critical Illness; Enteral Nutrition; Gastric Emptying; Gastrointestinal Absorption; Humans; Nutritional Status
PubMed: 25603226
DOI: 10.1097/MCO.0000000000000149 -
Journal of Clinical Gastroenterology Apr 2020Gastrointestinal (GI) disturbances are common during training and competition, especially among endurance athletes. Historically, little attention has been paid to the... (Review)
Review
Gastrointestinal (GI) disturbances are common during training and competition, especially among endurance athletes. Historically, little attention has been paid to the psychobiological etiology of GI problems in sport. The aim of this review is to: (1) provide a physiological overview of how psychological stress and anxiety impact GI system function; (2) review the literature that has examined the role of stress and anxiety in GI distress in athletes; and (3) provide suggestions for future research. Animal and human studies have documented that psychological stressors reduce gastric motility and delay stomach emptying while simultaneously increasing large intestine motility. These functional changes are likely mediated through the secretion of corticotropin-releasing factor and subsequent alterations in autonomic nervous system activity, which act to reduce splanchnic blood flow and increase GI permeability. In addition, chronic stress and anxiety may worsen GI discomfort by increasing visceral hypersensitization. Still, only a couple of studies have found modest associations between stress, anxiety, and the occurrence/severity of GI distress in active populations. As such, future work should attempt to confirm that experimentally inducing psychological stress results in the aforementioned GI problems during exercise. Furthermore, studies are needed to determine how psychological stress impacts the tolerance to nutritional fueling and whether it worsens the GI permeability that normally occurs with exercise.
Topics: Animals; Dyspepsia; Gastric Emptying; Gastrointestinal Diseases; Gastrointestinal Motility; Humans; Stress, Psychological
PubMed: 31851100
DOI: 10.1097/MCG.0000000000001308 -
Topics in Companion Animal Medicine Sep 2014Gastric dilatation-volvulus (GDV) is a devastating disease that most commonly affects large and giant-breed dogs. Though a number of risk factors have been associated... (Review)
Review
Gastric dilatation-volvulus (GDV) is a devastating disease that most commonly affects large and giant-breed dogs. Though a number of risk factors have been associated with the development of GDV, the etiology of GDV remains unclear. Abnormal gastric motility patterns and delayed gastric emptying have been previously described in dogs following GDV. Work evaluating the effects of gastropexy procedures and changes to gastric motility after experimental GDV has not found the same changes as those found in dogs with naturally occurring GDV. Although the role of abnormal gastric motility in dogs with GDV will need to be clarified with additional research, such study is likely to be facilitated by improved access to and development of noninvasive measurement techniques for the evaluation of gastric emptying and other motility parameters. In particular, the availability of Food and Drug Administration-approved wireless motility devices for the evaluation of gastrointestinal motility is particularly promising in the study of GDV and other functional gastrointestinal diseases of large and giant-breed dogs.
Topics: Animals; Dog Diseases; Dogs; Gastric Dilatation; Gastric Emptying; Stomach Volvulus
PubMed: 25496922
DOI: 10.1053/j.tcam.2014.09.006 -
International Journal of Pharmaceutics Aug 2016In recent decades, many efforts have been made in order to improve drug bioavailability after oral administration. Gastroretentive drug delivery systems are a good... (Review)
Review
In recent decades, many efforts have been made in order to improve drug bioavailability after oral administration. Gastroretentive drug delivery systems are a good example; they emerged to enhance the bioavailability and effectiveness of drugs with a narrow absorption window in the upper gastrointestinal tract and/or to promote local activity in the stomach and duodenum. Several strategies are used to increase the gastric residence time, namely bioadhesive or mucoadhesive systems, expandable systems, high-density systems, floating systems, superporous hydrogels and magnetic systems. The present review highlights some of the drugs that can benefit from gastroretentive strategies, such as the factors that influence gastric retention time and the mechanism of action of gastroretentive systems, as well as their classification into single and multiple unit systems.
Topics: Administration, Oral; Animals; Anti-Bacterial Agents; Biological Availability; Drug Delivery Systems; Gastric Emptying; Gastric Mucosa; Gastrointestinal Agents; Humans; Stomach
PubMed: 27173823
DOI: 10.1016/j.ijpharm.2016.05.016 -
The Quarterly Journal of Nuclear... Mar 2024Pediatric gastrointestinal imaging plays a crucial role in evaluating and managing digestive system disorders in children. This comprehensive review dives into the... (Review)
Review
Pediatric gastrointestinal imaging plays a crucial role in evaluating and managing digestive system disorders in children. This comprehensive review dives into the nuances of pediatric gastrointestinal imaging techniques, focusing on three specific modalities: gastric emptying scintigraphy (GES), intestinal transit scintigraphy (ITS), and gastrointestinal bleeding scintigraphy. GES involves real-time monitoring of stomach emptying using radiotracers and gamma camera technology. While challenges exist in standardizing protocols due to age-specific meal compositions, GES remains pivotal in diagnosing motility disorders, gastroesophageal reflux, and abdominal pain in children. ITS, utilizing [Ga], provides insights into gastrointestinal motility disorders such as Hirschsprung disease. It aids in whole-gut transit evaluation, guiding surgical interventions and improving long-term clinical outcomes. Gastrointestinal bleeding scintigraphy, employing [mTc], assists in diagnosing conditions like Meckel's diverticulum and occult bleeding, offering continuous monitoring to pinpoint the bleeding site along the entire gastrointestinal tract. SPECT-CT improves the accuracy and the standards of care. Each technique's protocol details, clinical indications, and diagnostic capabilities are thoroughly discussed, highlighting the importance of these non-invasive, functional imaging modalities in pediatric gastroenterology.
Topics: Humans; Child; Radionuclide Imaging; Gastric Emptying; Radioisotopes; Gastrointestinal Hemorrhage
PubMed: 38587360
DOI: 10.23736/S1824-4785.24.03548-9 -
European Journal of Obstetrics,... Oct 2023The effect of pregnancy on gastric emptying has not been established, although the predominant clinical assumption is that gastric emptying is delayed during pregnancy....
BACKGROUND/AIMS
The effect of pregnancy on gastric emptying has not been established, although the predominant clinical assumption is that gastric emptying is delayed during pregnancy. We hypothesized that the rate of emptying of nutrients during pregnancy is not delayed, but is actually more rapid when compared to the non-pregnant state. The rate of gastric emptying is a major determinant of postprandial glucose elevations.
MATERIALS AND METHODS
24 female and 4 male Spague-Dawley rats were used. Female rats were randomly divided into two groups: eight rats for the control group and sixteen rats for the pregnant group. Using physiologic, non-traumatic nuclear medicine scintigraphy imaging methodology, the authors studied gastric emptying of a liquid mixed meal in pregnant rats and non-pregnant controls. Body weights, daily food ingestion, and the rate of nutrient gastric emptying were recorded in both groups at pre-pregnancy, early pregnancy, and late pregnancy.
RESULTS
The authors found that pregnancy in this rat model is associated with a 37-43% increased rate of nutrient gastric emptying from the stomach in late pregnancy as compared to non-pregnant control rats and pre-pregnancy rats.
CONCLUSION
These findings contradict the current clinical assumption that gastric emptying is delayed in pregnancy. If further studies confirm a more rapid gastric emptying rate during human pregnancy, new therapies aimed at slowing the rate of nutrient absorption should be considered for the prevention and treatment of pregnancy-associated nausea, gestational diabetes, and other insulin-resistant pregnancy-associated states such as pre-eclampsia.
Topics: Humans; Animals; Rats; Female; Male; Pregnancy; Gastric Emptying; Body Weight; Cystography; Diabetes, Gestational; Glucose; Morning Sickness
PubMed: 37639818
DOI: 10.1016/j.ejogrb.2023.08.370 -
Neurogastroenterology and Motility Aug 2020The proximal and distal regions of the stomach are thought to have different roles during gastric accommodation and emptying; however, regional changes in gastric...
BACKGROUND
The proximal and distal regions of the stomach are thought to have different roles during gastric accommodation and emptying; however, regional changes in gastric structure and function during and after a meal have not been described in detail. This study applied non-invasive imaging to study changes in regional gastric volume and morphology during accommodation and emptying of a liquid nutrient meal.
METHOD
MRI studies were performed on 16 healthy volunteers. Three-dimensional (3D) gastric morphology was reconstructed by validated image processing technology. The 3D models were segmented into seven regions. The relative contribution of each region to gastric accommodation and emptying was assessed. Changes in morphology were documented by tracking movements of four distinct gastric landmarks.
KEY RESULTS
The initial 100 mL liquid nutrient increases distal stomach volume more than that of other gastric regions (∆V7 = 28 ± 6% ∆TGV; P ≤ .05). Subsequent volume is accommodated mainly in the proximal stomach (∆V1 = 42 ± 10% ∆TGV; P ≤ .05). Early-phase emptying occurs from distal stomach with proximal stomach volume remaining stable. Subsequently, distal stomach volume remains stable while proximal stomach volume decreases progressively. During gastric filling, the stomach elongates and expands anteriorly and inferiorly (15.2 ± 7.4 mm and 32.3 ± 8.4 mm, respectively, for the incisural midpoint) with torsion indicated by ~70° difference in the movements of proximal and distal gastric landmarks.
CONCLUSIONS AND INFERENCES
Non-invasive MRI describes volume change and distribution of a liquid meal within proximal and distal stomach during gastric accommodation and emptying. Additionally, novel observations of changes to 3D gastric morphology within the abdomen are documented.
Topics: Adult; Female; Gastric Emptying; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Male; Organ Size; Stomach; Young Adult
PubMed: 32390262
DOI: 10.1111/nmo.13865 -
Current Opinion in Pharmacology Dec 2018Functional dyspepsia (FD) and gastroparesis are frequent causes of upper gastrointestinal symptoms such as postprandial fullness, early satiation, epigastric pain or... (Review)
Review
Functional dyspepsia (FD) and gastroparesis are frequent causes of upper gastrointestinal symptoms such as postprandial fullness, early satiation, epigastric pain or burning, upper abdominal bloating, bothersome belching, nausea and vomiting. The underlying pathophysiological mechanisms are heterogeneous and involved mechanisms such as abnormal gastric motility (accommodation, emptying), visceral hypersensitivity, low grade mucosal inflammation and cellular changes in enteric nerves, muscle or interstitial cells of Cajal. Patient-reported outcomes for evaluating treatment efficacy in these conditions were recently developed and validated. Prokinetic agents, which enhance gastric motility, are used for treating both gastroparesis and FD. In FD, besides acid suppressive therapy and Helicobacter pylori eradication, neuromodulators and drugs that enhance gastric accommodation can be applied. In gastroparesis, anti-emetics may also provide symptom relief. Novel approaches under evaluation in these conditions are the fundus relaxing agents acotiamide and buspirone and the antidepressant mirtazapine in FD. For gastroparesis, recently studied agents include the prokinetic ghrelin agonist relamorelin, the prokinetic serotonergic agents velusetrag and prucalopride, the anti-emetic aprepitant and per-endoscopic pyloric myotomy procedures.
Topics: Animals; Diffusion of Innovation; Drug Design; Dyspepsia; Gastric Emptying; Gastrointestinal Agents; Gastroparesis; Humans; Risk Factors; Stomach
PubMed: 30245474
DOI: 10.1016/j.coph.2018.08.015