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Diabetologia Dec 2022Gastric emptying is a major determinant of postprandial blood glucose, accounting for ~35% of variance in peak glucose in both healthy individuals and those with type 2... (Review)
Review
Gastric emptying is a major determinant of postprandial blood glucose, accounting for ~35% of variance in peak glucose in both healthy individuals and those with type 2 diabetes. Gastric emptying is frequently disordered in individuals with diabetes (both abnormally delayed and accelerated). Delayed gastric emptying, i.e. diabetic gastroparesis, may be linked to upper gastrointestinal symptoms for which current treatment remains suboptimal; pharmacological acceleration of delayed emptying is only weakly associated with symptom improvement. Accordingly, the relationship between symptoms and delayed gastric emptying is not simply 'cause and effect'. In insulin-treated patients, disordered gastric emptying, even when not associated with gastrointestinal symptoms, can cause a mismatch between the onset of insulin action and the availability of absorbed carbohydrate, leading to suboptimal glycaemic control. In patients with type 2 diabetes, interventions that slow gastric emptying, e.g. glucagon-like peptide-1 receptor agonists, reduce postprandial blood glucose. This review focuses on recent insights into the impact of gastric emptying on postprandial blood glucose, effects of diabetes therapy on gastric emptying and the management of disordered gastric emptying in diabetes. In view of the broad relevance of gastric emptying to diabetes management, it is important that future clinical trials evaluating novel therapies that may affect gastric emptying should quantify the latter with an appropriate technique, such as scintigraphy or a stable isotope breath test.
Topics: Humans; Blood Glucose; Gastroparesis; Diabetes Mellitus, Type 2; Glycemic Control; Gastric Emptying; Postprandial Period; Insulin
PubMed: 36194250
DOI: 10.1007/s00125-022-05796-1 -
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 -
Obesity Surgery Jun 2021Intragastric balloon (IGB) is a minimally invasive and reversible therapy for weight loss with a good efficacy and safety profile. Introduced in the 1980s, IGBs have... (Review)
Review
Intragastric balloon (IGB) is a minimally invasive and reversible therapy for weight loss with a good efficacy and safety profile. Introduced in the 1980s, IGBs have significantly evolved in the last couple of decades. They mechanically act by decreasing the volume of the stomach and its reservoir capacity, delaying gastric emptying, and increasing satiety leading to a subsequent weight loss. Despite the low rates of complications and mortality associated with IGBs, adverse events and complications still occur and can range from mild to fatal. This review aims to provide an update on the current scientific evidence in regard to complications and adverse effects of the use of the IGB and its treatment. This is the first comprehensive narrative review in the literature dedicated to this subject.
Topics: Gastric Balloon; Gastric Emptying; Humans; Obesity, Morbid; Stomach; Treatment Outcome; Weight Loss
PubMed: 33788158
DOI: 10.1007/s11695-021-05352-7 -
Clinical Therapeutics Oct 2021Gastric emptying time is one of limiting factors that determines the pharmacokinetic properties of drugs administered by mouth. Despite the high prevalence of obesity... (Review)
Review
PURPOSE
Gastric emptying time is one of limiting factors that determines the pharmacokinetic properties of drugs administered by mouth. Despite the high prevalence of obesity worldwide, modifications in gastric emptying time have not been systematically addressed in this set of patients. The current analysis aims to quantitatively address obesity-related changes in gastric emptying time of solids, semisolids, and liquids compared with lean individuals, highlighting the relevant pharmacokinetic implications of oral drug absorption in patients with obesity.
METHODS
We searched the Cochrane Library, PubMed, Web of Science, and Embase for all relevant articles published until November 1, 2020. Differences in gastrointestinal variables in relation to gastric emptying between obese and lean individuals were quantified by weighted mean difference (WMD) and ratio of means (RoM). Robustness of the analyses was evaluated by subgroup analysis and publication bias test.
FINDINGS
A total of 17 studies with 906 participants were included. The gastric half-emptying time of solids (WMD, -10.4 minutes; P = 0.001; RoM, 0.90; P = 0.01) and liquids (WMD, -6.14 minutes; P < 0.001; RoM, 0.83, P = 0.03) was significantly shorter in individuals with obesity compared with lean individuals. These findings were confirmed by the subgroup analyses and publication bias tests.
IMPLICATIONS
Our pooled analysis systemically quantifies the differences in gastric half-emptying time between individuals with obesity and lean individuals, facilitating better understanding and prediction of drug absorption in individuals with obesity through physiologically based pharmacokinetic approaches. Obesity is associated with a faster transit of both solids and liquids through the stomach.
Topics: Gastric Emptying; Humans; Obesity; Pharmaceutical Preparations
PubMed: 34482960
DOI: 10.1016/j.clinthera.2021.08.006 -
Current Gastroenterology Reports Mar 2020This review highlights recent work that will lead to near-term advances in the understanding and treatment of gastroparesis (Gp). (Review)
Review
PURPOSE OF REVIEW
This review highlights recent work that will lead to near-term advances in the understanding and treatment of gastroparesis (Gp).
RECENT FINDINGS
Major current advancements in the pathophysiology of Gp, include recognition of the SIP syncytium as the pacemaking unit rather than ICC alone and that Gp may be part of a pan-enteric autoimmune and/or autonomic disorder with macrophage imbalance. The development of newer techniques to assess gastric emptying (gastric emptying breath test and wireless motility capsule) and pyloric distensibility (EndoFLIP®) are allowing clinicians better characterization of their patients. In addition to pharmaceutical compounds in the pipeline, neuromodulation and endosurgical techniques, such as G-POEM, may help address refractory Gp. We expect that the 2020 decade will witness exciting developments. Treatments targeting gastrointestinal motility, immunological dysfunction, and inflammatory mediators will be evaluated. We anticipate future studies will be guided by biomarkers correlated with patient outcomes and therapeutic efficacy to establish new paradigms in the management of Gp.
Topics: Biomarkers; Breath Tests; Capsule Endoscopy; Gastric Emptying; Gastrointestinal Motility; Gastroparesis; Humans; Pyloromyotomy
PubMed: 32193707
DOI: 10.1007/s11894-020-00761-7 -
The American Journal of Gastroenterology Jul 2021Functional dyspepsia (FD) is a prevalent condition with multifactorial pathophysiology, including impaired gastric accommodation (GA), hypersensitivity to gastric... (Review)
Review
INTRODUCTION
Functional dyspepsia (FD) is a prevalent condition with multifactorial pathophysiology, including impaired gastric accommodation (GA), hypersensitivity to gastric distention, and delayed gastric emptying. Drink tests (DT) have been proposed as a potential biomarker for the presence and severity of gastric sensorimotor dysfunction. Thus, we aimed to summarize the state of knowledge on different DT and their potential as a biomarker for FD.
METHODS
A PubMed and MEDLINE search was conducted for English language articles, reviews, meta-analyses, case series, and randomized controlled trials, including also published meeting abstracts.
RESULTS
Several DT have been described in literature (e.g., different type of liquid, number of calories used, pace of drinking, and subject's awareness of the amount of liquid drunk). FD patients ingest significantly less volume in the different variants of the tests. The slow nutrient ("satiety drinking") test (SDT) studies show the most consistent separation between health and FD and correlation with GA. However, sensitivity to distention may be correlated with rapid DT. SDTs were used to evaluate the effect of several pharmacological agents, often showing concordance between their effects on GA and tolerated nutrient volume. This correlation was not found mainly for agents with central actions.
DISCUSSION
An SDT is a potential diagnostic biomarker in FD, reflecting GA. Additional studies are required to confirm its role as a predictive biomarker for treatment outcome in FD.
Topics: Biomarkers; Case-Control Studies; Diagnostic Techniques, Digestive System; Drinking Behavior; Drinking Water; Dyspepsia; Gastric Emptying; Humans; Nutrients; Satiation; Severity of Illness Index; Time Factors
PubMed: 33941747
DOI: 10.14309/ajg.0000000000001242