Resistance of postprandial gastric functions and autonomic balance to taste stimulation
Marek WalugaAnna Kasicka-JonderkoMarek DzielickiMagdalena KamińskaMałgorzata BożekJoanna LaskowskaJoanna PalkaDaria JurzakJoanna RusekK Jonderko
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Exposure to unpleasant tastes leads to disturbances of interdigestive gastric myoelectrical activity (GMA) and may affect sympathetic/parasympathetic balance (SPB). We made a careful study to determine whether taste stimulation modulates the postprandial GMA, SPB, and gastric emptying (GE) of a solid meal. Eighteen healthy volunteers (9F/9M) entered the study. On six separate days, we recorded a four-channel electrogastrogram from each volunteer during a 35-min fasting period, then for 90 min after ingestion of a solid test meal of 300 kcal. GE was measured using a 13C-octanoic acid breath test. Heart rate variability (HRV) analysis was simultaneously performed. At the start of the 21st min after the test meal, subjects received an agar cube delivering either a sweet, salty, sour, or bitter taste, which they kept in the mouth for 35 min. Control procedures involved sessions performed with a tasteless agar cube, and without any stimulation. There was no effect of the experimental intervention upon the relative power share of particular GMA rhythms. Stimulation with the salty and the bitter taste evoked a statistically significant increase in the dominant frequency, whereas the sweet and sour taste did not affect it. Taste stimulation did not interfere with the meal-induced rise in the dominant power, nor affect slow wave coupling. The kinetics of the solid GE remained unchanged by the intervention. None of the taste stimulations affected the postprandial SPB. Taste stimulation elicited after ingestion of a meal, in contrast to that during a fast, did not adversely modify the postprandial pattern of either the GMA or SPB, nor affect the GE of solids.Keywords:
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We investigated the influence of standardized postprandial walking on the rates of gastric emptying and of intragastric meal distribution in 50 consecutive patients with longstanding insulin-dependent diabetes mellitus.Gastric emptying of a semisolid meal labeled with 99mTc was continuously recorded with a dual-head gamma camera with patients in the supine position for 90 min before and 20 min after a 30-min postprandial walk. Regions of interest enclosing total stomach, and proximal and distal gastric compartments were calculated to determine gastric emptying rates and intragastric meal distribution.The evaluation of gastric emptying rates before and after postprandial walking demonstrated two variants of delayed gastric emptying: one variant that was counteracted by postprandial walking in seven patients (14%, Group I) and another variant that was not influenced by postprandial walking in 11 patients (22%, Group II). In addition, the emptying rates of 28 patients (56%) were within the range of controls and in four patients the emptying was accelerated (8%). The filling of the proximal gastric compartment was predominant and remained dominant after walking in Groups I and II. In controls and in diabetics with normal gastric emptying, the preliminary predominant filling of the proximal compartment was equalized after walking and the proximal compartment regained predominance thereafter. The changes in gastric emptying characteristics from delayed to accelerated gastric emptying may be related to the duration of diabetes (r = -0.47, p<0.03) and were not indicated by symptoms of upper GI discomfort or by secondary diabetic manifestations.Postprandial walking may improve gastric emptying in 14% of patients with longstanding insulin-dependent diabetes mellitus.
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OBJECTIVE Upper gastrointestinal (GI) symptoms and delayed gastric emptying both occur frequently in patients with long-standing IDDM, but the relationship between them is relatively weak. Recent studies in normal subjects have indicated that blood glucose concentration may increase the perception of sensations arising from the upper GI tract. The purpose of this study was to examine the relationships among postprandial fullness, the rate of gastric emptying, and blood glucose concentration in IDDM patients. RESEARCH DESIGN AND METHODS We studied measurements of gastric emptying, blood glucose concentrations, cardiovascular autonomic nerve function, upper GI symptoms, and postprandial hunger and fullness in 40 IDDM patients (16 men, 24 women). ages 19–63 years. Gastric emptying of solids and liquids was measured scintigraphically, upper GI symptoms were measured by questionnaire immediately before ingestion of the test meal, and fullness and hunger were measured by visual analog scales every 15 min. Blood glucose concentrations were measured at −5, 30, 60, 90, and 120 min. RESULTS Solid gastric emptying was delayed in 58% of the patients, and both solid and liquid gastric emptying were slower (P < 0.05) in women than in men. The score for upper GI symptoms was not significantly related to gastric emptying. In contrast, postprandial fullness, but not hunger, was related to the amount of solid (r = 0.36, P < 0.05) but not liquid in the stomach. Both before (r = 0.39, P < 0.05) and after (r = 0.47, P < 0.01) the meal, fullness was related to blood glucose concentration. Postprandial fullness was also related to autonomic nerve dysfunction (r = 0.39, P < 0.05). Multiple regression analysis confirmed that blood glucose concentration, the rate of solid gastric emptying, and autonomic nerve dysfunction were independent determinants of postprandial fullness, together accounting for 47% of the variance. CONCLUSIONS These observations demonstrated that, in IDDM, postprandial fullness is influenced by blood glucose concentration, the rate of solid gastric emptying, and autonomic nerve function.
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[Objective] To study gastric motility with electrogastrogram(EGG) in patients suffering from type 2 diabetes mellitus(DM).[Methods] Sixty DM patients and thirty normal people were traced with EGG.Principal frequency(FP),amplitude(AP),percent of slow gastric motion(B%),and the relation of B% and fasting blood glucose(FBG) were analyzed.[Results] There was no significant difference in fasting and postprandial FP between the normal control group and the DM group.Postprandial amplitude was significantly higher than fasting amplitude in the two groups(P0.05).FBG was positive correlation with B% in fasting and postprandial(P(0.01).)[Conclusion]EGG is obviously abnormal in type 2 DM patients,which characteristics is disorders of more slow gastric motion.FBG is positive correlation with B% in fasting and postprandial in type 2 DM patients.
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OBJECTIVE: We investigated the influence of standardized postprandial walking on the rates of gastric emptying and of intragastric meal distribution in 50 consecutive patients with longstanding insulin-dependent diabetes mellitus. METHODS: Gastric emptying of a semisolid meal labeled with 99mTc was continuously recorded with a dual-head gamma camera with patients in the supine position for 90 min before and 20 min after a 30-min postprandial walk. Regions of interest enclosing total stomach, and proximal and distal gastric compartments were calculated to determine gastric emptying rates and intragastric meal distribution. RESULTS: The evaluation of gastric emptying rates before and after postprandial walking demonstrated two variants of delayed gastric emptying: one variant that was counteracted by postprandial walking in seven patients (14%, Group I) and another variant that was not influenced by postprandial walking in 11 patients (22%, Group II). In addition, the emptying rates of 28 patients (56%) were within the range of controls and in four patients the emptying was accelerated (8%). The filling of the proximal gastric compartment was predominant and remained dominant after walking in Groups I and II. In controls and in diabetics with normal gastric emptying, the preliminary predominant filling of the proximal compartment was equalized after walking and the proximal compartment regained predominance thereafter. The changes in gastric emptying characteristics from delayed to accelerated gastric emptying may be related to the duration of diabetes (r =−0.47, p < 0.03) and were not indicated by symptoms of upper GI discomfort or by secondary diabetic manifestations. CONCLUSION: Postprandial walking may improve gastric emptying in 14% of patients with longstanding insulin-dependent diabetes mellitus.
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The currently established gastric emptying test requires the patient to take a radioactive test meal and to stay under a gamma camera for acquiring abdominal images for 2 hours. It is invasive and expensive. Since the electrogastrogram (EGG) is a cutaneous recording of gastric myoelectrical activity which modulates gastric motor activity, we hypothesized that delayed gastric emptying might be predicted from the EGG using a neural network approach. In this study, simultaneous recordings of the EGG and the emptying rate of the stomach by means of the established method were made in 152 patients with suspected gastric motility disorders. A multilayer feedforward neural network approach for the diagnosis of delayed gastric emptying from the noninvasive EGG was developed. Using 5 spectral parameters of the EGG as inputs, a correct classification of 85% was achieved with an optimized three-layer network. This study indicates that the neural network approach is a potentially useful tool for the noninvasive diagnosis of delayed gastric emptying.
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Cutaneous electrogastrography is a method of recording gastric electrical activity. Abnormalities of the electrogastrogram have been described in a variety of disorders. The purpose of the study was to correlate the electrogastrograms of children with vomiting and dyspepsia with the results of radionucleotide gastric emptying studies.Nine patients (5-16 years old) with gastrointestinal symptoms of vomiting and/or abdominal pain were studied. The electrogastrogram was recorded using surface electrodes for 30 minutes in the fasting state and for 120 minutes after a radioisotope-labeled solid meal. Gastric emptying was simultaneously monitored for 120 minutes. The postprandial change in dominant power (power ratio: postprandial/fasting dominant power), percentages of normal slow wave, bradygastria, and tachygastria were recorded and analyzed.The patients were divided into two groups. The first group (four patients; five studies) had normal gastric emptying, whereas the second group (five patients) had delayed emptying (half-life, >90 minutes). The median power ratio in the first group was 1.69 and in the second group was 2.78; the difference was not statistically significant (P = 0.90). The median difference in slow wave percentages in the fasting and postprandial periods was 0.99 in the first group and 0.73 in the second group; again, the difference was not statistically significant (P = 0.27).Although it is a method of assessing gastric myoelectrical activity and gastric motility disorders, electrogastrogram does not correlate with nuclear scintigraphic gastric emptying studies in children.
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AIM: To study the pathogenesis of functional dyspepsia (FD) by electrogastrogram and gastric emptying test. METHODS: According to the RomeⅡcriteria, patients with FD were classified into 3 subclasses. From each subclass, 10 patients were randomly chosen in this study. 10 Healthy volunteers were used as normal control. All the patients and volunteers underwent electrogastrogram examination and gastric emptying test. Gastric emptying test was performed using 99 Tc m labelled solid food. Patients with FD were divided into 2 groups according to the results of gastric emptying test: normal gastric emptying group and delayed gastric emptying group. Data were collected accordingly and statistic analysis was performed. RESULTS: ① 18 patients showed gastric emptying delay. In patients with FD, post meal average amplitude (AP) and △AP reduced significantly ( P 0.05), compared with the control. However pre meal, post meal average frequency and pre meal AP did not show significant changes( P 0.05); ②In FD patients with normal gastric emptying, 41.7% showed abnormal electrogastrogram; ③ In the FD patients with delayed gastric emptying, 83.3% were abnormal in electrogastrogram and their post meal AP and △AP decreased significantly( P 0.05). However, pre meal and post meal average frequency, pre meal AP did not show significant changes( P 0.05). CONCLUSION: Motility disturbance of stomach plays an important role in the pathogenesis of FD. Electrogastrogram and gastric emptying test have a good consistency in determining FD.
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The relation between the cutaneous electrogastrogram (EGG) and gastric emptying was investigated in six rhesus monkeys. Gastric emptying was measured using scintigraphy after administration of two 80-ml mixed solid liquid meals (1.5 and 5.0 kcal/kg) tagged with 99mTc-sulfur colloid and 111In-diethylenetriamine pentaacetic acid. Six epigastric bipolar recordings of the EGG were concurrently obtained, digitized, and band-pass filtered. Portions of the signal with motion artifacts were automatically detected and excluded using two microwave motion sensors. During the early postprandial period, gastric emptying was greater after the 1.5-kcal/kg meal than after the 5-kcal/kg meal, and EGG amplitude increased significantly compared with fasting only after the 1.5-kcal/kg meal. Both emptying and EGG amplitude subsequently decreased after the 1.5-kcal/kg meal, whereas these two parameters increased after the 5-kcal/kg meal. As a result, EGG amplitude was significantly correlated with gastric emptying of solids in all six animals. In contrast, EGG frequency was not significantly different between the two meals and was not correlated with emptying. These results indicate that both the EGG and gastric emptying are modified differently by meals with different caloric contents and that the EGG may represent a useful, although indirect, index of gastric emptying.
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Glucagon-like peptide-1 (GLP-1) relaxes the stomach during fasting but decreases hunger and food consumption and retards gastric emptying. The interrelationships between volume, emptying, and postprandial symptoms in response to GLP-1 are unclear. We performed, in healthy human volunteers, a placebo-controlled study of the effects of intravenous GLP-1 on gastric volume using 99m Tc-single photon emission computed tomography imaging, gastric emptying of a nutrient liquid meal (Ensure) using scintigraphy, maximum tolerated volume (MTV) of Ensure, and postprandial symptoms 30 min after MTV. The role of vagal cholinergic function in the effects of GLP-1 was assessed by human pancreatic polypeptide (HPP) response to the Ensure meal. GLP-1 increased fasting and postprandial gastric volumes and retarded gastric emptying; MTV and postprandial symptoms were not different compared with controls. Effects on postprandial gastric function were associated with reduced postprandial HPP levels. GLP-1 does not induce postprandial symptoms despite significant inhibition of gastric emptying and vagal function; this may be partly explained by the increase in postprandial gastric volume.
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