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Wang Z, Kozu H, Uemura K, Kobayashi I, Ichikawa S. Effect of mechanical properties on in vitro dynamic digestion of starch contained in hydrogels. JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2024; 104:3498-3506. [PMID: 38145927 DOI: 10.1002/jsfa.13235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 12/18/2023] [Accepted: 12/26/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND This study evaluates the effect of mechanical properties on the in vitro dynamic gastrointestinal digestion of hydrogels containing starch (HCSs) as a model for studying the nutrient digestibility of solid foods. It provides a useful theoretical basis for the processing of specific foods. RESULT Four types of HCSs with two levels of fracture stress (17.4-20.9 kPa and 55.5-57.6 kPa) and two levels of fracture strain (25.4-28.5% and 53.7-57.4%) were prepared. For these HCSs, the degree of gastric disintegration of hydrogels reduced significantly when fracture strain exceeded 30% (P < 0.05). The gastric emptying of HCS particles was also affected by mechanical properties. For example, even at the same level of fracture stress (ca. 20 kPa), the dry solids retention ratio decreased markedly from 0.90 to 0.43 with a decrease in fracture strain from 53.7% to 25.4% (P < 0.05). For the starch hydrolysis of HCSs after gastric digestion, more than 70% of starch in the particles of all types of HCSs emptied did not undergo digestion. The starch hydrolysis of HCSs during small intestinal digestion was also influenced by their mechanical properties. Fracture strains of HCSs, rather than their fracture stress, affected starch digestibility in hydrogels. CONCLUSION The gastric disintegration, the gastric emptying, and the starch hydrolysis of HCSs are suppressed when fracture strain exceeded 30%. Even with the amount of nutritional components contained in hydrogels being the same, the in vitro gastrointestinal digestion behavior of HCSs depends on their mechanical properties. This behavior has the potential to be used in the design of processed foods with controlled bioaccessibility. © 2023 Society of Chemical Industry.
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Affiliation(s)
- Zaitian Wang
- Institute of Life and Environmental Sciences, University of Tsukuba, Tsukuba, Japan
| | - Hiroyuki Kozu
- Institute of Life and Environmental Sciences, University of Tsukuba, Tsukuba, Japan
- Institute of Food Research, NARO, Tsukuba, Japan
| | | | | | - Sosaku Ichikawa
- Institute of Life and Environmental Sciences, University of Tsukuba, Tsukuba, Japan
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2
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Tafti D, Farrell MB, Dearborn MC, Banks KP. Reexamining Compliance with Gastric Emptying Scintigraphy Guidelines: An Updated Analysis of the Intersocietal Accreditation Commission Database. J Nucl Med Technol 2024; 52:26-31. [PMID: 37316303 PMCID: PMC10924152 DOI: 10.2967/jnmt.123.265496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/10/2023] [Indexed: 06/16/2023] Open
Abstract
Many variables can influence the results of gastric emptying scintigraphy (GES). A lack of standardization causes variability, limits comparisons, and decreases the credibility of the study. To increase standardization, in 2009 the Society of Nuclear Medicine and Molecular Imaging (SNMMI) published a guideline for a standardized, validated GES protocol for adults based on a 2008 consensus document. Laboratories must closely follow the consensus guideline to provide valid and standardized results as an incentive to achieve consistency in patient care. As part of the accreditation process, the Intersocietal Accreditation Commission (IAC) evaluates compliance with such guidelines. The rate of compliance with the SNMMI guideline was assessed in 2016 and showed a substantial degree of noncompliance. The aim of this study was to reassess compliance with the standardized protocol across the same cohort of laboratories, looking for changes and trends. Methods: The IAC nuclear/PET database was used to extract GES protocols from all laboratories applying for accreditation from 2018 to 2021, 5 y after the initial assessment. The number of labs was 118 (vs. 127 in the initial assessment). Each protocol was again evaluated for compliance with the methods described in the SNMMI guideline. The same 14 variables were assessed in a binary fashion: patient preparation (4 variables-types of medications withheld, withholding of these medication for 48 h, blood glucose ≤ 200 mg/dL, blood glucose recorded), meal (5 variables-use of consensus meal, nothing by mouth for 4 h or more, meal consumed within 10 min, documentation of percentage of meal consumed, meal labeled with 18.5-37 MBq [0.5-1.0 mCi]), acquisition (2 variables-anterior and posterior projections obtained, imaging each hour out to 4 h), and processing (3 variables-use of the geometric mean, decay correction of data, and measurement of percentage retention). Results: Protocols from the 118 labs demonstrated that compliance is improving in some key areas but remains suboptimal in others. Overall, labs were compliant with an average of 8 of the 14 variables, with a low of 1-variable compliance at 1 site, and only 4 sites compliant with all 14 variables. Nineteen sites met an 80% threshold for compliance (11+ variables). The variable with the highest compliance was the patient's taking nothing by mouth for 4 h or more before the exam (97%). The variable with the lowest compliance was the recording of blood glucose values (3%). Notable areas of improvement include the use of the consensus meal, now 62% versus previously only 30% of labs. Greater compliance was also noted with measurement of retention percentages (instead of emptying percentages or half-times), with compliance by 65% of sites versus only 35% 5 y prior. Conclusion: Almost 13 y after the publication of the SNMMI GES guidelines, there is improving but still suboptimal protocol adherence among laboratories applying for IAC accreditation. Persistent variation in the performance of GES protocols may significantly affect patient management, as results may be unreliable. Using the standardized GES protocol permits interpretation of results in a consistent manner that allows interlaboratory comparisons and fosters acceptance of the test validity by referring clinicians.
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Affiliation(s)
- Dawood Tafti
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Radiology, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas; and
| | | | - M Cory Dearborn
- Department of Radiology, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas; and
| | - Kevin P Banks
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Radiology, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas; and
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3
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Muskus Veitia VM, Hawkins Barnett MC, Gibbons SR, LeMay DL, Jennings SG. An Evaluation of Gastric Emptying Scintigraphy Protocols in Health Care Institutions When Compared with the Society of Nuclear Medicine and Molecular Imaging Procedure Guidelines. J Nucl Med Technol 2024; 52:63-67. [PMID: 38443111 DOI: 10.2967/jnmt.123.267178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/17/2024] [Indexed: 03/07/2024] Open
Abstract
This study aimed to analyze the compliance of health care institutions with the Society of Nuclear Medicine and Molecular Imaging (SNMMI) procedure guidelines for gastric emptying scintigraphy (GES). Methods: A 19-question survey on demographics and the GES protocol was conducted using a Google form. The demographic questions covered position, number of technologists in the department, location, type of health care institution, and number of GES studies per month. The protocol questions included patient preparation, meal preparation, withholding of scheduled medications, radiopharmaceutical type, and radiopharmaceutical dose. The survey was sent to 7 nuclear medicine Facebook groups and a list of clinical affiliates provided by the Indiana University School of Medicine Nuclear Medicine Program. Descriptive statistics were compiled for most questions. A Fisher exact test with a significance level of 0.05 was used to compare the type of health care institution with compliance with the SNMMI GES protocol regarding radiolabeling time, meal preparation, and meal components, as well as to compare the type of health care institution with the number of GES studies performed per institution. Results: In total, 240 people responded to the survey. Most were nonsupervisory nuclear medicine technologists (72%) in nonacademic institutions (72%) and groups with 4 or more technologists (62%). Of the respondents, 72% followed the SNMMI guideline of adding the radiopharmaceutical before cooking, but only 37% followed the meal component guideline. There was no significant association between the type of institution or the number of GES studies and compliance with radiolabeling time or with meal preparation or components. Most respondents asked patients to withhold medications per SNMMI guidelines and used the recommended radiopharmaceutical (99mTc-sulfur colloid, 95%) at the recommended dose (18.5-37 MBq, 84%). Conclusion: Although most respondents followed most aspects of the SNMMI guidelines for GES, more than half did not use the recommended meal of liquid egg whites. Compliance did not vary between academic and nonacademic institutions or between groups performing a large or a small number of GES studies.
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Affiliation(s)
| | | | - Sarah R Gibbons
- Indiana University School of Medicine, Indianapolis, Indiana; and
| | - Deborah L LeMay
- Indiana University School of Medicine, Indianapolis, Indiana; and
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4
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Kuhar S, Seo JH, Pasricha PJ, Mittal R. In silico modelling of the effect of pyloric intervention procedures on gastric flow and emptying in a stomach with gastroparesis. J R Soc Interface 2024; 21:20230567. [PMID: 38263890 PMCID: PMC10824103 DOI: 10.1098/rsif.2023.0567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/02/2024] [Indexed: 01/25/2024] Open
Abstract
Pyloric interventions are surgical procedures employed to increase the gastric emptying rate in gastroparesis patients. In this study, we use an in silico model to investigate the consequences of pyloric intervention on gastric flow and emptying for two phenotypes of gastroparesis: antral hypomotility and decreased gastric tone. The transpyloric pressure gradient predicted by the in silico model, based on viscous fluid flow equations, is compared against in vivo measurements. Both phenotypes exhibit a similar pre-procedural emptying rate reduction, but after pyloric surgery, antral hypomotility case with preserved gastric tone shows significant improvements in emptying rates, up to 131%, accompanied by bile reflux from the duodenum into the stomach. Conversely, severely reduced gastric tone cases exhibited a post-procedural reduction in the net emptying rate due to the relatively larger bile reflux. In cases with a combination of antral hypomotility and reduced gastric tone, post-procedural improvements were observed only when both conditions were mild. Our findings highlight the pivotal role of the relative increase in pyloric orifice diameter in determining post-operative emptying rates. The study suggests a possible explanation for the selective response of patients toward these procedures and underscores the potential of in silico modelling to generate valuable insights to inform gastric surgery.
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Affiliation(s)
- Sharun Kuhar
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Jung-Hee Seo
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | | | - Rajat Mittal
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
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5
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Schop M, Nguyen-Ba H, Jansman AJM, de Vries S, Ellis JL, Bannink A, Gerrits WJJ. SNAPIG: a model to study nutrient digestion and absorption kinetics in growing pigs based on diet and ingredient properties. Animal 2023; 17 Suppl 5:101025. [PMID: 38016827 DOI: 10.1016/j.animal.2023.101025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 11/30/2023] Open
Abstract
Current feed formulation and evaluation practices rely on static values for the nutritional value of feed ingredients and assume additivity. Hereby, the complex interplay among nutrients in the diet and the highly dynamic digestive processes are ignored. Nutrient digestion kinetics and diet × animal interactions should be acknowledged to improve future predictions of the nutritional value of complex diets. Therefore, an in silico nutrient-based mechanistic digestion model for growing pigs was developed: "SNAPIG" (Simulating Nutrient digestion and Absorption kinetics in PIGs). Aiming to predict the rate and extent of nutrient absorption from diets varying in ingredient composition and physicochemical properties, the model represents digestion kinetics of ingested protein, starch, fat, and non-starch polysaccharides, through passage, hydrolysis, absorption, and endogenous secretions of nutrients along the stomach, proximal small intestine, distal small intestine, and caecum + colon. Input variables are nutrient intake and the physicochemical properties (i.e. solubility, and rate and extent of degradability). Data on the rate and extent of starch and protein hydrolysis of different ingredients per digestive segment were derived from in vitro assays. Passage of digesta from the stomach was modelled as a function of feed intake level, dietary nutrient solubility and diet viscosity. Model evaluation included testing against independent data from in vivo studies on nutrient appearance in (portal) blood of growing pigs. When simulating diets varying in physicochemical properties and nutrient source, SNAPIG can explain variation in glucose absorption kinetics (postprandial time of peak, TOP: 20-100 min observed vs 25-98 min predicted), and predict variation in the extent of ileal protein and fat digestion (root mean square prediction errors (RMSPE) = 12 and 16%, disturbance error = 12 and 86%, and concordance correlation coefficient = 0.34 and 0.27). For amino acid absorption, the observed variation in postprandial TOP (61 ± 11 min) was poorly predicted despite accurate mean predictions (58 ± 34 min). Recalibrating protein digestion and amino acid absorption kinetics require data on net-portal nutrient appearance, combined with observations on digestion kinetics, in pigs fed diets varying in ingredient composition. Currently, SNAPIG can be used to forecast the time and extent of nutrient digestion and absorption when simulating diets varying in ingredient and nutrient composition. It enhances our quantitative understanding of nutrient digestion kinetics and identifies knowledge gaps in this field of research. Already useful as research tool, SNAPIG can be coupled with a postabsorptive metabolism model to predict the effects of dietary and feeding-strategies on the pig's growth response.
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Affiliation(s)
- M Schop
- Animal Nutrition Group, Wageningen University & Research, PO BOX 338, 6700 AH Wageningen, the Netherlands.
| | - H Nguyen-Ba
- Wageningen Livestock Research, PO BOX 338, 6700 AH Wageningen, the Netherlands
| | - A J M Jansman
- Wageningen Livestock Research, PO BOX 338, 6700 AH Wageningen, the Netherlands
| | - S de Vries
- Animal Nutrition Group, Wageningen University & Research, PO BOX 338, 6700 AH Wageningen, the Netherlands
| | - J L Ellis
- Centre for Nutrition Modelling, University of Guelph, Ontario N1G 2W1, Canada
| | - A Bannink
- Wageningen Livestock Research, PO BOX 338, 6700 AH Wageningen, the Netherlands
| | - W J J Gerrits
- Animal Nutrition Group, Wageningen University & Research, PO BOX 338, 6700 AH Wageningen, the Netherlands
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6
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Tsume Y. Evaluation and prediction of oral drug absorption and bioequivalence with food-drug interaction. Drug Metab Pharmacokinet 2023; 50:100502. [PMID: 37001300 DOI: 10.1016/j.dmpk.2023.100502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/21/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023]
Abstract
This article reviews the impacts on the in vivo prediction of oral bioavailability (BA) and bioequivalence (BE) based on Biopharmaceutical classification systems (BCS) by the food-drug interaction (food effect) and the gastrointestinal (GI) environmental change. Various in vitro and in silico predictive methodologies have been used to expect the BA and BE of the test oral formulation. Food intake changes the GI physiology and environment, which affect oral drug absorption and its BE evaluation. Even though the pHs and bile acids in the GI tract would have significant influence on drug dissolution and, hence, oral drug absorption, those impacts largely depend on the physicochemical properties of oral medicine, active pharmaceutical ingredients (APIs). BCS class I and III drugs are high soluble drugs in the physiological pH range, food-drug interaction may not affect their BA. On the other hand, BCS class II and IV drugs have pH-dependent solubility, and the more bile acid secretion and the pH changes by food intake might affect their BA. In this report, the GI physiological changes between the fasted and fed states are described and the prediction on the oral drug absorption by food-drug interaction have been introduced.
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7
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Winter F, Schick P, Weitschies W. Bridging the Gap between Food Effects under Clinical Trial Conditions and Real Life: Modeling Delayed Gastric Emptying of Drug Substances and Gastric Content Volume Based on Meal Characteristics. Mol Pharm 2023; 20:1039-1049. [PMID: 36548544 DOI: 10.1021/acs.molpharmaceut.2c00782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Delayed gastric emptying is known to have a major impact on drug absorption. While the test meal recommended by the FDA and EMA to study food effects represents a worst-case scenario, it does not reflect the reality of the patients. Physiologically based pharmacokinetic (PBPK) models could bridge the gap between clinical settings of food effect studies and the diverse nonclinical situations by simulating the effect of meals with different compositions and volumes. A mathematical equation based on a stretched exponential function was reparameterized to describe the gastric emptying process of mixed solid meals. The model was fitted to literature data including the gastric emptying data of 23 meals from 15 studies. Using a multiple linear regression model, we were able to predict the two function parameters from the meal characteristics caloric content and the percentage of calories derived from fat. After implementation into the PBPK software PK-Sim, the model, together with a separate compartment for liquid gastric contents, was compared to commercially available software. The model is able to simulate the gastric emptying of mixed solid meals containing drugs based on specific meal characteristics. A second compartment allows for distribution between liquid and solid components and rapid gastric emptying along the Magenstrasse.
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Affiliation(s)
- Fabian Winter
- Institute of Pharmacy, Department of Biopharmaceutics and Pharmaceutical Technology, University of Greifswald, Greifswald17489, Germany
| | - Philipp Schick
- Institute of Pharmacy, Department of Biopharmaceutics and Pharmaceutical Technology, University of Greifswald, Greifswald17489, Germany
| | - Werner Weitschies
- Institute of Pharmacy, Department of Biopharmaceutics and Pharmaceutical Technology, University of Greifswald, Greifswald17489, Germany
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8
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Digestion of meat proteins in a human-stomach: A CFD simulation study. INNOV FOOD SCI EMERG 2022. [DOI: 10.1016/j.ifset.2022.103252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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9
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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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10
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Bertoli D, Steinkohl E, Mark EB, Brock C, Drewes AM, Frøkjaer JB. Quantification of gastric emptying with magnetic resonance imaging in healthy volunteers: A systematic review. Neurogastroenterol Motil 2022; 34:e14371. [PMID: 35340100 PMCID: PMC10078504 DOI: 10.1111/nmo.14371] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/17/2022] [Accepted: 03/14/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Several magnetic resonance imaging (MRI) protocols have been used to assess gastric emptying (GE) with MRI. This systematic review summarizes the current literature on the topic. The aim was to provide an overview of the available imaging protocols and underline the items that appear most agreed upon and those that deserve further investigation. METHODS According to PRISMA guidelines, two independent reviewers conducted a systematic literature search with a pre-specified strategy in different databases. Peer-reviewed articles that utilized MRI techniques to assess GE in healthy volunteers (HVs) were included. The quality and the outcomes of the studies were reported and analyzed. KEY RESULTS The literature search yielded 30 studies (531 HVs, weighted mean age 27.4, weighted mean body mass index 23.0 kg/m2 ), T2-weighted sequences, balanced turbo field echo, and balanced gradient echo were evenly utilized, with volunteers in the supine position (74% of the studies). After overnight fasting, both liquid (56%) and mixed (44%) meals were equally utilized. Segmentation of the volumes was predominantly performed manually (63%) with a reported mean T50 ranging from 7 to 330 min. CONCLUSIONS & INFERENCES As observed in this systematic review, MRI is a flexible tool for assessing GE. Different protocols were analyzed, showing an equal capacity to assess the GE. However, many items in these protocols still require further investigation to obtain a common standard and increase this assessment quality.
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Affiliation(s)
- Davide Bertoli
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Emily Steinkohl
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Mech-Sense, Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Esben Bolvig Mark
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Mech-Sense, Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Christina Brock
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Asbjørn Mohr Drewes
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jens Brøndum Frøkjaer
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Mech-Sense, Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
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11
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Kuhar S, Lee JH, Seo JH, Pasricha PJ, Mittal R. Effect of stomach motility on food hydrolysis and gastric emptying: Insight from computational models. PHYSICS OF FLUIDS (WOODBURY, N.Y. : 1994) 2022; 34:111909. [PMID: 36407285 PMCID: PMC9667910 DOI: 10.1063/5.0120933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
The peristaltic motion of stomach walls combines with the secretion of digestive enzymes to initiate the process that breaks down food. In this study, the mixing, breakdown, and emptying of a liquid meal containing protein is simulated in a model of a human stomach. In this model, pepsin, the gastric enzyme responsible for protein hydrolysis, is secreted from the proximal region of the stomach walls and allowed to react with the contents of the stomach. The velocities of the retropulsive jet induced by the peristaltic motion, the emptying rate, and the extent of hydrolysis are quantified for a control case as well as for three other cases with reduced motility of the stomach, which may result from conditions such as diabetes mellitus. This study quantifies the effect of stomach motility on the rate of food breakdown and its emptying into the duodenum and we correlate these observations with the mixing in the stomach induced by the wall motion.
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Affiliation(s)
- Sharun Kuhar
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, USA
| | | | | | - Pankaj J Pasricha
- Division of Gastroenterology and Hepatology, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, USA
| | - Rajat Mittal
- Author to whom correspondence should be addressed:
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12
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Liao D, Mark EB, Nedergaard RB, Jensen LR, Bertoli D, Frøkjær JB, Yu D, Zhao J, Brock C, Drewes AM. Indentation of a pressurized silicon stomach model - A non-invasive study of gastric wall stiffness and pressurized gastric content stiffness. J Mech Behav Biomed Mater 2022; 135:105449. [PMID: 36108417 DOI: 10.1016/j.jmbbm.2022.105449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/23/2022] [Accepted: 09/01/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS Evaluation of gastric wall stiffness and intragastric pressure is essential for detailed assessments of gastric accommodation. However, non-invasive assessments are needed for large scale clinical studies and none of the existing methods takes abdominal wall effect into the calculation. This study aimed to assess gastric wall stiffness and gastric content stiffness as a proxy for intragastric pressure using novel mechanical modeling and non-invasive indentation tests on a silicon stomach model. METHODS A silicon stomach model (scaling 1:1 with the human stomach) was indented using a pressure algometer at intragastric pressures from 0 to 0.8 kPa. Wall thicknesses and luminal cross-sectional areas along the stomach were measured with ultrasound images. The gastric wall stiffness was compared between measurements from tensile tests on strips cut from the silicon stomach and estimations from a shell indentation model. The pressurized gastric content stiffness was predicted from a bonded two-layer axisymmetric half-space indentation model. RESULTS The gastric wall stiffness estimated from the shell indentation model showed no difference to measurements from the mechanical tests on the cutting strips (p = 0.14). The predicted gastric content stiffness was strongly associated with the intragastric pressure (r > 0.83, p < 0.001). CONCLUSIONS The mechanical model developed in this study can simultaneously predict the gastric wall stiffness and the pressurized gastric content stiffness. In future studies, the method can be applied to reveal intragastric pressure conditions non-invasively via the pressurized gastric content stiffness during gastric accommodation and emptying such as with magnetic resonance imaging.
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Affiliation(s)
- Donghua Liao
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.
| | - Esben Bolvig Mark
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.
| | - Rasmus Bach Nedergaard
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.
| | | | - Davide Bertoli
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.
| | - Jens Brøndum Frøkjær
- Mech-Sense, Department of Radiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Donghong Yu
- Department of Chemistry and Bioscience, Aalborg University, Aalborg, Denmark.
| | - Jingbo Zhao
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; LBP (Chongqing) Pathological Diagnosis Center, Chongqing, China.
| | - Christina Brock
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Steno Diabetes Center North Denmark, Aalborg, Denmark.
| | - Asbjørn Mohr Drewes
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Steno Diabetes Center North Denmark, Aalborg, Denmark.
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13
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Jensen MM, Pedersen H, Clemmensen KKB, Wegeberg AM, Jensen NW, Quist JS, Færch K, Brock C. Human Gastrointestinal Transit and Hormonal Response to Different Meal Types: A Randomized Crossover Study. J Nutr 2022; 152:1358-1369. [PMID: 35020932 DOI: 10.1093/jn/nxac002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/02/2021] [Accepted: 01/04/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The wireless motility capsule (WMC) technique is a noninvasive and radiation-free method for measuring regional and whole gut transit in response to ingestion of a granola bar (SmartBar) or an eggbeater meal. The WMC has the potential to measure gastrointestinal transit in metabolic research as part of a standardized mixed meal tolerance test. OBJECTIVES To evaluate gastrointestinal transit with the WMC and postprandial plasma/serum concentrations of metabolites and gastrointestinal hormones as well as subjective appetite following ingestion of a SmartBar compared with a standardized mixed meal. METHODS Fourteen healthy participants [3 men, median (IQR) age 53.8 (45.8; 64.50) y, body weight 63.9 (59.9; 69.7) kg, BMI 23.1 (21.8; 23.9) kg/m2] completed a 2-d crossover study. Following ingestion of either a SmartBar (260 kcal, 7 energy percent (E%) fat, 74E% carbohydrate, and 19E% protein) or a standardized mixed meal (498 kcal, 34E% fat, 49E% carbohydrate, and 17E% protein), participants swallowed the WMC. Blood samples were drawn in the fasted state and postprandially for analyses of gastrointestinal hormones and metabolites. The primary outcome was difference in gastric emptying time between the 2 test days. Wilcoxon signed rank tests were used to test differences between test days. RESULTS Median (IQR) gastric emptying time was 98.0 (70.0; 113.0) min longer (P = 0.001) and incremental area under the curve of triglyceride, glucose-dependent insulinotropic polypeptide, and peptide YY were 40 mmol/L × min, 45.7%, and 63.7% greater after the standardized mixed meal compared with the SmartBar (all P < 0.001). CONCLUSIONS The WMC can be used in combination with a standardized mixed meal for evaluation of gastrointestinal transit in healthy men and women. Gastric emptying time was prolonged in response to the standardized mixed meal whereas transit times of the small bowel, colon, and whole gut did not differ between the test meals.
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Affiliation(s)
- Marie Møller Jensen
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Clinical Research, Herlev, Denmark
| | - Hanne Pedersen
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Clinical Research, Herlev, Denmark.,iMotions A/S, Frederiksberg, Denmark
| | | | - Anne-Marie Wegeberg
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Nina Wittorff Jensen
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Clinical Research, Herlev, Denmark
| | - Jonas Salling Quist
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Clinical Research, Herlev, Denmark
| | - Kristine Færch
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Clinical Research, Herlev, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christina Brock
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Steno Diabetes Center North Jutland, Aalborg, Denmark
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14
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Esmaeili M, Ajami M, Barati M, Javanmardi F, Houshiarrad A, Mousavi Khaneghah A. The significance and potential of functional food ingredients for control appetite and food intake. Food Sci Nutr 2022; 10:1602-1612. [PMID: 35592279 PMCID: PMC9094468 DOI: 10.1002/fsn3.2783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/23/2022] [Accepted: 01/29/2022] [Indexed: 12/18/2022] Open
Abstract
Dramatically rising global levels of obesity have raised consumers’ commercial and public health interest in foods that may help control appetite and weight. The satiety cascade consists of sensory, cognitive, physical, and hormonal events following food intake, preventing overeating, and the desire to eat for a long time. Functional foods can be one of the most influential factors in reducing appetite as long as effective ingredients, such as fiber and protein, are used to design these products. Also, functional foods should be designed to reduce appetite at different levels of oral processing, stomach, small intestine, and large intestine by various mechanisms. Therefore, the satiety power of functional foods depends on the type of ingredients and their amount. Because each compound has a different mechanism of action, it is recommended to use different compounds to influence satiety in functional foods.
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Affiliation(s)
- Mina Esmaeili
- Department of Nutrition Research National Nutrition and Food Technology Research Institute/School of Nutrition Sciences and Food Technology Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Marjan Ajami
- Department of Food and Nutrition Policy and Planning National Nutrition and Food Technology Research Institute School of Nutrition Sciences and Food Technology Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Meisam Barati
- Department of Cellular and Molecular Nutrition Faculty of Nutrition and Food Technology National Nutrition and Food Technology Research Institute Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Fardin Javanmardi
- Department of Food Science and Technology National Nutrition and Food Technology Research Institute/School of Nutrition Sciences and Food Technology Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Anahita Houshiarrad
- Department of Nutrition Research National Nutrition and Food Technology Research Institute/School of Nutrition Sciences and Food Technology Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Amin Mousavi Khaneghah
- Department of Food Science and Nutrition Faculty of Food Engineering University of Campinas (UNICAMP) Campinas Brazil
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15
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Pilot Double-Blind Randomised Controlled Trial: Effects of Jejunal Nutrition on Postprandial Distress in Diabetic Gastropathy (J4G Trial). Nutrients 2022; 14:nu14071321. [PMID: 35405934 PMCID: PMC9000869 DOI: 10.3390/nu14071321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/13/2022] [Accepted: 03/18/2022] [Indexed: 12/22/2022] Open
Abstract
Nausea, vomiting and abdominal pain in diabetic patients are often attributed to diabetic gastropathy (DG). Post-pyloric (“jejunal”) enteral nutrition (JN) may improve nutrition and glycaemia in difficult cases. The acute effects of JN on postprandial symptoms and gastric function in DG patients has not been studied. DG patients with moderate to severe symptoms (gastroparesis cardinal symptom index (GCSI) > 27), diabetic controls without symptoms (DC; GCSI < 14) and healthy controls (HV) were entered into a randomized, double blind controlled trial. JN with liquid nutrient (2 kcal/min) or water was infused for 60 min prior to ingestion of a standardized mixed solid/liquid test meal. Outcomes included postprandial symptoms and effects on gastrointestinal (GI)−peptide hormones and gastric emptying (GE) assessed by magnetic resonance imaging (MRI). Nine DG, nine DC and twelve HV were recruited. DG patients reported more symptoms after meals than other groups (p < 0.05). Post-prandial symptoms were reduced after JN in DG patients (p < 0.01). GE was more rapid after JN in DG and DC patients (p < 0.05). JN induced a GI−peptide response in all subjects; however, this was less pronounced in diabetic groups. JN has beneficial effects on DG patients’ symptoms after a meal. The mechanism is not primarily mediated by effects on GE, but appears to involve other aspects of GI function, including visceral sensitivity.
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16
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Lex TR, Rodriguez JD, Zhang L, Jiang W, Gao Z. Development of In Vitro Dissolution Testing Methods to Simulate Fed Conditions for Immediate Release Solid Oral Dosage Forms. AAPS J 2022; 24:40. [PMID: 35277760 DOI: 10.1208/s12248-022-00690-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 02/10/2022] [Indexed: 11/30/2022] Open
Abstract
In vitro dissolution testing is widely used to mimic and predict in vivo performance of oral drug products in the gastrointestinal (GI) tract. This literature review assesses the current in vitro dissolution methodologies being employed to simulate and predict in vivo drug dissolution under fasted and fed conditions, with emphasis on immediate release (IR) solid oral dosage forms. Notable human GI physiological conditions under fasted and fed states have been reviewed and summarized. Literature results showed that dissolution media, mechanical forces, and transit times are key dissolution test parameters for simulating specific postprandial conditions. A number of biorelevant systems, including the fed stomach model (FSM), GastroDuo device, dynamic gastric model (DGM), simulated gastrointestinal tract models (TIM), and the human gastric simulator (HGS), have been developed to mimic the postprandial state of the stomach. While these models have assisted in expanding physiological relevance of in vitro dissolution tests, in general, these models lack the ability to fully replicate physiological conditions/processes. Furthermore, the translatability of in vitro data to an in vivo system remains challenging. Additionally, physiologically based pharmacokinetic (PBPK) modeling has been employed to evaluate the effect of food on drug bioavailability and bioequivalence. Here, we assess the current status of in vitro dissolution methodologies and absorption PBPK modeling approaches to identify knowledge gaps and facilitate further development of in vitro dissolution methods that factor in fasted and fed states. Prediction of in vivo drug performance under fasted and fed conditions via in vitro dissolution testing and modeling may potentially help efforts in harmonizing global regulatory recommendations regarding in vivo fasted and fed bioequivalence studies for solid oral IR products.
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Affiliation(s)
- Timothy R Lex
- Division of Complex Drug Analysis, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, St. Louis, Missouri, 63110, USA
| | - Jason D Rodriguez
- Division of Complex Drug Analysis, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, St. Louis, Missouri, 63110, USA
| | - Lei Zhang
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, 20993, USA
| | - Wenlei Jiang
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland, 20993, USA.
| | - Zongming Gao
- Division of Complex Drug Analysis, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, St. Louis, Missouri, 63110, USA.
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17
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Lu KH, Liu Z, Jaffey D, Wo JM, Mosier KM, Cao J, Wang X, Powley TL. Automatic assessment of human gastric motility and emptying from dynamic 3D magnetic resonance imaging. Neurogastroenterol Motil 2022; 34:e14239. [PMID: 34431171 DOI: 10.1111/nmo.14239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 06/27/2021] [Accepted: 07/13/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Time-sequenced magnetic resonance imaging (MRI) of the stomach is an emerging technique for non-invasive assessment of gastric emptying and motility. However, an automated and systematic image processing pipeline for analyzing dynamic 3D (ie, 4D) gastric MRI data has not been established. This study uses an MRI protocol for imaging the stomach with high spatiotemporal resolution and provides a pipeline for assessing gastric emptying and motility. METHODS Diet contrast-enhanced MRI images were acquired from seventeen healthy humans after they consumed a naturalistic contrast meal. An automated image processing pipeline was developed to correct for respiratory motion, to segment and compartmentalize the lumen-enhanced stomach, to quantify total gastric and compartmental emptying, and to compute and visualize gastric motility on the luminal surface of the stomach. KEY RESULTS The gastric segmentation reached an accuracy of 91.10 ± 0.43% with the Type-I error and Type-II error being 0.11 ± 0.01% and 0.22 ± 0.01%, respectively. Gastric volume decreased 34.64 ± 2.8% over 1 h where the emptying followed a linear-exponential pattern. The gastric motility showed peristaltic patterns with a median = 4 wave fronts (range 3-6) and a mean frequency of 3.09 ± 0.07 cycles per minute. Further, the contractile amplitude was stronger in the antrum than in the corpus (antrum vs. corpus: 5.18 ± 0.24 vs. 3.30 ± 0.16 mm; p < 0.001). CONCLUSIONS & INFERENCES Our analysis pipeline can process dynamic 3D MRI images and produce personalized profiles of gastric motility and emptying. It will facilitate the application of MRI for monitoring gastric dynamics in research and clinical settings.
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Affiliation(s)
- Kun-Han Lu
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
- Purdue Institute for Integrative Neuroscience, Purdue University, West Lafayette, Indiana, USA
| | - Zhongming Liu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, Michigan, USA
| | - Deborah Jaffey
- Department of Psychological Sciences, Purdue University, West Lafayette, Indiana, USA
| | - John M Wo
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Jiayue Cao
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Xiaokai Wang
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Terry L Powley
- Purdue Institute for Integrative Neuroscience, Purdue University, West Lafayette, Indiana, USA
- Department of Psychological Sciences, Purdue University, West Lafayette, Indiana, USA
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18
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Febo-Rodriguez L, Chumpitazi BP, Sher AC, Shulman RJ. Gastric accommodation: Physiology, diagnostic modalities, clinical relevance, and therapies. Neurogastroenterol Motil 2021; 33:e14213. [PMID: 34337824 DOI: 10.1111/nmo.14213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 05/09/2021] [Accepted: 05/31/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Gastric accommodation is an essential gastric motor function which occurs following ingestion of a meal. Impaired gastric fundic accommodation (IFA) is associated with dyspeptic symptoms. Gastric accommodation is mediated by the vagal pathway with several important physiologic factors such as duodenal nutrient feedback playing a significant role. IFA has been described as a pathophysiologic factor in several gastrointestinal disorders including functional dyspepsia, diabetic gastropathy, post-Nissen fundoplication, postsurgical gastrectomy, and rumination syndrome. Modalities for gastric accommodation assessment include gastric barostat, intragastric meal distribution via scintigraphy, drinking tests (eg, water load), SPECT, MRI, 2D and 3D ultrasound, and intragastric high-resolution manometry. Several treatment options including sumatriptan, buspirone, tandospirone, ondansetron, and acotiamide may improve symptoms by increasing post-meal gastric volume. PURPOSE Our aim is to provide an overview of the physiology, diagnostic modalities, and therapies for IFA. A literature search was conducted on PubMed, Google Scholar, and other sources to identify relevant studies available until December 2020. Gastric accommodation is an important gastric motor function which if impaired, is associated with several upper gastrointestinal disorders. There are an increasing number of gastric accommodation testing modalities; however, each has facets which warrant consideration. Evidence regarding potentially effective therapies for IFA is growing.
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Affiliation(s)
- Liz Febo-Rodriguez
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Miami, Miami, Florida, USA
| | - Bruno P Chumpitazi
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine, Houston, Texas, USA.,United States Department of Agriculture, Agriculture Research Services, Children's Nutrition Research Center, Houston, Texas, USA
| | - Andrew C Sher
- Department of Pediatric Radiology, Texas Children's Hospital, Houston, Texas, USA
| | - Robert J Shulman
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine, Houston, Texas, USA.,United States Department of Agriculture, Agriculture Research Services, Children's Nutrition Research Center, Houston, Texas, USA
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19
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Sarhan K, Hasanin A, Melad R, Fouad R, Elhadi H, Elsherbeeny M, Arafa A, Mostafa M. Evaluation of gastric contents using ultrasound in full-term pregnant women fasted for 8 h: a prospective observational study. J Anesth 2021; 36:137-142. [PMID: 34773139 DOI: 10.1007/s00540-021-03019-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND We aimed to evaluate the gastric volume and contents after an 8-h fasting period in full-term, non-laboring, pregnant women following a standardized meal. METHODS In this prospective observational study, we included full-term pregnant women scheduled for elective cesarean delivery. The participants were instructed to fast after a standardized meal (apple juice, bread, and cheese). Participants were scanned in the semi-recumbent and right-lateral positions 8 h after the standardized meal. The primary outcome was the proportion of patients with gastric volume > 1.5 mL kg-1 calculated by two equations. Secondary outcomes included the antral cross-sectional area and gastric volume. Data are expressed as frequency (%, 95% confidence interval [CI]), mean ± standard deviation (95% CI of the mean), or median (quartiles) as appropriate. RESULTS Forty-one women were available for the final analysis. For the primary outcome, one participant (2.4%, 95% CI of 0.06 to 12.8%) had gastric volume > 1.5 mL kg-1, and none had solids in the antrum. For the secondary outcomes, the mean (95% CI of the mean) of the antral cross-sectional area was 2.11 ± 0.72 (1.88 to 2.34) cm2 and 4.08 ± 1.80 (3.51 to 4.65) cm2 during the semi-recumbent and right-lateral position, respectively. The median (quartiles) gastric volume was 0.53 (0.32, 0.66) mL kg-1 and 0.33 (0.13, 0.52) mL kg-1 as estimated by Perlas et al. and Roukhomovsky et al. equations, respectively. CONCLUSION After 8-h fasting following a standardized meal, full-term pregnant non-laboring women are less likely to have a high residual gastric volume.
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Affiliation(s)
- Khaled Sarhan
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, 01 Elsarayah Street, Elmanyal, Cairo, 11559, Egypt
| | - Ahmed Hasanin
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, 01 Elsarayah Street, Elmanyal, Cairo, 11559, Egypt
| | - Ramy Melad
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, 01 Elsarayah Street, Elmanyal, Cairo, 11559, Egypt
| | - Reham Fouad
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Hany Elhadi
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, 01 Elsarayah Street, Elmanyal, Cairo, 11559, Egypt
| | - Mona Elsherbeeny
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, 01 Elsarayah Street, Elmanyal, Cairo, 11559, Egypt
| | - Amany Arafa
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, 01 Elsarayah Street, Elmanyal, Cairo, 11559, Egypt
| | - Maha Mostafa
- Department of Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, 01 Elsarayah Street, Elmanyal, Cairo, 11559, Egypt.
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20
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Sclocco R, Nguyen C, Staley R, Fisher H, Mendez A, Velez C, Kettner NW, Kuo B, Napadow V. Non-uniform gastric wall kinematics revealed by 4D Cine magnetic resonance imaging in humans. Neurogastroenterol Motil 2021; 33:e14146. [PMID: 33797166 PMCID: PMC10315015 DOI: 10.1111/nmo.14146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 02/24/2021] [Accepted: 03/16/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Assessment of gastric function in humans has relied on modalities with varying degrees of invasiveness, which are usually limited to the evaluation of single aspects of gastric function, thus requiring patients to undergo a number of often invasive tests for a full clinical understanding. Therefore, the development of a non-invasive tool able to concurrently assess multiple aspects of gastric function is highly desirable for both research and clinical assessments of gastrointestinal (GI) function. Recently, technological advances in magnetic resonance imaging (MRI) have provided new tools for dynamic (or "cine") body imaging. Such approaches can be extended to GI applications. METHODS In the present work, we propose a non-invasive assessment of gastric function using a four-dimensional (4D, volumetric cine imaging), free-breathing MRI sequence with gadolinium-free contrast enhancement achieved through a food-based meal. In healthy subjects, we successfully estimated multiple parameters describing gastric emptying, motility, and peristalsis propagation patterns. KEY RESULTS Our data demonstrated non-uniform kinematics of the gastric wall during peristaltic contraction, highlighting the importance of using volumetric data to derive motility measures. CONCLUSIONS & INFERENCES MRI has the potential of becoming an important clinical and gastric physiology research tool, providing objective parameters for the evaluation of impaired gastric function.
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Affiliation(s)
- Roberta Sclocco
- Department of Radiology, Harvard Medical School, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Gastroenterology, Harvard Medical School, Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Radiology, Logan University, Chesterfield, MO, USA
| | - Christopher Nguyen
- Department of Radiology, Harvard Medical School, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Rowan Staley
- Department of Radiology, Harvard Medical School, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Gastroenterology, Harvard Medical School, Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA, USA
| | - Harrison Fisher
- Department of Radiology, Harvard Medical School, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - April Mendez
- Department of Gastroenterology, Harvard Medical School, Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher Velez
- Department of Gastroenterology, Harvard Medical School, Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA, USA
| | | | - Braden Kuo
- Department of Gastroenterology, Harvard Medical School, Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA, USA
| | - Vitaly Napadow
- Department of Radiology, Harvard Medical School, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Radiology, Logan University, Chesterfield, MO, USA
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21
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Goelen N, Doperé G, Byloos K, Ghysels S, Putzeys G, Vandecaveye V, Morales J, Van Huffel S, Tack J, Janssen P. Gastric accumulation of enteral nutrition reduces pressure changes induced by phasic contractility in an isovolumetric intragastric balloon. Neurogastroenterol Motil 2021; 33:e14088. [PMID: 33534195 DOI: 10.1111/nmo.14088] [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: 06/26/2020] [Revised: 12/15/2020] [Accepted: 01/05/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND An isovolumetric intragastric balloon to continuously measure gastric phasic contractility was recently developed by us. We aimed to investigate the readout of this technique in relation to gastric content and gastric emptying. METHODS In this crossover investigation, the VIPUNTM Gastric Monitoring System, which comprises a double lumen nasogastric feeding tube with integrated intragastric balloon, was used to assess phasic gastric contractility by interpretation of the pressure in an isovolumetric balloon in 10 healthy subjects. Balloon pressure was recorded in fasted state, during a 2-hour intragastric nutrient infusion (1 kcal/ml at 25, 75, or 250 ml/h) and 4 hours post-infusion, and quantified as Gastric Balloon Motility Index (GBMI), ranging from 0 (no contractility) to 1 (maximal contractility). Gastric accumulation was quantified with magnetic resonance imaging and gastric emptying with a13 C-breath test. Results are expressed as mean(SD). KEY RESULTS GBMI was significantly lower during infusion at 250 ml/h compared to baseline (0.13(0.05) versus 0.46(0.12)) and compared to infusion at 25 (0.54(0.21)) and 75 ml/h (0.43(0.20)), all P < 0.005. Gastric content volume was larger after infusion at 250 versus 75 ml/h (P < 0.001). Half-emptying time and accumulation were both negatively correlated with postprandial contractility. Postprandial GBMI was significantly lower when GCV>0 ml compared to when the stomach was empty. CONCLUSIONS AND INFERENCES Enteral nutrition dose-dependently decreased the contractility readout. This decrease was linked to gastric accumulation of enteral nutrition.
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Affiliation(s)
- Nick Goelen
- Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
| | - Glynnis Doperé
- Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
| | - Kris Byloos
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | - Stefan Ghysels
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | - Guido Putzeys
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | | | - John Morales
- Department of Electrical Engineering ESAT, Signal Processing and Data Analytics, STADIUS Center for Dynamical Systems, KU Leuven, Leuven, Belgium
| | - Sabine Van Huffel
- Department of Electrical Engineering ESAT, Signal Processing and Data Analytics, STADIUS Center for Dynamical Systems, KU Leuven, Leuven, Belgium
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
| | - Pieter Janssen
- Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium.,VIPUN Medical, Mechelen, Belgium
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22
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Geysen H, Michielsen S, Rommel N, Vanuytsel T, Tack J, Pauwels A. The gastro-sphincteric pressure gradient: A new parameter to diagnose a rumination episode. Neurogastroenterol Motil 2021; 33:e14068. [PMID: 33350555 DOI: 10.1111/nmo.14068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/18/2020] [Accepted: 12/01/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Rumination is defined as the repetitive, effortless regurgitation of recently ingested food into the mouth. These episodes are preceded by a rise in intragastric pressure (IGP) and mainly occur postprandially. IGP peaks >30 mmHg have been proposed as a cutoff to differentiate rumination from reflux events. In clinical practice, we observed that this cutoff, which does not consider esophagogastric junction (EGJ) resistance, is not always reached. METHODS We studied 27 patients with rumination syndrome [age: 43.6, 59% female] and 28 gastro-esophageal reflux disease patients [age: 45.9, 54% female]. For each rumination episode, reflux event, transient lower esophageal sphincter relaxation (TLESR), or straining without regurgitation, the following parameters were registered: maximal IGP, IGP, and EGJ pressure preceding the respective episodes. We also quantified the gastro-sphincteric pressure gradient (GSPG) prior to the respective episodes. KEY RESULTS Five reflux episodes were characterized by a maximal IGP >30 mmHg. In 28% of the rumination episodes, the IGP peak did not exceed 30 mmHg. Median GSPG was positive for rumination episodes and significantly higher compared with TLESRs, reflux episodes, and straining without regurgitation (7 [3-13] vs. 0 [-1-0] vs. 0 [-1-0] vs. -9 [-13--2]; p < 0.0001). CONCLUSIONS & INTERFERENCES Applying the proposed cutoff of 30 mmHg, 28% of the rumination episodes were missed. We found that the GSPG differentiates between rumination (positive GSPG), TLESRs and reflux events (GSPG around 0), and straining without regurgitation (negative GSPG). We propose a GSPG value ≥2 mmHg to distinguish rumination from reflux episodes, TLESRs, and straining without regurgitation.
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Affiliation(s)
- Hannelore Geysen
- Translational Research Center for Gastrointestinal Disease, KU Leuven, Leuven, Belgium
| | - Siebe Michielsen
- Translational Research Center for Gastrointestinal Disease, KU Leuven, Leuven, Belgium
| | - Nathalie Rommel
- Translational Research Center for Gastrointestinal Disease, KU Leuven, Leuven, Belgium.,ExpORL Department of Neurosciences, Deglutology, KU Leuven, Leuven, Belgium
| | - Tim Vanuytsel
- Translational Research Center for Gastrointestinal Disease, KU Leuven, Leuven, Belgium.,Department of Gastroenterology, Neurogastroenterology and Motility, University Hospitals, Leuven, Belgium
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disease, KU Leuven, Leuven, Belgium.,Department of Gastroenterology, Neurogastroenterology and Motility, University Hospitals, Leuven, Belgium
| | - Ans Pauwels
- Translational Research Center for Gastrointestinal Disease, KU Leuven, Leuven, Belgium
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23
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Goelen N, Janssen P, Ripken D, van Horssen P, Byloos K, Ghysels S, Putzeys G, Hofman Z, Vandecaveye V, Tack J. Effect of protein composition of enteral formula on gastric content volume during continuous feeding: A randomized controlled cross-over study in healthy adults. Clin Nutr 2021; 40:2663-2672. [PMID: 33933732 DOI: 10.1016/j.clnu.2021.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/18/2021] [Accepted: 03/12/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND & AIMS Enteral nutrition with polymeric intact protein formula is the preferred medical nutrition strategy in critically ill patients when oral intake is insufficient. Enteral nutrition formulas are often rich in casein protein, which has coagulating properties. Coagulation in the stomach impedes gastric emptying and might result in high gastric residual volumes which are a clinical sign of gastrointestinal intolerance and a major reason to decrease or to discontinue enteral feeding. In this study the impact of protein composition of enteral formula on gastric content volume (GCV) during and after continuous feeding was tested in healthy volunteers in whom gastrointestinal conditions of critically ill patients were mimicked. METHODS An enteral formula including 4 proteins (P4) with non-coagulating properties was compared to a casein-dominant formula (Cas) with coagulating properties. Esomeprazole and codeine were administered to mimic stress ulcer prophylaxis and induce gastroduodenal motor dysfunction, both being hallmarks of critically ill patients. GCV was measured with magnetic resonance imaging during and after continuous enteral feeding (100 mL/h for 4h) in a randomized single-center cross-over study. Results are provided as mean (SD). Significance level of p < 0.05 was applied. RESULTS Twenty subjects completed the study (14 women, 6 men, 25.8 (4.6) years old, BMI: 22.5 (1.5) kg/m2). The GCV as change from baseline at T = 240 (primary endpoint) did not differ between study products (P4: 124.3 (83.4) vs. Cas: 137.1 (102.0) mL, 95% CI: -57.4, 27.0, p = 0.457). During feeding and after cessation of feeding, the area under the GCV-curve (AUC0-360 GCV) for P4 and Cas was 44631.1 (15546.1) and 52822.2 (19686.1) mL∗min, respectively (p = 0.061). During feeding the GCV was lower at T = 180 min (175.4 (64.8) vs. 205.2 (75.4) mL, p = 0.038) and after cessation of feeding at T = 300 min (81.3 (71.1) vs. 116.3 (84.3) mL, p = 0.004) and T = 330 min (39.9 (53.9) vs. 73.6 (81.1) mL, p = 0.031). With P4 it took less time to reach half of the GCV at T = 240 min compared to Cas (52.8 (27.6) vs. 65.4 (29.9) min, p = 0.020). CONCLUSIONS In this study in which healthy volunteers received esomeprazole and codeine to mimic gastrointestinal conditions of critically ill patients, observations of secondary endpoints suggest faster gastric emptying with P4 compared to Cas, and less gastric accumulation, possibly due to the non-coagulating properties of the P4 protein blend. Considering the small effect and the possible clinical relevance of reduced intragastric accumulation of enteral nutrition, the potential impact of protein coagulation should be further investigated in relevant study populations. Registered under Netherlands Trial Register identifier no. NTR6423.
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Affiliation(s)
- Nick Goelen
- Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
| | - Pieter Janssen
- Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
| | - Dina Ripken
- Danone Nutricia Research, Specialized Nutrition, Utrecht, the Netherlands
| | - Peter van Horssen
- Danone Nutricia Research, Specialized Nutrition, Utrecht, the Netherlands
| | - Kris Byloos
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | - Stefan Ghysels
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | - Guido Putzeys
- Department of Radiology, University Hospital Leuven, Leuven, Belgium
| | - Zandrie Hofman
- Danone Nutricia Research, Specialized Nutrition, Utrecht, the Netherlands
| | | | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium.
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24
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Differential gastric emptiness according to preoperative stomach position in neurological impaired patients who underwent laparoscopic fundoplication and gastrostomy. Surg Today 2021; 51:1918-1923. [PMID: 33786644 DOI: 10.1007/s00595-021-02274-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE We sometimes experienced prolonged delayed gastric emptying (DGE) in neurologically impaired patients undergoing laparoscopic fundoplication and gastrostomy. We explored the difference in the DGE rate according to the preoperative stomach position. METHODS Thirty-two neurological impaired patients who underwent laparoscopic fundoplication and gastrostomy between 2015 and 2019 were classified into two groups based on stomach position: non-elevated stomach position (NESP) and elevated stomach position (ESP). Patients' characteristics, operative result and postoperative gastric emptying were reviewed. RESULTS The 11 ESP patients were significantly older than the 21 NESP patients (p < 0.05). The ESP patients had a significantly heavier body weight (BW) than the NESP patients (p < 0.05). The time taken (days) to reduce gastric drainage (days, below BW × 10 ml) in the NESP (4.3 ± 3.6) was significantly longer than that of ESP (1.3 ± 1.6) (p < 0.05). The time taken (days) to achieve full enteral nutrition in the NESP (14.1 ± 8.9) was significantly longer than that of the ESP patients (8.8 ± 3.1) (p < 0.05). CONCLUSION Elevated stomach position (ESP) patients archived full enteral nutrition earlier than NESP patients after laparoscopic fundoplication and gastrostomy. Stomach position correction might, therefore, be involved in the incidence of DGE.
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25
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Joshi Y, Dhamija S. Randomized Control Clinical Trial of Overnight Fasting to Clear Fluid Feeding 2 Hours Prior Anaesthesia and Surgery. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02369-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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26
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Raoufi N, Ye A, Han J. New insights into in vivo gastroduodenal digestion of oil-in-water emulsions: gastric stability and in vitro digestion modeling. Crit Rev Food Sci Nutr 2021; 62:3723-3737. [PMID: 33432823 DOI: 10.1080/10408398.2020.1868396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In this paper, effect of emulsion stability on gastroduodenal emptying/secretion was reviewed and differentiated. Moreover, novel perspectives on physiology of gastric lumen, duodenum, and gall bladder were achieved using mathematical models, being useful for designing artificial digestive systems. In this regard, numerical data for dynamic gastric emptying/secretion were offered for gastric-stable and gastric-unstable emulsion intakes. It was shown that alterations in human gastric and duodenal volume follow, respectively, linear and sinusoidal curves, with high correlation coefficients (r2 > 0.93). For both emulsions, about 30-40 mL ingesta discharged rapidly from stomach upon ingestion; However, further gastric emptying was regulated for the rest of digestion period, so that 0.1 mL/min oil was passing through duodenum. Intragastric evacuation of both emulsions started with a lag phase during which stomach stored secretions incrementally by slow gastric discharge. Lag phase ended with fat layering, when emptying considerably enhanced. This reduction was gradual for stable emulsion while unstable emulsion experienced a rapid emptying before slow declining trend. Along with initial gastric emptying, 87% of gallbladder content discharged into duodenum, prolonged up to the gradual reduction phase of stomach. Supplementary investigations are needed to quantify gastroduodenal secretions, particularly pepsin and pancreas in response to emulsion ingesta.
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Affiliation(s)
- Nassim Raoufi
- Department of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, PR China
| | - Aiqian Ye
- Riddet Institute, Massey University, Palmerston North, New Zealand
| | - Jianzhong Han
- Department of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, PR China
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27
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Loisios-Konstantinidis I, Dressman J. Physiologically Based Pharmacokinetic/Pharmacodynamic Modeling to Support Waivers of In Vivo Clinical Studies: Current Status, Challenges, and Opportunities. Mol Pharm 2020; 18:1-17. [PMID: 33320002 DOI: 10.1021/acs.molpharmaceut.0c00903] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Physiologically based pharmacokinetic/pharmacodynamic (PBPK/PD) modeling has been extensively applied to quantitatively translate in vitro data, predict the in vivo performance, and ultimately support waivers of in vivo clinical studies. In the area of biopharmaceutics and within the context of model-informed drug discovery and development (MID3), there is a rapidly growing interest in applying verified and validated mechanistic PBPK models to waive in vivo clinical studies. However, the regulatory acceptance of PBPK analyses for biopharmaceutics and oral drug absorption applications, which is also referred to variously as "PBPK absorption modeling" [Zhang et al. CPT: Pharmacometrics Syst. Pharmacol. 2017, 6, 492], "physiologically based absorption modeling", or "physiologically based biopharmaceutics modeling" (PBBM), remains rather low [Kesisoglou et al. J. Pharm. Sci. 2016, 105, 2723] [Heimbach et al. AAPS J. 2019, 21, 29]. Despite considerable progress in the understanding of gastrointestinal (GI) physiology, in vitro biopharmaceutic and in silico tools, PBPK models for oral absorption often suffer from an incomplete understanding of the physiology, overparameterization, and insufficient model validation and/or platform verification, all of which can represent limitations to their translatability and predictive performance. The complex interactions of drug substances and (bioenabling) formulations with the highly dynamic and heterogeneous environment of the GI tract in different age, ethnic, and genetic groups as well as disease states have not been yet fully elucidated, and they deserve further research. Along with advancements in the understanding of GI physiology and refinement of current or development of fully mechanistic in silico tools, we strongly believe that harmonization, interdisciplinary interaction, and enhancement of the translational link between in vitro, in silico, and in vivo will determine the future of PBBM. This Perspective provides an overview of the current status of PBBM, reflects on challenges and knowledge gaps, and discusses future opportunities around PBPK/PD models for oral absorption of small and large molecules to waive in vivo clinical studies.
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Affiliation(s)
| | - Jennifer Dressman
- Institute of Pharmaceutical Technology, Goethe University, Frankfurt am Main 60438, Germany.,Fraunhofer Institute of Translational Pharmacology and Medicine (ITMP), Carl-von-Noorden Platz 9, Frankfurt am Main 60438, Germany
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28
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Krishnasamy S, Lomer MCE, Marciani L, Hoad CL, Pritchard SE, Paul J, Gowland PA, Spiller RC. Processing Apples to Puree or Juice Speeds Gastric Emptying and Reduces Postprandial Intestinal Volumes and Satiety in Healthy Adults. J Nutr 2020; 150:2890-2899. [PMID: 32805050 DOI: 10.1093/jn/nxaa191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/16/2020] [Accepted: 06/12/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Whole apples produce greater satiety than processed apples, but the underlying mechanisms remain unclear. OBJECTIVE Our aim was to assess the intragastric processing of apple preparations and the associated small and large bowel contents using MRI. METHODS An open label, 3-way crossover, randomized, controlled trial. Eighteen healthy adults (mean ± SD age, 25 ± 4 y; BMI, 22.7 ± 3.5 kg/m2) underwent serial MRI scans on 3 occasions separated by 7 d, after consumption of isocaloric (178 kcal) portions of either whole apples, apple puree, or apple juice. Gastric emptying, small bowel water content (SBWC; primary endpoint), were measured at baseline and at 45 min intervals (0-270 min) postmeal ingestion. Fullness and satiety were also assessed at each time point. Treatment effects between groups were analyzed using ANOVA. RESULTS Gastric emptying half-time (GE t50) was greater (P < 0.0001) after participants consumed whole apple (mean ± SEM), 65 (3.3) min compared with when they consumed apple puree (41 [2.8] min) or apple juice (38 [2.9] min), times that did not differ. Postprandial area under the curve (AUC) (135-270 min) SBWC was also greater for whole apples than puree (P = 0.025) and juice (P = 0.0004) but juice and puree did not differ. AUC for fullness and satiety (0-270 min) postingestion was also greater (P = 0.002 and 0.004, respectively) for whole apple compared with juice but juice and puree did not differ. CONCLUSIONS Gastric emptying is slower after whole apple consumption causing a greater sensation of fullness and satiety than puree or juice in healthy adults. Whole apples increased small bowel and colonic contents during the later phase of the study which may be relevant for subsequent food consumption.This study was registered at clinicaltrials.gov as NCT03714464.
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Affiliation(s)
- Shanthi Krishnasamy
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia.,National Institute of Health Research, Nottingham Biomedical Research Centre (BRC) at Nottingham University Hospitals National Health Service Trust and University of Nottingham, Nottingham, United Kingdom.,Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | | | - Luca Marciani
- National Institute of Health Research, Nottingham Biomedical Research Centre (BRC) at Nottingham University Hospitals National Health Service Trust and University of Nottingham, Nottingham, United Kingdom.,Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Caroline Louise Hoad
- National Institute of Health Research, Nottingham Biomedical Research Centre (BRC) at Nottingham University Hospitals National Health Service Trust and University of Nottingham, Nottingham, United Kingdom.,Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
| | - Susan Elizabeth Pritchard
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
| | - Joe Paul
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
| | - Penny Ann Gowland
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
| | - Robin Charles Spiller
- National Institute of Health Research, Nottingham Biomedical Research Centre (BRC) at Nottingham University Hospitals National Health Service Trust and University of Nottingham, Nottingham, United Kingdom.,Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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29
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Limketkai BN, LeBrett W, Lin L, Shah ND. Nutritional approaches for gastroparesis. Lancet Gastroenterol Hepatol 2020; 5:1017-1026. [PMID: 33065041 DOI: 10.1016/s2468-1253(20)30078-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 12/12/2022]
Abstract
Patients with gastroparesis often have signs and symptoms including nausea, vomiting, epigastric discomfort, and early satiety, thus leading to inadequate food intake and a high risk of malnutrition. There is a considerable scarcity of data about nutritional strategies for gastroparesis, and current practices rely on extrapolated evidence. Some approaches include the modification of food composition, food consistency, and food volume in the context of delayed gastric emptying. If the patient is unable to consume adequate calories through a solid food diet, stepwise nutritional interventions could include the use of liquid meals, oral nutrition supplements, enteral nutrition, and parenteral nutrition. This Review discusses the role, rationale, and current evidence of diverse nutritional interventions in the management of gastroparesis.
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Affiliation(s)
- Berkeley N Limketkai
- Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA School of Medicine, Los Angeles, CA, USA.
| | - Wendi LeBrett
- Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA School of Medicine, Los Angeles, CA, USA
| | - Lisa Lin
- Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA School of Medicine, Los Angeles, CA, USA
| | - Neha D Shah
- Nutrition and Food Services, University of California San Francisco, San Francisco, CA, USA
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Abstract
This review outlines the current use of magnetic resonance (MR) techniques to study digestion and highlights their potential for providing markers of digestive processes such as texture changes and nutrient breakdown. In vivo digestion research can be challenging due to practical constraints and biological complexity. Therefore, digestion is primarily studied using in vitro models. These would benefit from further in vivo validation. NMR is widely used to characterise food systems. MRI is a related technique that can be used to study both in vitro model systems and in vivo gastro-intestinal processes. MRI allows visualisation and quantification of gastric processes such as gastric emptying and coagulation. Both MRI and NMR scan sequences can be configured to be sensitive to different aspects of gastric or intestinal contents. For example, magnetisation transfer and chemical exchange saturation transfer can detect proton (1H) exchange between water and proteins. MRI techniques have the potential to provide molecular-level and quantitative information on in vivo gastric (protein) digestion. This requires careful validation in order to understand what these MR markers of digestion mean in a specific digestion context. Combined with other measures they can be used to validate and inform in vitro digestion models. This may bridge the gap between in vitro and in vivo digestion research and can aid the optimisation of food properties for different applications in health and disease.
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31
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Banerjee S, Pal A, Fox M. Volume and position change of the stomach during gastric accommodation and emptying: A detailed three-dimensional morphological analysis based on MRI. Neurogastroenterol Motil 2020; 32:e13865. [PMID: 32390262 DOI: 10.1111/nmo.13865] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 03/13/2020] [Accepted: 04/02/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND The proximal and distal regions of the stomach are thought to have different roles during gastric accommodation and emptying; however, regional changes in gastric structure and function during and after a meal have not been described in detail. This study applied non-invasive imaging to study changes in regional gastric volume and morphology during accommodation and emptying of a liquid nutrient meal. METHOD MRI studies were performed on 16 healthy volunteers. Three-dimensional (3D) gastric morphology was reconstructed by validated image processing technology. The 3D models were segmented into seven regions. The relative contribution of each region to gastric accommodation and emptying was assessed. Changes in morphology were documented by tracking movements of four distinct gastric landmarks. KEY RESULTS The initial 100 mL liquid nutrient increases distal stomach volume more than that of other gastric regions (∆V7 = 28 ± 6% ∆TGV; P ≤ .05). Subsequent volume is accommodated mainly in the proximal stomach (∆V1 = 42 ± 10% ∆TGV; P ≤ .05). Early-phase emptying occurs from distal stomach with proximal stomach volume remaining stable. Subsequently, distal stomach volume remains stable while proximal stomach volume decreases progressively. During gastric filling, the stomach elongates and expands anteriorly and inferiorly (15.2 ± 7.4 mm and 32.3 ± 8.4 mm, respectively, for the incisural midpoint) with torsion indicated by ~70° difference in the movements of proximal and distal gastric landmarks. CONCLUSIONS AND INFERENCES Non-invasive MRI describes volume change and distribution of a liquid meal within proximal and distal stomach during gastric accommodation and emptying. Additionally, novel observations of changes to 3D gastric morphology within the abdomen are documented.
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Affiliation(s)
- Sreerup Banerjee
- Department of Biological Sciences and Bio-Engineering (BSBE), Indian Institute of Technology Kanpur (IITK), Kanpur, India
| | - Anupam Pal
- Department of Biological Sciences and Bio-Engineering (BSBE), Indian Institute of Technology Kanpur (IITK), Kanpur, India
| | - Mark Fox
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Switzerland.,NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.,Digestive Function: Basel, Laboratory and Clinic for motility disorders and functional GI diseases, Center for integrative Gastroenterology, Klinik Arlesheim, Arlesheim, Switzerland
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32
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Effects of Laparoscopic Sleeve Gastrectomy on Gastric Structure and Function Documented by Magnetic Resonance Imaging Are Strongly Associated with Post-operative Weight Loss and Quality of Life: a Prospective Study. Obes Surg 2020; 30:4741-4750. [PMID: 32642883 DOI: 10.1007/s11695-020-04831-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND This prospective study applied magnetic resonance imaging (MRI) to assess the effect of laparoscopic sleeve gastrectomy (LSG) on gastric structure and function. The impact of these changes on patient outcomes was analyzed. METHOD Obese patients without gastrointestinal symptoms referred for bariatric surgery were recruited prospectively. Pre-operative assessment included (i) high-resolution manometry and pH-impedance monitoring and (ii) magnetic resonance imaging (MRI) measurement of gastric capacity, accommodation, and emptying with the 400 ml liquid Nottingham test meal (NTM). Studies were repeated 6-7 months after LSG. Weight loss and changes in the Gastrointestinal Quality of Life Index (GIQLI) assessed patient outcomes. RESULTS From 35 patients screened, 23 (66%) completed the study (17 females, age 36 ± 10 years, BMI 42 ± 5 kg/m2). Mean excess weight loss was 59 ± 18% at follow-up. Total gastric volume (capacity) after the meal was 467 mL (455-585 ml) before and 139 mL (121-185 ml) after LSG (normal reference 534 (419-675) mL), representing a mean 70% reduction (p < 0.0001). Similar findings were present for gastric content volume indicating rapid early-phase gastric emptying (GE) post-LSG. Conversely, late-phase GE was slower post-LSG (2.5 ± 1.0 vs. 1.4 ± 0.6 mL/min; p < 0.0001; (reference 1.5(1.4-4.9) mL/min)). Patients with ≥ 80% reduction in gastric capacity had greater weight loss (p = 0.008), but worse gastrointestinal outcomes (p = 0.023). CONCLUSIONS MRI studies quantified the marked reduction in gastric capacity after LSG. The reduction in capacity was associated with rapid early- but slow late-phase GE after surgery. These changes were associated with weight loss; however, reductions in gastric capacity ≥ 80% were linked to increased acid reflux and impacted on gastrointestinal quality of life.
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Dongare PA, Bhaskar SB, Harsoor SS, Garg R, Kannan S, Goneppanavar U, Ali Z, Gopinath R, Sood J, Mani K, Bhatia P, Rohatgi P, Das R, Ghosh S, Mahankali SS, Singh Bajwa SJ, Gupta S, Pandya ST, Keshavan VH, Joshi M, Malhotra N. Perioperative fasting and feeding in adults, obstetric, paediatric and bariatric population: Practice Guidelines from the Indian Society of Anaesthesiologists. Indian J Anaesth 2020; 64:556-584. [PMID: 32792733 PMCID: PMC7413358 DOI: 10.4103/ija.ija_735_20] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/20/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023] Open
Affiliation(s)
- Pradeep A Dongare
- Assistant Professor, Department of Anaesthesiology, ESIPGIMSR, Bengaluru, India
| | - S Bala Bhaskar
- Department of Anaesthesiology, Vijayanagar Institute of Medical Sciences, Ballari, India
| | - S S Harsoor
- Professor, Department of Anaesthesiology, Dr BR Ambedkar Medical College and Hospital, Bengaluru, India
| | - Rakesh Garg
- Additional Professor, Department of Onco-Anaesthesia, Pain and Palliative Medicine, DR BRAIRCH, AIIMS, New Delhi, India
| | - Sudheesh Kannan
- Professor, Department of Anaesthesiology, BMCRI, Bengaluru, India
| | - Umesh Goneppanavar
- Professor, Department of Anaesthesiology, Dharwad Institute of Mental Health and Neurosciences, Dharwad, India
| | - Zulfiqar Ali
- Associate Professor, Department of Anesthesiology and Critical Care, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Ramachandran Gopinath
- Professor and Head,Department of Anaesthesiology and Intensive Care, ESIC Medical College and Hospital, Hyderabad, India
| | - Jayashree Sood
- Honorary. Joint Secretary, Board of Management, Chairperson, Institute of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Kalaivani Mani
- Scientist IV, Department of Biostatistics, AIIMS, New Delhi, India
| | - Pradeep Bhatia
- Professor and Head, Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, India
| | | | - Rekha Das
- Professor and Head, Department Anaesthesiology, Critical care and Pain, Acharya Harihar Post Graduate Institute of Cancer, Cuttack, India
| | - Santu Ghosh
- Assistant Professor, Department of Biostatistics, St John's Medical College, Bengaluru, India
| | | | - Sukhminder Jit Singh Bajwa
- Professor and Head, Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Punjab, India
| | - Sunanda Gupta
- Professor and Head, Department of Anaesthesiology, Geetanjali Medical College and Hospital, Udaipur, India
| | - Sunil T Pandya
- Chief of Anaesthesia and Surgical ICU, AIG Hospitals, Hyderabad, India
| | - Venkatesh H Keshavan
- Senior Consultant and Chief, Department of Neuroanaesthesia and Critical Care, Apollo Hospitals, Bengaluru, India
| | - Muralidhar Joshi
- Head, Department of Anaesthesia and Pain Medicine, Virinchi Hospitals, Hyderabad, India
| | - Naveen Malhotra
- Professor, Department of Anaesthesiology and In Charge Pain Management Centre, Pt BDS PGIMS, Haryana, India
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Liu W, Jin Y, Wilde PJ, Hou Y, Wang Y, Han J. Mechanisms, physiology, and recent research progress of gastric emptying. Crit Rev Food Sci Nutr 2020; 61:2742-2755. [DOI: 10.1080/10408398.2020.1784841] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Weilin Liu
- School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
| | - Yangyi Jin
- School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
| | - Peter J. Wilde
- School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
- Food Innovation and Health Programme, Quadram Institute Bioscience, Norwich Research Park, Norwich, UK
| | - Yingying Hou
- School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
| | - Yanping Wang
- School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
| | - Jianzhong Han
- School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
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35
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Investigation of drug partition kinetics to fat in simulated fed state gastric conditions based on drug properties. Eur J Pharm Sci 2020; 146:105263. [DOI: 10.1016/j.ejps.2020.105263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/09/2020] [Accepted: 02/10/2020] [Indexed: 02/08/2023]
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Hate SS, Reutzel-Edens SM, Taylor LS. Absorptive Dissolution Testing: An Improved Approach to Study the Impact of Residual Crystallinity on the Performance of Amorphous Formulations. J Pharm Sci 2020; 109:1312-1323. [DOI: 10.1016/j.xphs.2019.11.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/24/2019] [Accepted: 11/15/2019] [Indexed: 12/25/2022]
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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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Goelen N, de Hoon J, Morales JF, Varon C, Van Huffel S, Augustijns P, Mols R, Herbots M, Verbeke K, Vanuytsel T, Tack J, Janssen P. Codeine delays gastric emptying through inhibition of gastric motility as assessed with a novel diagnostic intragastric balloon catheter. Neurogastroenterol Motil 2020; 32:e13733. [PMID: 31595608 DOI: 10.1111/nmo.13733] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/13/2019] [Accepted: 09/16/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND The use of opioids as analgesic is on the rise, despite their inhibitory effect on gastric emptying. A novel feeding catheter with integrated intragastric balloon was developed to continuously assess gastric motility, enabling to investigate the effect of opioids on motility and emptying simultaneously. We aimed to discriminate normal and pharmacologically impaired gastric motility and its impact on gastric emptying in healthy adults. METHODS The VIPUN Gastric Monitoring System comprises a nasogastric balloon catheter and a monitoring unit. In a four-way randomized, single-blinded, cross-over study, subjects received either placebo or 58.8 mg codeine phosphate in combination with either an uninflated or an inflated (180 mL) balloon catheter. Motility-induced pressure changes were recorded for 6 hours. During the first 2 hours, nutrients were infused (225 kcal, 75 mL/h). Gastric emptying was assessed with a 13 C-octanoate breath test and expressed as gastric half-emptying time (GET½). An algorithm, designed to detect phasic contractility, converted pressure changes to a gastric balloon motility index (GBMI). Results are presented as mean(SD). KEY RESULTS Eighteen subjects completed the investigation (32(13) years, 22(2) kg/m2 ). After codeine, GBMI was lower (0.31(0.16)) and GET½ was longer (233(57) minutes) compared with placebo (GBMI: 0.48(0.15), P < .01 and GET½: 172(12) minutes, P < .001). Within-subject ΔGET½ correlated significantly with ΔGBMI (r = -0.77 and P < .001). CONCLUSIONS AND INFERENCES The VIPUN Gastric Monitoring System allowed to assess gastric motility safely and continuously. The correlation between pharmacologically decreased gastric emptying and motility indicates a strong link between both. Gastric motility, measured with this innovative device, can be an indicator for gastrointestinal intolerance.
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Affiliation(s)
- Nick Goelen
- Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
| | - Jan de Hoon
- Center for Clinical Pharmacology, Leuven University Hospital, Leuven, Belgium
| | - John F Morales
- Department of Electrical Engineering-ESAT, STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium.,IMEC, Leuven, Belgium
| | - Carolina Varon
- Department of Electrical Engineering-ESAT, STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium.,IMEC, Leuven, Belgium
| | - Sabine Van Huffel
- Department of Electrical Engineering-ESAT, STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium.,IMEC, Leuven, Belgium
| | - Patrick Augustijns
- Drug Delivery and Disposition, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Raf Mols
- Drug Delivery and Disposition, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Marissa Herbots
- Center for Clinical Pharmacology, Leuven University Hospital, Leuven, Belgium
| | - Kristin Verbeke
- Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
| | - Tim Vanuytsel
- Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium.,Leuven Intestinal Failure and Transplantation (LIFT), Leuven University Hospital, Leuven, Belgium
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
| | - Pieter Janssen
- Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
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Bisinotto FMB, Silveira LAMD, Rossi TC, Martins LB, Zago GP, Mendonça MAL. Comparative ultrasound study of gastric emptying between an isotonic solution and a nutritional supplement. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2019. [PMID: 30528849 PMCID: PMC9391766 DOI: 10.1016/j.bjane.2018.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background and objectives Preoperative fasting may lead to undesirable effects in the surgical patient in whom there is a stimulus to ingesting clear liquids until 2 hours before anesthesia. The aim of this study was to evaluate the gastric emptying of two different solutions using ultrasound. Methods In a prospective, randomized, blind study, 34 healthy volunteers ingested 200 mL of two solutions without residues in two steps: an isotonic solution with carbohydrates, electrolytes, osmolarity of 292 mOsm.L−1, and 36 kcal; and other nutritional supplementation with carbohydrates, proteins, electrolytes, osmolarity of 680 mO.L−1, and 300 kcal. After 2 hours, a gastric ultrasound was performed to assess the antrum area and gastric volume, and the relation of gastric volume to weight (vol.w−1), whose value above 1.5 mL.kg−1 was considered a risk for bronchoaspiration. A p-value <0.05 was considered statistically significant. Results There was a significant difference between all parameters evaluated 2 hours after the ingestion of nutritional supplementation compared to fasting. The same occurred when the parameters between isotonic solution and nutritional supplementation were compared 2 hours after ingestion. Only one patient had vol.w−1 <1.5 mL.kg−1 2 hours after ingestion of nutritional supplementation; and only one had vol.w−1 >1.5 mL.kg−1 after ingestion of isotonic solution. Conclusion This study demonstrated that gastric emptying of equal volumes of different solutions depends on their constitution. Those with high caloric and high osmolarity, and with proteins present, 2 hours after ingestion, increased the gastric volumes, which is compatible with the risk of gastric aspiration.
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Increasing intake of dietary soluble nutrients affects digesta passage rate in the stomach of growing pigs. Br J Nutr 2019; 121:529-537. [DOI: 10.1017/s0007114518003756] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractThe passage rate of solids and liquids through the gastrointestinal tract differs. Increased dietary nutrient solubility causes nutrients to shift from the solid to the liquid digesta fraction and potentially affect digesta passage kinetics. We quantified: (1) the effect of three levels of dietary nutrient solubility (8, 19 and 31 % of soluble protein and sucrose in the diet) at high feed intake level (S) and (2) the effect of lowv.high feed intake level (F), on digesta passage kinetics in forty male growing pigs. The mean retention time (MRT) of solids and liquids in the stomach and small intestine was assessed using TiO2and Cr-EDTA, respectively. In addition, physicochemical properties of digesta were evaluated. Overall, solids were retained longer than liquids in the stomach (2·0 h,P<0·0001) and stomach+small intestine (1·6 h,P<0·001). When S increased, MRT in stomach decreased by 1·3 h for solids (P=0·01) and 0·7 h for liquids (P=0·002) but only at the highest level of S. When F increased using low-soluble nutrients, MRT in stomach increased by 0·8 h for solids (P=0·041) and 0·7 h for liquids (P=0·0001). Dietary treatments did not affect water-binding capacity and viscosity of digesta. In the stomach of growing pigs, dietary nutrient solubility affects digesta MRT in a non-linear manner, while feed intake level increases digesta MRT depending on dietary nutrient solubility. Results can be used to improve predictions on the kinetics of nutrient passage and thereby of nutrient digestion and absorption in the gastrointestinal tract.
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Carlson TL, Yildiz H, Dar Z, Lock JY, Carrier RL. Lipids alter microbial transport through intestinal mucus. PLoS One 2018; 13:e0209151. [PMID: 30576356 PMCID: PMC6303031 DOI: 10.1371/journal.pone.0209151] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 12/02/2018] [Indexed: 01/05/2023] Open
Abstract
Mucus constitutes a protective layer which coats the gastrointestinal tract, controlling interactions of both commensal and pathogenic microbes with underlying tissues. Changes to the mucus barrier, for example due to altered mucin expression or external stimuli, may impact interactions with microbes and thus potentially contribute to altered gut homeostasis, onset of inflammation, or pathogen invasion. Food-associated stimuli, including lipids, have been shown to change mucus barrier properties and reduce transport of model drug carriers through mucus. Here, we explore the impact of lipids, specifically triglycerides in a model intestinal medium mimicking a fed state, on Escherichia coli (E. coli) transport through mucus by directly imaging swimming patterns and analyzing associated changes in mucus structure. Lipids in model fed state intestinal contents reduced E. coli speed and track linearity within mucus. These changes may be due in part to changes in molecular interactions within the mucus network as well as crowding of the mucus network by lipid emulsion droplets, which visibly stay intact in the mucus gel. In addition, observed physical interactions between bacteria and lipid structures may impact microbial speed and trajectories. As lipids are normal food components and thus represent safe, mild stimuli, these results support exploration of lipid-based strategies to alter the mucus barrier to control interactions with microbes and potentially prevent microbial invasion of underlying epithelium.
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Affiliation(s)
- Taylor L. Carlson
- Department of Chemical Engineering, Northeastern University, Boston, Massachusetts, United States of America
| | - Hasan Yildiz
- Antisense Oligonucleotide Manufacturing and Development, Biogen, Cambridge, Massachusetts, United States of America
| | - Zaineb Dar
- Department of Bioengineering, Northeastern University, Boston, Massachusetts, United States of America
| | - Jaclyn Y. Lock
- Department of Bioengineering, Northeastern University, Boston, Massachusetts, United States of America
| | - Rebecca L. Carrier
- Department of Chemical Engineering, Northeastern University, Boston, Massachusetts, United States of America
- * E-mail:
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Paixão P, Bermejo M, Hens B, Tsume Y, Dickens J, Shedden K, Salehi N, Koenigsknecht MJ, Baker JR, Hasler WL, Lionberger R, Fan J, Wysocki J, Wen B, Lee A, Frances A, Amidon GE, Yu A, Benninghoff G, Löbenberg R, Talattof A, Sun D, Amidon GL. Linking the Gastrointestinal Behavior of Ibuprofen with the Systemic Exposure between and within Humans-Part 2: Fed State. Mol Pharm 2018; 15:5468-5478. [PMID: 30417648 PMCID: PMC8859981 DOI: 10.1021/acs.molpharmaceut.8b00736] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Exploring the intraluminal behavior of an oral drug product in the human gastrointestinal (GI) tract remains challenging. Many in vivo techniques are available to investigate the impact of GI physiology on oral drug behavior in fasting state conditions. However, little is known about the intraluminal behavior of a drug in postprandial conditions. In a previous report, we described the mean solution and total concentrations of ibuprofen after oral administration of an immediate-release (IR) tablet in fed state conditions. In parallel, blood samples were taken to assess systemic concentrations. The purpose of this work was to statistically evaluate the impact of GI physiology (e.g., pH, contractile events) within and between individuals (intra and intersubject variability) for a total of 17 healthy subjects. In addition, a pharmacokinetic (PK) analysis was performed by noncompartmental analysis, and PK parameters were correlated with underlying physiological factors (pH, time to phase III contractions postdose) and study parameters (e.g., ingested amount of calories, coadministered water). Moreover, individual plasma profiles were deconvoluted to assess the fraction absorbed as a function of time, demonstrating the link between intraluminal and systemic behavior of the drug. The results demonstrated that the in vivo dissolution of ibuprofen depends on the present gastric pH and motility events at the time of administration. Both intraluminal factors were responsible for explaining 63% of plasma Cmax variability among all individuals. For the first time, an in-depth analysis was performed on a large data set derived from an aspiration/motility study, quantifying the impact of physiology on systemic behavior of an orally administered drug product in fed state conditions. The data obtained from this study will help us to develop an in vitro biorelevant dissolution approach and optimize in silico tools in order to predict the in vivo performance of orally administered drug products, especially in fed state conditions.
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Affiliation(s)
- Paulo Paixão
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, 428 Church Street, Ann Arbor, Michigan 48109–1065, United States
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Avenida Professor Gama Pinto, 1649-003 Lisboa, Portugal
| | - Marival Bermejo
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, 428 Church Street, Ann Arbor, Michigan 48109–1065, United States
- Department of Engineering, Pharmacy Section, Miguel Hernandez University, San Juan de Alicante, 03550 Alicante, Spain
| | - Bart Hens
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, 428 Church Street, Ann Arbor, Michigan 48109–1065, United States
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Yasuhiro Tsume
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, 428 Church Street, Ann Arbor, Michigan 48109–1065, United States
| | - Joseph Dickens
- Department of Statistics, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Kerby Shedden
- Department of Statistics, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Niloufar Salehi
- Center for the Study of Complex Systems and Department of Chemical Engineering, University of Michigan, Ann Arbor, Michigan 48109-2136, United States
| | - Mark J. Koenigsknecht
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, 428 Church Street, Ann Arbor, Michigan 48109–1065, United States
| | - Jason R Baker
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan 48109, United States
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - William L. Hasler
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan 48109, United States
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Robert Lionberger
- Office of Generic Drugs, Center for Drug Evaluation and Research, US. Food and Drug Administration, Silver Spring, Maryland 20993, United States
| | - Jianghong Fan
- Office of Generic Drugs, Center for Drug Evaluation and Research, US. Food and Drug Administration, Silver Spring, Maryland 20993, United States
| | - Jeffrey Wysocki
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, 428 Church Street, Ann Arbor, Michigan 48109–1065, United States
| | - Bo Wen
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, 428 Church Street, Ann Arbor, Michigan 48109–1065, United States
| | - Allen Lee
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan 48109, United States
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Ann Frances
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, 428 Church Street, Ann Arbor, Michigan 48109–1065, United States
| | - Gregory E. Amidon
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, 428 Church Street, Ann Arbor, Michigan 48109–1065, United States
| | - Alex Yu
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, 428 Church Street, Ann Arbor, Michigan 48109–1065, United States
| | - Gail Benninghoff
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, 428 Church Street, Ann Arbor, Michigan 48109–1065, United States
| | - Raimar Löbenberg
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada T6G 2H7
| | - Arjang Talattof
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, 428 Church Street, Ann Arbor, Michigan 48109–1065, United States
| | - Duxin Sun
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Avenida Professor Gama Pinto, 1649-003 Lisboa, Portugal
| | - Gordon L. Amidon
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, 428 Church Street, Ann Arbor, Michigan 48109–1065, United States
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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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Bisinotto FMB, Silveira LAMD, Rossi TC, Martins LB, Zago GP, Mendonça MAL. [Comparative ultrasound study of gastric emptying between an isotonic solution and a nutritional supplement]. Rev Bras Anestesiol 2018; 69:115-121. [PMID: 30528849 DOI: 10.1016/j.bjan.2018.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Preoperative fasting may lead to undesirable effects in the surgical patient in whom there is a stimulus to ingesting clear liquids until 2hours before anesthesia. The aim of this study was to evaluate the gastric emptying of two different solutions using ultrasound. METHODS In a prospective, randomized, blind study, 34 healthy volunteers ingested 200mL of two solutions without residues in two steps: an isotonic solution with carbohydrates, electrolytes, osmolarity of 292 mOsm.L-1, and 36 kcal; and other nutritional supplementation with carbohydrates, proteins, electrolytes, osmolarity of 680 mO.L-1, and 300 kcal. After 2hours, a gastric ultrasound was performed to assess the antrum area and gastric volume, and the relation of gastric volume to weight (vol.w-1), whose value above 1.5mL.kg-1 was considered a risk for bronchoaspiration. A p-value <0.05 was considered statistically significant. RESULTS There was a significant difference between all parameters evaluated 2hours after the ingestion of nutritional supplementation compared to fasting. The same occurred when the parameters between isotonic solution and nutritional supplementation were compared 2hours after ingestion. Only one patient had vol.w-1 <1.5mL.kg-1 2hours after ingestion of nutritional supplementation; and only one had vol.w-1> 1.5mL.kg-1 after ingestion of isotonic solution. CONCLUSION This study demonstrated that gastric emptying of equal volumes of different solutions depends on their constitution. Those with high caloric and high osmolarity, and with proteins present, 2hours after ingestion, increased the gastric volumes, which is compatible with the risk of gastric aspiration.
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Affiliation(s)
- Flora Margarida Barra Bisinotto
- Universidade Estadual Paulista (Unesp), Departamento de Anestesiologia, São Paulo, SP, Brasil; Universidade Federal do Triângulo Mineiro (UFTM), Departamento de Cirurgia, Uberaba, MG, Brasil
| | - Luciano Alves Matias da Silveira
- Universidade Federal do Triângulo Mineiro (UFTM), Departamento de Cirurgia, Uberaba, MG, Brasil; Universidade Federal do Triângulo Mineiro (UFTM), Instituto de Ciências Biológicas e Naturais, Uberaba, MG, Brasil.
| | - Tiago Caneu Rossi
- Universidade Federal do Triângulo Mineiro (UFTM), Centro de Ensino e Treinamento do Hospital de Clínicas (CET/SBA/HC), Departamento de Anestesiologia, Uberaba, MG, Brasil
| | - Laura Bisinotto Martins
- Universidade Federal do Triângulo Mineiro (UFTM), Centro de Ensino e Treinamento do Hospital de Clínicas (CET/SBA/HC), Departamento de Anestesiologia, Uberaba, MG, Brasil
| | - Gustavo Palis Zago
- Universidade Federal do Triângulo Mineiro (UFTM), Centro de Ensino e Treinamento do Hospital de Clínicas (CET/SBA/HC), Departamento de Anestesiologia, Uberaba, MG, Brasil
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Ferreira CHF, Martinez FE, Crott GC, Belik J. Gavage Feed Volume Determines the Gastric Emptying Rate in Preterm Infants. J Pediatr Gastroenterol Nutr 2018; 67:e43-e46. [PMID: 29601436 DOI: 10.1097/mpg.0000000000001985] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Feeding intolerance, manifesting as increased gastric residual, is a common finding in preterm neonates. Little is known about the regulation of gastric emptying early in life and the extent to which this plays a role in the preterm infants' feeding tolerance. The goal of this study was to evaluate clinically stable 28- to 32-week gestation neonates during the first 4 weeks of life and noninvasively determine their gastric emptying rate. STUDY DESIGN Ultrasound measurements of gastric milk content volume were obtained from 25 neonates immediately after, 30 and/or 60 minutes following routine gavage feeds. The content emptying rate was calculated from the gastric volume data. RESULTS Gastric emptying rate was not postnatal age-dependent, was significantly higher at 30 minutes, whenever compared with 60-minute postfeed and directly proportional to the feed volume. At any postnatal age, the gastric emptying rate was at least 6-fold greater, when comparing the lowest and highest average stomach content volumes. CONCLUSIONS The gastric emptying rate of preterm infants is content volume-dependent and unrelated to the postnatal age. Given the present findings, further investigation on the gastric residual of preterm infants receiving larger than currently administered feed volumes at the initiation of enteral nutrition, is warranted.
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Affiliation(s)
- Cristina H F Ferreira
- Hospital das Clínicas, Ribeirão Preto, University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | - Francisco E Martinez
- Hospital das Clínicas, Ribeirão Preto, University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | - Gerson C Crott
- Hospital das Clínicas, Ribeirão Preto, University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | - Jaques Belik
- Physiology & Experimental Medicine Program, Department of Paediatrics and Physiology, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, University of Toronto, Toronto, Ontario, Canada
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47
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Klein S, Seeger N, Mehta R, Missaghi S, Grybos R, Rajabi-Siahboomi A. Robustness of barrier membrane coated metoprolol tartrate matrix tablets: Drug release evaluation under physiologically relevant in vitro conditions. Int J Pharm 2018; 543:368-375. [PMID: 29630933 DOI: 10.1016/j.ijpharm.2018.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 03/16/2018] [Accepted: 04/04/2018] [Indexed: 11/15/2022]
Abstract
Robust in vitro drug release behavior is an important feature of extended release (ER) hydrophilic matrix formulations for accurate prediction of in vivo drug release. In this study, ER hydrophilic matrix tablets of metoprolol tartrate were formulated using a high viscosity grade of hypromellose as a rate-limiting polymer. Expectedly, this formulation showed an undesirable initial burst release followed by controlled drug release. Application of a barrier membrane (BM) coating of ethylcellulose with a pore former (hypromellose) resulted in the elimination of the burst effect. The aim of this study was to investigate the robustness of in vitro metoprolol release from BM-coated hydrophilic matrix tablets by simulating the physicochemical properties of gastrointestinal fluids and mechanical stress in the fasted- and fed state human gastrointestinal (GI) tract. Uncoated and BM-coated matrices were subjected to various dissolution studies simulating the varying pH conditions and additional physicochemical parameters, and the mechanical stress that can be caused by GI motility during both fasted and fed state GI passage. The BM-coated formulation showed robust drug release without an initial burst in all test scenarios. BM-coated matrix formulations thus represent a very promising approach for obtaining a highly controlled and robust drug release from oral ER formulations.
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Affiliation(s)
- Sandra Klein
- Ernst Moritz Arndt University, Department of Pharmacy, Institute of Biopharmaceutics and Pharmaceutical Technology, Center of Drug Absorption and Transport, 3 Felix Hausdorff Street, Greifswald 17489, Germany.
| | - Nicole Seeger
- Ernst Moritz Arndt University, Department of Pharmacy, Institute of Biopharmaceutics and Pharmaceutical Technology, Center of Drug Absorption and Transport, 3 Felix Hausdorff Street, Greifswald 17489, Germany
| | - Raxit Mehta
- Colorcon Inc., Global Headquarters, 275 Ruth Road, Harleysville, PA 19438, USA
| | - Shahrzad Missaghi
- Colorcon Inc., Global Headquarters, 275 Ruth Road, Harleysville, PA 19438, USA
| | - Relindis Grybos
- Ernst Moritz Arndt University, Department of Pharmacy, Institute of Biopharmaceutics and Pharmaceutical Technology, Center of Drug Absorption and Transport, 3 Felix Hausdorff Street, Greifswald 17489, Germany
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Ferreira CHF, Shifrin Y, Pan J, Ivanovska J, McNamara PJ, Belik J. The newborn rat gastric emptying rate is volume and not developmentally dependent. Neurogastroenterol Motil 2018; 30:e13233. [PMID: 29024213 DOI: 10.1111/nmo.13233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/19/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Gastric residuals are a common finding in enterally fed preterm neonates and traditionally thought to reflect immaturity-related delayed gastric emptying. Adult human data suggest that the meal volume regulate the gastric emptying rate, but early in life, this has not been adequately evaluated. The goal of this study was to study the rat postnatal changes in gastric emptying rate and the strain-induced effect on muscle contraction. We hypothesized that the stomach content volume and not developmental factors determines the newborn gastric emptying rate, via the Rho-kinase 2 (ROCK-2) pathway. METHODS Gastric volume and emptying rate measurements were obtained by ultrasound at different postprandial times and the wall strain-dependent changes in muscle contraction were evaluated ex vivo. KEY RESULTS The newborn rat gastric emptying rate was unrelated to postnatal age, maximal 30 min postprandial, and directly proportional to content volume. In vitro measurements showed that the agonist-induced gastric muscle contraction was directly proportional to the stomach wall strain. These changes were mediated via upregulation of ROCK-2 activity. CONCLUSIONS & INFERENCES The newborn rat gastric emptying rate is not developmentally regulated, but dependent on the content volume via wall strain-induced ROCK-2 activation. Further clinical studies addressing the content volume effect on the rate of gastric emptying are warranted, to enhance feeding tolerance in preterm neonates.
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Affiliation(s)
- C H F Ferreira
- Hospital das Clinicas, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Y Shifrin
- Departments of Paediatrics and Physiology, Translational Medicine Program, Hospital for Sick Children Research Institute, University of Toronto, Toronto, ON, Canada
| | - J Pan
- Departments of Paediatrics and Physiology, Translational Medicine Program, Hospital for Sick Children Research Institute, University of Toronto, Toronto, ON, Canada
| | - J Ivanovska
- Departments of Paediatrics and Physiology, Translational Medicine Program, Hospital for Sick Children Research Institute, University of Toronto, Toronto, ON, Canada
| | - P J McNamara
- Departments of Paediatrics and Physiology, Translational Medicine Program, Hospital for Sick Children Research Institute, University of Toronto, Toronto, ON, Canada
| | - J Belik
- Departments of Paediatrics and Physiology, Translational Medicine Program, Hospital for Sick Children Research Institute, University of Toronto, Toronto, ON, Canada
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Perrella SL, Hepworth AR, Gridneva Z, Simmer KN, Hartmann PE, Geddes DT. Gastric emptying of different meal volumes of identical composition in preterm infants: a time series analysis. Pediatr Res 2018; 83:778-783. [PMID: 29166375 DOI: 10.1038/pr.2017.292] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 11/01/2017] [Indexed: 11/09/2022]
Abstract
BackgroundPreterm infants' meals typically progress to higher volumes over time. Knowledge of gastric emptying (GE) responses to differing meal volumes may inform enteral feeding management. We examined the effect of meal volume and composition on preterm GE.MethodsForty infants were studied at 33.3±1.4 (29.7-35.6) weeks postmenstrual age when fully enteral fed (target 150 ml/kg/day). Intraindividual comparisons of GE were made for paired meals of 100% and 75% prescribed volume and identical composition of mother's own milk (n=21) and pasteurized donor human milk (n=19). Serial stomach ultrasound images were used to calculate gastric residual volumes (GRVs) and remaining meal proportions (% meal).ResultsGE was faster in the early postprandial period and slowed over time (P<0.001). Reduced volume meals had slower GE rates and lower GRV (P<0.001). Serial postprandial % meal was similar between reduced and full volume meals (P=0.41). Higher milk casein concentration was associated with slower GE (P=0.04). Complete gastric emptying (GRV=0 ml) was more common in infants fed at 3 h intervals compared with those fed every 2 h (P=0.002).ConclusionEarly postprandial GE is more rapid for larger meal volumes. Stable preterm infants may tolerate feeding of a 3 h meal volume at shorter intervals.
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Affiliation(s)
- Sharon L Perrella
- School of Molecular Sciences, The University of Western Australia, Crawley, Perth, Western Australia, Australia
| | - Anna R Hepworth
- School of Molecular Sciences, The University of Western Australia, Crawley, Perth, Western Australia, Australia
| | - Zoya Gridneva
- School of Molecular Sciences, The University of Western Australia, Crawley, Perth, Western Australia, Australia
| | - Karen N Simmer
- Centre for Neonatal Research and Education, School of Paediatrics and Child Health, The University of Western Australia, Crawley, Perth, Western Australia, Australia
| | - Peter E Hartmann
- School of Molecular Sciences, The University of Western Australia, Crawley, Perth, Western Australia, Australia
| | - Donna T Geddes
- School of Molecular Sciences, The University of Western Australia, Crawley, Perth, Western Australia, Australia
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Lipids in the Stomach – Implications for the Evaluation of Food Effects on Oral Drug Absorption. Pharm Res 2018; 35:55. [DOI: 10.1007/s11095-017-2289-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 10/20/2017] [Indexed: 10/18/2022]
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