Nizatidine accelerates gastric emptying of a solid meal in rats

Nizatidine, a new histamine-2-receptor antagonist, stimulates gastrointestinal motility in dogs and gastric emptying of liquids in rats. Effect of nizatidine on gastric emptying of a solid meal was investigated using a novel gastric emptying model in rats. Male Wistar rats (weighing 200–300 g) were supplied with powdered food containing 30 w/w% barium 14 hr before the beginning of the experiment and x-ray photography of rat stomach was taken under light ether anesthesia. Gastric emptying was assessed by percentage of a decrease in area 30 min after drug was injected intraperitoneally. There was a positive correlation between the area of the gastric outline and the weight of the gastric contents (r=0.94,P<0.01). Ether anesthesia itself did not affect gastric emptying. Nizatidine increased gastric emptying dose-dependently (emptied percentage; vehicle: 4.9±1.5%, 1 mg/kg: 7.2±0.4%, 3 mg/kg: 10.4±2.0%, 10 mg/kg: 16.7±4.9%, 30 mg/kg: 25.7±7.4%).N-Desmethyl nizatidine (NDM) also stimulated gastric emptying, but nizatidineS-oxide, cimetidine, an famotidine had no significant effects on gastric emptying. Nizatidine and neostigmine, but not NDM, at a subthreshold dose accelerated gastric emptying treated with a low dose of acetylcholine (0.1 mg/kg). Atropine (2 mg/kg, –30 min) did not modulate the gastroprokinetic action of nizatidine, but blocked that of NDM. These findings suggest that this noninvasive method may allow measurement of gastric emptying of solids accurately and that nizatidine and NDM facilitate gastric emptying probably mediated by a direct and/or an indirect (acetylcholinesterase inhibition) cholinergic mechanism.     

Relation among plasma ghrelin level, gastric emptying, and psychologic condition in patients with functional dyspepsia

BACKGROUND AND GOALS: Neurohormonal factors might play a role in the pathogenesis of functional dyspepsia (FD). However, the role of ghrelin, a gastrointestinal hormone that stimulates gastric motility, in FD is not yet clearly defined. The present study was designed to investigate plasma ghrelin levels and their relation with gastric emptying and psychologic status in FD. METHODS: Sixteen patients with FD of the dysmotility type and 19 healthy controls were enrolled in the study. Plasma active and desacyl ghrelin concentrations before and after test meal were measured by enzyme-linked immunosorbent assay. Gastric emptying and psychologic condition were studied using C acetate breath test and questionnaires, respectively. RESULTS: Gastric emptying was significantly prolonged in patients with FD compared with controls. Fasting desacyl and total ghrelin levels were significantly lower in FD patients than in controls, but fasting active ghrelin levels and postprandial levels of ghrelin in both forms were similar between the 2 groups. Fasting total ghrelin levels in FD patients did not differ from the postprandial levels, in contrast to what was found for controls. There was no significant association among gastric emptying, plasma ghrelin levels, and psychologic factors in FD patients. CONCLUSIONS: Total secretory ability or metabolic condition of ghrelin may be altered in patients with FD. This seems to play a role in the pathophysiology of dysmotility type FD, independent of delayed gastric emptying or psychologic disorders.     

Rapid gastric emptying, rather than delayed gastric emptying, might provoke functional dyspepsia

It has been suggested that there could be three possible mechanisms of gastric dysfunction in patients with FD: (i) delayed gastric emptying, (ii) impaired gastric accommodation of food intake, and (iii) hypersensitivity to gastric distention. Postprandial fullness seems to be the most severe symptom in patients who report aggravation of their symptoms after meals. Therefore, it has been assumed that delayed gastric emptying and consequent prolonged antral distension could reduce hunger, increase satiety, and even cause gastric discomfort, all of which would pose a significant barrier to adequate nutrition. We previously reported that postprandial water intake inhibits gastric antral motility along with an increase of cholecystokinin (CCK) in normal subjects. We assumed that the rapid increase of CCK after water intake was initiated by a feedback mechanism related to the inflow of fatty chyme into the duodenum that inhibits gastric antral activity. This duodeno-gastric interaction is known as the "duodenal break." We also reported that total gastric emptying was more rapid after the intake of a high-viscosity liquid meal than after a low-viscosity meal, because the low-viscosity liquid meal inhibits gastric emptying after rapid initial inflow into the duodenum. Considering these results, we hypothesized that rapid gastric emptying, rather than delayed gastric emptying, could be a cause of FD. In some patients with postprandial distress syndrome (PDS), we have found a significant correspondence between PDS-related dyspepsia and accelerated gastric emptying in the early postprandial period. It is worth emphasizing that the duodenum and the duodeno-gastric interaction (duodenal break) could have an important role in the pathophysiology of FD. We consider that rapid gastric emptying might be a more important factor than delayed gastric emptying in patients with FD.     

Nizatidine and Gastric Emptying in Functional Dyspepsia

In clinical practice, H2-receptor antagonists, including nizatidine, in addition to their use in the treatment of peptic ulcer and gastroesophageal reflux, are also useful in alleviating dyspeptic symptoms. Patients with functional dyspepsia show a tendency to delayed gastric emptying. Results of preliminary studies have demonstrated that nizatidine has a prokinetic effect due to its cholinergic properties. The aim of this study was to evaluate the effect of nizatidine on gastric emptying in patients with functional dyspepsia. Sixteen patients with dyspeptic symptoms referred for gastroscopy by primary care physicians were enrolled in this randomized, placebo-controlled, double-blind cross-over study. They received nizatidine 150 mg twice daily or placebo for 2 months. After a 1-month washout period, the 2-month treatment was repeated, with these patients acting as their own controls. Gastric emptying was measured by scintigraphy, and dyspeptic symptoms and quality of life were evaluated at the end of both treatment periods. Gastric emptying of solids during nizatidine therapy was prolonged (T1/2 110.1 +/- 76.7 vs. 65.6 +/- 23.2 min, P = 0.03), but nizatidine had no effect on gastric emptying of liquids. Nizatidine improved the symptom scores and seven of eight aspects of quality of life - but not significantly. In conclusion, nizatidine decreases the gastric emptying rate of solids without having a significant effect on symptoms or quality of life in functional dyspepsia.     

Concurrent assessment of reservoir and emptying of the stomach for dyspepsia patients

BACKGROUND/AIMS: We simultaneously examined the reservoir function of the stomach as well as emptying by one single assessment for gastric emptying, and investigated their association in patients with functional dyspepsia (FD). Next, we examined the interaction between the association and abdominal symptoms. METHODOLOGY: Sixty-one FD patients according to the Rome III criteria were recruited for this study. We measured the radioactive changes of the proximal and the whole stomach by the scintigraphy until 120 min, and assessed the reservoir function and the respective half-emptying time. We assessed the symptoms by the previously validated questionnaires. RESULTS: Disordered emptying was seen in 55.7% (34/61) of patients, delay in 67.6% (23/34), and acceleration in 32.4% (11/34). Impaired reservoir function was found in 49.2% (30/61) of patients, which had an association with delayed (p = 0.025) and disordered (delay+acceleration) emptying (p = 0.027). Through the period, the radioactive decrease was dynamic in the normal, but virtually unchanged in the impaired reservoir function group. Symptoms in the motility disordered group tended to be more severe than in the normal group. CONCLUSIONS: Gastric reservoir function was associated with emptying in FD patients. Abdominal symptoms of FD patients were partly derived from the impairment of coordinated gastric motility.     

Ghrelin stimulates gastric emptying and hunger in normal-weight humans

CONTEXT: Ghrelin is produced primarily by enteroendocrine cells in the gastric mucosa and increases gastric emptying in patients with gastroparesis. MAIN OBJECTIVE: The objective of the study was to evaluate the effect of ghrelin on gastric emptying, appetite, and postprandial hormone secretion in normal volunteers. DESIGN: This was a randomized, double-blind, crossover study. SUBJECTS: Subjects included normal human volunteers and patients with GH deficiency. INTERVENTION: Intervention included saline or ghrelin (10 pmol/kg.min) infusion for 180 min after intake of a radioactively labeled omelette (310 kcal) or GH substitution in GH-deficient patients. MAIN OUTCOME MEASURES: Measures consisted of gastric empty-ing parameters and postprandial plasma levels of ghrelin, cholecystokinin, glucagon-like peptide-1, peptide YY, and motilin. RESULTS: The emptying rate was significantly faster for ghrelin (1.26 +/- 0.1% per minute), compared with saline (0.83% per minute) (P < 0.001). The lag phase (16.2 +/- 2.2 and 26.5 +/- 3.8 min) and half-emptying time (49.4 +/- 3.9 and 75.6 +/- 4.9 min) of solid gastric emptying were shorter during ghrelin infusion, compared with infusion of saline (P < 0.001). The postprandial peak in plasma concentration for cholecystokinin and glucagon-like peptide-1 occurred earlier and was higher during ghrelin infusion. There was no significant effect of ghrelin on plasma motilin or peptide YY. There was no difference in gastric emptying before and after GH substitution. CONCLUSION: Our results demonstrate that ghrelin increases the gastric emptying rate in normal humans. The effect does not seem to be mediated via GH or motilin but may be mediated by the vagal nerve or directly on ghrelin receptors in the stomach. Ghrelin receptor agonists may have a role as prokinetic agents.     

Obesity does not increase effects of synthetic ghrelin on human gastric motor functions

BACKGROUND & AIMS: Ghrelin is secreted by the stomach and stimulates food intake. Obese individuals have lower fasting plasma ghrelin levels but increased appetite, suggesting greater responses to endogenous ghrelin in obesity. The aim of this study was to compare effects of exogenous ghrelin (at a dose that stimulates growth hormone [GH] release in the physiologic range) versus placebo on gastric emptying, gastric volume, and postprandial symptoms and determine whether body mass (ranging from normal weight to obesity) influences responses to ghrelin. METHODS: After intravenous bolus synthetic human ghrelin (0.33 mug/kg) or saline, we measured plasma GH, gastric volume, and gastric emptying by combined (99m)Tc-single-photon emission computed tomography and scintigraphy ((111)In egg meal, 300 kcal) and postprandial symptoms using visual analogue scales. RESULTS: In 25 obese subjects (5 men and 20 women; body mass index [BMI], 36 +/- 4 kg/m(2)) and 13 female normal-weight (BMI, 22 +/- 2 kg/m(2)) subjects of similar ages, ghrelin increased GH levels (15.0 +/- 2.4 ng/mL) at 40 minutes postinjection and tended to decrease fasting gastric volumes compared with placebo (P = .059). There were no effects of BMI on treatment response and no differences between ghrelin and saline on postprandial (P = .09) or change in (postprandial minus fasting) gastric volumes, gastric emptying, or aggregate postprandial symptoms. Effects of ghrelin did not differ between obese and normal-weight participants. CONCLUSIONS: At doses that stimulate physiologic GH plasma levels, synthetic ghrelin tended to decrease fasting gastric volumes without altering postprandial volumes or gastric emptying in a predominantly female cohort. The data are not consistent with the hypothesis that higher body mass is associated with increased gastric responsiveness to ghrelin.     

符合罗马Ⅲ标准的功能性消化不良患者固体胃排空功能研究

背景：罗马Ⅲ标准对功能性消化不良（FD）的定义作了更新和修订，相应FD患者人群亦发生改变。目的：研究符合罗马Ⅲ标准的FD患者的固体胃排空功能，以及新的FD症状谱和分型与固体胃排空功能之间的关系。方法：对36例符合罗马Ⅲ标准的FD患者和32名健康志愿者行^99Tc固体胃排空试验。比较不同症状分型FD患者的固体胃排空功能，分析固体胃排空功能与罗马Ⅲ标准中FD症状的相关性。结果：10例（27．8％）FD患者固体胃半排空时间超过正常上限，9例（25．0％）2h残留率高于正常上限。餐后不适综合征（PDS）、上腹痛综合征（EPS）和PDS＋EPS型FD患者固体胃半排空时间分别为（150．3±40．2）min、（118．3±25．1）min和（150．5±51．2）min，三组间差异无统计学意义（P=0．126）。餐后饱胀不适症状与固体胃半排空时间和2h残留率均呈线性正相关．相关系数分别为11．5（P=0．043）和0．045（P=0．040）。结论：本组27．8％的FD患者存在固体胃排空延迟。PDS和PDS＋EPS型FD的固体胃半排空时间有长于EPS的趋势。FD患者的餐后饱胀不适症状与固体胃排空延迟有关，固体胃排空延迟是符合罗马Ⅲ标准的FD患者的病理生理机制之一。     

Itopride for gastric volume,gastric emptying and drinking capacity in functional dyspepsia

AIM To study the effect of itopride on gastric accommodation, gastric emptying and drinking capacity in functional dyspepsia(FD). METHODS Randomized controlled trial was conducted to check the effect of itopride on gastric accommodation, gastric emptying, capacity of tolerating nutrient liquid and symptoms of FD. We recruited a total of 31 patients having FD on the basis of ROME III criteria. After randomization, itopride was received by 15 patients while 16 patients received placebo. Gastric accommodation was determined using Gastric Scintigraphy. ~(13) C labeled octanoic breadth test was performed to assess gastric emptying. Capacity of tolerating nutrient liquid drink was checked using satiety drinking capacity test. Theintervention group comprised of 150 mg itopride. Patients in both arms were followed for 4 wk. RESULTS Mean age of the recruited participant 33 years(SD = 7.6) and most of the recruited individuals, i.e., 21(67.7%) were males. We found that there was no effect of itopride on gastric accommodation as measured at different in volumes in the itopride and control group with the empty stomach(P = 0.14), at 20 min(P = 0.38), 30 min(P = 0.30), 40 min(P = 0.43), 50 min(P = 0.50), 60 min(P = 0.81), 90 min(P = 0.25) and 120 min(P = 0.67). Gastric emptying done on a sub sample(n = 11) showed no significant difference(P = 0.58) between itopride and placebo group. There was no significant improvement in the capacity to tolerate liquid in the itopride group as compared to placebo(P = 0.51). Similarly there was no significant improvement of symptoms as assessed through a composite symptom score(P = 0.74). The change in QT interval in itopride group was not significantly different from placebo(0.10). CONCLUSION Our study found no effect of itopride on gastric accommodation, gastric emptying and maximum tolerated volume in patients with FD.     

胃排空障碍与功能性消化不良相关性的研究

目的：探讨胃排空障碍与功能性消化不良（FD）之间的关系。方法：以双核素标记试餐SPECT技术检测了22例FD患者的液、固体食物胃排空和食物胃内分布，并以实时超声检测了72例FD患者在西沙必利治疗前后的液体胃排空变化，分析这些变化与症状积分变化的相关性．结果：68．2％的FD患者存在胃排空障碍，以固体胃排空延迟为主，单纯液体排空障碍较少；摄食后比对照组有更多的食物滞留于远端胃内，然而，延迟的胃排空和改变了的固体食物胃内分布与FD的主要症状无显著相关性。西沙必利明显缩短FD患者的液体胃排空时间，改善其中部分患者的临床症状，而另一部分患者的症状无明显缓解．结论：西沙必利改善FD症状并非完全依赖于其促排空效应，胃排空障碍与FD之间缺乏必然的联系，它们可能是同一病生基础的两种不同表现．     

Ghrelin enhances gastric emptying in diabetic gastroparesis: a double blind, placebo controlled, crossover study

BACKGROUND: Diabetic gastroparesis is a disabling condition with no consistently effective treatment. In animals, ghrelin increases gastric emptying and reverses postoperative ileus. We present the results of a double blind, placebo controlled, crossover study of ghrelin in gastric emptying in patients with diabetic gastroparesis. METHODS: Ten insulin requiring diabetic patients (five men, six type I) referred with symptoms indicative of gastroparesis received a two hour infusion of either ghrelin (5 pmol/kg/min) or saline on two occasions. Blood glucose was controlled by euglycaemic clamp. Gastric emptying rate (GER) was calculated by real time ultrasound following a test meal. Blood was sampled for ghrelin, growth hormone (GH), and pancreatic polypeptide (PP) levels. Cardiovagal neuropathy was assessed using the Mayo Clinic composite autonomic severity score (range 0 (normal)-3). RESULTS: Baseline ghrelin levels were mean 445 (SEM 36) pmol/l. Ghrelin infusion achieved a peak plasma level of 2786 (188) pmol/l at 90 minutes, corresponding to a peak GH of 70.9 (19.8) pmol/l. Ghrelin increased gastric emptying in seven of 10 patients (30 (6)% to 43 (5)%; p = 0.04). Impaired cardiovagal tone correlated inversely with peak postprandial PP values (p < 0.05) but did not correlate with GER. CONCLUSIONS: Ghrelin increases gastric emptying in patients with diabetic gastroparesis. This is independent of vagal tone. We propose that analogues of ghrelin may represent a new class of prokinetic agents.     

Effect of gastric volume or emptying on meal-related symptoms after liquid nutrients in obesity: a pharmacologic study.

BACKGROUND & AIMS: Altered postprandial satiation influences food intake in obesity. The aim of this study was to evaluate the contribution of gastric motor functions to intra- and postprandial symptoms in obese, otherwise healthy, people. METHODS: In a randomized, parallel-group, double-blind design, 40 obese (body mass index>30 kg/m2) healthy volunteers (n=10/group) received intravenous saline (placebo), atropine (.02 mg/kg), or erythromycin (1 or 3 mg/kg) to alter gastric volume and emptying after liquid nutrient meals, measured by validated imaging methods. The nutrient drink test assessed the volume ingested at maximum satiation, and intra- and early postprandial symptoms. Relationships between gastric motor functions, meal size, and symptoms were assessed by using multiple regression. Circulating levels of candidate upper-gut hormones involved in satiation were measured. RESULTS: Relative to placebo, atropine retarded gastric emptying and increased gastric volumes; erythromycin accelerated gastric emptying and reduced gastric volumes during fasting. Although similar maximal tolerated volumes were recorded across treatments, intra- and immediate postprandial symptoms were increased by these perturbations, particularly nausea and bloating. Upper-gut hormonal profiles generally reflected changes in gastric emptying. Regression analysis showed that fasting predrug gastric volume was a significant predictor of intra- and postprandial bloating. Change in gastric volume postdrug or postmeal did not contribute additionally to predicting intra- or postprandial symptoms. There was significant (negative) association between gastric emptying and fullness score, and significant (positive) association with hunger score 30 minutes postprandially. CONCLUSIONS: In obese individuals, fasting gastric volumes and gastric emptying, but not postprandial gastric volumes, were associated with intra- and postprandial symptoms. Understanding the determinants of gastric volume may provide insights on mechanisms controlling satiation.     

功能性消化不良患者胃排空与症状的相关性及影响因素分析

目的了解胃排空异常与消化不良症状的相关性,分析影响功能性消化不良（FD）患者胃排空的因素。方法纳入32例FD患者。量化记录餐后上腹饱胀、上腹痛、上腹烧灼感、早饱、嗳气、恶心、呕吐7组症状及静息心率。以心率的中位数将其转化为二分类变量进行非条件Logistic回归分析统计。运用核素闪烁法检测空腹固体试餐,试餐参考美国胃肠动力学会、神经胃肠学会及核医学联合推荐的标准低脂试餐以及诊断标准。结果 32例FD患者,8例（25%）T1/2延迟,7例（21.88%）Retention%2 h增加,Retention%1 h均在正常范围内。Retention%2 h正常组与Retention%2 h增加组以及T1/2正常组与T1/2延长组之间,心率均存在显著差异（P=0.031,P=0.022）,心率与Retention%2 h、T1/2存在正相关（r=0.448,P=0.01;r=0.423,P=0.016）。在控制了性别、年龄及其他症状因素的影响下,心率〉70 bpm是Retention%2 h增加、T1/2延长的独立因素（OR=12.378,P=0.042;OR=8.180,P=0.072）。在Retention%2 h正常组与Retention%2 h增加组之间恶心症状指数有显著差异（P=0.003）,恶心与Retention%2 h、T1/2存在正相关（r=0.527,P=0.002;r=0.381,P=0.032）。结论心率、恶心症状与功能性消化不良患者的胃排空存在一定相关性,在控制了性别、年龄、BMI及其他症状的因素影响下,静息心率增加、出现恶心症状可能是胃排空延缓的独立因素。     

伊托必利、多潘立酮和甲氧氯普胺联合用药对FD患者胃肠功能和Ghrelin表达的影响

目的:研究伊托必利、多潘立酮和甲氧氯普胺联合应用对功能性消化不良(FD)患者胃肠功能和Ghrelin含量的影响.方法:以FD患者为研究对象,依据罗马Ⅱ标准,将符合纳入标准的患者120例随机分为6组,分别给予盐酸伊托必利,多潘立酮,甲氧氯普胺,以及联合用药给予盐酸伊托必利+多潘立酮,盐酸伊托必利+甲氧氯普胺和多潘立酮+甲氧氯普胺,观察用药前后各临床症状积分改善程度、胃肠排空率及血清Ghrelin的水平改变.结果:各组FD患者服药后消化不良等症状均明显改善,在症状缓解率,联合用药组明显优于单独用药组(P＜0.01);在胃排空率,各联合用药组明显优于单独用药组(54.26%±18.57%,55.12%±18.22%.47.17%±15.21% vs 36.23%±11.68%,32.16%±10.08%,32.24%±10.12%,均P＜0.01);在肠排空率,联合用药组中伊托必利+多潘立酮组和伊托必利+甲氧氯普胺组明显优于多潘立酮+甲氧氯普胺组(89.27%±11.36%.88.67%±13.25% vs 69.16%±19.26%.均P＜0.011:单独用药组中伊托必利明显优于多潘立酮或甲氧氯普胺(78.23%±12.56% vs58.96%±12.20%,58.33%±12.57%,P＜0.01);但伊托必利单独用药明显优于多潘立酮+甲氧氯普胺联合用药(P＜0.05).FD患者血清Ghrelin水平明显降低(P＜0.05).经药物治疗后Ghrelin水平明显回升,联合用药组明显高于单独用药组(P＜0.05或0.01).结论:伊托必利、多潘立酮和甲氧氯普胺联合用药比单独用药更有效,可显著改善FD患者的胃肠动力,该功能可能与血清ghrelin水平改变有关.     

功能性消化不良患者血浆ghrelin变化及其与胃排空的关系

背景：ghrelin已被证实具有促进胃肠动力的作用,而胃肠动力障碍是功能性消化不良（FD）的重要发病机制,目前关于ghrelin与FD关系的临床研究较少。目的：探讨FD患者血浆ghrelin变化及其与临床症状和胃排空的关系。方法：纳人40例FD患者．其中餐后不适综合征（PDS）25例,上腹痛综合征（EPS）15例,并以20名健康者作为对照。评估临床症状评分,以实时B超检测胃半排空时间（GET1/2）,ELISA法检测血浆酰基化ghrelin水平,并分析血浆酰基化ghrelin水平与临床症状评分和GET1的关系。结果：与对照组相比,PDS组GET1/2和血浆酰基化ghrelin水平明显升高（P〈0．05）,而EPS组无明显差异（P〉0．05）。FD患者餐后饱胀与早饱症状评分之和与GET1/2呈正相关（r=0．33,P=0．04）,但与血浆酰基化ghrelin水平无关。PDS组和EPS组患者血浆酰基化ghrelin水平与临床症状评分均无关。PDS组患者血浆酰基化ghrelin水平与GET1/2呈正相关（r=0．43,P=0．033）,而EPS组中两者无关。结论：PDS患者血浆酰基化ghrelin水平明显升高,并与胃排空功能相关,提示ghrelin在FD的发生过程中发挥一定的作用。     

Dyspeptic symptoms and gastric emptying in the irritable bowel syndrome

OBJECTIVES: Irritable bowel syndrome (IBS) and dyspepsia often overlap. Delayed gastric emptying has been reported in IBS patients, although conflicting results exist. Whether overlapping dyspepsia correlates with gastric emptying abnormalities in IBS patients has not been clarified. This study aimed to evaluate gastric emptying of solids and its relationship with dyspeptic symptoms in IBS patients. METHODS: A total of 146 IBS outpatients seen in a referral center were evaluated for dyspeptic symptoms using a validated questionnaire. Gastric emptying of solids was evaluated scintigraphically in all patients and in 50 healthy controls. RESULTS: Overlapping dyspepsia was diagnosed in 96 (66%) IBS patients. On average, gastric emptying rates were lower in IBS patients (mean +/- SEM, 33% +/- 1%/h) compared with controls (40% +/- 2%/h; p < 0.01). Specifically, gastric emptying was delayed in IBS patients with overlapping dyspepsia (31% +/- 1%/h; p < 0.01), whereas IBS patients without dyspeptic complaints showed gastric emptying rates (37% +/- 2%/h) that were similar to those of healthy controls (40% +/- 2%/h). Relevant postprandial fullness (OR = 4.7, 95% CI = 1.8-12.5) and relevant nausea (OR = 3.3, 95% CI 1.2-9.3) were independently associated with delayed gastric emptying. CONCLUSIONS: IBS patients without overlapping dyspepsia have normal gastric emptying of solids. A significant association exists in IBS patients between delayed gastric emptying and overlapping relevant postprandial fullness and nausea.     

Nizatidine: A New Histamine Receptor Blocker in the Treatment of Active Duodenal Ulcers

Forty-three patients with newly diagnosed duodenal ulcers were treated with a new histamine blocker, nizatidine, and with placebo. The incidence of complete endoscopic healing was 38, 74, and 82% in the nizatidine treated patients compared with 25, 37, and 50% in the placebo treated group after 2, 4, and 8 wk of treatment, respectively. Nizatidine was clearly more effective than placebo after 4 wk of treatment. The size of unhealed ulcers decreased more than 50% in 62, 50, and 50% in the nizatidine treated groups versus 27, 25, and 40% in the placebo treated groups after 2, 4, and 8 wk of treatment, respectively. The difference between the two was not statistically significant for any given period. There was a significant correlation between day pain relief and ulcer healing in both treatment groups. Nizatidine significantly improved day pain relief only after 8 wk of treatment (p less than 0.01). No patient developed any side effects as a result of nizatidine treatment, except that the serum creatinine level rose from 1.05 to 1.1 mg/100 ml but still remained within the normal accepted range. This study demonstrated that nizatidine at 150 mg po bid could be effectively used in the treatment of duodenal ulcer disease.     

功能性消化不良患者胃排空障碍与胃肠激素的关系

目的 探讨功能性消化不良(FD)患者胃排空障碍与胃肠激素间的关系。方法 对54例四患者进行胃排空检查，根据结果将其分为胃排空延缓的FD组(FDD组)和胃排空正常的四组(FDN组)，另以17名正常人作为对照组。用放免法测定受试者血浆(空脂和餐后)、胃窦十二指肠粘膜组织的神经降压素(NT)和胃动宗(MTL)含量。结果 FDD组空脂和餐后血浆、胃窦和十二指肠粘膜组织的NT含量均明显高于对照组及FDN组。各组试餐前后血浆NT增幅差异无显著性。FDD组空脂和餐后血浆、胃窦和十二指肠粘膜组织的MIL含量均明显低于对照组及FDN组。各组十二指肠粘膜组织MTL含量均明显高于胃窦粘膜。结论 FD患者胃排空障碍与NT、MIL密切相关。NT、MIL在FD的发病机制中可能具有一定作用。     

Effects of postprandial walking on delayed gastric emptying and intragastric meal distribution in longstanding diabetics

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.     

Changes in patients&rsquo; symptoms and gastric emptying after Helicobacter pylori treatment

AIM: To investigate the changes in clinical symptoms and gastric emptying and their association in functional dyspepsia (FD) patients. METHODS: Seventy FD patients were enrolled and divided into 2 groups Helicobacter pylori (H. pylori)-negative group (28 patients), and H. pylori-positive group (42 patients). Patients in the H. pylori-positive group were further randomly divided into groups: H. pylori-treatment group (21 patients) and conventional treatment group (21 patients). Seventy two healthy subjects were selected as the control group. The proximal and distal stomach area was measured by ultrasound immediately after patients took the test meal, and at 20, 40, 60 and 90 min; then, gastric half-emptying time was calculated. The incidence of symptoms and gastric half-emptying time between the FD and control groups were compared. The H. pylori-negative and conventional treatment groups were given conventional treatment: domperidone 0.6 mg/(kg/d) for 1 mo. The H. pylori-treatment group was given H. pylori eradication treatment + conventional treatment: lansoprazole 30 mg once daily, clarithromycin 0.5 g twice daily and amoxicillin 1.0 g twice daily for 1 wk, then domperidone 0.6 mg/(kg/d) for 1 mo. The incidence of symptoms and gastric emptying were compared between the FD and control groups. The relationship between dyspeptic symptoms and gastric half-emptying time in the FD and control groups were analyzed. Then total symptom scores before and after treatment and gastric half-emptying time were compared among the 3 groups. RESULTS: The incidence of abdominal pain, epigastric burning sensation, abdominal distension, nausea, belching, and early satiety symptoms in the FD group were significantly higher than in the control group (50.0% vs 20.8%; 37.1% vs 12.5%; 78.6% vs 44.4%; 45.7% vs 22.2%; 52.9% vs 15.3%; 57.1% vs 19.4%; all P < 0.05). The gastric half-emptying times of the proximal end, distal end, and the whole stomach in the FD group were slower than in the control group (93.7 ± 26.2 vs 72.0 ± 14.3; 102.2 ± 26.4 vs 87.5 ± 18.2; 102.1 ± 28.6 vs 78.3 ± 14.1; all P < 0.05). Abdominal distension, belching and early satiety had an effect on distal gastric half-emptying time (P < 0.05). Abdominal distension and abdominal pain had an effect on the gastric half-emptying time of the whole stomach (P < 0.05). All were risk factors (odds ratio > 1). The total symptom score of the 3 groups after treatment was lower than before treatment (P < 0.05). Total symptom scores after treatment in the H. pylori-treatment group and H. pylori-negative group were lower than in the conventional treatment group (5.15 ± 2.27 vs 7.02 ± 3.04, 4.93 ± 3.22 vs 7.02 ± 3.04, All P < 0.05). The gastric half-emptying times of the proximal end, distal end, and the whole stomach in the H. pylori-negative and H. pylori-treatment groups were shorter than in the conventional treatment group (P < 0.05). CONCLUSION: FD patients have delayed gastric emptying. H. pylori infection treatment helps to improve symptoms of dyspepsia and is a reasonable choice for treatment in clinical practice.