Imaging and modelling of digestion in the stomach and the duodenum

Review of in vitro digestion models for rapid screening of emulsion-based systems

There is increasing interest in understanding and controlling the digestion of emulsified lipids within the food and pharmaceutical industries. Emulsion-based delivery systems are being developed to encapsulate, protect, and release non-polar lipids, vitamins, nutraceuticals, and drugs. These delivery systems are also being used to control the stability and digestion of lipids within the human gastrointestinal tract so as to create foods that enhance satiety and reduce hunger. In vitro digestion models are therefore needed to test the efficacy of different approaches of controlling lipid digestion under conditions that simulate the human gastrointestinal tract. This article reviews the current status of in vitro digestion models for simulating lipid digestion, with special emphasis on the pH stat method. The pH stat method is particularly useful for the rapid screening of food emulsions and emulsion-based delivery systems with different compositions and structures. Successful candidates can then be tested with more rigorous in vitro digestion models, or using animal or human feeding studies.

Origin and propagation of human gastric slow-wave activity defined by high-resolution mapping

Slow waves coordinate gastric motility, and abnormal slow-wave activity is thought to contribute to motility disorders. The current understanding of normal human gastric slow-wave activity is based on extrapolation from data derived from sparse electrode recordings and is therefore potentially incomplete. This study employed high-resolution (HR) mapping to reevaluate human gastric slow-wave activity. HR mapping was performed in 12 patients with normal stomachs undergoing upper abdominal surgery, using flexible printed circuit board (PCB) arrays (interelectrode distance 7.6 mm). Up to six PCBs (192 electrodes; 93 cm(2)) were used simultaneously. Slow-wave activity was characterized by spatiotemporal mapping, and regional frequencies, amplitudes, and velocities were defined and compared. Slow-wave activity in the pacemaker region (mid to upper corpus, greater curvature) was of greater amplitude (mean 0.57 mV) and higher velocity (8.0 mm/s) than the corpus (0.25 mV, 3.0 mm/s) (P < 0.001) and displayed isotropic propagation. A marked transition to higher amplitude and velocity activity occurred in the antrum (0.52 mV, 5.9 mm/s) (P < 0.001). Multiple (3-4) wavefronts were found to propagate simultaneously in the organoaxial direction. Frequencies were consistent between regions (2.83 +/- 0.35 cycles per min). HR mapping has provided a more complete understanding of normal human gastric slow-wave activity. The pacemaker region is associated with high-amplitude, high-velocity activity, and multiple wavefronts propagate simultaneously. These data provide a baseline for future HR mapping studies in disease states and will inform noninvasive diagnostic strategies.

Effects of proton pump inhibitors on gastric emptying: a systematic review

The proton pump inhibitor (PPI) is widely used for the treatment of gastroesophageal reflux disease, peptic ulcer diseases, and functional dyspepsia. The pathogenesis of these acid-related and/or functional upper gastrointestinal disorders is potentially associated with abnormal gastric emptying. To date, variable effects of PPIs on gastric emptying have been reported. Therefore, it is relevant to gather and analyze published information on this topic. A systematic literature search has been performed, showing that the delaying effect of PPIs on gastric emptying of solid meals is consistent, whereas the effect of PPIs on the emptying of liquids is inconsistent. The underlying mechanisms whereby PPIs may affect gastric emptying have been discussed, most of which still remain hypothetic. Gastric emptying of solids involves a process of peptic hydrolysis. PPIs impair the hydrolytic digestion by inhibiting acid-dependent peptic activity, thereby delaying the solid emptying. Gastric emptying of liquids largely depends on volume and energy density of intragastric contents. PPIs variably modify the volume and the energy density by reducing gastric fluid secretion, thereby modifying the liquid emptying in an unpredictable manner. Hypergastrinemia has been considered to delay gastric emptying, but it seems of minor importance in the regulation of gastric emptying during PPI use. The delayed emptying of solids due to PPI therapy may have clinical implications in the management of gastroesophageal reflux disease, functional dyspepsia, as well as diabetes.

Self-assembled structures and pKa value of oleic acid in systems of biological relevance

In the human digestion process, triglycerides are hydrolyzed by lipases to monoglycerides and the corresponding fatty acids. Here we report the self-assembly of structures in biologically relevant, emulsified oleic acid-monoolein mixtures at various pH values and oleic acid concentrations. Small-angle X-ray scattering, cryogenic transmission electron microscopy, and dynamic light scattering were used to investigate the structures formed, and to follow their transitions while these factors were varied. The addition of oleic acid to monoolein-based cubosomes was found to increase the critical packing parameter in the system. Structural transitions from bicontinuous cubosomes through hexosomes and micellar cubosomes (Fd3m symmetry) to emulsified microemulsions occur with increasing oleic acid concentration. At sufficiently high oleic acid concentration, the internal particle structure was also found to strongly depend on the pH of the aqueous phase: transformations from emulsified microemulsion through micellar cubosomes, hexosomes, and bicontinuous cubosomes to vesicles can be observed as a function of increasing pH. The reversible transition from liquid crystals to vesicles occurs at intestinal pH values (between pH 7 and 8). The hydrodynamic radius of the particles decreases from around 120 nm for internally structured particles to around 60 nm for vesicles. All transitions with pH are reversible. Finally, the apparent pK(a) for oleic acid in monoolein could be determined from the change of structure with pH. This value is within the physiological pH range of the intestine and depends somewhat on composition.

Manipulating digestion with foods designed to change the physical characteristics of digesta

We explore how foods can be designed to modulate digestion and to promote health by changing the physical properties of digesta. The physical characteristics of digesta are discussed along with their impact on the physiology of digestion with special reference to sites where these characteristics are likely to influence digestive efficiency. Evidence is reviewed regarding the effects of supplementation with viscoactive agents on the flow and mixing of digesta in particular segments of the human gut that, by changing the rheology and liquid permeability of digesta in that segment, influence specific aspects of digestion and absorption.

Origin and propagation of the slow wave in the canine stomach: the outlines of a gastric conduction system

Slow waves are known to originate orally in the stomach and to propagate toward the antrum, but the exact location of the pacemaker and the precise pattern of propagation have not yet been studied. Using assemblies of 240 extracellular electrodes, simultaneous recordings of electrical activity were made on the fundus, corpus, and antrum in open abdominal anesthetized dogs. The signals were analyzed off-line, pathways of slow wave propagation were reconstructed, and slow wave velocities and amplitudes were measured. The gastric pacemaker is located in the upper part of the fundus, along the greater curvature. Extracellularly recorded slow waves in the pacemaker area exhibited large amplitudes (1.8 +/- 1.0 mV) and rapid velocities (1.5 +/- 0.9 cm/s), whereas propagation in the remainder of the fundus and in the corpus was slow (0.5 +/- 0.2 cm/s) with low-amplitude waveforms (0.8 +/- 0.5 mV). In the antrum, slow wave propagation was fast (1.5 +/- 0.6 cm/s) with large amplitude deflections (2.0 +/- 1.3 mV). Two areas were identified where slow waves did not propagate, the first in the oral medial fundus and the second distal in the antrum. Finally, recordings from the entire ventral surface revealed the presence of three to five simultaneously propagating slow waves. High resolution mapping of the origin and propagation of the slow wave in the canine stomach revealed areas of high amplitude and rapid velocity, areas with fractionated low amplitude and low velocity, and areas with no propagation; all these components together constitute the elements of a gastric conduction system.

Computer simulation of flow and mixing at the duodenal stump after gastric resection

AIM: To investigate the flow and mixing at the duodenal stump after gastric resection, a computer simulation was implemented.

METHODS: Using the finite element method, two different Billroth II procedure cases (A and B) were modeled. Case A was defined with a shorter and almost straight duodenal section, while case B has a much longer and curved duodenal section. Velocity, pressure and food concentration distribution were determined and the numerical results were compared with experimental observations.

RESULTS: The pressure distribution obtained by numerical simulation was in the range of the recorded experimental results. Case A had a more favorable pressure distribution in comparison with case B. However, case B had better performance in terms of food transport because of more continual food distribution, as well as better emptying of the duodenal section.

CONCLUSION: This study offers insight into the transport process within the duodenal stump section after surgical intervention, which can be useful for future patient-specific predictions of a surgical outcome.

Lessons from nature: "Pathogen-Mimetic" systems for mucosal nano-medicines

Mucosal surfaces establish an interface with external environments that provide a protective barrier with the capacity to selectively absorb and secrete materials important for homeostasis of the organism. In man, mucosal surfaces such as those in the gastrointestinal tract, respiratory tree and genitourinary system also represent significant barrier to the successful administration of certain pharmaceutical agents and the delivery of newly designed nano-scale therapeutic systems. This review examines morphological, physiological and biochemical aspects of these mucosal barriers and presents currently understood mechanisms used by a variety of virulence factors used by pathogenic bacteria to overcome various aspects of these mucosal barriers. Such information emphasizes the impediments that biologically active materials must overcome for absorption across these mucosal surfaces and provides a template for strategies to overcome these barriers for the successful delivery of nano-scale bioactive materials, also known as nano-medicines.

Disintegration of solid foods in human stomach

Knowledge of the disintegration of solid foods in human stomach is essential to assess the bioavailability of nutrients in the gastrointestinal (GI) tract. A comprehensive review of food gastric digestion, focusing on disintegration of solid foods, is presented. Most of the research reviewed in this paper is contained in the medical, pharmaceutical, food, and nutritional literature. Stomach physiology is briefly introduced, including composition and rheological properties of gastric contents, stomach wall motility in fed/fasted states, and hydrodynamic and mechanical forces that act on the ingested food. In vivo and in vitro methods used for studying food and drug digestion in GI are summarized. Stomach emptying rate, which controls the rate of absorption of nutrients, is highly related to the disintegration of foods. This topic is highlighted with focus on the important mechanisms and the influence of chemical and physical properties of foods. Future research in this area is identified to increase our fundamental understanding of the food digestion process in the stomach as related to the food composition, material properties such as texture and microstructure, and chemical characteristics. This information is necessary to develop new guidelines for seeking innovative processing methods to manufacture foods specifically targeted for health.

Hormones of the gut-brain axis as targets for the treatment of upper gastrointestinal disorders

The concept of the gut forming the centre of an integrated gut-brain-energy axis - modulating appetite, metabolism and digestion - opens up new paradigms for drugs that can tackle multiple symptoms in complex upper gastrointestinal disorders. These include eating disorders, nausea and vomiting, gastroesophageal reflux disease, gastroparesis, dyspepsia and irritable bowel syndrome. The hormones that modulate gastric motility represent targets for gastric prokinetic drugs, and peptides that modify eating behaviours may be targeted to develop drugs that reduce nausea, a currently poorly treated condition. The gut-brain axis may therefore provide a range of therapeutic opportunities that deliver a more holistic treatment of upper gastrointestinal disorders.

Mechanics of flow and mixing at antroduodenal junction

The morphology of tissue structures composing the pyloric orifice is thought to play a role in effectively mixing aqueous gastric effluent with duodenal secretions. To understand the physical mechanisms leading to efficient digestion requires computational models that allow for analyses of the contributions of individual structural components. Thus, we have simulated 2-D channel flows through representative models of the duodenum with moving boundary capabilities in order to quantitatively assess the importance of notable features. A well-tested flow solver was used to computationally isolate and compare geometric and kinematic parameters that lead to various characteristics of fluid motion at the antroduodenal junction. Scalar variance measurement was incorporated to quantify the mixing effectiveness of each component. It was found that the asymmetric geometry of the pyloric orifice in concert with intermittent gastric outflow and luminal constriction is likely to enhance homogenization of gastric effluent with duodenal secretions.