|
1
|
Arunachala Murthy T, Chapman M, Jones KL, Horowitz M, Marathe CS. Inter-relationships between gastric emptying and glycaemia: Implications for clinical practice. World J Diabetes 2023; 14:447-459. [PMID: 37273253 PMCID: PMC10236995 DOI: 10.4239/wjd.v14.i5.447] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 12/09/2022] [Accepted: 04/07/2023] [Indexed: 05/15/2023] Open
Abstract
Gastric emptying (GE) exhibits a wide inter-individual variation and is a major determinant of postprandial glycaemia in health and diabetes; the rise in blood glucose following oral carbohydrate is greater when GE is relatively more rapid and more sustained when glucose tolerance is impaired. Conversely, GE is influenced by the acute glycaemic environment acute hyperglycaemia slows, while acute hypoglycaemia accelerates it. Delayed GE (gastroparesis) occurs frequently in diabetes and critical illness. In diabetes, this poses challenges for management, particularly in hospitalised individuals and/or those using insulin. In critical illness it compromises the delivery of nutrition and increases the risk of regurgitation and aspiration with consequent lung dysfunction and ventilator dependence. Substantial advances in knowledge relating to GE, which is now recognised as a major determinant of the magnitude of the rise in blood glucose after a meal in both health and diabetes and, the impact of acute glycaemic environment on the rate of GE have been made and the use of gut-based therapies such as glucagon-like peptide-1 receptor agonists, which may profoundly impact GE, in the management of type 2 diabetes, has become commonplace. This necessitates an increased understanding of the complex inter-relationships of GE with glycaemia, its implications in hospitalised patients and the relevance of dysglycaemia and its management, particularly in critical illness. Current approaches to management of gastroparesis to achieve more personalised diabetes care, relevant to clinical practice, is detailed. Further studies focusing on the interactions of medications affecting GE and the glycaemic environment in hospitalised patients, are required.
Collapse
Affiliation(s)
- Tejaswini Arunachala Murthy
- Adelaide Medical School, University of Adelaide, Adelaide 5000, SA, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide 5000, SA, Australia
| | - Marianne Chapman
- Adelaide Medical School, University of Adelaide, Adelaide 5000, SA, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide 5000, SA, Australia
- NHMRC Centre of Clinical Research Excellence in Nutritional Physiology, Interventions and Outcomes, University of Adelaide, Adelaide 5000, SA, Australia
| | - Karen L Jones
- Adelaide Medical School, University of Adelaide, Adelaide 5000, SA, Australia
- NHMRC Centre of Clinical Research Excellence in Nutritional Physiology, Interventions and Outcomes, University of Adelaide, Adelaide 5000, SA, Australia
| | - Michael Horowitz
- Adelaide Medical School, University of Adelaide, Adelaide 5000, SA, Australia
- NHMRC Centre of Clinical Research Excellence in Nutritional Physiology, Interventions and Outcomes, University of Adelaide, Adelaide 5000, SA, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide 5000, SA, Australia
| | - Chinmay S Marathe
- Adelaide Medical School, University of Adelaide, Adelaide 5000, SA, Australia
- NHMRC Centre of Clinical Research Excellence in Nutritional Physiology, Interventions and Outcomes, University of Adelaide, Adelaide 5000, SA, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide 5000, SA, Australia
| |
Collapse
|
|
2
|
Febo-Rodriguez L, Chumpitazi BP, Sher AC, Shulman RJ. Gastric accommodation: Physiology, diagnostic modalities, clinical relevance, and therapies. Neurogastroenterol Motil 2021; 33:e14213. [PMID: 34337824 DOI: 10.1111/nmo.14213] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 05/09/2021] [Accepted: 05/31/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Gastric accommodation is an essential gastric motor function which occurs following ingestion of a meal. Impaired gastric fundic accommodation (IFA) is associated with dyspeptic symptoms. Gastric accommodation is mediated by the vagal pathway with several important physiologic factors such as duodenal nutrient feedback playing a significant role. IFA has been described as a pathophysiologic factor in several gastrointestinal disorders including functional dyspepsia, diabetic gastropathy, post-Nissen fundoplication, postsurgical gastrectomy, and rumination syndrome. Modalities for gastric accommodation assessment include gastric barostat, intragastric meal distribution via scintigraphy, drinking tests (eg, water load), SPECT, MRI, 2D and 3D ultrasound, and intragastric high-resolution manometry. Several treatment options including sumatriptan, buspirone, tandospirone, ondansetron, and acotiamide may improve symptoms by increasing post-meal gastric volume. PURPOSE Our aim is to provide an overview of the physiology, diagnostic modalities, and therapies for IFA. A literature search was conducted on PubMed, Google Scholar, and other sources to identify relevant studies available until December 2020. Gastric accommodation is an important gastric motor function which if impaired, is associated with several upper gastrointestinal disorders. There are an increasing number of gastric accommodation testing modalities; however, each has facets which warrant consideration. Evidence regarding potentially effective therapies for IFA is growing.
Collapse
Affiliation(s)
- Liz Febo-Rodriguez
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Miami, Miami, Florida, USA
| | - Bruno P Chumpitazi
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine, Houston, Texas, USA.,United States Department of Agriculture, Agriculture Research Services, Children's Nutrition Research Center, Houston, Texas, USA
| | - Andrew C Sher
- Department of Pediatric Radiology, Texas Children's Hospital, Houston, Texas, USA
| | - Robert J Shulman
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine, Houston, Texas, USA.,United States Department of Agriculture, Agriculture Research Services, Children's Nutrition Research Center, Houston, Texas, USA
| |
Collapse
|
|
3
|
Housman B, Lee DS, Wolf A, Nicastri D, Kaufman A, Rizk N, Housman A, Song K, Hakami A, Flores RM. Major modifications to minimize thoracic esophago-gastric leak and eradicate esophageal stricture after Ivor Lewis esophagectomy. J Surg Oncol 2021; 124:529-539. [PMID: 34081346 DOI: 10.1002/jso.26550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/20/2021] [Accepted: 05/19/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Ivor Lewis esophagectomy (ILE) remains the procedure of choice for localized middle or lower esophageal carcinoma. Nevertheless, anastomotic leak remains a common complication with rates from 3% to 25% and a stricture rate as high as 40%. The frequency of these complications suggests that the procedure itself may have inherent limitations including the use of potentially ischemic tissue for the esophagogastric anastomosis. We introduce a modified technique that reduces operative steps, preserves blood supply, and uses a modified esophagogastric anastomosis. METHODS All consecutive patients undergoing ILE with the described modified technique were identified. An esophagram was performed on postoperative day six or seven. To ensure that all cases were identified, anastomotic leaks were defined as any radiographic evidence of contrast extravasation. RESULTS A total of 110 patients underwent the modified esophagectomy with 2 anastomotic leaks (1.82%) and zero strictures. There was 1 late death but no early deaths (<30 or 90 days) or early re-admissions (<30 days). The average number of risk factors was 2.12, and 98 patients (90%) had at least 1 risk factor in their medical history. CONCLUSIONS The modifications proposed simplify procedural steps, limit unnecessary dissection and introduce a technique that ends the practice of connecting ischemic tissue. We believe this technique contributes to surgical durability and reduces the rate of postoperative leak and eliminates stricture.
Collapse
Affiliation(s)
- Brian Housman
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Dong-Seok Lee
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Andrea Wolf
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Daniel Nicastri
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Andrew Kaufman
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Nabil Rizk
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Arno Housman
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Kimberly Song
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Ardeshir Hakami
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Raja M Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| |
Collapse
|
|
4
|
Gastric Sensory and Motor Functions and Energy Intake in Health and Obesity-Therapeutic Implications. Nutrients 2021; 13:nu13041158. [PMID: 33915747 PMCID: PMC8065811 DOI: 10.3390/nu13041158] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/18/2021] [Accepted: 03/26/2021] [Indexed: 01/19/2023] Open
Abstract
Sensory and motor functions of the stomach, including gastric emptying and accommodation, have significant effects on energy consumption and appetite. Obesity is characterized by energy imbalance; altered gastric functions, such as rapid gastric emptying and large fasting gastric volume in obesity, may result in increased food intake prior to reaching usual fullness and increased appetite. Thus, many different interventions for obesity, including different diets, anti-obesity medications, bariatric endoscopy, and surgery, alter gastric functions and gastrointestinal motility. In this review, we focus on the role of the gastric and intestinal functions in food intake, pathophysiology of obesity, and obesity management.
Collapse
|
|
5
|
Raoufi N, Ye A, Han J. New insights into in vivo gastroduodenal digestion of oil-in-water emulsions: gastric stability and in vitro digestion modeling. Crit Rev Food Sci Nutr 2021; 62:3723-3737. [PMID: 33432823 DOI: 10.1080/10408398.2020.1868396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In this paper, effect of emulsion stability on gastroduodenal emptying/secretion was reviewed and differentiated. Moreover, novel perspectives on physiology of gastric lumen, duodenum, and gall bladder were achieved using mathematical models, being useful for designing artificial digestive systems. In this regard, numerical data for dynamic gastric emptying/secretion were offered for gastric-stable and gastric-unstable emulsion intakes. It was shown that alterations in human gastric and duodenal volume follow, respectively, linear and sinusoidal curves, with high correlation coefficients (r2 > 0.93). For both emulsions, about 30-40 mL ingesta discharged rapidly from stomach upon ingestion; However, further gastric emptying was regulated for the rest of digestion period, so that 0.1 mL/min oil was passing through duodenum. Intragastric evacuation of both emulsions started with a lag phase during which stomach stored secretions incrementally by slow gastric discharge. Lag phase ended with fat layering, when emptying considerably enhanced. This reduction was gradual for stable emulsion while unstable emulsion experienced a rapid emptying before slow declining trend. Along with initial gastric emptying, 87% of gallbladder content discharged into duodenum, prolonged up to the gradual reduction phase of stomach. Supplementary investigations are needed to quantify gastroduodenal secretions, particularly pepsin and pancreas in response to emulsion ingesta.
Collapse
Affiliation(s)
- Nassim Raoufi
- Department of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, PR China
| | - Aiqian Ye
- Riddet Institute, Massey University, Palmerston North, New Zealand
| | - Jianzhong Han
- Department of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, PR China
| |
Collapse
|
|
6
|
A comparison of different physical stomach models and an analysis of shear stresses and strains in these system. Food Res Int 2020; 135:109296. [DOI: 10.1016/j.foodres.2020.109296] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/21/2020] [Accepted: 05/04/2020] [Indexed: 01/28/2023]
|
|
7
|
Banerjee S, Pal A, Fox M. Volume and position change of the stomach during gastric accommodation and emptying: A detailed three-dimensional morphological analysis based on MRI. Neurogastroenterol Motil 2020; 32:e13865. [PMID: 32390262 DOI: 10.1111/nmo.13865] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 03/13/2020] [Accepted: 04/02/2020] [Indexed: 01/11/2023]
Abstract
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.
Collapse
Affiliation(s)
- Sreerup Banerjee
- Department of Biological Sciences and Bio-Engineering (BSBE), Indian Institute of Technology Kanpur (IITK), Kanpur, India
| | - Anupam Pal
- Department of Biological Sciences and Bio-Engineering (BSBE), Indian Institute of Technology Kanpur (IITK), Kanpur, India
| | - Mark Fox
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Switzerland.,NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.,Digestive Function: Basel, Laboratory and Clinic for motility disorders and functional GI diseases, Center for integrative Gastroenterology, Klinik Arlesheim, Arlesheim, Switzerland
| |
Collapse
|
|
8
|
Klemm L, Seydewitz R, Borsdorf M, Siebert T, Böl M. On a coupled electro-chemomechanical model of gastric smooth muscle contraction. Acta Biomater 2020; 109:163-181. [PMID: 32294551 DOI: 10.1016/j.actbio.2020.04.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 12/13/2022]
Abstract
The stomach is a central organ in the gastrointestinal tract that performs a variety of functions, in which the spatio-temporal organisation of active smooth muscle contraction in the stomach wall (SW) is highly regulated. In the present study, a three-dimensional model of the gastric smooth muscle contraction is presented, including the mechanical contribution of the mucosal and muscular layer of the SW. Layer-specific and direction-dependent model parameters for the active and passive stress-stretch characteristics of the SW were determined experimentally using porcine smooth muscle strips. The electrical activation of the smooth muscle cells (SMC) due to the pacemaker activity of the interstitial cells of Cajal (ICC) is modelled by using FitzHugh-Nagumo-type equations, which simulate the typical ICC and SMC slow wave behaviour. The calcium dynamic in the SMC depends on the SMC membrane potential via a gaussian function, while the chemo-mechanical coupling in the SMC is modelled via an extended Hai-Murphy model. This cascade is coupled with an additional mechano-electrical feedback-mechanism, taking into account the mechanical response of the ICC and SMC due to stretch of the SW. In this way the relaxation responses of the fundus to accommodate incoming food, as well as the typical peristaltic contraction waves in the antrum for mixing and transport of the chyme, have been well replicated in simulations performed at the whole organ level. STATEMENT OF SIGNIFICANCE: In this article, a novel three-dimensional electro-chemomechanical model of the gastric smooth muscle contraction is presented. The propagating waves of electrical membrane potential in the network ofinterstitial cells of Cajal (ICC) and smooth muscle cells (SMC) lead to a global pattern of change in the calciumdynamics inside the SMC. Taking additionally into account the mechanical response of the ICC and SMC due to stretch of the stomach wall, also referred to as mechanical feedback-mechanism, the result is a complex spatio-temporal regulation of the active contraction and relaxation of the gastric smooth muscle tissue. Being a firstapproach, in future view such a three-dimensional model can give an insight into the complexload transferring system of the stomach wall, as well as into the electro-chemomechanicalcoupling process underlying smooth muscle contraction in health and disease.
Collapse
Affiliation(s)
- Lisa Klemm
- Institute of Solid Mechanics, Technische Universität Braunschweig, Braunschweig D-38106, Germany
| | - Robert Seydewitz
- Institute of Solid Mechanics, Technische Universität Braunschweig, Braunschweig D-38106, Germany
| | - Mischa Borsdorf
- Institute of Sport and Motion Science, University of Stuttgart, Stuttgart D-70569, Germany
| | - Tobias Siebert
- Institute of Sport and Motion Science, University of Stuttgart, Stuttgart D-70569, Germany
| | - Markus Böl
- Institute of Solid Mechanics, Technische Universität Braunschweig, Braunschweig D-38106, Germany.
| |
Collapse
|
|
9
|
Masuy I, Carbone F, Holvoet L, Vandenberghe A, Vanuytsel T, Tack J. The effect of rikkunshito on gastrointestinal symptoms and gastric motor function: The first study in a Belgian functional dyspepsia population. Neurogastroenterol Motil 2020; 32:e13739. [PMID: 31608532 DOI: 10.1111/nmo.13739] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Rikkunshito, a traditional Kampo medicine, has shown efficacy to treat functional dyspepsia (FD) in controlled trials in Japan. Its putative benefit for European patients and mechanism of action has not been established. METHODS This study examined the effect of rikkunshito on gastric motility and GI symptom perception in FD-PDS patients in a randomized, placebo-controlled, cross-over study. After a 2-week run-in period, patients received rikkunshito or matching placebo (2.5 g t.i.d.) for 4 weeks, separated by a 4-week washout period. Symptoms were assessed by the Leuven Postprandial Distress Scale (LPDS) diary throughout the study. At baseline and after both treatment arms, intragastric pressure (IGP) was measured to evaluate gastric accommodation and gastric motility. Simultaneously, GI symptoms were scored on a 100 mm visual analogue scale. Validated symptom questionnaires (PAGI-SYM, VSI, DSS, and PHQ) were completed each study visit. KEY RESULTS Twenty-three patients completed the study (33 ± 14 years, 22.7 ± 3.22 kg/m2 ). Intragastric pressure was numerically, but not significantly, lower after rikkunshito compared with baseline and placebo (P = .14). No differences were found in gastric accommodation, nutrient volume tolerance, and symptoms assessed during IGP measurements. Early satiation and postprandial fullness (daily diary) decreased after rikkunshito compared with baseline (P < .041 for both). Placebo also improved most other symptoms assessed. No significant changes in VSI scores occurred. No adverse reactions occurred. CONCLUSIONS Rikkunshito did not alter gastric motility. Treatment with rikkunshito improved upper GI symptoms in FD patients but similarly high placebo effects were observed using the LPDS diary, PAGI-SYM, SF-NDI, and DSS scores. Rikkunshito was safe and well-tolerated.
Collapse
Affiliation(s)
- Imke Masuy
- Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
| | | | | | | | - Tim Vanuytsel
- Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium.,University Hospitals Leuven, Leuven, Belgium
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium.,University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
|
10
|
Leucine-grafted starch as a new superdisintegrant for the formulation of domperidone tablets. J Drug Deliv Sci Technol 2019. [DOI: 10.1016/j.jddst.2019.01.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
|
11
|
|
|
12
|
Akashi T, Matsumoto K, Hashimoto R. Continuation of Enteral Nutrition and Relief from Vomiting by Administration of a New Formula: a Case Report. Clin Nutr Res 2017; 6:306-309. [PMID: 29124051 PMCID: PMC5665752 DOI: 10.7762/cnr.2017.6.4.306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/01/2017] [Accepted: 09/08/2017] [Indexed: 11/19/2022] Open
Abstract
Gastro-esophageal reflux (GER) is a common and serious complication in patients receiving enteral nutrition, making continuation of enteral nutrition difficult. Semi-solid enteral nutrients were developed to prevent feeding-related GER. Semi-solid enteral nutrients have high viscosity and, therefore, are typically administered through a large-diameter percutaneous endoscopic gastrostomy (PEG) tube. Recently, a new formula (Mermed®, Mermed Plus®) was introduced that uses alginate, which behaves like a gelatin in acidic conditions. This formula improved GER during enteral feedings. Our case report shows that this new formula enables the continuation of enteral nutrition via a nasogastric tube (NGT) in patients with difficulty tolerating enteral nutrition secondary to vomiting. An 86-year-old woman with an atherothrombotic cerebral infarction vomited during tube feeding, resulting in aspiration pneumonia. After 1 week, we introduced a viscosity regulator and restarted enteral feeding using a 100 mL liquid diet, but vomiting persisted. Because of the continued difficulty in tolerating enteral nutrition, the patient was transferred to our hospital. From hospital day 4, Mermed Plus® (300 mL/225 kcal, administered for 1 hour, 3 times a day) was started, eventually increasing to 535 mL/400 kcal at hospital day 5. After this, vomiting ceased. Mermed Plus® was easily administered via NGT, and its effects were immediate. This treatment appeared to improve the patient's quality of life while reducing the burden on medical staff.
Collapse
Affiliation(s)
- Tetsuro Akashi
- Department of Internal Medicine, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Kazuhide Matsumoto
- Department of Internal Medicine, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Risa Hashimoto
- Department of Internal Medicine, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| |
Collapse
|
|
13
|
Tomalka A, Borsdorf M, Böl M, Siebert T. Porcine Stomach Smooth Muscle Force Depends on History-Effects. Front Physiol 2017; 8:802. [PMID: 29093684 PMCID: PMC5651592 DOI: 10.3389/fphys.2017.00802] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 09/29/2017] [Indexed: 12/11/2022] Open
Abstract
The stomach serves as food reservoir, mixing organ and absorption area for certain substances, while continually varying its position and size. Large dimensional changes during ingestion and gastric emptying of the stomach are associated with large changes in smooth muscle length. These length changes might induce history-effects, namely force depression (FD) following active muscle shortening and force enhancement (FE) following active muscle stretch. Both effects have impact on the force generating capacity of the stomach, and thus functional relevance. However, less is known about history-effects and active smooth muscle properties of stomach smooth muscle. Thus, the aim of this study was to investigate biomechanical muscle properties as force-length and force-velocity relations (FVR) of porcine stomach smooth muscle strips, extended by the analysis of history-effects on smooth muscle force. Therefore, in total n = 54 tissue strips were dissected in longitudinal direction from the ventral fundus of porcine stomachs. Different isometric, isotonic, and isokinetic contraction protocols were performed during electrical muscle stimulation. Cross-sectional areas (CSA) of smooth muscles were determined from cryo-histological sections stained with Picrosirius Red. Results revealed that maximum smooth muscle tension was 10.4 ± 2.6 N/cm2. Maximum shortening velocity (Vmax) and curvature factor (curv) of the FVR were 0.04 ± 0.01 [optimum muscle length/s] and 0.36 ± 0.15, respectively. The findings of the present study demonstrated significant (P < 0.05) FD [up to 32% maximum muscle force (Fim)] and FE (up to 16% Fim) of gastric muscle tissue, respectively. The FE- and FD-values increased with increasing ramp amplitude. This outstanding muscle behavior is not accounted for in existing models so far and strongly supports the idea of a holistic reflection of distinct stomach structure and function. For the first time this study provides a comprehensive set of stomach smooth muscle parameters including classic biomechanical muscle properties and history-dependent effects, offering the possibility for the development and validation of computational stomach models. Furthermore, this data set facilitates novel insights in gastric motility and contraction behavior based on the re-evaluation of existing contractile mechanisms. That will likely help to understand physiological functions or dysfunctions in terms of gastric accommodation and emptying.
Collapse
Affiliation(s)
- André Tomalka
- Department of Sport and Motion Science, University of Stuttgart, Stuttgart, Germany
| | - Mischa Borsdorf
- Department of Sport and Motion Science, University of Stuttgart, Stuttgart, Germany
| | - Markus Böl
- Department of Mechanical Engineering, Institute of Solid Mechanics, Braunschweig University of Technology, Braunschweig, Germany
| | - Tobias Siebert
- Department of Sport and Motion Science, University of Stuttgart, Stuttgart, Germany
| |
Collapse
|
|
14
|
Shava U, Srivastava A, Mathias A, Yachha SK, Poddar U. Nutrient drink test: Normative values in Indian children. Indian J Gastroenterol 2017; 36:405-410. [PMID: 29071541 DOI: 10.1007/s12664-017-0794-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 09/25/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Nutrient drink test (NDT) is a simple, non-invasive method to assess gastric function including accommodation. However, data on normal satiety drink volume (SDV) in children is scanty with no information about postprandial symptoms (PPS). Our aims were to establish normal values of NDT in healthy children and evaluate its correlation with age, gender, and anthropometry. METHODS Six- to 18-year-old healthy children underwent the NDT. The nutrient drink (0.94 kcal/mL) was given at a constant rate of 15 mL/min in 6-12-year-old subjects and at 30 mL/min in 13-18-year-old subjects till satiety score of 5 was reached. Postprandial symptoms (30 min) of fullness, nausea, bloating, and pain were scored using a visual analogue scale (0-100 mm) individually and as aggregate score. RESULTS Sixty-seven children (40 boys, age 12 [6-18 years]) were enrolled. Median SDV was 360 [180-960 mL], higher in 13-18-year-olds in comparison to 6-12-year-old children (360 [240-1002] vs. 300 [148-960] mL; p=0.005). SDV showed significant correlation with age, weight, and height. SDV was higher in boys than girls (450 [240-1074] vs. 330 [240-480] mL; p=0.02) in the older children (13-18 y), but it was similar in the younger children. Mild fullness (40 [0-80]) was the only PPS seen in 85% children and none had pain. PPS were not different between boys and girls or younger and older children. CONCLUSION The study provides normative data of SDV and PPS by NDT in 6-18-year-old children. SDV correlated with age and was higher in adolescent boys than girls.
Collapse
Affiliation(s)
- Upender Shava
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Anshu Srivastava
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India.
| | - Amrita Mathias
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Surender Kumar Yachha
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Ujjal Poddar
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| |
Collapse
|
|
15
|
Burgstaller J, Wittek T, Smith GW. Invited review: Abomasal emptying in calves and its potential influence on gastrointestinal disease. J Dairy Sci 2017; 100:17-35. [DOI: 10.3168/jds.2016-10949] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 09/22/2016] [Indexed: 11/19/2022]
|
|
16
|
Development of an advanced in vitro model of the stomach and its evaluation versus human gastric physiology. Food Res Int 2016. [DOI: 10.1016/j.foodres.2016.01.030] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
|
17
|
Buisman WJ, Mauritz FA, Westerhuis WE, Gilja OH, van der Zee DC, van Herwaarden-Lindeboom MYA. Evaluation of Gastric Volumes: Comparison of 3-D Ultrasound and Magnetic Resonance Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1423-1430. [PMID: 27067418 DOI: 10.1016/j.ultrasmedbio.2016.01.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 01/14/2016] [Accepted: 01/23/2016] [Indexed: 06/05/2023]
Abstract
To investigate gastric accommodation, accurate measurements of gastric volumes are necessary. An excellent technique to measure gastric volumes is dynamic magnetic resonance imaging (MRI). Unfortunately, dynamic MRI is expensive and not always available. A new 3-D ultrasound (US) method using a matrix transducer was developed to measure gastric volumes. In this prospective study, 14 healthy volunteers underwent a dynamic MRI and a 3-D US. Gastric volumes were calculated with intra-gastric liquid content and total gastric volume. Mean postprandial liquid gastric content was 397 ± 96.5 mL. Mean volume difference was 1.0 mL with limits of agreement of -8.9 to 10.9 mL. When gastric air was taken into account, mean total gastric volume was 540 ± 115.4 mL SD. Mean volume difference was 2.3 mL with limits of agreement of -21.1 to 26.4 mL. The matrix 3-D US showed excellent agreement with dynamic MRI. Therefore matrix 3-D US is a reliable alternative to measure gastric volumes.
Collapse
Affiliation(s)
- Wijnand J Buisman
- Department of Pediatric Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Femke A Mauritz
- Department of Pediatric Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wouter E Westerhuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - David C van der Zee
- Department of Pediatric Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | |
Collapse
|
|
18
|
Buisman WJ, van Herwaarden-Lindeboom MYA, Mauritz FA, El Ouamari M, Hausken T, Olafsdottir EJ, van der Zee DC, Gilja OH. Validation of a Novel 3-Dimensional Sonographic Method for Assessing Gastric Accommodation in Healthy Adults. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1411-1418. [PMID: 27208194 DOI: 10.7863/ultra.15.04086] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 10/26/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES A novel automated 3-dimensional (3D) sonographic method has been developed for measuring gastric volumes. This study aimed to validate and assess the reliability of this novel 3D sonographic method compared to the reference standard in 3D gastric sonography: freehand magneto-based 3D sonography. METHODS A prospective study with 8 balloons (in vitro) and 16 stomachs of healthy volunteers (in vivo) was performed. After a 500-mL liquid meal, 1 preprandial and 3 postprandial volume scans of the stomachs were performed by the novel 3D sonographic method and the current reference-standard 3D sonographic method. RESULTS The in vitro study showed a mean volume difference between the novel method and the true balloon volume of -1.3 mL; limits of agreement (LoA) were small (-39.3 to12.3 mL), with an intraclass correlation coefficient (ICC) of 0.998. The in vivo study showed a mean gastric volume of 321 mL between the novel method and the freehand magneto-based method, with a mean volume difference of -4.4 mL; LoA were -40.1 to 31.2 mL, and the ICC was 0.991. The intraobserver and interobserver variability rates were low, at 0.8 mL (LoA, -24.0 to 25.6 mL), with an ICC of 0.995, and 0.5 mL (LoA, of -26.8 to 27.8 mL), with an ICC of 0.999, respectively. CONCLUSIONS The novel 3D sonographic method with automated acquisition showed good agreement with the current reference-standard gastric 3D sonographic method, with low intraobserver and interobserver variability. This novel 3D sonographic method is a valid and reliable technique for determining gastric accommodation.
Collapse
Affiliation(s)
- Wijnand J Buisman
- Department of Pediatric Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Femke A Mauritz
- Department of Pediatric Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mourad El Ouamari
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Trygve Hausken
- Department of Clinical Medicine, University of Bergen, Bergen, Norway. National Center for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | | | - David C van der Zee
- Department of Pediatric Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Odd Helge Gilja
- Department of Clinical Medicine, University of Bergen, Bergen, Norway. National Center for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
|
19
|
Feinle-Bisset C. Upper gastrointestinal sensitivity to meal-related signals in adult humans - relevance to appetite regulation and gut symptoms in health, obesity and functional dyspepsia. Physiol Behav 2016; 162:69-82. [PMID: 27013098 DOI: 10.1016/j.physbeh.2016.03.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/08/2016] [Accepted: 03/16/2016] [Indexed: 12/20/2022]
Abstract
Both the stomach and small intestine play important roles in sensing the arrival of a meal, and its physico-chemical characteristics, in the gastrointestinal lumen. The presence of a meal in the stomach provides a distension stimulus, and, as the meal empties into the small intestine, nutrients interact with small intestinal receptors, initiating the release of gut hormones, associated with feedback regulation of gastrointestinal functions, including gut motility, and signaling to the central nervous system, modulating eating behaviours, including energy intake. Lipid appears to have particularly potent effects, also in close interaction with, and modulating the effects of, gastric distension, and involving the action of gut hormones, particularly cholecystokinin (CCK). These findings have not only provided important, and novel, insights into how gastrointestinal signals interact to modulate subjective appetite perceptions, including fullness, but also laid the foundation for an increasing appreciation of the role of altered gastrointestinal sensitivities, e.g. as a consequence of excess dietary intake in obesity, or underlying the induction of gastrointestinal symptoms in functional dyspepsia (a condition characterized by symptoms, including bloating, nausea and early fullness, amongst others, after meals, particularly those high in fat, in the absence of any structural or functional abnormalities in the gastrointestinal tract). This paper will review the effects of dietary nutrients, particularly lipid, on gastrointestinal function, and associated effects on appetite perceptions and energy intake, effects of interactions of gastrointestinal stimuli, as well as the role of altered gastrointestinal sensitivities (exaggerated, or reduced) in eating-related disorders, particularly obesity and functional dyspepsia.
Collapse
Affiliation(s)
- Christine Feinle-Bisset
- University of Adelaide Discipline of Medicine, Royal Adelaide Hospital, Adelaide, SA 5000, Australia; National Health and Medical Research Council of Australia (NHMRC) Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, SA 5000, Australia.
| |
Collapse
|
|
20
|
Amiriani T, Javadi H, Raiatnavaz T, Pashazadeh AM, Semnani S, Tabib SM, Assadi M. Assessment of Gastric Accommodation in Patients with Functional Dyspepsia by 99mTc-Pertechtenate Single Photon Emission Computed Tomography Imaging: Practical but not Widely Accepted. Mol Imaging Radionucl Ther 2015; 24:105-109. [PMID: 27529885 PMCID: PMC4745402 DOI: 10.4274/mirt.36854] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 09/04/2015] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Impaired gastric accommodation is one of the main symptoms in patients with functional dyspepsia. The aim of the present study was to assess gastric accommodation in patients with functional dyspepsia using single photon emission computed tomography (SPECT) imaging. METHODS Twenty-four patients with functional dyspepsia and 50 healthy volunteers as control group were enrolled in this study. All participants were given 5 mCi 99mTc-pertechtenate intravenously, served with a low fat meal, and underwent SPECT scanning 20 minutes after the meal. RESULTS Based on the scintigraphic data, gastric volumes were found to be significantly increased after food ingestion in both patient and control groups. We also found that while there was no significant difference between patient and control groups in terms of fasting gastric volumes, postprandial gastric volume was significantly lower in patients as compared to healthy individuals (p<0.05). CONCLUSION Measuring gastric volume by using SPECT can be a valuable method in the detection of functional dyspepsia and in differentiation of this entity from other organic disorders.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Majid Assadi
- Bushehr University of Medical Sciences, The Persian Gulf Nuclear Medicine Research Center, Bushehr, Iran Phone: +90 0098-771-2580169 E-mail:
| |
Collapse
|
|
21
|
Ferrua MJ, Singh RP. Computational modelling of gastric digestion: current challenges and future directions. Curr Opin Food Sci 2015. [DOI: 10.1016/j.cofs.2015.06.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
|
22
|
Bickelhaupt S, Froehlich JM, Cattin R, Raible S, Bouquet H, Bill U, Patak MA. Software-supported evaluation of gastric motility in MRI: a feasibility study. J Med Imaging Radiat Oncol 2015; 58:11-7. [PMID: 24131557 DOI: 10.1111/1754-9485.12097] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 06/07/2013] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the feasibility of dedicated motility assessment software for quantitative evaluation of basic gastric motility and to validate it using manual measurements. METHODS Ten patients (5 males/5 females, mean 41 years) out of a previous series of small bowel MR-enterography examinations with well visible stomachs were included in this Institutional Reviews Board approved, retrospective study. MRI (1.5-T, Siemens Sonata) was performed after standardised oral preparation (3% aqueous mannitol over 1 h). Coronal 2DtrueFISP (TR 283.8/TE 1.89/FOV400/10 mm slice) motility acquisitions covering the entire abdomen were performed in apnoea. For each patient, image analysis for assessment of gastric motility was performed both manually and using the dedicated software either the proximal (n = 5) or in the distal (n = 5) gastric corpus. The main quantitative endpoints (amplitude, frequency) describing gastric motility were compared using (paired) Student's t-Test. RESULTS All motility curves qualitatively matched each other (10/10). No significant differences (P > 0.05) were found for amplitudes (mean: 18.17 mm manual; 17.78 mm software), contraction frequencies (5.1/min; 4.7/min) and mean lumen diameters (34.12 mm; 33.13 mm), respectively. Mean duration for a single measurement was significantly (P < 0.001) lower with the software (6.40 min manual technique; 1.40 min software assisted). CONCLUSIONS The software proves to be feasible for fast and accurate measurement of basic gastric motility parameters providing comparable data in comparison to manual assessment methods. It might help to reduce the time needed for assessment of relevant characteristics of gastric motility.
Collapse
|
|
23
|
Schulze KS. The imaging and modelling of the physical processes involved in digestion and absorption. Acta Physiol (Oxf) 2015; 213:394-405. [PMID: 25313872 DOI: 10.1111/apha.12407] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 06/17/2014] [Accepted: 10/07/2014] [Indexed: 01/18/2023]
Abstract
The mechanical activity of the gastro-intestinal tract serves to store, propel and digest food. Contractions disperse particles and transform solids and secretions into the two-phase slurry called chyme; movements of the intestine deliver nutrients to mucosal sites of absorption, and from the submucosa into the lymphatic and portal venous circulation. Colonic motor activity helps to extract fluid and electrolytes from chyme and to compound and compact luminal debris into faeces for elimination. We outline how dynamic imaging by ultrasound and magnetic resonance can demonstrate intestinal flow processes critical to digestion like mixing, dilution, swelling, dispersion and elution. Computational fluid mechanics enables a numerical rendition of the forces promoting digestion: pressure and flow fields, the shear stresses dispersing particles or the effectiveness of bolus mixing can be calculated. These technologies provide new insights into the mechanical processes that promote digestion and absorption.
Collapse
Affiliation(s)
- K. S. Schulze
- Department of Internal Medicine; University of Iowa; Iowa City IA USA
- VAMC; Iowa City IA USA
| |
Collapse
|
|
24
|
Bharucha AE, Karwoski RA, Fidler J, Holmes DR, Robb RA, Riederer SJ, Zinsmeister AR. Comparison of manual and semiautomated techniques for analyzing gastric volumes with MRI in humans. Am J Physiol Gastrointest Liver Physiol 2014; 307:G582-7. [PMID: 25012844 PMCID: PMC4182289 DOI: 10.1152/ajpgi.00048.2014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Gastric emptying, accommodation, and motility can be quantified with magnetic resonance imaging (MRI). The first step in image analysis entails segmenting the stomach from surrounding structures, usually by a time-consuming manual process. We have developed a semiautomated process to segment and measure gastric volumes with MRI. Gastric images were acquired with a three-dimensional gradient echo MRI sequence at 5, 10, 20, and 30 min after ingestion of a liquid nutrient (Ensure, 296 ml) labeled with gadolinium in 20 healthy volunteers and 29 patients with dyspeptic symptoms. The agreement between gastric volumes measured by manual segmentation and our new semiautomated algorithm was assessed with Lin's concordance correlation coefficient (CCC) and the Bland Altman test. At 5 min after a meal, food volumes measured by manual (352 ± 4 ml) and semiautomated (346 ± 4 ml) techniques were correlated {CCC[95% confidence interval (CI)] 0.70 (0.52, 0.81)}; air volumes measured by manual (88 ± 6 ml) and semiautomated (84 ± 6 ml) techniques were also correlated [CCC (95% CI) 0.89 (0.82, 0.94)]. Findings were similar at subsequent time points. The Bland Altman test was not significant. The time required for semiautomated segmentation ranged from an average of 204 s for the 5-min images to 233 s for the 20-min images. These times were appreciably smaller than the typical times of many tens of minutes, even hours, required for manual segmentation. To conclude, a semiautomated process can measure gastric food and air volume using MRI with comparable accuracy and far better efficiency than a manual process.
Collapse
Affiliation(s)
- Adil E. Bharucha
- 1Division of Gastroenterology and Hepatology, Clinical Enteric Neuroscience Translational and Epidemiological Research Program, College of Medicine, Mayo Clinic, Rochester, Minnesota;
| | - Ronald A. Karwoski
- 2Biomedical Imaging Resource, College of Medicine, Mayo Clinic, Rochester, Minnesota;
| | - Jeff Fidler
- 3Department of Radiology, College of Medicine, Mayo Clinic, Rochester, Minnesota;
| | - David R. Holmes
- 2Biomedical Imaging Resource, College of Medicine, Mayo Clinic, Rochester, Minnesota;
| | - Richard A. Robb
- 2Biomedical Imaging Resource, College of Medicine, Mayo Clinic, Rochester, Minnesota;
| | - Stephen J. Riederer
- 4MR Research Laboratory, College of Medicine, Mayo Clinic, Rochester, Minnesota; and
| | - Alan R. Zinsmeister
- 5Division of Biostatistics, College of Medicine, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
|
25
|
Espinós JC, Turró R, Mata A, Cruz M, da Costa M, Villa V, Buchwald JN, Turró J. Early experience with the Incisionless Operating Platform™ (IOP) for the treatment of obesity : the Primary Obesity Surgery Endolumenal (POSE) procedure. Obes Surg 2014; 23:1375-83. [PMID: 23591548 DOI: 10.1007/s11695-013-0937-8] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND We report our initial experience and 6-month outcomes in a single center using the per-oral Incisionless Operating Platform™ (IOP) (USGI Medical) to place transmural plications in the gastric fundus and distal body using specialized suture anchors (the Primary Obesity Surgery Endolumenal [POSE] procedure). METHODS A prospective observational study was undertaken with institutional Ethics Board approval in a private hospital in Barcelona, Spain. Indicated patients were WHO obesity class I-II, or III, where patients refused a surgical approach. RESULTS Between February 28, 2011 and March 23, 2012, the POSE procedure was successfully performed in 45 patients: 75.6 % female; mean age 43.4 ± 9.2 SD (range 21.0-64.0). At baseline: mean absolute weight (AW, kg), 100.8 ± 12.9 (75.5-132.5); body mass index (BMI, kg/m(2)), 36.7 ± 3.8 (28.1-46.6). A mean 8.2 suture-anchor plications were placed in the fundus, 3.0 along the distal body wall. Mean operative time, 69.2 ± 26.6 min (32.0-126.0); patients were discharged in <24 h. Six-month mean AW was 87.0 ± 10.3 (68.0-111.5); BMI decreased 5.8 to 31.3 ± 3.3 (25.1-38.6) (p < 0.001); EWL was 49.4 %; TBWL, 15.5 %. No mortality or operative morbidity. Minor postoperative side effects resolved with treatment by discharge. Patients reported less hunger and earlier satiety post procedure. Liquid intake began 12 h post procedure with full solids by 6 weeks. CONCLUSIONS At 6-month follow-up of a prospective case series, the POSE procedure appeared to provide safe and effective weight loss without the scarring, pain, and recovery issues of open and laparoscopic bariatric surgery. Long-term follow-up and further study are required.
Collapse
Affiliation(s)
- J C Espinós
- Unidad de Endoscopia, Centro Médico Teknon, Vilana, 12, 08022 Barcelona, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
|
26
|
Espinós JC, Turró R, Mata A, Cruz M, da Costa M, Villa V, Buchwald JN, Turró J. Early experience with the Incisionless Operating Platform™ (IOP) for the treatment of obesity : the Primary Obesity Surgery Endolumenal (POSE) procedure. Obes Surg 2014. [PMID: 31309524 DOI: 10.1007/s11695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND We report our initial experience and 6-month outcomes in a single center using the per-oral Incisionless Operating Platform™ (IOP) (USGI Medical) to place transmural plications in the gastric fundus and distal body using specialized suture anchors (the Primary Obesity Surgery Endolumenal [POSE] procedure). METHODS A prospective observational study was undertaken with institutional Ethics Board approval in a private hospital in Barcelona, Spain. Indicated patients were WHO obesity class I-II, or III, where patients refused a surgical approach. RESULTS Between February 28, 2011 and March 23, 2012, the POSE procedure was successfully performed in 45 patients: 75.6 % female; mean age 43.4 ± 9.2 SD (range 21.0-64.0). At baseline: mean absolute weight (AW, kg), 100.8 ± 12.9 (75.5-132.5); body mass index (BMI, kg/m(2)), 36.7 ± 3.8 (28.1-46.6). A mean 8.2 suture-anchor plications were placed in the fundus, 3.0 along the distal body wall. Mean operative time, 69.2 ± 26.6 min (32.0-126.0); patients were discharged in <24 h. Six-month mean AW was 87.0 ± 10.3 (68.0-111.5); BMI decreased 5.8 to 31.3 ± 3.3 (25.1-38.6) (p < 0.001); EWL was 49.4 %; TBWL, 15.5 %. No mortality or operative morbidity. Minor postoperative side effects resolved with treatment by discharge. Patients reported less hunger and earlier satiety post procedure. Liquid intake began 12 h post procedure with full solids by 6 weeks. CONCLUSIONS At 6-month follow-up of a prospective case series, the POSE procedure appeared to provide safe and effective weight loss without the scarring, pain, and recovery issues of open and laparoscopic bariatric surgery. Long-term follow-up and further study are required.
Collapse
Affiliation(s)
- J C Espinós
- Unidad de Endoscopia, Centro Médico Teknon, Vilana, 12, 08022 Barcelona, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
|
27
|
Curcic J, Sauter M, Schwizer W, Fried M, Boesiger P, Steingoetter A. Validation of a golden angle radial sequence (GOLD) for abdominal T1 mapping during free breathing: demonstrating clinical feasibility for quantifying gastric secretion and emptying. J Magn Reson Imaging 2014; 41:157-64. [PMID: 24391022 DOI: 10.1002/jmri.24530] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 11/14/2013] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To validate a magnetic resonance imaging sequence suitable for quantitative assessment of acid suppression by a proton pump inhibitor (PPI) on gastric secretion and emptying in clinical practice. METHODS A golden angle radial sequence (GOLD) was validated in a series of in vitro and in vivo experiments and clinical feasibility was shown in two studies. The impact of free breathing and image plane orientation on T1 values was evaluated in a controlled in vivo experiment. The free-breathing GOLD sequence was compared against a standard breath-hold gradient echo sequence for gastric half emptying time in 23 subjects during a gastric emptying study. Pilot data from five subjects assessed the sensitivity of the GOLD sequence to detect changes in acid secretion volume produced by PPI treatment. RESULTS The coronal free-breathing GOLD sequence and the axial breath-hold standard gradient echo sequence showed good agreement of the gastric half emptying time (6 ± 3 min, P = 0.053). The GOLD sequence demonstrated sensitivity to reduction of gastric secretion volumes induced by PPI treatment (55 ± 5 mL, P < 0.001). CONCLUSION The GOLD sequence allowed for free breathing, multislice, combined imaging and T1 mapping of the stomach content. GOLD presents a promising multipurpose, noninvasive imaging tool for monitoring gastric function in clinical studies.
Collapse
Affiliation(s)
- Jelena Curcic
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland; Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | | | | | | | | | | |
Collapse
|
|
28
|
Wysocka B, Moseley J, Brock K, Lockwood G, Wilson G, Simeonov A, Haider MA, Menard C, Bissonnette JP, Dawson LA, Ringash J. Assessment of nonrespiratory stomach motion in healthy volunteers in fasting and postprandial states. Pract Radiat Oncol 2013; 4:288-293. [PMID: 25194096 DOI: 10.1016/j.prro.2013.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 10/02/2013] [Accepted: 10/02/2013] [Indexed: 12/23/2022]
Abstract
PURPOSE To characterize nonrespiratory stomach motion in the fasting state and postprandial. METHODS AND MATERIALS Ten healthy volunteers underwent 2-dimensional Fiesta cine magnetic resonance imaging studies in 30-second voluntary breath hold, in axial, coronal, and 2 oblique planes while fasting, and 5, 15, 30, 45, and 60 minutes postmeal. Each stomach contour was delineated and sampled with 200 points. Matching points were found for all contours in the same 30-second acquisition. Using deformable parametric analysis (Matlab, version 7.1), mean magnitude, and standard deviation of displacement of each point were determined for each patient. Maximal, minimal, and median population values in 6 cardinal, and in any direction, were calculated. RESULTS The median of mean displacements for the baseline position of each point was small and rarely exceeded 1.1 mm; greatest value was 1.6 mm superior-inferior. Median displacement (pooled across time) in the right-left, superior-inferior, and anterior-posterior directions was 0.3 (range, -0.7 to 1.3), 0.8 (-0.4 to 2.4), and 0.3 (-1.1 to 1.6) mm, respectively. Fasting and postprandial standard deviation did not differ. CONCLUSIONS Nonrespiratory stomach displacement is small and stomach position is stable after a small, standard meal. Radiation therapy may be delivered at any time within the first hour after eating without significant compromise of planned planning target volumes.
Collapse
Affiliation(s)
- Barbara Wysocka
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Joanne Moseley
- Department of Radiation Physics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kristy Brock
- Department of Radiation Physics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Gina Lockwood
- Department of Biostatistics, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Graham Wilson
- Department of Radiation Physics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Anna Simeonov
- Department of Radiation Physics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Masoom A Haider
- Department of Medical Imaging, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia Menard
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jean-Pierre Bissonnette
- Department of Radiation Physics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Laura A Dawson
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
|
29
|
Madsen JL. Scintigraphic assessment of gastrointestinal motility: a brief review of techniques and data interpretation. Clin Physiol Funct Imaging 2013; 34:243-53. [DOI: 10.1111/cpf.12089] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 09/09/2013] [Indexed: 12/16/2022]
Affiliation(s)
- Jan L. Madsen
- Department of Clinical Physiology and Nuclear Medicine; Centre of Functional Imaging and Research; Hvidovre Hospital; Hvidovre Denmark
| |
Collapse
|
|
30
|
Wang RF, Wang ZF, Ke MY, Fang XC, Sun XH, Zhu LM, Zhang J. Temperature can influence gastric accommodation and sensitivity in functional dyspepsia with epigastric pain syndrome. Dig Dis Sci 2013; 58:2550-5. [PMID: 22945476 DOI: 10.1007/s10620-012-2363-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 08/04/2012] [Indexed: 01/26/2023]
Abstract
BACKGROUND Functional dyspepsia-epigastric pain syndrome (FD-EPS) is characterized pathophysiologically by visceral hypersensitivity, but the effect of the temperature stimulation on gastric function has been seldom studied. AIM The purpose of this study was to investigate the effects of liquid nutrients at different temperatures on the gastric accommodation, sensitivity, and gastric-wall compliance of healthy subjects (HS) and FD-EPS patients. METHODS Ten FD-EPS patients (Roma III criteria) and ten HS were recruited into the study. Intragastric pressure (IGP) and gastric perfusion were measured and compared following the administration of liquid nutrients at 37 °C on day 1 and at 8 °C on day 2. RESULTS Seven patients developed abdominal discomfort or abdominal pain after being given cold liquid nutrient. The administration of liquid nutrient at 8 °C resulted in an increase of IGP in HS (P=0.044), a significant decrease in gastric perfusion (P<0.0001), a marked increase in IGP (P=0.015), and a dramatic reduction in gastric wall compliance (P=0.012) in patients compared to the effects of liquid nutrient at 37 °C. In addition, IGP in patients was lower than that in HS at 37 °C liquid nutrient (P=0.036), and the gastric perfusion volume in patients at maximal satiety was also significantly reduced at 8 °C liquid nutrient compared with HS (P=0.017). CONCLUSIONS Cold stimulation can increase the IGP in HS and FD-EPS patients, elevate the visceral sensitivity and reduce the gastric volume of FD-EPS patients. FD-EPS patients who are sensitive to cold may develop epigastric discomfort or pain.
Collapse
Affiliation(s)
- Rui-Feng Wang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, 100730, China
| | | | | | | | | | | | | |
Collapse
|
|
31
|
Fan XP, Wang L, Zhu Q, Ma T, Xia CX, Zhou YJ. Sonographic evaluation of proximal gastric accommodation in patients with functional dyspepsia. World J Gastroenterol 2013; 19:4774-4780. [PMID: 23922476 PMCID: PMC3732851 DOI: 10.3748/wjg.v19.i29.4774] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 06/14/2013] [Accepted: 07/18/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the value of ultrasonography (US) in evaluation of proximal gastric accommodation disorder in patients with functional dyspepsia (FD).
METHODS: Between April 2011 and March 2012, 45 patients with FD and 27 healthy volunteers were enrolled in this study. Two-dimensional ultrasound (2DUS) and 3-dimensional ultrasound (3DUS) were performed sequentially to measure proximal gastric area (PGA), maximal proximal gastric diameter (MPGD), and proximal gastric volume (PGV). These values were measured separately in the two groups every other 5 min for a duration of 25 min after the beginning of ingestion of a test meal. Air pocket grading was done separately for images of 2DUS and blocks of 3DUS obtained at five scanning time points.
RESULTS: Both PGA and PGV of patients were significantly smaller than healthy controls (P = 0.000 and 0.002, respectively). Comparing the two parameters between the groups at each time point, the differences were also statistically significant (P = 0.000-0.013), except at 10 min for the PGV (P = 0.077). However, no overall difference was found between the groups in the MPGD measurements (P = 0.114), though it was statistically significant at a 20-minute examination point (P = 0.026). A total of 360 sets or blocks of images were obtained for both 2DUS and 3DUS. For the images analyzed by 2DUS, none were excluded because of gastric gas, and 50 (13.9%) and 310 (86.1%) sets were determined as air pockets grades 1 and 2, respectively. For the images analyzed by 3DUS, 23 (6.4%) blocks were excluded from the measurement due to presence of a large fundus air pocket (grade 3); fifty (13.9%) and 287 (79.7%) blocks were also graded as 1 and 2, respectively.
CONCLUSION: Measurement of both PGA and PGV by 2DUS and 3DUS could be useful for assessment of the proximal gastric accommodation.
Collapse
|
|
32
|
|
|
33
|
Koziolek M, Garbacz G, Neumann M, Weitschies W. Simulating the Postprandial Stomach: Physiological Considerations for Dissolution and Release Testing. Mol Pharm 2013; 10:1610-22. [DOI: 10.1021/mp300604u] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Mirko Koziolek
- Institute of Pharmacy, Department
of Biopharmaceutics and Pharmaceutical Technology, Center of Drug
Absorption and Transport, University of Greifswald, Felix-Hausdorff-Strasse
3, 17487 Greifswald, Germany
| | - Grzegorz Garbacz
- Physiolution GmbH, Walther-Rathenau-Strasse
49a, 17489 Greifswald, Germany
| | - Marco Neumann
- Institute of Pharmacy, Department
of Biopharmaceutics and Pharmaceutical Technology, Center of Drug
Absorption and Transport, University of Greifswald, Felix-Hausdorff-Strasse
3, 17487 Greifswald, Germany
| | - Werner Weitschies
- Institute of Pharmacy, Department
of Biopharmaceutics and Pharmaceutical Technology, Center of Drug
Absorption and Transport, University of Greifswald, Felix-Hausdorff-Strasse
3, 17487 Greifswald, Germany
| |
Collapse
|
|
34
|
Imai Y, Kobayashi I, Ishida S, Ishikawa T, Buist M, Yamaguchi T. Antral recirculation in the stomach during gastric mixing. Am J Physiol Gastrointest Liver Physiol 2013; 304:G536-42. [PMID: 23275619 DOI: 10.1152/ajpgi.00350.2012] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We investigate flow in the stomach during gastric mixing using a numerical simulation with an anatomically realistic geometry and free-surface flow modeling. Because of momentum differences between greater and lesser curvatures during peristaltic contractions, time-averaged recirculation is generated in the antrum, with retropulsive flow away from the pylorus and compensation flow along the greater curvature toward the pylorus. Gastric content in the distal stomach is continuously transported to the distal antrum by the forward flow of antral recirculation, and it is then mixed by the backward retropulsive flow. Hence, the content inside the antral recirculation is well mixed independently of initial location, whereas the content outside the recirculation is poorly mixed. Free-surface modeling enables us to analyze the effects of posture on gastric mixing. In the upright, prone, and right lateral positions, most of the antrum is filled with content, and the content is well mixed by antral recirculation. In contrast, in the supine and left lateral positions, most of the content is located outside antral recirculation, which results in poor mixing. The curved, twisted shape of the stomach substantially supports gastric mixing in fluid mechanical terms.
Collapse
Affiliation(s)
- Yohsuke Imai
- Department of Bioengineering and Robotics, Tohoku University, 6-6-01 Aoba, Aoba, Sendai 980-8579, Japan.
| | | | | | | | | | | |
Collapse
|
|
35
|
Xu QQ, Zhang YL, Yao SK. Progress in measurements of proximal gastric accommodation in patients with functional dyspepsia. Shijie Huaren Xiaohua Zazhi 2013; 21:2530. [DOI: 10.11569/wcjd.v21.i25.2530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
|
36
|
Liao D, Zhao J, Gregersen H. A novel 3D shape context method based strain analysis on a rat stomach model. J Biomech 2012; 45:1566-73. [PMID: 22542373 DOI: 10.1016/j.jbiomech.2012.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 04/10/2012] [Accepted: 04/12/2012] [Indexed: 02/07/2023]
Abstract
The stomach has the ability to change its geometry and volume during digestion. Thus, the stomach shape changes dynamically due to changes in contents and due to pressure from adjacent organs. Full-field strain analysis is therefore important for accurate estimation of the true deformation in this highly non-homogeneous, anisotropic organ. The aim of this study is to introduce a modified non-rigid image registration based 3D shape context method combined with a full-field strain analysis method to describe a distension-induced 3D gastric deformation. The geometry of a normal rat stomach at distension pressures from 0.05 kPa to 0.8 kPa were obtained by ultrasonic scanning. The full-field strain distribution of the 3D gastric model between the reference state and the distended state were computed on the basis of the improved 3D shape context method and full-field strain analysis method. The registered surface showed a good agreement with the real deformed surface for all distension states. However, the errors increased with the distension pressure due to increasing dissimilarity between the deformed and the reference surface. The strain distributions on the stomach surface were non-uniform with the largest deformation in the non-glandular part and the greater and lesser curvature when the pressure was higher than 0.2 kPa. The wall stiffness of the non-glandular part was softer than that of the glandular part. The modelling analysis method which is closely allied with the non-rigid image registration and strain analysis provides a kinematically possible deformation mode of the gastric wall. This method can be potentially used for clinical data estimating the kinematical properties of the human visceral organs in health and disease.
Collapse
Affiliation(s)
- Donghua Liao
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | | | | |
Collapse
|
|
37
|
Koseki J, Oshima T, Kondo T, Tomita T, Fukui H, Watari J, Hattori T, Kase Y, Miwa H. Role of transient receptor potential ankyrin 1 in gastric accommodation in conscious guinea pigs. J Pharmacol Exp Ther 2012; 341:205-12. [PMID: 22262922 DOI: 10.1124/jpet.111.189027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2025] Open
Abstract
We report the establishment of a new model for measuring gastric tone and liquid meal-induced accommodation in conscious guinea pigs and the role played by transient receptor potential ankyrin 1 (TRPA1). An indwelling polyethylene bag was placed in proximal stomachs of 5-week-old male Hartley guinea pigs. Gastric tone was measured by distending the bag and recording changes in intrabag pressure at various volumes. Gastric accommodation was measured by administering liquid meals and recording intrabag pressure over time. N(ω)-nitro-L-arginine methyl ester hydrochloride (L-NAME) (a nitric-oxide synthase inhibitor), atropine sulfate (atropine) (a muscarinic receptor antagonist), allyl isothiocyanate (AITC) (a TRPA1 agonist), or theophylline-7-(N-4-isopropylphenyl) acetamide (HC-030031) (a selective TRPA1 antagonist) was administered 15 to 60 min before measurement. Gastric tone was increased by stepwise distension of the bag and was further significantly increased by L-NAME and significantly decreased by atropine. A liquid meal (15% w/v; 1.7 kcal) significantly decreased intrabag pressure 5 to 20 min after administration, indicating gastric accommodation; this was completely suppressed by L-NAME and further enhanced by atropine. AITC significantly increased gastric tone; this increase was decreased by HC-030031 and atropine. A combination of AITC and L-NAME significantly increased gastric tone compared with L-NAME alone. HC-030031 alone significantly decreased gastric tone. Liquid meal-induced gastric accommodation was significantly suppressed by pretreatment with AITC. We established a new model for measuring gastric tone and accommodation in conscious guinea pigs. TRPA1 activation suppresses gastric accommodation by increasing gastric tone through cholinergic neuronal pathways.
Collapse
Affiliation(s)
- Junichi Koseki
- Division of Upper Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
|
38
|
Ferrua MJ, Kong F, Singh RP. Computational modeling of gastric digestion and the role of food material properties. Trends Food Sci Technol 2011. [DOI: 10.1016/j.tifs.2011.04.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
|
39
|
Abstract
During gastric digestion, food is disintegrated by a complex interaction of chemical and mechanical effects. Although the mechanisms of chemical digestion are usually characterized by using in vitro analysis, the difficulty in reproducing the stomach geometry and motility has prevented a good understanding of the local fluid dynamics of gastric contents. The goal of this study was to use computational fluid dynamics (CFD) to develop a 3-D model of the shape and motility pattern of the stomach wall during digestion, and use it to characterize the fluid dynamics of gastric contents of different viscosities. A geometrical model of an averaged-sized human stomach was created, and its motility was characterized by a series of antral-contraction waves of up to 80% relative occlusion. The flow field within the model (predicted using the software Fluent™) strongly depended on the viscosity of gastric contents. By increasing the viscosity, the formation of the 2 flow patterns commonly regarded as the main mechanisms driving digestion (i.e., the retropulsive jet-like motion and eddy structures) was significantly diminished, while a significant increase of the pressure field was predicted. These results were in good agreement with experimental data previously reported in the literature, and suggest that, contrary to the traditional idea of a rapid and complete homogenization of the meal, gastric contents associated with high viscous meals are poorly mixed. This study illustrates the capability of CFD to provide a unique insight into the fluid dynamics of the gastric contents, and points out its potential to develop a fundamental understanding and modeling of the mechanisms involved in the digestion process.
Collapse
Affiliation(s)
- M J Ferrua
- Riddet Inst., Massey Univ., Palmerston North, New Zealand
| | | |
Collapse
|
|
40
|
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is a useful technique for evaluating gastrointestinal (GI) motor functions because it provides multi-planar imaging capability, high imaging speed, good spatial resolution and excellent soft tissue contrast. Moreover, multiple parameters of GI function can be assessed non-invasively during a single study. PURPOSE This critical review of the literature discusses the strengths and limitations of MRI for evaluating GI motor functions.
Collapse
Affiliation(s)
- L Marciani
- Nottingham Digestive Diseases Centre and NIHR Biomedical Research Unit, Nottingham University Hospitals, University of Nottingham, Nottingham, UK.
| |
Collapse
|
|
41
|
Janssen P, Verschueren S, Ly HG, Vos R, Van Oudenhove L, Tack J. Intragastric pressure during food intake: a physiological and minimally invasive method to assess gastric accommodation. Neurogastroenterol Motil 2011; 23:316-22, e153-4. [PMID: 21299720 DOI: 10.1111/j.1365-2982.2011.01676.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The stomach relaxes upon food intake and thereby provides a reservoir while keeping the intragastric pressure (IGP) low. We set out to determine whether we could use IGP as a measurement for stomach accommodation during food intake. METHODS In fasted healthy volunteers (n = 7-17) a manometer and an infusion catheter were positioned in the proximal stomach. After a stabilization period a nutrient drink was intragastrically infused at 15, 30 and 60 mL min(-1). To investigate the effect of impaired accommodation the effect of N(G)-monomethyl-L-arginine (L-NMMA) was examined. The volunteers scored satiation until maximum, when the experiment ended. The IGP was presented as a change from baseline (mean ± SEM) and compared with repeated measures anova. KEY RESULTS Independent on the ingestion speed, the IGP decreased initially and gradually increased thereafter. Volunteers scored maximal satiation after 699 ± 62, 809 ± 90 and 997 ± 120 mL nutrient drink infused (15, 30 and 60 mL min(-1) respectively; P < 0.01). Maximum IGP decrease was 3.4 ± 0.5 mmHg after 205 ± 28 mL, 5.1 ± 0.7 mmHg after 212 ± 46 mL, and 5.2 ± 0.7 mmHg after 296 ± 28 mL infused volume [15, 30 and 60 mL min(-1) respectively; not significant (ns)]. Post hoc analysis showed significant correlations between IGP and satiation score increase. During L-NMMA infusion IGP was significantly increased while subjects drank significantly less (816 ± 91 vs 1032 ± 71 mL; P < 0.005). Interestingly, the correlation between IGP increase and satiation score increase did not differ after L-NMMA treatment. CONCLUSIONS & INFERENCES The IGP during nutrient drink ingestion provides a minimally invasive alternative to the barostat for the assessment of gastric accommodation. These findings furthermore indicate that IGP is a major determinant of satiation.
Collapse
Affiliation(s)
- P Janssen
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium.
| | | | | | | | | | | |
Collapse
|
|
42
|
Ferrua MJ, Singh RP. Understanding the fluid dynamics of gastric digestion using computational modeling. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.profoo.2011.09.217] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
|
43
|
Odunsi ST, Camilleri M. Selected interventions in nuclear medicine: gastrointestinal motor functions. Semin Nucl Med 2009; 39:186-94. [PMID: 19341838 DOI: 10.1053/j.semnuclmed.2008.11.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
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.
Collapse
Affiliation(s)
- Suwebatu T Odunsi
- Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER) Group, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | |
Collapse
|
|
44
|
Abstract
There is an array of tests available to measure gastric motility. Some tests measure end points, such as gastric emptying, that result from several different functions, whereas other tests are more specific and test only a single parameter, such as contractility. This article reviews the tests most commonly available in practice and research to evaluate in vivo the gastric functions of emptying, accommodation, contractility, and myoelectrical activity. The rationale for testing, the relative strengths and weaknesses of each test, and technical details are summarized. We also briefly indicate the applications and validations of the tests for use in experimental animal studies.
Collapse
Affiliation(s)
- Lawrence A Szarka
- Clinical Enteric Neuroscience Translational and Epidemiological Research, Mayo Clinic, Charlton 8-110, 200 First St. S.W., Rochester, MN 55905, USA
| | | |
Collapse
|
|
45
|
Zhao J, Liao D, Chen P, Kunwald P, Gregersen H. Stomach stress and strain depend on location, direction and the layered structure. J Biomech 2008; 41:3441-7. [DOI: 10.1016/j.jbiomech.2008.09.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 09/05/2008] [Accepted: 09/08/2008] [Indexed: 12/30/2022]
|
|
46
|
Kindt S, Coulie B, Wajs E, Janssens J, Tack J. Reproducibility and symptomatic predictors of a slow nutrient drinking test in health and in functional dyspepsia. Neurogastroenterol Motil 2008; 20:320-9. [PMID: 18371010 DOI: 10.1111/j.1365-2982.2008.01092.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Impaired accommodation to a meal has been recognized as a pathophysiological mechanism in functional dyspepsia (FD). Based on observations in tertiary care patients, the drinking test has been proposed as a non-invasive tool to estimate accommodation. Our aim was to assess the reproducibility of the drinking test and its correlation with demographic, symptomatic and pathophysiological parameters in secondary care FD patients and healthy controls. Thirty-four healthy controls and 78 FD patients completed a drinking test (3 respectively 2 times), a gastric emptying study and an FD symptom questionnaire. Factors influencing maximal volume and gastric emptying were determined, and the reproducibility of the drinking test was investigated. The maximal satiety was reached at a lower volume in patients (489 +/- 276 and 503 +/- 248 mL for first and second test respectively vs 937 +/- 428 and 1048 +/- 421 mL, P < 0.0001). The ingested amount depended on age, sex and baseline FD symptom score. Patients' sex, final satiety score, total score for stomach complaints at screening and total symptom score before test accounted for the total symptom score after the test. The slow nutrient drinking test confirms its possible role as an attractive non-invasive and reproducible tool for the diagnosis of impaired accommodation and for the assessment of treatment responsiveness.
Collapse
Affiliation(s)
- S Kindt
- Center for Gastroenterological Research, University of Leuven, K.U. Leuven, Belgium
| | | | | | | | | |
Collapse
|
|
47
|
Américo MF, Oliveira RB, Romeiro FG, Baffa O, Corá LA, Miranda JRA. Scintigraphic validation of AC Biosusceptometry to study the gastric motor activity and the intragastric distribution of food in humans. Neurogastroenterol Motil 2007; 19:804-11. [PMID: 17883432 DOI: 10.1111/j.1365-2982.2007.00960.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Abnormal intragastric distribution of food (IDF) and a phasic contractility in the proximal stomach have been related to dyspeptic symptoms. Thus, the behaviour of the stomach and the proximal region, in particular, continues to attract attention and demand for reliable and comfortable techniques. The aims of this study were to employ AC Biosusceptometry (ACB) and scintigraphy to evaluate IDF and gastric motor activity in humans. Fifteen healthy volunteers ingested 60 mL of yogurt containing 2 mCi of 99mTc and 4 g of ferrite. Each volunteer had gastric motility and IDF evaluated twice on separate days; on one occasion by ACB and another by scintigraphy. Digital signal processing was performed in MatLab (Mathworks Inc., Natick, MA, USA). Results were expressed as mean +/- SD. Similar results of distal accumulation time (P < 0.001) were obtained for scintigraphy (6.93 +/- 3.25 min) and for ACB (7.04 +/- 3.65 min). Fast Fourier Transform revealed two dominant frequencies (P > 0.9). Besides the well-know frequency of 3 cpm, our results showed identical frequencies in proximal stomach recordings (P < 0.001) for scintigraphic (1.01 +/- 0.01 cpm) and ACB (0.98 +/- 0.06 cpm). In summary, our data showed that scintigraphy and ACB are promising techniques to evaluate several aspects of gastric motility. Moreover, ACB is non-invasive, radiation-free and deserves the same importance as conventional methods for this kind of analysis.
Collapse
Affiliation(s)
- M F Américo
- Departamento de Fisiologia, FMRP, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | | | | | | | | |
Collapse
|
|
48
|
Abstract
The objective of this research was to use abdominal computed tomography (CT) scans to non-invasively quantify anthropometrical data of the human stomach and to concomitantly create an anatomically correct and distensible ex-vivo gastric model. Thirty-three abdominal CT scans of human subjects were obtained and were imported into reconstruction software to generate 3D models of the stomachs. Anthropometrical data such as gastric wall thickness, gastric surface area and gastric volume were subsequently quantified. A representative 3D computer model was exported into a selective laser sintering (SLS) rapid prototyping machine to create an anatomically correct solid gastric model. Subsequently, a replica wax template of the SLS model was created. A negative mould was offset around the wax template such that the offset distance was equivalent to that of the gastric wall thickness. A silicone with similar mechanical properties to the human stomach was poured into the offset. The lost wax manufacturing technique was employed to create a hollow distensible stomach model. 3D computer gastric models were generated from the CT scans. A hollow distensible silicone ex-vivo gastric model with similar compliance to that of the human stomach was created. The anthropometrical data indicated that there is no significant relationship between BMI and gastric surface area or gastric volume. There were inter- and intra-group differences between groups with respect to gastric wall thickness. This study demonstrates that abdominal CT scans can be used to both non-invasively determine gastric anthropometrical data as well as create realistic ex-vivo stomach models.
Collapse
Affiliation(s)
- Jerome A Henry
- Department of Mechanical and Biomedical Engineering, National Centre for Biomedical Engineering Science, National University of Ireland, Galway, Ireland
| | | | | |
Collapse
|
|
49
|
Madsen JL, Fuglsang S, Graff J. Single photon emission computed tomography for gastric volume assessment: A method with observer-defined regions of interest. Nucl Med Commun 2007; 28:135-40. [PMID: 17198355 DOI: 10.1097/mnm.0b013e328013e5ce] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM Single photon emission computed tomography (SPECT) imaging allows non-invasive measurement of gastric volume. In previous studies, the processing of the SPECT data involved global threshold algorithms that do not take into account the non-uniform distribution of radioactivity in the gastric wall. The aim of this study was to develop a simple alternative method based on observer-defined regions of interest. METHODS A phantom study was performed to standardize volume calculations from SPECT derived cross-sectional areas. In 12 healthy volunteers, the principle was then used to determine gastric volume before and after a 600 ml liquid meal. Furthermore, gastric emptying of the meal was followed with planar scintigraphy. RESULTS The median volume of the stomach was 86 ml (range 62-130 ml) at baseline, 642 ml (536-748 ml) immediately after the meal, and 370 ml (221-481 ml) 1 h after the meal. The coefficient of variation for the calculations was 9%, 2% and 4%, respectively. The median increase in gastric volume was 562 ml (501-628 ml) immediately after the meal and 294 ml (159-370 ml) after 1 h. Gastric retention of the meal was 68% (50-73%) after 0.5 h and 51% (39-57%) after 1 h. CONCLUSIONS The present manual technique may be a reliable alternative to the automated SPECT methods for assessing gastric volume. The liquid meal that was used in our study did not seem to cause an increase in gastric volume that differed from the volume of the meal.
Collapse
Affiliation(s)
- Jan L Madsen
- Department of Clinical Physiology and Nuclear Medicine, Hvidovre Hospital, Hvidovre, Denmark.
| | | | | |
Collapse
|
|
50
|
Gregersen H, Kwiatek MA, Schwizer W, Tutuian R. Contribution of sensitivity, volume and tone to visceral perception in the upper gastrointestinal tract in man: emphasis on testing. Neurogastroenterol Motil 2007; 19:47-61. [PMID: 17280585 DOI: 10.1111/j.1365-2982.2006.00874.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Upper gastrointestinal (GI) symptoms occur frequently in the general population, making them among the most common indications responsible for patients consulting the healthcare system. Consequently, understanding and characterization of the upper GI symptoms is important for the diagnosis and assessment of organ dysfunction. In practice, assessment of clinical symptoms is difficult and it is still to a large extent unclear how sensitivity, volume and tone contribute to visceral perception in the upper GI tract. The goal of advanced research in upper GI symptoms is to obtain a better understanding of the mechanisms involved in transduction, transmission, and perception under normal and pathophysiological conditions. An important step towards this goal is understanding the information provided by and the inherent limitations of the currently available measuring techniques. This article focuses on the sensory testing of the oesophagus, and methods and concepts used to assess the relation between gastric volumes or tone and upper GI symptoms. It also summarizes the contributions of these techniques towards identifying the components responsible for the generation of upper GI symptoms.
Collapse
Affiliation(s)
- H Gregersen
- Center for Visceral Biomechanics and Pain, Aalborg Hospital and University, Aalborg, Denmark
| | | | | | | |
Collapse
|