-
Seminars in Nuclear Medicine May 2009The measurement of gastrointestinal functions by the use of scintigraphy is established in clinical practice and research. The most commonly used test is the... (Review)
Review
The measurement of gastrointestinal functions by the use of scintigraphy is established in clinical practice and research. The most commonly used test is the gastric-emptying test, which is acknowledged as the gold standard to measure gastric motility and is conducted according to a consensus statement from the national nuclear medicine and motility societies. Other techniques are somewhat more esoteric (eg, measurement of gastric accommodation with single-photon emission computed tomography) or the scintigraphic approach is not the acknowledged gold standard (eg, colonic transit, rectoanal angle, and emptying, esophageal transit). The performance characteristics of many of the scintigraphic measurements have been published and the pros and cons established in the literature. Pharmacologic interventions may also be used during scintigraphy to aid in diagnosis and treatment. Gastrointestinal scintigraphy is an integral and important component of the assessment of gastrointestinal function.
Topics: Gastric Emptying; Gastrointestinal Motility; Gastrointestinal Tract; Gastrointestinal Transit; Humans; Stomach; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed
PubMed: 19341838
DOI: 10.1053/j.semnuclmed.2008.11.002 -
European Journal of Pharmaceutical... Jan 2017Before being absorbed in the small intestine and/or colon, orally administered drugs inevitably need to pass through the stomach. Hence, it seems reasonable that the... (Review)
Review
Before being absorbed in the small intestine and/or colon, orally administered drugs inevitably need to pass through the stomach. Hence, it seems reasonable that the residence of a dosage form in the gastric environment, however brief it may be, may influence drug disposition further down the gastrointestinal tract and may potentially impact systemic exposure to a drug of interest. However, research efforts in the past mainly focused on drug disposition at the level of the intestine, i.e. the main site of absorption, hereby disregarding or oversimplifying the stomach's contribution to gastrointestinal drug disposition. In the first part of this review, the complexity of the stomach with regard to anatomy, physiology and gastric fluid composition is emphasized. Between-population differences in gastric functioning and physicochemical characteristics of gastric fluids are discussed. The second part of this review focuses on several of the processes to which a dosage form can be exposed during its passage through the stomach and the implications for gastrointestinal drug behaviour and systemic drug disposition. Finally, the influence of real-life dosing conditions on drug disposition is discussed in the context of the stomach.
Topics: Administration, Oral; Animals; Chemistry, Pharmaceutical; Gastric Emptying; Gastric Mucosa; Gastrointestinal Tract; Humans; Intestinal Absorption; Pharmaceutical Preparations; Stomach
PubMed: 27597144
DOI: 10.1016/j.ejps.2016.08.060 -
Journal of Nuclear Medicine : Official... Aug 2015Although 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; Fluoroscopy; Gamma Cameras; Gastric Emptying; Gastroenterology; Gastrointestinal Motility; Gastrointestinal Tract; Gastrointestinal Transit; Humans; Positron-Emission Tomography; Radionuclide Imaging; Tomography, Emission-Computed, Single-Photon; Video Recording
PubMed: 26025963
DOI: 10.2967/jnumed.112.114314 -
European Review For Medical and... Mar 2023Pulmonary aspiration of gastric content is a serious complication of anesthesia. It is unclear what effects different parts of the menstrual cycle have on how long it... (Observational Study)
Observational Study
OBJECTIVE
Pulmonary aspiration of gastric content is a serious complication of anesthesia. It is unclear what effects different parts of the menstrual cycle have on how long it takes for the stomach to empty. This prospective observational study assessed the relationship between menstrual cycle phases and gastric emptying using ultrasonography (USG) in volunteers of reproductive age.
PATIENTS AND METHODS
Between days 8-10 of the menstrual cycle in the follicular phase and days 18-20 of the luteal phase, a total of 24 healthy volunteers received four stomach USG procedures. In both phases, the gastric antrum was evaluated with USG in the right lateral decubitus position after fasting for 10 hours, followed by 2 hours of fasting after liquid intake and 6 hours of fasting after solid food intake. The gastric content, gastric antrum area, and estimated gastric volume determined whether the stomach was full or empty.
RESULTS
A full stomach was detected in 8 (8.3%) out of 96 measurements performed on the volunteers. After liquid food intake, a full stomach was detected in 2 subjects in the luteal phase, while all the subjects had an empty stomach during the follicular phase (p=0.500). After solid food intake, a full stomach was detected in 6 subjects in the luteal phase, and again, all subjects had an empty stomach during the follicular phase (p=0.031).
CONCLUSIONS
Ultrasound assessment of gastric volume in volunteers of reproductive age has shown that gastric emptying of solid foods is slowed during the luteal phase of the menstrual cycle.
Topics: Female; Humans; Gastric Emptying; Prospective Studies; Stomach; Menstrual Cycle; Luteal Phase; Ultrasonography
PubMed: 36930497
DOI: 10.26355/eurrev_202303_31564 -
Anesthesiology Apr 2022The lack of reliable data on gastric emptying of solid food during labor has led to some discrepancies between current guidelines regarding fasting for solid food in the...
BACKGROUND
The lack of reliable data on gastric emptying of solid food during labor has led to some discrepancies between current guidelines regarding fasting for solid food in the parturient. This prospective comparative study aimed to test the hypothesis that the gastric emptying fraction of a light meal would be reduced in parturients receiving epidural analgesia and with no labor analgesia compared with nonpregnant and pregnant women.
METHODS
Ten subjects were enrolled and tested in each group: nonpregnant women, term pregnant women, parturients with no labor analgesia, and parturients with epidural labor analgesia. After a first ultrasound examination was performed to ensure an empty stomach, each subject ingested a light meal (125 g yogurt; 120 kcal) within 5 min. Then ultrasound measurements of the antral area were performed at 15, 60, 90, and 120 min. The fraction of gastric emptying at 90 min was calculated as [(antral area90 min / antral area15 min) - 1] × 100, and half-time to gastric emptying was also determined. For the Parturient-Epidural group, the test meal was ingested within the first hour after the induction of epidural analgesia.
RESULTS
The median (interquartile range) fraction of gastric emptying at 90 min was 52% (46 to 61), 45% (31 to 56), 7% (5 to 10), and 31% (17 to 39) for nonpregnant women, pregnant women, parturients without labor analgesia, and parturients with labor epidural analgesia, respectively (P < 0.0001). The fraction of gastric emptying at 90 min was statistically significant and lower in the Parturient-Epidural group than in the Nonpregnant and Pregnant Control groups. In addition, the fraction of gastric emptying at 90 min was statistically significant and lower in the Parturient-No-Epidural group than in the Parturient-Epidural group.
CONCLUSIONS
Gastric emptying in parturients after a light meal was delayed, and labor epidural analgesia seems not to worsen but facilitates gastric emptying. This should be taken into consideration when allowing women in labor to consume a light meal.
Topics: Analgesia, Epidural; Analgesia, Obstetrical; Analgesics; Female; Gastric Emptying; Humans; Labor, Obstetric; Pregnancy; Prospective Studies
PubMed: 35103759
DOI: 10.1097/ALN.0000000000004133 -
Journal of Nuclear Medicine : Official... Sep 1990
Topics: Animals; Cats; Cholecystokinin; Erythromycin; Gastric Emptying; Humans; Radionuclide Imaging; Stomach
PubMed: 2395018
DOI: No ID Found -
American Journal of Physiology. Cell... May 2023The main function of the stomach is to digest ingested food. Gastric antrum muscular contractions mix ingested food with digestive enzymes and stomach acid and propel...
The main function of the stomach is to digest ingested food. Gastric antrum muscular contractions mix ingested food with digestive enzymes and stomach acid and propel the chyme through the pyloric sphincter at a rate in which the small intestine can process the chyme for optimal nutrient absorption. Mfge8 binding to α8β1 integrins helps regulate gastric emptying by reducing the force of antral smooth muscle contractions. The source of Mfge8 within gastric muscles is unclear. Since Mfge8 is a secreted protein, Mfge8 could be delivered via the circulation, or be locally secreted by cells within the muscle layers. In this study, we identify a source of Mfge8 within human gastric antrum muscles using spatial transcriptomic analysis. We show that Mfge8 is expressed in subpopulations of Mef2c perivascular cells within the submucosa layer of the gastric antrum. Mef2c is expressed in subpopulations of NG2 and PDGFRB pericytes. Mfge8 is expressed in NG2/Mef2c pericytes, but not in NG2/Mef2c, PDGFRB/Mef2c, or PDGFRB/Mef2c pericytes. Mfge8 is absent from CD34 endothelial cells but is expressed in a small population of perivascular ACTA2 cells. We also show that α8 integrin is not expressed by interstitial cells of Cajal (ICC), supporting the findings that Mfge8 attenuates gastric antrum smooth muscle contractions by binding to α8β1 integrins on enteric smooth muscle cells. These findings suggest a novel, supplementary mechanism of regulation of gastric antrum motility by cellular regulators of capillary blood flow, in addition to the regulation of gastric antrum motility by the enteric nervous system and the SMC, ICC, and PDGFRα cell (SIP) syncytium.
Topics: Humans; Pyloric Antrum; Pericytes; Endothelial Cells; Receptor, Platelet-Derived Growth Factor beta; Pylorus; Gastric Emptying; Integrins; Obesity; Antigens, Surface; Milk Proteins
PubMed: 36939201
DOI: 10.1152/ajpcell.00043.2023 -
European Journal of Clinical... Mar 2019Several gallstone patients complain of dyspeptic symptoms, irrespective of the presence of typical colicky pain. Symptoms often persist after a cholecystectomy....
BACKGROUND AND AIM
Several gallstone patients complain of dyspeptic symptoms, irrespective of the presence of typical colicky pain. Symptoms often persist after a cholecystectomy. Systematic studies on dyspepsia and dynamic gastrointestinal motor function are missing in gallstone patients with preserved gallbladder or after a cholecystectomy.
MATERIALS AND METHODS
Forty-six gallstone patients (age 55 ± 2 years; 15M, 31F) and 24 cholecystectomized patients (age 57 ± 2 years; 6M, 18F) (no difference in type and volume of gallstones between the two groups) were compared against a group of 65 healthy controls (age 51 ± 2 years; 30M, 35F). Dyspepsia occurring in the prior months was assessed by a questionnaire, gastric and gallbladder emptying by functional ultrasonography and orocecal transit time by a hydrogen breath test using a lactulose-enriched standard liquid meal.
RESULTS
Gallstone patients had significantly greater dyspepsia, fasting and residual gallbladder volumes, and slower gallbladder emptying, gastric emptying and small intestinal transit time than controls. In cholecystectomized patients, gastric emptying further delayed, compared to gallstone patients and controls.
CONCLUSION
Gallstone patients with the gallbladder "in situ" or after a cholecystectomy display dyspeptic symptoms. Symptoms are associated with multiple gastrointestinal motility defects involving the gallbladder, stomach and small intestine. After cholecystectomy, gastric emptying worsens.
Topics: Cholecystectomy; Dyspepsia; Female; Gallbladder Emptying; Gallstones; Gastric Emptying; Gastrointestinal Transit; Humans; Male; Middle Aged; Postoperative Complications
PubMed: 30592298
DOI: 10.1111/eci.13066 -
Frontiers in Endocrinology 2022This study aimed to determine the change of gastrointestinal (GI) emptying time after ileal interposition (IT) and elucidate the role of altered GI peristalsis in...
OBJECTIVE
This study aimed to determine the change of gastrointestinal (GI) emptying time after ileal interposition (IT) and elucidate the role of altered GI peristalsis in diabetic control.
MATERIALS AND METHODS
Twelve male Goto-Kakizaki rats were randomly divided into IT and sham groups. Body weight and food intake were recorded. Oral glucose tolerance test (OGTT), insulin tolerance test (ITT), plasma glucagon-like peptide-1 (GLP-1), and gastric emptying were measured at baseline and 4 and 8 weeks after operation. At 9 weeks postoperatively, the rats in the IT group were given atropine which can suppress the emptying of stomach and upper intestine, while sham rats were given metoclopramide (to expedite gastric emptying) for 1 week. At week 10 postoperatively, OGTT and GLP-1 were detected. The intestinal transit was tested at postoperative 12 weeks.
RESULTS
No differences were found between groups at baseline. After operation, the IT rats had lower body weight than sham rats. At 4 and 8 weeks postoperatively, the IT group showed better OGTT and ITT, with significantly elevated GLP-1 relative to sham. After administration of the GI motility drugs, however, the effect of diabetic control for the two groups became similar. The GI transit after IT was significantly slower than sham at all tested time points.
CONCLUSIONS
Although IT inhibits the GI transit time, the earlier interaction between undigested nutrients and interpositioned ileum promotes gut hormone secretion and thus reduces body weight and alleviates hyperglycemia. A decrease of GI transit of IT rats exacerbates the antidiabetic effects.
Topics: Animals; Blood Glucose; Body Weight; Diabetes Mellitus; Gastric Emptying; Gastrointestinal Transit; Glucagon-Like Peptide 1; Ileum; Male; Rats
PubMed: 35311237
DOI: 10.3389/fendo.2022.849923 -
Pediatric Critical Care Medicine : a... Nov 2015We aimed to review gastric dysmotility in critically ill children: 1) its pathophysiology, with a focus on critical care diseases and therapies that affect gastric... (Review)
Review
OBJECTIVE
We aimed to review gastric dysmotility in critically ill children: 1) its pathophysiology, with a focus on critical care diseases and therapies that affect gastric motility, 2) diagnostic methodologies, and 3) current and future potential therapies.
DATA SOURCES
Eligible studies were identified from PubMed and MEDLINE.
STUDY SELECTION
Literature search included the following key terms: "gastric emptying," "gastric motility/dysmotility," "gastrointestinal motility/dysmotility," "nutrition intolerance," and "gastric residual volume."
DATA EXTRACTION
Studies since 1995 were extracted and reviewed for inclusion by the authors related to the physiology, pathophysiology, diagnostic methodologies, and available therapies for gastric emptying.
DATA SYNTHESIS
Delayed gastric emptying, a common presentation of gastric dysmotility, is present in up to 50% of critically ill children. It is associated with the potential for aspiration, ventilator-associated pneumonia, and inadequate delivery of enteral nutrition and may affect the efficacy of enteral medications, all of which may be result in poor patient outcomes. Gastric motility is affected by critical illness and its associated therapies. Currently available diagnostic tools to identify gastric emptying at the bedside have not been systematically studied and applied in this cohort. Gastric residual volume measurement, used as an indirect marker of delayed gastric emptying in PICUs around the world, may be inaccurate.
CONCLUSIONS
Gastric dysmotility is common in critically ill children and impacts patient safety and outcomes. However, it is poorly understood, inadequately defined, and current therapies are limited and based on scant evidence. Understanding gastric motility and developing accurate bedside measures and novel therapies for gastric emptying are highly desirable and need to be further investigated.
Topics: Blood Glucose; Child; Critical Care; Critical Illness; Gastric Emptying; Humans; Hyperglycemia; Inflammation; Respiration, Artificial; Stomach; Stomach Diseases
PubMed: 26218259
DOI: 10.1097/PCC.0000000000000493