Aperitif effects on gastric emptying: a crossover study using continuous real-time 13C breath test (BreathID System)

Early effects of acotiamide or mosapride intake on gastric emptying: a randomized 3-way crossover study using the 13C breath test

The effects of acotiamide on gastrointestinal motility have not been sufficiently investigated. The aim of this study was to determine whether single preprandial acotiamide or mosapride intake might affect the gastric emptying rate using the ¹³C breath test. Here, 11 healthy volunteers participated in a randomized three-way crossover study. The subjects received acotiamide (100 mg) or mosapride (5 mg) or placebo before liquid test meal ingestion. Gastric emptying was estimated by determining following parameters: the time required for 50% emptying of the labeled meal (T1/2), lag time for 10% emptying of the labeled meal (Tlag), gastric emptying coefficient (GEC) and regression-estimated constants (β and κ). These parameters were calculated from a ¹³CO₂ breath excretion curve using conventional formulas. The acotiamide, mosapride and placebo conditions were compared, revealing that for gastric emptying rates (values expressed as median), T1/2 (87.83571 min vs 79.95057 min vs 88.74378 min, p = 0.1496), Tlag (46.36449 min vs 42.2897 min vs 47.08094 min, p = 0.4966), GEC (4.382027 vs 4.211441 vs 4.248495, p = 0.8858), β (1.917728 vs 1.757062 vs 1.869141, p = 0.4066) and κ (0.834051 vs 0.819820 vs 0.789523, p = 0.1225) did not significantly differ. In this study, acotiamide (100 mg) or mosapride (5 mg) had no effect on gastric emptying.

Men and Women Differ in Gastric Fluid Retention and Neural Activation after Consumption of Carbonated Beverages

Background

The most commonly consumed carbonated beverages are soda and beer. Carbon dioxide increases gastric volume, which can lead to epigastric discomfort. Women are more susceptible to this; however, correlations with neural activity and gastric distention are unknown.

Objective

This study sought to determine the subjective, gastric, and neural correlates of epigastric discomfort in men and women.

Methods

Thirty-four healthy, normal-weight adults [17 women; mean ± SD body mass index (BMI; kg/m2): 22.3 ± 1.9; 17 men; BMI: 22.8 ± 1.8] participated in a randomized crossover study with 2 treatments: ingestion of 500 mL beer or soda. Before and after consumption, gastric content and brain activity were measured with magnetic resonance imaging (MRI). Participants rated fullness, bloating, hunger, and nausea at baseline and at t = 0, 10, 20, and 30 min together with gastric MRI. Brain activity [cerebral blood flow (CBF)] was measured at baseline and at t = 5 and 35 min. Liquid, gas, and total gastric volume (TGV) were segmented from gastric MRI. Ratings and gastric content areas under the curve (AUCs) were tested with a mixed model with sex and drink as factors.

Results

For subjective ratings, only nausea in the beer condition scored significantly greater for women (9.4-point increase; P = 0.045). Liquid stomach content was significantly greater for women (2525 mL × min increase; P = 0.019). In both men and women, the strongest correlation for bloating was with TGV (r = 0.45, P < 0.01) and for nausea was with the liquid fraction AUC (r = 0.45, P < 0.01). CBF changes did not differ between the drinks. Men showed greater CBF than women in the left precentral and postcentral gyri at t = 5 min.

Conclusions

There are differences between sexes when it comes to appetite ratings, gastric fluid retention, and neural activation. Discomfort in women may be related to fluid rather than gas in the stomach, because they retain more fluid than men. Differences between men and women should be considered when studying digestion. This study was registered with the Dutch Trial Registry as NTR5418 (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5418).

The menstrual cycle influences the gastric emptying of alcohol

We previously reported that ingestion of 60 mL of red wine or vodka prior to the ingestion of a pancake significantly inhibited the gastric emptying of the pancake in male subjects, but not in female subjects, and that the retention times of wine and vodka were significantly longer than those of the congener of red wine and mineral water in male subjects, whereas in female subjects the retention times of these four drinks did not differ significantly from one another. We hypothesized that the menstrual cycle may influence the gastric emptying of alcohol beverages. Here, we determined and compared the retention times of vodka and water in the stomach during the luteal phase and the follicular phase. Ten female healthy volunteers were studied. They recorded their basal body temperatures every day, and participated in the following experiments: each volunteer drank mineral water or vodka containing 14% alcohol (60 mL) during the low-temperature (follicular) phase as well as during the high-temperature (luteal) phase. The retention time of vodka was significantly longer than that of mineral water during the follicular phase, but no significant differences between the retention times of the two drinks were observed during the luteal phase. In conclusion, the menstrual cycle influences the gastric emptying rate of alcohol.

Bitters: Time for a New Paradigm

In plant-based medical systems, bitter tasting plants play a key role in managing dyspepsia. Yet when it comes to defining their mechanism of activity, herbalists and pharmacologists are split between two theories: one involves cephalic elicited vagal responses while the other comprises purely local responses. Recent studies indicate that bitters elicit a range of cephalic responses which alter postprandial gastric phase haemodynamics. Caffeine and regular coffee (Coffea arabica semen, L.) increase heart rate whereas gentian (Gentiana lutea radix, L.) and wormwood (Artemisia absinthium herba L.) increase tonus in the vascular resistance vessels. Following meals increased cardiac activity acts to support postprandial hyperaemia and maintain systemic blood pressure. The increased vascular tonus acts in parallel with the increased cardiac activity and in normal adults this additional pressor effect results in a reduced cardiac workload. The vascular response is a sympathetic reflex, evident after 5 minutes and dose dependent. Thus gentian and wormwood elicit cephalic responses which facilitate rather than stimulate digestive activity when postprandial hyperaemia is inadequate. Encapsulated caffeine elicits cardiovascular responses indicating that gastrointestinal bitter receptors are functionally active in humans. However, neither encapsulated gentian nor wormwood elicited cardiovascular responses during the gastric phase. These findings provide the platform for a new evidence-based paradigm.

Early Effect of Single-dose Sitagliptin Administration on Gastric Emptying: Crossover Study Using the (13)C Breath Test

Background/Aims

The gastrointestinal motility effects of endogenous incretin hormones enhanced by dipeptidyl peptidase-IV (DPP-IV) inhibitors have not yet been sufficiently investigated. The aim of this study was to determine whether single pre-prandial sitagliptin, the DPP-IV inhibitor, administration might have an effect on the rate of liquid gastric emptying using the ¹³C-acetic acid breath test.

Methods

Ten healthy male volunteers participated in this randomized, two-way crossover study. The subjects fasted for overnight and were randomly assigned to receive 50 mg sitagliptin 2 hours before ingestion of the liquid test meal (200 kcal per 200 mL, containing 100 mg ¹³C-acetate) or the test meal alone. Under both conditions, breath samples were collected for 150 minutes following the meal. Liquid gastric emptying was estimated by the values of the following parameters: the time required for 50% emptying of the labeled meal (T_1/2), the analog to the scintigraphy lag time for 10% emptying of the labeled meal (T_lag), the gastric emptying coefficient and the regression-estimated constants (β and κ), calculated by using the ¹³CO₂ breath excretion curve using the conventional formulae. The parameters between the 2 test conditions were compared statistically.

Results

No significant differences in the calculated parameters, including T_1/2, T_lag, gastric emptying coefficient or β and κ, were observed between the 2 test conditions.

Conclusions

The present study revealed that single-dose sitagliptin intake had no significant influence on the rate of liquid gastric emptying in asymptomatic volunteers.

Effect of sumatriptan on gastric emptying: A crossover study using the BreathID system

AIM: To determine the effect of oral sumatriptan on gastric emptying using a continuous ¹³C breath test (BreathID system).

METHODS: Ten healthy male volunteers participated in this randomized, 2-way crossover study. The subjects fasted overnight and were randomly assigned to receive a test meal (200 kcal/200 mL) 30 min after pre-medication with sumatriptan 50 mg (sumatriptan condition), or the test meal alone (control condition). Gastric emptying was monitored for 4 h after administration of the test meal by the ¹³C-acetic acid breath test performed continually using the BreathID system. Then, using Oridion Research Software (β version), the time taken for emptying of 50% of the labeled meal (T_1/2) similar to the scintigraphy lag time for 10% emptying of the labeled meal (T_lag), the gastric emptying coefficient (GEC), and the regression-estimated constants (β and κ) were calculated. The statistical significance of any differences in the parameters were analyzed using Wilcoxon’s signed-rank test.

RESULTS: In the sumatriptan condition, significant differences compared with the control condition were found in T_1/2 [median 131.84 min (range, 103.13-168.70) vs 120.27 min (89.61-138.25); P = 0.0016], T_lag [median 80.085 min (59.23-125.89) vs 61.11 min (39.86-87.05); P = 0.0125], and β [median 2.3374 (1.6407-3.8209) vs 2.0847 (1.4755-2.9269); P = 0.0284]. There were no significant differences in the GEC or κ between the 2 conditions.

CONCLUSION: This study showed that oral sumatriptan significantly delayed gastric emptying of a liquid meal.

Mosapride accelerates the delayed gastric emptying of high-viscosity liquids: a crossover study using continuous real-time C breath test (BreathID System)

Background/Aims

The administration of liquid nutrients to patients is often accompanied by complications such as gastroesophageal reflux. To prevent gastroesophageal reflux, high-viscosity liquid meals are used widely, however, it still remains controversial whether high-viscosity liquid meals have any effect on the rate of gastric emptying. The present study was conducted with the aim of determining whether high-viscosity liquid meals had any effect on the rate of gastric emptying and mosapride might accelerate the rate of gastric emptying of high-viscosity liquid meals.

Methods

Six healthy male volunteers underwent 3 tests at intervals of > 1 week. After fasting for > 8 hours, each subject received one of three test meals (liquid meal only, high-viscosity liquid meal [liquid meal plus pectin] only, or high-viscosity liquid meal 30 minutes after intake of mosapride). A ¹³C-acetic acid breath test was performed, which monitored the rate of gastric emptying for 4 hours. Using the Oridion Research Software (β version), breath test parameters were calculated. The study parameters were examined for all the 3 test conditions and compared using the Freidman test.

Results

Gastric emptying was significantly delayed following intake of a high-viscosity liquid meal alone as compared with a liquid meal alone; however, intake of mosapride prior to a high-viscosity liquid meal was associated with a significantly accelerated rate of gastric emptying as compared with a high-viscosity liquid meal alone.

Conclusions

This study showed that high-viscosity liquid meals delayed gastric emptying: however, mosapride recovered the delayed rate of gastric emptying by high-viscosity liquid meals.

Effects of Histamine-2 Receptor Antagonists and Proton Pump Inhibitors on the Rate of Gastric Emptying: A Crossover Study Using a Continuous Real-Time C Breath Test (BreathID System)

BACKGROUND/AIMS

The effects of Histamine-2 receptor antagonists and proton pump inhibitors on the gastrointestinal motility have not yet been sufficiently investigated. The aim of this study was to determine the effects of intravenous bolus administration of famotidine and omeprazole on the rate of gastric emptying using the continuous (13)C breath test (BreathID system, Exalenz Bioscience Ltd, Israel).

METHODS

Twelve healthy male volunteers participated in this randomized, 3-way crossover study. After fasting overnight, the subjects were randomly assigned to receive 20 mg of famotidine, 20 mg of omeprazole or 20 mL of saline alone by intravenous bolus injection before a test meal (200 kcal per 200 mL, containing 100 mg of (13)C-acetate). Gastric emptying was monitored for 4 hours after the ingestion of test meal by the (13)C-acetic acid breath test performed using the BreathID system.

RESULTS

No significant differences in the calculated parameters, namely, the T(1/2), T(lag), GEC, β and κ, were observed among the 3 test conditions.

CONCLUSIONS

The study revealed that intravenous administration of gastric acid suppressant drugs had no significant influence on the rate of gastric emptying in comparison with that of saline alone as a placebo. Our results indicating the absence of any effect of either famotidine or omeprazole on accelerating the rate of gastric emptying suggest that both medications can be administered safely to patients suffering from hemorrhagic peptic ulcers who need to be kept nil by mouth from the viewpoint of possible acceleration of gastrointestinal motility in the clinical setting.

Change of gastric emptying with chewing gum: evaluation using a continuous real-time C breath test (BreathID system)

Background/Aims

There are few reports on the correlation between chewing gum and the gastrointestinal functions. But previous report showed use of chewing gum to be an effective method for controlling gastrointestinal symptoms. The aim of this study was to determine the correlation between chewing gum and gastric emptying using the continuous real time ¹³C breath test (BreathID system).

Methods

Ten healthy male volunteers participated in this randomized, 2-way crossover study. The subjects fasted overnight and were randomly assigned to chewing gum (Xylish, 2-3/1 tablet) for an hour following intake of a test meal (200 kcal/200 mL) or intake of the test meal alone. Gastric emptying was monitored for 4 hours after administration of the test meal by the ¹³C-acetic acid breath test performed continually using the BreathID system.

Results

No significant differences in the calculated parameters, namely, T_1/2 (median, 111.82 vs 109.26 minutes; P = 0.575), T_lag (median, 53.28 vs 56.53 minutes; P = 0.333), gastric emptying coefficient (median, 3.58 vs 3.65; P = 0.285), regression-estimated constant β (median, 1.85 vs 1.80; P = 0.575) and regression-estimated constant κ (median, 0.61 vs 0.62; P = 0.959) were observed between the test meal alone group and the test meal and chewing gum group.

Conclusions

This study showed that chewing gum had no effect on the rate of gastric emptying. Therefore, since chewing gum did not enhance the speed of gastric emptying, it may ameliorate gastrointestinal symptoms through other mechanisms, such as saliva and autonomic nervous system.

Reduced ¹³C-D-xylose absorption in alcoholics is more likely caused by alterations in small intestinal mucosa than delayed gastric emptying

OBJECTIVE

Alterations of the small intestinal absorptive surface are a probable cause of D-xylose malabsorption in chronic alcoholism. Delayed gastric emptying, however, may influence the (13)C-D-xylose breath test, which is used to study intestinal function in alcoholics. The aim of this study was to measure gastric emptying in alcoholics to elucidate whether retention of the test meal could explain the malabsorptive pattern of the (13)C-D-xylose breath test observed in alcoholics.

MATERIAL AND METHODS

Fifteen alcoholics performed the (13)C-octanoic acid and the (13)C-D-xylose breath tests on consecutive days in a random order. The (13)CO(2) expired was measured every 30 or 15 min for 4 h in the (13)C-D-xylose and the (13)C-octanoic acid breath tests, respectively, using a mass spectrometer equipped with a gas chromatograph. Test meals consisted of 100 mg of (13)C-D-xylose and 5 g of unmarked D-xylose dissolved in 250 ml water and 91 mg (13)C-octanoic acid embedded in a one-egg omelette served with white bread with margarine, respectively.

RESULTS

The alcoholic patients had a lower (13)C-D-xylose breath index compared with healthy controls (p < 0.0001). None of the (13)C-octanoic acid breath test variables, T(50%), T(max), T(lag), or GEC revealed any significant differences between the groups.

CONCLUSION

The pathological (13)C-D-xylose breath test in this group of alcoholics is unlikely to be caused by delayed gastric emptying. Malabsorption is the probable cause of the pathological (13)C-D-xylose breath test results in alcoholics.

A novel continuous breath test versus scintigraphy for gastric emptying rate measurement

BACKGROUND

Gastric scintigraphy (GS) is considered the gold standard for gastric emptying rate (GER) measurement; however, it requires expensive equipment and special licensing for radioactive substances.

AIM

To compare a new nonradioactive, real-time, continuous breath test (CBT) method with GS for the GER measurement.

METHODS

Simultaneous GER analysis by both GS and CBT was carried out on 8 dyspeptic patients and 6 healthy controls. After a 14 hour fast, participants ate a standard meal of 250 Kcal double labeled with 1 mCi of Tc-99m and 100 μg of C-13 labeled octanoic acid. The participants underwent simultaneous GS for 120 minutes on single-detector γ camera and CBT carried out by attaching the nasal cannula of the system (Oridion, BreathID, Israel), which automatically and continuously collected and analyzed breath samples with real time display. A linear fit model was used to calculate gastric empting half-time. A half-time of more than 100 minutes for GS and 80 minutes for CBT were considered pathologic. The GS and CBT were compared by κ test of agreement in normal/abnormal results.

RESULTS

Good correlation was found for GER measurements between GS and the CBT methods with a linear correlation coefficient of R=0.74. The κ test indicated excellent agreement with value of 0.86 for the qualitative determination of pathologic and normal results.

CONCLUSIONS

The novel CBT provides reliable and reasonably accurate data for on-line GER estimate, in a simple manner suitable for medical clinics or bedside setting, without the use of radioactive substances.

Effect on gastric function and symptoms of drinking wine, black tea, or schnapps with a Swiss cheese fondue: randomised controlled crossover trial

OBJECTIVE

To compare the effects of drinking white wine or black tea with Swiss cheese fondue followed by a shot of cherry schnapps on gastric emptying, appetite, and abdominal symptoms.

DESIGN

Randomised controlled crossover study.

PARTICIPANTS

20 healthy adults (14 men) aged 23-58.

INTERVENTIONS

Cheese fondue (3260 kJ, 32% fat) labelled with 150 mg sodium (13)Carbon-octanoate was consumed with 300 ml of white wine (13%, 40 g alcohol) or black tea in randomised order, followed by 20 ml schnapps (40%, 8 g alcohol) or water in randomised order.

MAIN OUTCOME MEASURES

Cumulative percentage dose of (13)C substrate recovered over four hours (higher values indicate faster gastric emptying) and appetite and dyspeptic symptoms (visual analogue scales).

RESULTS

Gastric emptying was significantly faster when fondue was consumed with tea or water than with wine or schnapps (cumulative percentage dose of (13)C recovered 18.1%, 95% confidence interval 15.2% to 20.9% v 7.4%, 4.6% to 10.3%; P<0.001). An inverse dose-response relation between alcohol intake and gastric emptying was evident. Appetite was similar with consumption of wine or tea (difference 0.11, -0.12 to 0.34; P=0.35), but reduced if both wine and schnapps were consumed (difference -0.40, -0.01 to -0.79; P<0.046). No difference in dyspeptic symptoms was present.

CONCLUSIONS

Gastric emptying after a Swiss cheese fondue is noticeably slower and appetite suppressed if consumed with higher doses of alcohol. This effect was not associated with dyspeptic symptoms.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00943696.