Disentangling the links between gastric emptying and binge eating v. purging in eating disorders using a case-control design

Abstract Background Prior work supports delayed gastric emptying in anorexia nervosa and bulimia nervosa (BN) but not binge-eating disorder, suggesting that neither low body weight nor binge eating fully accounts for slowed gastric motility. Specifying a link between delayed gastric emptying and self-induced vomiting could offer new insights into the pathophysiology of purging disorder (PD). Methods Women (N = 95) recruited from the community meeting criteria for DSM-5 BN who purged (n = 26), BN with nonpurging compensatory behaviors (n = 18), PD (n = 25), or healthy control women (n = 26) completed assessments of gastric emptying, gut peptides, and subjective responses over the course of a standardized test meal under two conditions administered in a double-blind, crossover sequence: placebo and 10 mg of metoclopramide. Results Delayed gastric emptying was associated with purging with no main or moderating effects of binge eating in the placebo condition. Medication eliminated group differences in gastric emptying but did not alter group differences in reported gastrointestinal distress. Exploratory analyses revealed that medication caused increased postprandial PYY release, which predicted elevated gastrointestinal distress. Conclusions Delayed gastric emptying demonstrates a specific association with purging behaviors. However, correcting disruptions in gastric emptying may exacerbate disruptions in gut peptide responses specifically linked to the presence of purging after normal amounts of food.

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Secretin effects on gastric functions, hormones and symptoms in functional dyspepsia and health: randomized crossover trial

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.00371.2019 ◽

2020 ◽

Vol 318 (4) ◽

pp. G635-G645 ◽

Cited By ~ 2

Author(s):

Justin Brandler ◽

Laurence J. Miller ◽

Xiao Jing Wang ◽

Duane Burton ◽

Irene Busciglio ◽

...

Keyword(s):

Gastric Emptying ◽

Functional Dyspepsia ◽

Animal Studies ◽

Delayed Gastric Emptying ◽

Gastrointestinal Hormones ◽

Receptor Activation ◽

Gastric Accommodation ◽

Double Blind ◽

Secretin Receptor ◽

Therapeutic Mechanism

Abnormal gastric accommodation (GA) and gastric emptying contribute to pathophysiology in functional dyspepsia (FD). Secretin is a key regulator of GA in animal studies. Our aim was to study the effects of secretin on gastric motility, satiation, postprandial symptoms, and key hormones. We performed two double-blind, randomized, saline-controlled crossover trials in 10 healthy volunteers and 10 patients with FD by Rome IV criteria. We used measured GA (by validated SPECT method) after a 111In radiolabeled Ensure 300-mL meal and quantified gastric emptying for 30 min by scintigraphy. Satiation was measured by volume to fullness (VTF) and maximum tolerated volume (MTV) on an Ensure nutrient drink test and postprandial symptoms 30 min post-MTV. Fasting and postprandial GLP-1, GIP, and HPP were measured. The ages and sex distribution of healthy controls and patients with FD were similar. Compared with placebo, secretin delayed gastric emptying at 30 min in both health [−11% (−16, −4), P = 0.004]; and FD [−8% (−9, 0), P = 0.03]. Satiation (VTF and MTV), GA, and plasma levels of GLP-1, GIP, and HPP did not differ between treatment arms in health or FD. On ANCOVA analysis (adjusting for age and sex), secretin did not consistently increase postprandial symptoms in health or FD. Secretin delayed gastric emptying in both health and FD without significantly altering GA, VTF, or MTV or selected hormones. Thus, secretin receptor activation may provide a novel therapeutic mechanism for patients with FD and rapid gastric emptying. NEW & NOTEWORTHY The naturally occurring hormone secretin retards gastric emptying of solids without deleteriously affecting gastric accommodation, satiation, other upper gastrointestinal hormones, or postprandial symptoms. Given these findings, a subset of patients with rapid gastric emptying (e.g., the estimated 20% of patients with functional dyspepsia) could be candidates for treatments that stimulate a secretin receptor such as sacubitril, which inhibits neprilysin, an enzyme that degrades secretin.

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Metoclopramide therapy in patients with delayed gastric emptying: A randomized, double-blind study

Gastroenterology ◽

10.1016/0016-5085(78)93296-1 ◽

1978 ◽

Vol 74 (5) ◽

pp. 1076

Author(s):

M.S. Perkel ◽

C. Moore ◽

C. Haun ◽

E. Davidson ◽

T. Hersh

Keyword(s):

Gastric Emptying ◽

Delayed Gastric Emptying ◽

Blind Study ◽

Double Blind Study ◽

Double Blind

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Does delayed gastric emptying shorten theH pylorieradication period A double blind clinical trial

World Journal of Gastroenterology ◽

10.3748/wjg.v12.i39.6310 ◽

2006 ◽

Vol 12 (39) ◽

pp. 6310 ◽

Cited By ~ 3

Author(s):

Mohammad Hassan Emami

Keyword(s):

Clinical Trial ◽

Gastric Emptying ◽

Delayed Gastric Emptying ◽

Double Blind ◽

Double Blind Clinical Trial

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The Effect of Continuous Intake of Lactobacillus gasseri OLL2716 on Mild to Moderate Delayed Gastric Emptying: A Randomized Controlled Study

Nutrients ◽

10.3390/nu13061852 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1852

Author(s):

Toshihiro Ohtsu ◽

Ken Haruma ◽

Yumiko Ide ◽

Atsushi Takagi

Keyword(s):

Placebo Group ◽

Gastric Emptying ◽

Odds Ratio ◽

Delayed Gastric Emptying ◽

Controlled Study ◽

Salivary Amylase ◽

Double Blind ◽

Gastric Emptying Rate ◽

Lactobacillus Gasseri ◽

Liquid Meal

Probiotics have been suggested to be effective for functional dyspepsia, but their effect on gastric motility is not clear. We evaluated the effect of Lactobacillus gasseri OLL2716 (LG21 strain) on mild to moderate delayed gastric emptying by a double-blind, parallel-group, placebo-controlled, randomized trial. Participants (n = 28) were randomly assigned to ingest LG21 strain-containing yogurt (LG21 strain group) or LG21 strain-free yogurt (placebo group) for 12 weeks. The 13C gastric emptying breath test was performed to measure the gastric emptying rate over time following ingestion of a liquid meal, and the time to reach the peak (Tmax) was used as an indicator of gastric emptying. We also measured the salivary amylase concentration, an indicator of autonomic dysfunction under stress. The per-protocol population (n = 27, male n = 4, female n = 23) was evaluated for efficacy. When a ≥30% reduction in the difference between participant’s Tmax and the Japanese mean Tmax was defined as an improvement, the odds ratio of improvement in delayed gastric emptying compared to placebo after 12 weeks was 4.1 (95% confidence interval, 0.8 to 20.2). Moreover, salivary amylase concentrations were significantly lower than in the placebo group, indicating an improvement in autonomic function. The present data were not enough to support the beneficial effects of the LG21 strain on delayed gastric emptying. However, if we define the odds ratio in further study investigated with a larger number of participants, LG21 strain might be expected to have some impact on delayed gastric emptying.

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