Effect of intragastric barostat bag on proximal and  distal gastric accommodation in response to liquid meal

The barostat is the gold standard for measurement of proximal gastric accommodation. Ultrasonography can be used to measure gastric volume. The aim was to investigate the effects of the barostat bag on gastric accommodation and transpyloric flow. Accommodation after a liquid meal (300 ml, 450 kcal) was measured twice at random in eight healthy volunteers. Proximal accommodation was measured once using barostat and once using ultrasound (US). Antrum accommodation was measured using US. Bag volume (BV), antral area (AA), proximal gastric area, and proximal gastric diameter (PGD) data were assessed before and 1, 5, 15, 30, 40, 50, and 60 min postprandially. Transpyloric flow was measured using Doppler 1–5 min postprandially. Fasted, AA size was not affected by the barostat bag (1 mmHg > minimal distension pressure; 2.7 ± 0.5 vs. 2.6 ± 0.3 cm2). Postprandially, AAs were larger with the bag present (ANOVA, P < 0.04). Maximum AA was reached with the bag in 5 min, without the bag in 1 min postprandially (15.1 ± 2.3 vs. 9.4 ± 1.5 cm2; P < 0.03). Furthermore, AAs were related to BVs ( r = 0.57; P < 0.01). After bag deflation, AA decreased (11.9 ± 1.8 to 7.0 ± 0.9 cm2; P = 0.02) and was comparable with the 60-min AA size without the bag (7.1 ± 1.2 cm2; P = 0.76) present. Proximal gastric radius calculated from the BVs and PGDs was larger with the bag present (ANOVA, P < 0.001). No effect on early gastric emptying was observed. Postprandially, the barostat bag causes dilatation of the antrum due to meal displacement without influencing early gastric emptying. This antral dilatation is likely to induce exaggerated proximal gastric relaxation observed in studies using the barostat to evaluate fundic accommodation.

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Gastric Accommodation Influences Proximal Gastric and Total Gastric Emptying in Concurrent Measurements Conducted in Healthy Volunteers

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.00008.2021 ◽

2021 ◽

Author(s):

Xiao Jing Wang ◽

Duane D. Burton ◽

Margaret Breen-Lyles ◽

Michael Camilleri

Keyword(s):

Gastric Emptying ◽

Gastrointestinal Symptoms ◽

Gastric Volume ◽

Proximal Stomach ◽

Gastric Accommodation ◽

Liquid Meal ◽

Proximal Half ◽

Automated Method ◽

Upper Gastrointestinal Symptoms ◽

Phantom Studies

Gastric emptying and gastric accommodation play roles in generation of upper gastrointestinal symptoms. Whereas, both functions have been measured simultaneously using MRI or 99mTc- SPECT methodology, correlation of these two functions has not been evaluated simultaneously using solid and liquid meals. To study relationships of whole or proximal stomach volumes to emptying, we concurrently measured postprandial gastric accommodation and emptying (over 4 hours) of a 111In-labeled mixed solid and liquid meal. A semi-automated method allowing selection of a segmentation threshold based on greyscale image was used to measure volume of the proximal half of stomach, defined as the top half of axial slices along the vertical length of stomach. A correction factor derived from phantom studies was applied for up-scatter from 99mTc to 111In window. Relationships of time to emptying 10, 25 50 and 75% of the meal to fasting and postprandial gastric volumes were evaluated using Spearman correlation. Whole stomach fed and accommodation volumes were significantly correlated with all gastric emptying times 10%, 25%, 50%. Proximal stomach fed volumes were similarly associated with 50% and 75% proximal gastric emptying. Fed proximal gastric volume was associated with 50% and 75% whole gastric emptying. Fed proximal accommodation volume was associated with 50% gastric emptying. Fasting gastric volumes were not significant determinants of emptying rates. In conclusion, postprandial gastric accommodation is significantly associated with the rate of gastric emptying, with higher gastric volumes associated with prolongation of emptying. Novel methods to measure proximal gastric accommodation and correct for radioisotope up-scatter are described.

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A modified sonographic technique for assessment of gastric emptying of liquid

Acta Radiologica ◽

10.1080/j.1600-0455.2003.00055.x ◽

2003 ◽

Vol 44 (3) ◽

pp. 340-342 ◽

Cited By ~ 4

Author(s):

J. F. Pedersen

Keyword(s):

Gastric Emptying ◽

Repeated Measurements ◽

Intraindividual Variation ◽

Ultrasound Technique ◽

Liquid Meal ◽

Ultrasound Monitoring ◽

Gastric Emptying Time ◽

The Mean ◽

Antral Area ◽

Emptying Time

Purpose: Ultrasound scanning is replacing scintigraphy in studies of gastric emptying of liquid, but both have considerable day-to-day variability. This study describes a modified ultrasound technique for assessing gastric emptying of liquid, and evaluates the inter- and intraindividual variation in emptying time. Material and Methods: On different days, each of 12 healthy volunteers had meals of 350 ml broth. The antral area was measured at sonography 5 times before the meal as a baseline, and every 1–4 min after the meal. The time until the antral area had decreased to 150% of baseline (T150) was determined and used as surrogate expression of gastric emptying time. Results: The mean T150 for a broth meal was 12.6 min (range 5–21) and 13.5 min (6–23) (first and second meal, respectively). The standard deviation of the differences between the 12 pairs of repeated measurements was 3.1 min and the coefficient of variation was 24%. Conclusion: Ultrasound monitoring of antral size after a liquid meal is a well suited method for assessing gastric emptying of liquid.

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868 PROXIMAL AND WHOLE GASTRIC ACCOMMODATION INFLUENCE PROXIMAL AND TOTAL GASTRIC EMPTYING DEMONSTRATED BY SIMULTANEOUS MEASUREMENTS CONDUCTED IN HEALTHY VOLUNTEERS

Gastroenterology ◽

10.1016/s0016-5085(21)01178-1 ◽

2021 ◽

Vol 160 (6) ◽

pp. S-180

Author(s):

Xiao Jing Wang ◽

Duane Burton ◽

Margaret K. Breen-Lyles ◽

Michael Ryks ◽

Michael Camilleri

Keyword(s):

Gastric Emptying ◽

Healthy Volunteers ◽

Gastric Accommodation ◽

Simultaneous Measurements

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232 Gastric Emptying, Gastric Accommodation, Satiation and Return of Hunger: A Randomized, Single Blind, Cross-Over Study Comparing Soy and Cow Milk in Healthy Volunteers

Gastroenterology ◽

10.1016/s0016-5085(12)60221-2 ◽

2012 ◽

Vol 142 (5) ◽

pp. S-57

Author(s):

Pantelis Oustamanolakis ◽

Pieter Janssen ◽

Sofie Verschueren ◽

Kristin Verbeke ◽

Jan F. Tack

Keyword(s):

Gastric Emptying ◽

Healthy Volunteers ◽

Cow Milk ◽

Gastric Accommodation ◽

Single Blind

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Influence of sildenafil on gastric sensorimotor function in humans

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.00419.2003 ◽

2004 ◽

Vol 287 (5) ◽

pp. G988-G992 ◽

Cited By ~ 45

Author(s):

Giovanni Sarnelli ◽

Daniel Sifrim ◽

Jozef Janssens ◽

Jan Tack

Keyword(s):

Gastric Emptying ◽

Healthy Subjects ◽

Soluble Guanylate Cyclase ◽

Therapeutic Potential ◽

Muscle Relaxation ◽

Gastric Wall ◽

Gastric Volume ◽

Gastric Fundus ◽

Smooth Muscle Relaxation ◽

Gastric Accommodation

After a meal, the proximal stomach relaxes probably through the activation of nitrergic neurons in the gastric wall. Nitric oxide-induced smooth muscle relaxation involves activation of soluble guanylate cyclase, with cGMP production, which is then degradated by phosphodiesterase-5 (PDE-5). The aim of this study was to investigate the effect of sildenafil, a selective PDE-5 inhibitor, on fasting and postprandial proximal gastric volume and on gastric emptying rates in humans. A gastric barostat was used to study gastric compliance and perception to isobaric distension in healthy subjects before and after placebo ( n = 13) or sildenafil, 50 mg ( n = 15). In 10 healthy subjects, two gastric barostat studies were performed in randomized order to study the effect of placebo or sildenafil on postprandial gastric relaxation. Similarly, solid and liquid gastric emptying rates were studied in 12 healthy subjects. Sildenafil significantly increased fasting intragastric volume (141 ± 15 vs. 163 ± 15 ml, P < 0.05) and volumes of first perception. Sildenafil induced a higher and prolonged gastric relaxation either at 30 min (357 ± 38 vs. 253 ± 42 ml, P < 0.05) or 60 min (348 ± 49 vs. 247 ± 38 ml, P < 0.05) after the meal. Sildenafil did not alter solid half-emptying time but significantly delayed liquid emptying (43 ± 4 vs. 56 ± 4 min, P < 0.01). In conclusion, sildenafil significantly increases postprandial gastric volume and slows liquid emptying rate, confirming that meal-induced accommodation in humans involves the activation of a nitrergic pathway. The effect of sildenafil on gastric fundus suggests a therapeutic potential for phosphodiesterase inhibitors in patients with impaired gastric accommodation.

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The Effect of Pancreatic Polypeptide on Gastric Emptying, Gastric Accommodation and Satiation in Healthy Volunteers

Gastroenterology ◽

10.1016/s0016-5085(11)61225-0 ◽

2011 ◽

Vol 140 (5) ◽

pp. S-305

Author(s):

Sofie Verschueren ◽

Pieter Janssen ◽

Rita Vos ◽

Kristin Verbeke ◽

Jan F. Tack

Keyword(s):

Gastric Emptying ◽

Healthy Volunteers ◽

Pancreatic Polypeptide ◽

Gastric Accommodation

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Effect of GLP-1 on gastric volume, emptying, maximum volume ingested, and postprandial symptoms in humans

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.2002.282.3.g424 ◽

2002 ◽

Vol 282 (3) ◽

pp. G424-G431 ◽

Cited By ~ 110

Author(s):

Silvia Delgado-Aros ◽

Doe-Young Kim ◽

Duane D. Burton ◽

George M. Thomforde ◽

Debra Stephens ◽

...

Keyword(s):

Gastric Emptying ◽

Single Photon ◽

Photon Emission ◽

Gastric Volume ◽

Significant Inhibition ◽

Controlled Study ◽

Emission Computed Tomography ◽

Healthy Human ◽

Liquid Meal ◽

Human Pancreatic Polypeptide

Glucagon-like peptide-1 (GLP-1) relaxes the stomach during fasting but decreases hunger and food consumption and retards gastric emptying. The interrelationships between volume, emptying, and postprandial symptoms in response to GLP-1 are unclear. We performed, in healthy human volunteers, a placebo-controlled study of the effects of intravenous GLP-1 on gastric volume using99mTc-single photon emission computed tomography imaging, gastric emptying of a nutrient liquid meal (Ensure) using scintigraphy, maximum tolerated volume (MTV) of Ensure, and postprandial symptoms 30 min after MTV. The role of vagal cholinergic function in the effects of GLP-1 was assessed by human pancreatic polypeptide (HPP) response to the Ensure meal. GLP-1 increased fasting and postprandial gastric volumes and retarded gastric emptying; MTV and postprandial symptoms were not different compared with controls. Effects on postprandial gastric function were associated with reduced postprandial HPP levels. GLP-1 does not induce postprandial symptoms despite significant inhibition of gastric emptying and vagal function; this may be partly explained by the increase in postprandial gastric volume.

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Synchronized gastric electrical stimulation improves vagotomy-induced impairment in gastric accommodation via the nitrergic pathway in dogs

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.90525.2008 ◽

2009 ◽

Vol 296 (2) ◽

pp. G310-G318 ◽

Cited By ~ 17

Author(s):

Jie Chen ◽

Thillai Koothan ◽

Jiande D. Z. Chen

Keyword(s):

Electrical Stimulation ◽

Gastric Emptying ◽

Gastric Volume ◽

Slow Waves ◽

Gastric Electrical Stimulation ◽

Proximal Stomach ◽

Gastric Accommodation ◽

Gastric Tone ◽

Gastric Dysrhythmia ◽

Gastric Slow Waves

Impaired gastric accommodation and gastric dysrhythmia are common in gastroparesis and functional dyspepsia. Recent studies have shown that synchronized gastric electrical stimulation (SGES) accelerates gastric emptying and enhances antral contractions in dogs. The aim of this study was to investigate the effects and mechanism of SGES on gastric accommodation and slow waves impaired by vagotomy in dogs. Gastric tone, compliance, and accommodation as well as slow waves with and without SGES were assessed in seven female regular dogs and seven dogs with bilateral truncal vagotomy, chronically implanted with gastric serosal electrodes and a gastric cannula. We found that 1) vagotomy impaired gastric accommodation that was normalized by SGES. The postprandial increase in gastric volume was 283.5 ± 50.6 ml in the controlled dogs, 155.2 ± 49.2 ml in the vagotomized dogs, and 304.0 ± 57.8 ml in the vagotomized dogs with SGES. The ameliorating effect of SGES was no longer observed after application of Nω-nitro-l-arginine (l-NNA); 2) vagotomy did not alter gastric compliance whereas SGES improved gastric compliance in the vagotomized dogs, and the improvement was also blocked by l-NNA; and 3) vagotomy impaired antral slow wave rhythmicity in both fasting and fed states. SGES at the proximal stomach enhanced the postprandial rhythmicity and amplitude (dominant power) of the gastric slow waves in the antrum. In conclusion, SGES with appropriate parameters restores gastric accommodation and improves gastric slow waves impaired by vagotomy. The improvement in gastric accommodation with SGES is mediated via the nitrergic pathway. Combined with previously reported findings (enhanced antral contractions and accelerated gastric emptying) and findings in this study (improved gastric accommodation and slow waves), SGES may be a viable therapy for gastroparesis.

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Gastric Emptying of Low- and High-Caloric Liquid Meals Measured Using Ultrasonography in Healthy Volunteers

Ultrasound International Open ◽

10.1055/a-0783-2170 ◽

2019 ◽

Vol 05 (01) ◽

pp. E27-E33 ◽

Cited By ~ 7

Author(s):

Tarek Mazzawi ◽

Emily Bartsch ◽

Sara Benammi ◽

Rosa Ferro ◽

Ekaterina Nikitina ◽

...

Keyword(s):

Gastric Emptying ◽

Healthy Volunteers ◽

Functional Dyspepsia ◽

Delayed Gastric Emptying ◽

Neurological Diseases ◽

Random Order ◽

Caloric Content ◽

Dyspeptic Symptoms ◽

Males And Females ◽

Antral Area

Abstract Delayed gastric emptying is present in patients with functional dyspepsia (FD), diabetes mellitus, and neurological diseases. Diet may affect gastric emptying symptoms in patients with FD. We sought to determine the extent to which gastric emptying and symptoms of dyspepsia are influenced by caloric content in healthy subjects using ultrasonography. 32 healthy volunteers were given 2 meals with different caloric content in random order. Gastric emptying was determined using ultrasonography to measure antral area when fasting, and postprandially at intervals of 0, 10, 20, and 30 min. Dyspeptic symptoms including discomfort, nausea, and fullness were graded. The antral area following a high-caloric meal compared to a low-caloric meal was significantly increased at 0, 10, 20, and 30 min (P=0.0203,<0.0001<0.0001,<0.0001, respectively), as was the median fullness (P<0.0048, 0.0001, 0.0009, 0.0001, respectively) measured at the same time points. There was a weak correlation (r2=0.1, P<0.0001) between the antral area and subjective fullness. No differences between gastric emptying in males and females were found.The caloric content of a meal influences gastric emptying. Using ultrasonography to measure the antral area helps us to assess gastric emptying and therefore to assess patients with functional dyspepsia.

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