Comparison of gastric emptying of a solid and a liquid nutritional rehabilitation food

OBJECTIVE: To compare gastric emptying of a solid and a liquid nutritional rehabilitation food. DESIGN: Cross-over trial. Eight volunteers took, in random order at least 1 week apart, 2100 kJ of a solid and a liquid nutritional rehabilitation food with added labelled [13C] glycine. SETTING: Research ward for healthy volunteers. SUBJECTS: Eight healthy volunteers. METHODS: Appearance of 13CO2 was monitored in expired gas every 15 min for 240 min after meal intake and compared between solid and liquid meals. Parameters of gastric emptying were then calculated. RESULTS: Gastric half-emptying time was slightly longer for solid meal compared to liquid meal (101+/-6.0 vs 88+/-9.8 min, P=0.24). 13CO2 excretion peaked 138+/-5.3 min after the solid meal compared with 119+/-8.6 min with liquid meal (P=0.06). 13CO2 excretion was higher for the liquid food up to 110 min after the meal but then became higher for the solid food. Analysis of variance for repeated measures of 13CO2 excretion showed a significant interaction term between the type of food and time indicating a delayed elimination of 13CO2 for the solid food (P=0.018). CONCLUSIONS: Attempts to replace liquid nutritional rehabilitation foods by a solid food in malnourished patients should take into account a possible slower gastric emptying. SPONSORSHIP: Supported by a grant from Nutriset (Malaunay, France) and ANVAR (Agence Nationale de la Valorisation de la Recherche, contract no. A9703021P).     

Starting solid foods: does the feeding method matter?

The weaning period, in which complementary foods are introduced into the infant’s diet, can be challenging, with dislike of novel foods known to be common. However, even though at six months (the current recommended age for the introduction of complementary foods) most infants are able to feed themselves with graspable pieces of food, the majority of the research to date assumes the use of spoon feeding and pureed food. The potential impact of the format of the food and the feeding method on the development of food preferences has not been explored. This paper describes the development and piloting of a coding scheme to examine infants’ responses to their first solid food offered in two formats – whole and pureed – and by two methods – self-feeding and spoon feeding, and its first use. The findings for the 10 infants in the study point to some important differences between the two feeding methods.     

The effect of ethanol and alcoholic beverages on gastric emptying of solid meals in humans

AIMS: The systematic study of the effect of pure ethanol, alcoholic beverages, and their non-alcoholic components on gastric emptying of solid meals in humans. METHODS: 16 fasting healthy male subjects received once weekly 300 ml of the following solutions in random order: 4 and 10% (v/v) ethanol, beer, red wine, 5.5 and 11.4% (w/v) glucose, and water. The test solutions were given either together with a low caloric (270 kcal, n = 8) or a high caloric (740 kcal, n = 8) solid meal. Ultrasonography of the antrum was used to determine gastric emptying. RESULTS: Gastric half emptying time (t(1/2) ) of the high caloric solid meal with water was 131.3 +/- 7 min. The ingestion of 4 and 10% (v/v) ethanol (158.8 +/- 9.3 and 165.6 +/- 6.2 min, respectively), beer (163.1 +/- 11 min), and red wine (186.3 +/- 8.4 min) resulted in a significantly longer t(1/2) than water. The lag phases after 4 and 10% (v/v) ethanol, beer, and red wine were not significantly different from that of water (48.1 +/- 6.5 min). Compared with water, the ingestion of 5.5 and 11.4% (w/v) glucose resulted in a significantly longer t(1/2) (153.8 +/- 5 and 168.1 +/- 14.4 min, respectively) by increasing the duration of the lag phase. The high caloric meals resulted in a 2-fold prolongation of t(1/2) when compared with the low caloric meals. The effect of the solutions on the gastric emptying times, however, was similar for both test meals. CONCLUSIONS: (i) Ethanol in low concentrations of 4 and 10% (v/v) prolongs gastric emptying of solid meals; this inhibitory effect is not dose-dependent. (ii) Alcoholic beverages (beer and red wine) also result in a prolongation of gastric emptying. The inhibitory effect of red wine, but not of beer, is more pronounced than that of the corresponding ethanol concentration and amount. (iii) The inhibitory effect of ethanol and alcoholic beverages is mainly induced by a prolongation of the gastric emptying phase (without affecting the lag phase), whereas 5.5 and 11.4% (w/v) glucose prolong the lag phase in a dose-dependent manner. (iv) The inhibitory effect of ethanol, beer, and red wine on gastric emptying does not depend on the caloric content of the meal.     

Treatment of severely delayed gastric emptying

For the drug treatment of gastroparesis, domperidone, metoclopramide and cisapride may be prescribed as prokinetics. Positive effects on the rate of emptying of the stomach, dyspeptic symptoms and quality of life are best documented for cisapride. Simultaneous use of cisapride with substances that inhibit the metabolism of cisapride or that may lengthen the QT interval, is contraindicated because of the risk of arrhythmias. Erythromycin is a powerful prokinetic, but because of its antibiotic effects it is usually prescribed only for a brief period. For patients who in spite of drug treatment have persistent unacceptable symptoms and keep losing weight, invasive treatment should be considered. The first step is then insertion of a jejunal tube, followed, if necessary, by antrectomy with Billroth-I reconstruction. The next step is subtotal gastrectomy with Roux-Y reconstruction, this may result in abatement of the symptoms, which, however, rarely disappear altogether.     

Relationship between the rate of gastric emptying and glucose and insulin responses to starchy foods in young healthy adults

Twelve young healthy adults (five men, seven women) ingested four test meals on four occasions so we could examine the relationship between the rate of gastric emptying (GE) and the glucose response to different starchy foods. Each meal consisted of one food product containing 50 g starch: spaghetti, rice, French bread, or mashed potato. Basal and postprandial glucose and insulin responses were measured for 3 h. The foods were labeled with 3.7 MBq Tc99m-albumin and GE was studied by scintigraphy for 3 h. The rate of GE (expressed by the GE half-time) was fastest for mashed potatoes, then bread, rice, and slowest for spaghetti. Blood glucose and serum insulin responses were similar. A significant negative correlation was found between the GE half-time and the maximum variation in blood glucose level (r = -0.6, p less than 0.0001). The glucose response to all four foods is strongly related to the GE rate.     

Effect of guar gum on gastric emptying after gastric resection

Gastric emptying after a conventional semisolid meal containing 5 g of guar gum granules or placebo was measured in a double-blind, controlled trial, using a radioisotopic (technetium Tc-99m DTPA) technique, in 11 patients who had undergone gastric resection, and who were experiencing the dumping syndrome. Guar gum clearly slowed gastric emptying in five of the 11 patients, and the results suggest that the addition of guar gum to normal meals, especially those rich in monosaccharides or disaccharides, may be helpful to post-gastrectomy patients suffering from the dumping syndrome.     

Measurement of gastric emptying by octanoate metabolism

PURPOSE OF REVIEW: Since its introduction just over 10 years ago, there have been a number of studies that have used the octanoate breath test to assess gastric emptying. Although use of the method is on the increase (the number of gastric emptying studies published on PubMed using the octanoate breath test has doubled between the periods 1997-2000 and 2001-2004 compared with a drop of approximately 20% in the use of scintigraphy over the same periods), the methodology has not achieved universal acceptance, primarily because it can provide results comparable to established techniques only indirectly. RECENT FINDINGS: Recent methods for overcoming this difficulty are reviewed, including modified methods for breath test interpretation and the application of the related saliva test. The latter promises to be useful as a non-invasive proxy for established techniques, such as scintigraphy, for further validation of the breath test. Recent applications of octanoate-based methods are briefly considered. SUMMARY: A novel approach detailed in this review for breath test interpretation, where the bicarbonate pool is modelled as a single compartment, could prove useful for obtaining breath test gastric emptying parameters that are directly comparable with those obtained from the gold standard, gamma scintigraphy. In combination with the saliva test, this could add credence to use of the octanoate breath test as a clinically accepted diagnostic tool, in addition to its potential in research.     

A comparison of the gastric emptying characteristics of selected sports drinks.

The purpose of this study was to determine the effects of repeated ingestion of drinks containing varying concentrations of carbohydrate on gastric emptying rate during steady-state exercise. On five separate occasions, 14 subjects cycled for 90 min at an average power output of 151 +/- 2 W. At 15-min intervals, subjects ingested 227 +/- 3 ml of either water, 4% carbohydrate (CHO), 6% CHO, or 8% CHO. Gastric volume was determined prior to each drink and at 90 min using the modified double-sampling technique. Gross gastric volumes were significantly greater and mean gastric emptying rates and the percentage of ingested beverage emptied from the stomach were significantly less for 8% CHO. These data indicate that repeated ingestion of an 8% CHO beverage during exercise significantly reduces gastric emptying rate, whereas lower concentrations of carbohydrate do not. In addition, beverage osmolality is not as important as beverage energy content in influencing gastric emptying rate at these carbohydrate concentrations.     

A simple method for fume cupboard performance assessment

The performance of a fume cupboard is determined by a complex interaction of factors which are time consuming and expensive to determine. This paper describes a simple and practical means of ranking, and assessing fume cupboard installations that can help to discharge managerial responsibility for a 'safe' environment. The method also gives an economically viable and technically defensible system for assessing fume cupboard performance as part of upgrading exercises or performance audits. The assessment strategy uses flow visualisation techniques and measurements of inflow air velocity as well as overall condition evaluation to rank performance and identify poor performing cupboards. The method has been used to carry out a condition and performance survey of 199 fume cupboards, both aerodynamic and box-type designs, in an academic institution. The results of this survey are presented which not only highlight performance characteristics but also provide insights into user attitudes and knowledge of fume cupboard operation and performance. It is suggested that surveys such as this could be helpful in training programmes for laboratory workers to enable them to optimise the use of fume cupboards.