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Neurogastroenterology and Motility Dec 2022Several magnetic resonance imaging (MRI) protocols have been used to assess gastric emptying (GE) with MRI. This systematic review summarizes the current literature on... (Review)
Review
BACKGROUND
Several magnetic resonance imaging (MRI) protocols have been used to assess gastric emptying (GE) with MRI. This systematic review summarizes the current literature on the topic. The aim was to provide an overview of the available imaging protocols and underline the items that appear most agreed upon and those that deserve further investigation.
METHODS
According to PRISMA guidelines, two independent reviewers conducted a systematic literature search with a pre-specified strategy in different databases. Peer-reviewed articles that utilized MRI techniques to assess GE in healthy volunteers (HVs) were included. The quality and the outcomes of the studies were reported and analyzed.
KEY RESULTS
The literature search yielded 30 studies (531 HVs, weighted mean age 27.4, weighted mean body mass index 23.0 kg/m ), T2-weighted sequences, balanced turbo field echo, and balanced gradient echo were evenly utilized, with volunteers in the supine position (74% of the studies). After overnight fasting, both liquid (56%) and mixed (44%) meals were equally utilized. Segmentation of the volumes was predominantly performed manually (63%) with a reported mean T50 ranging from 7 to 330 min.
CONCLUSIONS & INFERENCES
As observed in this systematic review, MRI is a flexible tool for assessing GE. Different protocols were analyzed, showing an equal capacity to assess the GE. However, many items in these protocols still require further investigation to obtain a common standard and increase this assessment quality.
Topics: Humans; Adult; Gastric Emptying; Meals; Magnetic Resonance Imaging; Fasting; Healthy Volunteers
PubMed: 35340100
DOI: 10.1111/nmo.14371 -
Nature Reviews. Gastroenterology &... Jun 2009Ghrelin is a peptide hormone that possesses unique orexigenic properties. By acting on the growth-hormone secretagogue receptor 1a, ghrelin induces a short-term increase... (Review)
Review
Ghrelin is a peptide hormone that possesses unique orexigenic properties. By acting on the growth-hormone secretagogue receptor 1a, ghrelin induces a short-term increase in food consumption, which ultimately induces a positive energy balance and increases fat deposition. Reduced ghrelin levels have been observed in obese patients and after bariatric surgery. In particular, bariatric procedures that involve gastric resection or bypass lead to reduced ghrelin levels. Administration of physiological doses of exogenous ghrelin to humans does not significantly alter gastric motility; however, administration of high doses stimulates gastric motility, with increased gastric tone and emptying, and increased activity of migrating motor complexes in the small bowel. The potential of ghrelin agonists to be used as prokinetics is being tested in patients with gastroparesis and postoperative ileus. Ghrelin acts directly on pancreatic islet cells to reduce insulin production. Findings from studies in animals have revealed that small-molecule ghrelin antagonists favorably influence glucose tolerance, appetite suppression and weight loss. Other studies have demonstrated that ghrelin antagonists retard gastric emptying only at very high doses, which suggests that these agents will probably not induce upper gastrointestinal symptoms. The potential of this new class of therapeutic agents to influence appetite and glycemic control strongly indicates that they should be tested in clinical trials.
Topics: Energy Metabolism; Gastric Emptying; Gastrointestinal Diseases; Ghrelin; Humans
PubMed: 19434096
DOI: 10.1038/nrgastro.2009.72 -
Digestion 2006
Topics: Cholecystokinin; Dietary Fats; Digestion; Fatty Acids, Nonesterified; Gallbladder Emptying; Gastric Emptying; Humans; Risk Factors
PubMed: 17220630
DOI: 10.1159/000098559 -
Neurogastroenterology and Motility Aug 2016Most drug-drug interactions involve overlap or competition in drug metabolic pathways. However, there are medications, typically resins, whose function is to bind... (Review)
Review
Most drug-drug interactions involve overlap or competition in drug metabolic pathways. However, there are medications, typically resins, whose function is to bind injurious substances such as bile acids or potassium within the digestive tract. The objective of this article is to review the functions of the stomach and the kinetics of emptying of different food forms or formulations to make recommendations on timing of medication administration in order to avoid intragastric drug interactions. Based on the profiles and kinetics of emptying of liquid nutrients and homogenized solids, a window of 3 h between administration of a resin drug and another 'target' medication would be expected to allow a median of 80% of medications with particle size <1 mm to empty from the stomach and, hence, avoid potential interaction such as binding of the 'target' medication within the stomach.
Topics: Drug Administration Schedule; Food; Gastric Emptying; Gastrointestinal Agents; Gastroparesis; Humans; Stomach
PubMed: 26987693
DOI: 10.1111/nmo.12823 -
World Journal of Gastroenterology Dec 2019Management of gastroparesis remains challenging, particularly in pediatric patients. Supportive care and pharmacological therapies for symptoms remain the mainstay... (Review)
Review
Management of gastroparesis remains challenging, particularly in pediatric patients. Supportive care and pharmacological therapies for symptoms remain the mainstay treatment. Although they are effective for mild and some moderately severe cases, often time they do not work for severe gastroparesis. There are a few prokinetics available, yet the use of these drugs is limited by a lack of persistent efficacy and/or safety concerns. Currently, the only modality for adult patients with severe intractable gastroparesis is surgery, ., pyloroplasty and partial gastrectomy, however, this option is generally considered too radical for a growing child. Novel therapeutic approaches, particularly those which are less invasive, are needed. This article explores gastric electrical stimulation (GES), a new therapy for gastroparesis. Unlike others, it neither needs medications nor gastrectomy; rather, it treats through the use of microelectrodes to deliver high-frequency low energy electric stimulation to the pacemaker area of the stomach. Thus, it is tolerated and safe in children. Like in adult patients, GES appears to work in releasing symptoms, improving nutrition, and enhancing the quality of life; it also helps wean off medications and eliminate many needs for hospitalization. Considering the transient nature of gastroparesis in children in many occasions, GES is considered a "bridging" therapy after failed medical interventions and before surgery.
Topics: Adult; Age Factors; Child; Electric Stimulation Therapy; Gastrectomy; Gastric Emptying; Gastroparesis; Humans; Neurotransmitter Agents; Palliative Care; Pylorus; Quality of Life; Stomach; Treatment Outcome
PubMed: 31908392
DOI: 10.3748/wjg.v25.i48.6880 -
Pharmaceutical Research Jan 2022The aim of our work was to develop a biorelevant dissolution method for a better understanding of the in vivo performance of delayed-release tablet formulations.
PURPOSE
The aim of our work was to develop a biorelevant dissolution method for a better understanding of the in vivo performance of delayed-release tablet formulations.
METHODS
The typical pH profile and residence times in the stomach and small intestine were determined in fasted conditions based on the published results of swallowable monitoring devices. Then, a multi-stage pH shift dissolution method was developed by adding different amounts of phosphate-based buffer solutions to the initial hydrochloric acid solution. Because of the highly variable in vivo residence times in the stomach, two alternatives of the method were applied, modeling rapid and slow gastric emptying as well. This approach provided an opportunity to study the effect of the acidic treatment on post gastric release. Six enteric-coated low-dose acetylsalicylic acid (ASA) formulations including the reference Aspirin Protect were tested as a model compound. Moreover, the thickness of the coating of each formulation was investigated by scanning electron microscope.
RESULTS
Comparing the in vitro results to the known properties of the formulations, the new method was found to be more discriminative than the USP dissolution method. Ingredients affecting the in vitro dissolution, and thus probably the in vivo performance, were identified in both the tablet core and the coating of the tested formulations. The limited available in vivo data also indicated an increased predictivity.
CONCLUSION
Overall, the presented method may be an efficient tool to support the development of enteric coated generic formulations.
Topics: Gastric Emptying; Hydrogen-Ion Concentration; Intestine, Small; Solubility; Stomach; Tablets; Tablets, Enteric-Coated
PubMed: 35043354
DOI: 10.1007/s11095-021-03163-0 -
Anaesthesia Jan 1994
Topics: Anesthesia, General; Anesthesia, Obstetrical; Female; Gastric Emptying; Gastroesophageal Reflux; Humans; Pneumonia, Aspiration; Postpartum Period; Pregnancy; Premedication; Puerperal Disorders
PubMed: 8311203
DOI: 10.1111/j.1365-2044.1994.tb03301.x -
Turkish Journal of Medical Sciences Feb 2020Autoimmune gastritis is an autoimmune and inflammatory disorder. The aim of this study is to examine dynamic thiol/disulfide homeostasis and ischemia modified albumin...
BACKGROUND/AIM
Autoimmune gastritis is an autoimmune and inflammatory disorder. The aim of this study is to examine dynamic thiol/disulfide homeostasis and ischemia modified albumin levels, and to analyze the association between thiol/disulfide homeostasis and gastric emptying time in autoimmune gastritis.
MATERIALS AND METHODS
Thiol/disulfide homeostasis tests and ischemia modified albumin levels were determined in 50 autoimmune gastritis patients and 53 healthy subjects. Patients with delayed and normal gastric emptying were compared by thiol/disulfide homeostasis tests.
RESULTS
The results showed that native thiol (μmol/L), total thiol (μmol/L), and native thiol/total thiol ratio (%) of the patients with autoimmune gastritis decreased compared to the control group (177.7 ± 34.18 vs. 245.25 ± 33.83, P = 0.001, 227.25 ± 36.78 vs. 284.20 ± 27.19, P = 0.03, and 8.84 ± 1.1 vs. 7.74% ± 1.3%, P = 0.001). In addition, native thiol (μmol/L), total thiol (μmol/L), and native thiol/ total thiol ratio (%) were found to be lower in patients with delayed gastric emptying (198.65 ± 24.27 vs. 167.12 ± 20.51, 241.81 ± 27.14 vs. 213.92 ± 26.35, 8.34 ± 1.29 vs. 7.20 ± 1.83, P = 0.001). Disulfide level, disulfide/native thiol, disulfide/total thiol (P = 0.001) ratios, and ischemia modified albumin levels (ABSU, 0.71 ± 0.08 vs. 0.83 ± 0.07) were found to be higher in autoimmune gastritis patients with delayed gastric emptying (P = 0.001).
CONCLUSION
The results showed that thiol/disulfide homeostasis in patients with autoimmune gastritis caused an increase in ischemia modified albumin and disulfide whereas a decrease in thiols. An altered thiol/disulfide balance was also observed in patients with delayed gastric emptying. These results suggest that the oxidative process is involved in patients with autoimmune gastritis.
Topics: Aged; Autoimmune Diseases; Biomarkers; Disulfides; Female; Gastric Emptying; Gastritis; Homeostasis; Humans; Male; Middle Aged; Prospective Studies; Reference Values; Serum Albumin; Serum Albumin, Human; Stomach; Sulfhydryl Compounds
PubMed: 31814373
DOI: 10.3906/sag-1902-17 -
American Journal of Physiology.... May 2021Gastric emptying and gastric accommodation play a role in generation of upper gastrointestinal symptoms. Although both functions have been measured simultaneously using...
Gastric emptying and gastric accommodation play a role in generation of upper gastrointestinal symptoms. Although both functions have been measured simultaneously using MRI or Tc SPECT methodology, the correlation of these two functions has not been evaluated simultaneously using a solid and liquid meal. To study relationships of whole or proximal stomach volumes to emptying, we concurrently measured postprandial gastric accommodation and emptying (over 4 h) of a In-labeled mixed solid and liquid meal. A semiautomated method allowing selection of a segmentation threshold based on a grayscale image was used to measure volume of the proximal half of the stomach, defined as the top half of axial slices along the vertical length of the stomach. A correction factor derived from phantom studies was applied for upscatter from the Tc to the In window. Relationships of time to emptying 10%, 25%, 50%, and 75% of the meal to fasting and postprandial gastric volumes were evaluated using Spearman correlation. Whole stomach fed and accommodation volumes were significantly correlated with all gastric emptying times (10%, 25%, and 50%). Proximal stomach fed volumes were similarly associated with 50% and 75% proximal gastric emptying. Fed proximal gastric volume was associated with 50% and 75% whole gastric emptying. Fed proximal accommodation volume was associated with 50% gastric emptying. Fasting gastric volumes were not significant determinants of emptying rates. In conclusion, postprandial gastric accommodation is significantly associated with the rate of gastric emptying, with higher gastric volumes associated with prolongation of emptying. Novel methods to measure proximal gastric accommodation and correct for radioisotope upscatter are described. In vivo human studies evaluated concurrently the volume of the stomach during fasting and after a solid and liquid meal using a new SPECT-based method. Although fasting gastric volumes did not impact the rates of gastric emptying, both postprandial and accommodation volumes of the whole and proximal stomach were significantly correlated with gastric emptying. Larger stomach volumes were associated with slower gastric emptying.
Topics: Adolescent; Adult; Female; Gastric Emptying; Healthy Volunteers; Humans; Male; Meals; Postprandial Period; Stomach; Tomography, Emission-Computed, Single-Photon; Young Adult
PubMed: 33719546
DOI: 10.1152/ajpgi.00008.2021 -
Gut Apr 1979In a series of measurements of liquid-phase gastric emptying using a radionuclide marker on 35 subjects, five were identified in whom the proximal stomach and antrum...
In a series of measurements of liquid-phase gastric emptying using a radionuclide marker on 35 subjects, five were identified in whom the proximal stomach and antrum were clearly distinguishable. Three of these subjects were normal controls and two suffered from systemic sclerosis. In the three normal subjects, analysis of the movement of the liquid showed the expected movement from fundus to antrum and thence through the pylorus. In the two patients with systemic sclerosis, there was, in contrast, evidence of mass retropulsion of the contents of the antrum into the fundus. In such cases, the measurement of stomach emptying based on the assumption of a single-compartment system in likely to be misleading.
Topics: Gastric Emptying; Humans; Pyloric Antrum; Scleroderma, Systemic; Stomach
PubMed: 447111
DOI: 10.1136/gut.20.4.309