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Tagiling N, Ibrahim IL, Lee YY, Udin MY, Mohamad Kamarulzaman MD, Phoa PKA, Damulira E, Mohd Rohani MF, Wan Zainon WMN, Mat Nawi N. Randomized, crossover trial: comparing the effects of standardized egg-white meal and Vital ® on global gastric emptying parameters and intragastric meal distribution in healthy Asian participants. J Gastroenterol Hepatol 2024. [PMID: 38705971 DOI: 10.1111/jgh.16585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 02/29/2024] [Accepted: 04/11/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND AND AIM Measurements of gastric emptying and accommodation for alternative test-meal protocol during gastric emptying scintigraphy (GES), such as high-calorie nutrient drinks, are not fully established. We aimed to compare the effects of standardized egg-white meal (EWM) versus high-calorie nutrient drink (Vital®; Abbott Laboratories) on global GES parameters and intragastric meal distribution at immediate scan (IMD0h). METHODS Of 84 screened participants, 60 asymptomatic healthy Asian population (38 females; 24.0 ± 1.5 years; 23.8 ± 2.6 kg/m2) were recruited in this 2 × 2 (AB/BA) crossover trial. Participants were randomized to a 4-h GES with 99mTc-radiolabeled EWM (~255.8 kcal), followed by a 200 mL Vital® (300 kcal), or vice versa, separated by a 2-week washout period. Global meal retention (GMR), power-exponential model emptying parameters (half-emptying [T1/2], lag phases [Tlag2%, Tlag5%, Tlag10%]), and IMD0h were determined and compared. RESULTS GMRs for both test meals were within the international standard references for solid GES. Compared to EWM, Vital® exhibited significantly lower GMRs (faster emptying) from 0.5 to 3 h (all P < 0.001) but comparable at 4 h (P = 0.153). Similar observations were found for the model-based T1/2 and the different Tlag thresholds (all P < 0.001). Furthermore, IMD0h was found to be lower with Vital®, indicating lower gastric accommodation (faster antral filling) immediately post-ingestion (P < 0.001). Both test meals showed significant moderate-to-strong positive associations at the late-phase GE (GMR 2-4 h, T1/2) (all P < 0.05). CONCLUSIONS Overall, Vital® is an acceptable alternative test meal to the EWM for GES; however, exercise caution when interpreting early-phase GE. The normative values for global GES parameters and IMD0h are also established.
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Affiliation(s)
- Nashrulhaq Tagiling
- Department of Nuclear Medicine, Radiotherapy and Oncology, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150, Kota Bharu, Kelantan, Malaysia
- Gastrointestinal Function and Motility (GIFM) Unit, Clinical Examination Lab, Hospital Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia
| | - Izleen Laili Ibrahim
- Medical Physics Program, School of Physics, Universiti Sains Malaysia Main Campus, 11800 Bertam, Penang, Malaysia
| | - Yeong Yeh Lee
- Gastrointestinal Function and Motility (GIFM) Unit, Clinical Examination Lab, Hospital Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia
- Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150, Kota Bharu, Kelantan, Malaysia
| | - Muhamad Yusri Udin
- Department of Nuclear Medicine, Radiotherapy and Oncology, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150, Kota Bharu, Kelantan, Malaysia
- Department of Hematology and Transfusion Medicine Unit, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150, Kota Bharu, Kelantan, Malaysia
| | - Mohamad Dzulhilmi Mohamad Kamarulzaman
- Aseptic Dispensary and Radiopharmacy Unit, Department of Pharmacy, Hospital Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia
- Department of Nuclear Medicine, Radiotherapy and Oncology, Hospital Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia
| | - Picholas Kian Ann Phoa
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, 47500, Subang Jaya, Selangor, Malaysia
| | - Edrine Damulira
- Département de physique, Complexe des sciences, Université de Montréal, 1375, Montréal, Quebec, Canada
| | - Mohd Fazrin Mohd Rohani
- Department of Nuclear Medicine, Hospital Kuala Lumpur, 50300 Wilayah Persekutuan Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Wan Mohd Nazlee Wan Zainon
- Department of Family Medicine, Hospital Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia
| | - Norazlina Mat Nawi
- Department of Nuclear Medicine, Radiotherapy and Oncology, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150, Kota Bharu, Kelantan, Malaysia
- Department of Nuclear Medicine, Radiotherapy and Oncology, Hospital Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia
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2
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Camilleri M, Zheng T, Vosoughi K, Lupianez-Merly C, Eckert D, Busciglio I, Burton D, Dilmaghani S. Optimal measurement of gastric emptying of solids in gastroparesis or functional dyspepsia: evidence to establish standard test. Gut 2023; 72:2241-2249. [PMID: 37726164 PMCID: PMC10872889 DOI: 10.1136/gutjnl-2023-330733] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE Symptoms in gastroparesis (Gp) and functional dyspepsia (FD) overlap; using egg protein substitute to measure gastric emptying of solids (GES), ~40% of patients are reclassified from Gp to FD, and vice versa. Our aim was to assess inter-individual and intra-individual coefficients of variation (COV) in GES in symptomatic patients with Gp or FD with documented slow or normal GES, respectively. DESIGN Scintigraphic GES (T1/2 and GE% at 2 and 4 hours) using a 320 kcal real egg meal (30% fat) was tested in the following: single measurements in 20 patients with diabetes mellitus (10 each type 1 and type 2); repeat GES to estimate COVintra measured: 3 days apart in 9 Gp, 4 weeks apart in 21 Gp and 18 with FD with normal GE assigned to placebo and in 70 patients at 94.3 weeks (median) apart. RESULTS COVinter for GE% at 4 hours and GE T1/2 were respectively 14.2% and 23.5% in FD and 27.5% and 33% in Gp; COVintra for GE% at 4 hours and GE T1/2 up to 4 weeks apart were 23.4% and 37.9% in FD and 20.1% and 33% in Gp. GE% at 2 hours showed less consistent results. However, >85% retained original diagnosis as normal or delayed. From clinical GES to baseline research for Gp group, repeat GES (after treatment) showed the COVintra for GE% at 4 hours was 37.3% at median 94.3 weeks, with 26/70 changed diagnoses. CONCLUSION The 320 kcal (30% fat) GES scintigraphic test provides consistent diagnosis in >85% and should be the standard test for suspected gastric emptying disorders.
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Affiliation(s)
| | - Ting Zheng
- Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kia Vosoughi
- Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Deborah Eckert
- Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Duane Burton
- Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
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3
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Notghi A, James G, Hay PD. British Nuclear Medicine Society Clinical Guidelines for Gastric empty. Nucl Med Commun 2023; 44:563-570. [PMID: 37288619 DOI: 10.1097/mnm.0000000000001699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Alp Notghi
- Department of Physics and Nuclear Medicine, Consultant Physician in Nuclear Medicine, Sandwell and West Birmingham NHS Trust, Birmingham
| | - Gregory James
- Head of Nuclear Medicine Physics, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Staffordshire
| | - Peter D Hay
- Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK
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4
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Hay PD, Corsetti M, Tucker E, Fox MR, Perkins A. Tolerability, gastric emptying patterns, and symptoms during the Nottingham Test Meal in 330 secondary care non-diabetic dyspeptic patients. Neurogastroenterol Motil 2022; 34:e14454. [PMID: 36082399 PMCID: PMC10078298 DOI: 10.1111/nmo.14454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 07/05/2022] [Accepted: 08/05/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Scintigraphy is used for overall assessment of gastric emptying. Adherence to an international consensus protocol is recommended to ensure quality; however, this has not been widely adopted because preparation of the "egg-beater" meal is inconvenient in clinical practice. In this report, we audit the tolerability and the results of gastric emptying scintigraphy with the 400 ml Tc-99 m-labeled liquid nutrient Nottingham Test Meal (NTM). METHODS Results from 330 consecutive adult, non-diabetic patients with dyspeptic symptoms referred for gastric scintigraphy were analyzed. Gastric half-emptying time (T50) and validated measurements of early- and late-phase gastric emptying were acquired. Postprandial sensations of fullness, bloating, heartburn, nausea, and epigastric pain were recorded using 100 mm visual analog scales (VAS) before and 0, 30, and 90 min after NTM ingestion. Results were compared with those previously obtained in healthy subjects. KEY RESULTS Almost all (98%) of the patients were able to consume the 400 ml NTM. Considering early- and late-phase gastric emptying, frequently observed patterns included normal early- with slow late-phase (25%) and fast early- with slow late-phase emptying (27%). Abnormal score of fullness and/ or dyspeptic symptoms were observed in 88% of dyspeptic patients. Abnormal fullness at T0 (after completed drink ingestion) was associated with slow late phase of gastric emptying, especially in women. CONCLUSIONS Gastric scintigraphy with the NTM is simple to perform and well tolerated. Whether the identified abnormal gastric emptying patterns could predict different treatment outcome in patients with functional dyspepsia is the subject of ongoing prospective studies.
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Affiliation(s)
- Peter D Hay
- Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Maura Corsetti
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust, The University of Nottingham, Nottingham, UK.,Translational Medical Sciences, Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Emily Tucker
- Gastroenterology, Royal Derby Hospital, University Hospitals of Derby and Burton NHS foundation Trust, Derby, UK
| | - Mark R Fox
- Clinic for Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.,Digestive Function: Basel, Laboratory and Clinic for Motility Disorders and Functional Digestive Diseases, Klinik Arlesheim, Arlesheim, Switzerland
| | - Alan Perkins
- Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Queen's Medical Centre Nottingham, Radiological Sciences, School of Medicine, University of Nottingham, Nottingham, UK
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5
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Strunz PP, Vuille-Dit-Bille RN, R Fox M, Geier A, Maggiorini M, Gassmann M, Fruehauf H, Lutz TA, Goetze O. Effect of high altitude on human postprandial 13 C-octanoate metabolism, intermediary metabolites, gastrointestinal peptides, and visceral perception. Neurogastroenterol Motil 2022; 34:e14225. [PMID: 34342373 DOI: 10.1111/nmo.14225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/08/2021] [Accepted: 07/07/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE At high altitude (HA), acute mountain sickness (AMS) is accompanied by neurologic and upper gastrointestinal symptoms (UGS). The primary aim of this study was to test the hypothesis that delayed gastric emptying (GE), assessed by 13 C-octanoate breath testing (OBT), causes UGS in AMS. The secondary aim was to assess post-gastric mechanisms of OBT, which could confound results under these conditions, by determination of intermediary metabolites, gastrointestinal peptides, and basal metabolic rate. METHODS A prospective trial was performed in 25 healthy participants (15 male) at 4559 m (HA) and at 490 m (Zurich). GE was assessed by OBT (428 kcal solid meal) and UGS by visual analogue scales (VAS). Blood sampling of metabolites (glucose, free fatty acids (FFA), triglycerides (TG), beta-hydroxyl butyrate (BHB), L-lactate) and gastrointestinal peptides (insulin, amylin, PYY, etc.) was performed as well as blood gas analysis and spirometry. STATISTICAL ANALYSIS variance analyses, bivariate correlation, and multilinear regression analysis. RESULTS After 24 h under hypoxic conditions at HA, participants developed AMS (p < 0.001). 13 CO2 exhalation kinetics increased (p < 0.05) resulting in reduced estimates of gastric half-emptying times (p < 0.01). However, median resting respiratory quotients and plasma profiles of TG indicated that augmented beta-oxidation was the main predictor of accelerated 13 CO2 -generation under these conditions. CONCLUSION Quantification of 13 C-octanoate oxidation by a breath test is sensitive to variation in metabolic (liver) function under hypoxic conditions. 13 C-breath testing using short-chain fatty acids is not reliable for measurement of gastric function at HA and should be considered critically in other severe hypoxic conditions, like sepsis or chronic lung disease.
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Affiliation(s)
- Patrick-Pascal Strunz
- Division of Rheumatology and Immunology, Department of Medicine II, University Hospital Wurzburg, Germany
| | | | - Mark R Fox
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.,Digestive Function: Basel, Laboratory and Clinic for Motility Disorders and Functional Digestive Diseases, Klinik Arlesheim, Arlesheim, Switzerland
| | - Andreas Geier
- Division of Hepatology, Department of Medicine II, University Hospital Wurzburg, Germany
| | - Marco Maggiorini
- Institute of Intensive Care, University Hospital Zurich, Zurich, Switzerland
| | - Max Gassmann
- Institute of Veterinary Physiology, Vetsuisse Faculty and Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Heiko Fruehauf
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zentrum für Gastroenterologie und Hepatologie, Zurich, Switzerland
| | - Thomas A Lutz
- Institute of Veterinary Physiology, Vetsuisse Faculty and Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Oliver Goetze
- Division of Hepatology, Department of Medicine II, University Hospital Wurzburg, Germany
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6
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Egboh SMC, Abere S. Gastroparesis: A Multidisciplinary Approach to Management. Cureus 2022; 14:e21295. [PMID: 35186557 PMCID: PMC8846567 DOI: 10.7759/cureus.21295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 11/24/2022] Open
Abstract
Gastroparesis is a neuromuscular disorder whose hallmark is delayed gastric emptying. It is a global challenge to the healthcare system because of poor treatment satisfaction for both the patients and clinicians, eventually leading to a reduction in the quality of life, with antecedent anxiety and depression. Although it is multifactorial in origin, diabetic, idiopathic, and drug-induced gastroparesis are the major risk factors. Disrupted interstitial cells of Cajal (ICC) and gastric dysrhythmia are pivotal to the pathogenesis, with most of the investigations targeted toward assessing gastric emptying and accommodation usually affected by distorted ICC and other neural networks. The treatment challenges can be overcome by a multidisciplinary approach involving gastroenterologists, gastrointestinal surgeons, biomedical engineers, nutritionists, psychologists, nurses, radionuclide radiologists, pharmacists, and family physicians. The exploration of the fundamental physiological processes underlying gastroparesis with the use of biomechanical materials should be given more attention by biomedical engineers to integrate innovative engineering with medicine for solving complex medical issues.
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Affiliation(s)
| | - Sarah Abere
- Internal Medicine, Rivers State University Teaching Hospital, Port Harcourt, NGA
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Abstract
Dark chocolate is claimed to have effects on gastrointestinal function and to improve well-being. This randomised controlled study tested the hypothesis that cocoa slows gastric emptying and intestinal transit. Functional brain imaging identified central effects of cocoa on cortical activity. Healthy volunteers (HV) ingested 100 g dark (72 % cocoa) or white (0 % cocoa) chocolate for 5 d, in randomised order. Participants recorded abdominal symptoms and stool consistency by the Bristol Stool Score (BSS). Gastric emptying (GE) and intestinal and colonic transit time were assessed by scintigraphy and marker studies, respectively. Combined positron emission tomography-computed tomography (PET-CT) imaging assessed regional brain activity. A total of sixteen HV (seven females and nine males) completed the studies (mean age 34 (21-58) years, BMI 22·8 (18·5-26·0) kg/m2). Dark chocolate had no effect on upper gastrointestinal function (GE half-time 82 (75-120) v. 83 (60-120) min; P=0·937); however, stool consistency was increased (BSS 3 (3-5) v. 4 (4-6); P=0·011) and there was a trend to slower colonic transit (17 (13-26) v. 21 (15-47) h; P=0·075). PET-CT imaging showed increased [18F]fluorodeoxyglucose (FDG) in the visual cortex, with increased FDG uptake also in somatosensory, motor and pre-frontal cortices (P<0·001). In conclusion, dark chocolate with a high cocoa content has effects on colonic and cerebral function in HV. Future research will assess its effects in patients with functional gastrointestinal diseases with disturbed bowel function and psychological complaints.
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8
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Hens B, Corsetti M, Bermejo M, Löbenberg R, González PM, Mitra A, Desai D, Chilukuri DM, Aceituno A. "Development of Fixed Dose Combination Products" Workshop Report: Considerations of Gastrointestinal Physiology and Overall Development Strategy. AAPS JOURNAL 2019; 21:75. [PMID: 31172358 DOI: 10.1208/s12248-019-0346-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/27/2019] [Indexed: 12/14/2022]
Abstract
The gastrointestinal (GI) tract is one of the most popular and used routes of drug product administration due to the convenience for better patient compliance and reduced costs to the patient compared to other routes. However, its complex nature poses a great challenge for formulation scientists when developing more complex dosage forms such as those combining two or more drugs. Fixed dose combination (FDC) products are two or more single active ingredients combined in a single dosage form. This formulation strategy represents a novel formulation which is as safe and effective compared to every mono-product separately. A complex drug product, to be dosed through a complex route, requires judicious considerations for formulation development. Additionally, it represents a challenge from a regulatory perspective at the time of demonstrating bioequivalence (BE) for generic versions of such drug products. This report gives the reader a summary of a 2-day short course that took place on the third and fourth of November at the Annual Association of Pharmaceutical Scientists (AAPS) meeting in 2018 at Washington, D.C. This manuscript will offer a comprehensive view of the most influential aspects of the GI physiology on the absorption of drugs and current techniques to help understand the fate of orally ingested drug products in the complex environment represented by the GI tract. Through case studies on FDC product development and regulatory issues, this manuscript will provide a great opportunity for readers to explore avenues for successfully developing FDC products and their generic versions.
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Affiliation(s)
- Bart Hens
- Department of Pharmaceutical & Pharmacological Sciences, KU Leuven, Herestraat 49, Gasthuisberg, Box 921, 3000, Leuven, Belgium.
| | - Maura Corsetti
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.,Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Marival Bermejo
- Department Engineering Pharmacy Section, Miguel Hernandez University, San Juan de Alicante, 03550, Alicante, Spain
| | - Raimar Löbenberg
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, T6G 2H7, Canada
| | - Pablo M González
- Departamento de Farmacia, Facultad de Química y de Farmacia, Pontificia Universidad Católica de Chile, Av Vicuña Mackenna, 4860, Santiago, Chile
| | - Amitava Mitra
- Clinical Development, Sandoz, Inc. (A Novartis Division), Princeton, New Jersey, 08540, USA
| | - Divyakant Desai
- Drug Product Science and Technology, Bristol-Myers Squibb Company, New Brunswick, New Jersey, 08903-0191, USA
| | - Dakshina Murthy Chilukuri
- Office of Clinical Pharmacology, Office of Translational Sciences, CDER, FDASilver Spring, US Food & Drug Administration (US FDA), Prince Georges Counties, Maryland, USA
| | - Alexis Aceituno
- Subdepto. Biofarmacia y Equivalencia Terapéutica, Agencia Nacional de Medicamentos (ANAMED), Instituto de Salud Pública de Chile, Santiago, Chile y Facultad de Farmacia, Universidad de Valparaíso, Valparaíso, Chile
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9
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Schindler V, Giezendanner S, Bütikofer S, Murray F, Runggaldier D, Schnurre L, Zweig A, Fried M, Pohl D. Differentiation of functional gastrointestinal disorders from healthy volunteers by lactulose hydrogen breath test and test meal. J Gastroenterol Hepatol 2019; 34:843-851. [PMID: 30562837 DOI: 10.1111/jgh.14551] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 10/30/2018] [Accepted: 11/05/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Functional dyspepsia (FD) is a common disorder of gut-brain interaction with incompletely understood pathophysiology. Consequently, heterogeneous expert opinions on diagnostic tests and assessment of treatment efficacies exist. So far, no consensus about the most relevant diagnostic and outcome tool has been reached. In this study, we aimed to analyze the significance of a combined lactulose hydrogen breath test (LHBT) and liquid meal, yet representing a standardized test in irritable bowel syndrome (IBS), in FD. METHODS We analyzed data of 146 FD, 204 IBS patients, and 50 healthy volunteers (HV). All patients underwent LHBT with a meal-drink consisting of 30-g Lactulose and 400-mL Ensure®. Effect of abdominal symptom generation in FD/IBS compared with HV was assessed on a patient-reported Likert-scale. RESULTS There was a significant difference between FD/IBS patients and HV in LHBT-induced abdominal pain (odds ratio [OR] 246.9, 95% confidence interval [CI] 26.6-2290.7; OR 161.2, 95% CI 16.9-1534.8), abdominal bloating (OR 384.8, 95% CI 92.9-2135.4; OR 524.1, 95% CI 114.7-3432.3), borborygmi (OR 9.9, 95% CI 2.2-46.9; OR 17.7, 95% CI 4.7-67.4), nausea only in FD (OR 174.4, 95% CI 15.5-5375.5), and diarrhea in IBS only (OR 25.8, 95% CI 2.0-7012.6). Hydrogen production was not significantly different in FD/IBS and HV. CONCLUSIONS In this study, we demonstrated significant differences in postprandial symptom generation in FD and IBS compared with HV after LHBT. This does not only allow us to discriminate FD/IBS from HV but may also represent a diagnostic and monitoring tool for FD/IBS in the future, including monitoring of treatment effects.
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Affiliation(s)
- Valeria Schindler
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | | | - Simon Bütikofer
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Fritz Murray
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Daniel Runggaldier
- Department of Otorhinolaryngology, University Hospital Zürich, Zürich, Switzerland
| | - Larissa Schnurre
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Annina Zweig
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Michael Fried
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Daniel Pohl
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
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10
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Parker H, Hoad CL, Tucker E, Costigan C, Marciani L, Gowland P, Fox M. Gastric motor and sensory function in health assessed by magnetic resonance imaging: Establishment of reference intervals for the Nottingham test meal in healthy subjects. Neurogastroenterol Motil 2018; 30:e13463. [PMID: 30216596 DOI: 10.1111/nmo.13463] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/08/2018] [Accepted: 08/13/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Current investigations of gastric emptying rarely identify the cause of symptoms or provide a definitive diagnosis in patients with dyspepsia. This study assessed gastric function by magnetic resonance imaging (MRI) using the modular "Nottingham test meal" (NTM) in healthy volunteers (HVs). METHODS The NTM comprises (a) 400 mL liquid nutrient (0.75 kcal/mL) labeled with Gadolinium-DOTA and (b) an optional solid component (12 agar-beads [0 kcal]). Filling sensations were documented. MRI measurements of gastric volume, emptying, contraction wave frequency, and secretion were obtained using validated methods. KEY RESULTS Gastric function was measured in a population of 73 HVs stratified for age and sex. NTM induced moderate satiety and fullness. Labeled fluid was observed in the small bowel in all subjects after meal ingestion ("early-phase" GE). Secretion was rapid such that postprandial gastric content volume was often greater than meal volume (GCV0 > 400 mL), and there was increasing dilution of the meal during the study (P < 0.001). Gastric half-time was median 66-minutes (95% reference interval 35 to 161-minutes ["late-phase" GE]). The number of intact agar beads in the stomach was 7/12 (58%) at 60-minutes and 1/12 (8%) at 120-minutes. Age, bodyweight and sex had measurable effects on gastric function; however, these were small compared to inter-individual variation for most metrics. CONCLUSIONS AND INFERENCES Reference intervals are presented for MRI measurements of gastric function assessed for the mixed liquid/solid NTM. Studies in patients will determine which metrics are of clinical value and also whether the reference intervals presented here offer optimal diagnostic sensitivity and specificity.
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Affiliation(s)
- Helen Parker
- NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.,Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK.,Zürich Neurogastroenterology and Motility Research Group, Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.,Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Caroline L Hoad
- NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.,Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Emily Tucker
- NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.,Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Carolyn Costigan
- NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Luca Marciani
- NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.,Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Penny Gowland
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Mark Fox
- NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.,Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK.,Zürich Neurogastroenterology and Motility Research Group, Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
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Owei I, Jain N, Jones D, Umekwe N, Dagogo-Jack S. Physiology of Glycemic Recovery and Stabilization After Hyperinsulinemic Euglycemic Clamp in Healthy Subjects. J Clin Endocrinol Metab 2018; 103:4155-4162. [PMID: 30239760 PMCID: PMC6194810 DOI: 10.1210/jc.2018-01569] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/11/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND The hyperinsulinemic euglycemic clamp (HEC) is the gold standard for measuring insulin sensitivity, but glycemic recovery and stabilization after the procedure have not been well studied. Here, we assessed the physiological determinants of postclamp recovery. METHODS We analyzed data from 207 healthy subjects [102 African American (AA) and 105 European American (EA)] who underwent HEC in the Pathobiology of Prediabetes in a Biracial Cohort study. At the end of HEC, insulin infusion was stopped, and dextrose (20%) infusion was tapered and stopped when plasma glucose stabilized ≥20 mg/dL above the preclamp value (∼100 mg/dL). Glucose recovery time (GRT) was defined as the interval from cessation of insulin infusion to discontinuation of dextrose infusion. Insulin clearance was calculated under basal and clamp conditions. RESULTS The mean (± SD) age and body mass index were 46.3 ± 9.96 years and 30.7 ± 8.43 kg/m2, respectively. Plasma glucose (mg/dL) was 92.2 ± 6.26 preclamp and 124.2 ± 26.9 postclamp. The median GRT (minutes) was 65 (range, 30 to 270); mean GRT was 77.1 ± 42.7 (men: 82.9 ± 45.5; women: 74.4 ± 42.3; AA, 82.0 ± 49.6; EA, 72.3 ± 34.2; P > 0.1 for sex or race). The 90th percentile for GRT was 119 minutes. In regression models, significant predictors of GRT were age (P = 0.03), weight (P = 0.009), 2-hour plasma glucose (P = 0.0002), insulin sensitivity (P = 0.03), disposition index (P = 0.017), and basal insulin clearance (P = 0.02). CONCLUSIONS In our biracial cohort, glycemic recovery after hyperinsulinemic clamp was independent of sex or race but was significantly predicted by age, weight, and glucose tolerance and by insulin sensitivity, secretion, and clearance. We recommend that monitoring be maintained for ∼2 hours postclamp to ensure adequate glycemic stabilization.
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Affiliation(s)
- Ibiye Owei
- Division of Endocrinology, Department of Medicine, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Nidhi Jain
- Division of Endocrinology, Department of Medicine, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, Tennessee
| | - David Jones
- Division of Endocrinology, Department of Medicine, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Nkiru Umekwe
- Division of Endocrinology, Department of Medicine, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Sam Dagogo-Jack
- Division of Endocrinology, Department of Medicine, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, Tennessee
- Correspondence and Reprint Requests: Sam Dagogo-Jack, MD, Division of Endocrinology, Department of Medicine, Diabetes and Metabolism, University of Tennessee Health Science Center, 920 Madison Avenue Suite 300A, Memphis, Tennessee 38163. E-mail
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Clinical measurement of gastrointestinal motility and function: who, when and which test? Nat Rev Gastroenterol Hepatol 2018; 15:568-579. [PMID: 29872118 DOI: 10.1038/s41575-018-0030-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Symptoms related to abnormal gastrointestinal motility and function are common. Oropharyngeal and oesophageal dysphagia, heartburn, bloating, abdominal pain and alterations in bowel habits are among the most frequent reasons for seeking medical attention from internists or general practitioners and are also common reasons for referral to gastroenterologists and colorectal surgeons. However, the nonspecific nature of gastrointestinal symptoms, the absence of a definitive diagnosis on routine investigations (such as endoscopy, radiology or blood tests) and the lack of specific treatments make disease management challenging. Advances in technology have driven progress in the understanding of many of these conditions. This Review serves as an introduction to a series of Consensus Statements on the clinical measurements of gastrointestinal motility, function and sensitivity. A structured, evidence-based approach to the initial assessment and empirical treatment of patients presenting with gastrointestinal symptoms is discussed, followed by an outline of the contribution of modern physiological measurement on the management of patients in whom the cause of symptoms has not been identified with other tests. Discussions include the indications for and utility of high-resolution manometry, ambulatory pH-impedance monitoring, gastric emptying studies, breath tests and investigations of anorectal structure and function in day-to-day practice and clinical management.
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Corsetti M, Fox M. The management of functional dyspepsia in clinical practice: what lessons can be learnt from recent literature? F1000Res 2017; 6:1778. [PMID: 29043076 PMCID: PMC5621105 DOI: 10.12688/f1000research.12089.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2017] [Indexed: 12/18/2022] Open
Abstract
Functional dyspepsia is a prevalent functional gastrointestinal disorder that can significantly erode the quality of life of sufferers and places a major cost burden on healthcare services. In this article, we review the recent literature, selecting the information we consider relevant since it has changed our clinical management of patients with functional dyspepsia.
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Affiliation(s)
- Maura Corsetti
- National Institute for Health Research, Nottingham Digestive Diseases Biomedical Research Centre, Nottingham University Hospitals NHS Trust , University of Nottingham, Nottingham, UK
| | - Mark Fox
- Abdominal Centre: Gastroenterology, St Claraspital, Basel, Switzerland
- Clinic of Gastroenterology & Hepatology, University Hospital Zürich, Zürich, Switzerland
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