Changes of gallbladder and gastric dynamics in patients with acute hepatitis A

Transient alterations of gallbladder morphology and dynamics have been reported in patients with during acute hepatitis A. The presence of dyspepsia also suggests involvement of gastric motility. During a 60-day follow-up, we investigated gallbladder and gastric motility in relation to dyspepsia in acute viral hepatitis A patients. Twenty patients were assessed at referral (day 0) and at days 7, 21, 42 and 60 and compared with 20 healthy volunteers. Gallbladder morphology and motility and gastric motility were assessed in the fasting and postprandial period by functional ultrasonography using a liquid test meal. Dyspeptic symptoms were scored. At day 0, fasting gallbladder volume was 5.9 +/- 1.3 mL, 32.6 +/- 4.6 mL, and 21.5 +/- 1.9 mL (mean +/- SE) in patients with gallbladder sludge (n = 7), without sludge (n = 13) and controls, respectively (P < 0.05 in sludge vs. no sludge and controls; P < 0.05 in no sludge vs. controls, ANOVA). Small fasting gallbladder volume in patients with sludge increased and sludge disappeared within 7 days. At day 0, patients with sludge also had increased thickness of fasting gallbladder wall and increased serum transaminase levels compared with patients without sludge and controls. Gallbladder contraction was similar in patients and controls. However, patients had delayed gastric emptying, which positively correlated with dyspepsia score. Gallbladder morphological changes observed in the acute phase of hepatitis A are transient and are associated with hepatocellular damage. Gastric emptying is delayed during the first week of disease and is associated with dyspeptic symptoms.     

Effects of cholestyramine on gallbladder and gastric emptying in obese and lean subjects

Abstract. Gallbladder stasis is frequent in obese subjects and may contribute to their increased risk for gallstone formation. The bile salt sequestrant cholestyramine acutely enhances postprandial gallbladder emptying in lean subjects, through dis-inhibition of a negative feedback between intraluminal bile salts and CCK release. In this study the effect of cholestyramine on both gallbladder and gastric antrum dynamics were studied by realtime ultrasonography in 12 obese and 15 lean subjects. For the acute study, on different days, subjects ingested a liquid meal (two egg yolks plus water 200 mL, 50 kJ) or a meal with 4g cholestyramine. Gallbladder emptying was impaired in obese patients who had significantly larger fasting gallbladder volume (39.4 ± 6.9 vs. 21.6 ± l.7mL, P <0.02), larger residual volume (12.3 ± 1.8 vs. 4.0 ± 0.5ml, P < 0.0006) and slower emptying time ( T /2: 33 ± 2 vs. 21 ± 2 min, P < 0.05) than lean subjects. Integrated antral emptying was also less in obese than lean subjects (5521 ± 578 vs. 7908 ± 491 % 120min^-1, P <0.02). Cholestyramine enhanced postprandial gallbladder emptying in both obese and lean subjects. Gastric emptying was delayed with cholestyramine in lean but not obese subjects. For the chronic study, after 1 month therapy with cholestyramine (4 g every 2 days), the motility tests were repeated in nine obese subjects. Gallbladder and gastric responses to a test meal, with or without cholestyramine, were preserved. We conclude that both gallbladder and antral emptying of a liquid test meal are impaired in obese subjects. Gallbladder emptying improves after acute administration of a low dose cholestyramine with test meal. This effect is sustained after 1 month treatment with a low dose of cholestyramine and does not interfere with gastric emptying of obese patients. Cholestyramine may improve gallbladder hypomotility in obese people.     

Gallbladder motility and cholesterol crystallization in bile from patients with pigment and cholesterol gallstones

BACKGROUND: Little is known about gallbladder motility in patients with black pigment stones when compared to cholesterol gallstone patients, or about their relationship to biliary composition, crystallization and stone characteristics. DESIGN: Fasting and postprandial gallbladder volumes were studied by ultrasonography in 49 gallstone patients with pigment (n = 14) or cholesterol (n = 35) stones and 30 healthy controls. After cholecystectomy stone composition, gallbladder wall inflammation, cholesterol saturation index and appearance of platelike cholesterol crystals in bile were evaluated in gallstone patients. RESULTS: Fasting gallbladder volume was significantly (P < 0.05) increased in cholesterol stone patients (31.7 +/- 1.9 mL) but not in pigment stone patients (21.9 +/- 3.1 mL), compared to controls (21.0 +/- 1.5 mL). Postprandial emptying was delayed in patients (half-emptying time: 31 +/- 2 min, 35 +/- 3 min, 24 +/- 2 min in cholesterol stone patients, pigment stone patients and controls, respectively, P < 0.05) and incomplete (residual volume: 43.2 +/- 2.7%, 40.0 +/- 4.3%, 15.8 +/- 1.6% min in cholesterol stone patients, pigment stone patients and controls, respectively, P < 0.05). The inflammation of the gallbladder wall was mild or absent in all cases. Biliary cholesterol saturation index was 152.3 +/- 8.5% and 92.9 +/- 4.8% in patients with cholesterol and pigment stones, respectively (P < 0.01). Whereas cholesterol crystals never appeared during 21 days in biles from patients with pigment stones, crystal observation time in patients with cholesterol gallstone was 5 days (median) and was significantly shorter in patients with multiple (4 days) than in patients with solitary (12 days) cholesterol stones (P = 0.0019). CONCLUSIONS: Patients with black pigment stones who do not have excess cholesterol and do not grow cholesterol crystals in bile have decreased gallbladder emptying, although to a lesser extent than patients with cholesterol stones. Thus, gallbladder stasis is likely to put a subset of subjects at risk for the formation of pigment gallstones, and pathogenic mechanisms need to be further investigated.     

Ultrasonographic assessment of gallbladder bile exchanges in healthy subjects and in gallstone patients.

Impaired gallbladder motility may contribute to gallstone pathogenesis by providing time for nucleation and aggregation of cholesterol crystals. Simultaneous scintigraphic-ultrasonographic techniques have been proposed to assess alternating phases of gallbladder emptying and filling. To evaluate patterns of gallbladder motility and of postprandial bile flow by means of a single ultrasonographic technique, 12 healthy volunteers and 20 gallstone patients underwent minute-by-minute gallbladder ultrasonography for 3 h postprandially. Mathematical analysis of volume measurements was used to estimate hepatic and cholecystic bile flux through the gallbladder. Compared to controls, gallstone patients showed greater amounts of unexchanged cholecystic-to-hepatic bile (11% vs. 1%, p <.001) and most of them showed impaired gallbladder washout efficacy. Utrasonographic values of bile exchanges were similar to those derived from scintigraphic-sonographic studies in comparable groups of subjects. This study provides new ultrasonographic variables, which better express gallbladder bile retention in gallstone patients and strongly discriminate gallstone patients from controls.     

Effect of rectal distension on gallbladder emptying and circulating gut hormones

BACKGROUND: Abnormalities of upper gut motility, including a delay of gastric emptying and small bowel transit, found in patients with constipation may be secondary to factors originating in the colon or rectum as a result of faecal stasis. The aim was to determine if stimulation of mechanosensory function by rectal distension affects postprandial gallbladder emptying and release of gastrointestinal peptides participating in control of upper gut motility. MATERIALS AND METHODS: Eight healthy volunteers were studied with an electronic barostat and a plastic bag positioned in the rectum. Intrabag pressure was maintained at minimal distension pressure + 2 mmHg on one occasion and on a pressure that induced a sensation of urge on the other. Gallbladder volume and plasma concentrations of cholecystokinin (CCK), pancreatic polypeptide (PP) and peptide YY (PYY) were measured before and after ingestion of a 450-kcal mixed liquid meal. RESULTS: Rectal distension enhanced maximum gallbladder emptying from 66 +/- 7% to 78 +/- 5% (P < 0.05). Distension tended to increase integrated plasma PYY from 77 +/- 30 pM min to 128 +/- 40 pM min in the first hour after the meal (P = 0.08) and it suppressed integrated plasma PP from 1133 +/- 248 pM min to 269 +/- 284 pM min in the second hour (P < 0.05). Integrated plasma CCK concentrations were not significantly affected. CONCLUSION: Mechanosensory stimulation of the rectum enhances postprandial gallbladder emptying and influences postprandial release of gut hormones involved in the regulation of gastrointestinal motility in healthy subjects. These mechanisms may play a role in the pathogenesis of the upper gastrointestinal motor abnormalities observed in constipated patients.     

Gallbladder and gastric motility in patients with idiopathic slow-transit constipation

OBJECTIVE: Idiopathic slow-transit constipation (STC) has been suggested to be a pangastrointestinal motility disorder. We investigated scintigraphically whether motility in the gallbladder and stomach was impaired in slow-transit constipation. METHODS: Twenty-four patients with STC were studied. Colon transit time, gallbladder motility, and solid-phase gastric emptying were measured by scintigraphy. RESULTS: Gallbladder dysmotility was observed in 8 of 18 (44.4%) patients. Mean gallbladder ejection fraction was 41.6 +/- 13.6% (range, 16.3-67.0%). Gastric emptying was delayed in 9 of 18 (50%) patients. Mean solid-phase gastric half-emptying time was 75 minutes. STC may be associated with impaired function of other gastrointestinal organs. Approximately half of patients with STC presented gallbladder or gastric dysmotility. CONCLUSION: STC may not be a pure colonic abnormality; it may be a component of a pangastrointestinal tract motility disorder involving several organs.     

Dyspepsia in AIDS is correlated to ultrasonographic changes of antral distension.

OBJECTIVES: Patients with acquired immune deficiency syndrome (AIDS) frequently complain about dyspeptic symptoms. We set out to test whether changes in antral emptying or antral distension may account for these dyspeptic symptoms in AIDS. METHODS: We studied antral emptying in ten patients with HIV infection (CDC 1993 classification stage C) by means of an established real-time ultrasonographic method. Organic abdominal lesions had been excluded. Six upper gastrointestinal symptoms were evaluated using a score ranging from 0 to 3. Fifteen subjects without any abdominal complaints and without any abdominal history served as controls. Antral cross sectional area was measured after an overnight fast and at 0, 15, 30, 45, 60, 90, 120 min after an semisolid test meal. Antral postprandial distension was expressed using an antral expansion ratio (postcibal antral area/fasting antral area). Gastric emptying of the test meal was derived from the measurement of the area under the postcibal antral distension curve (AUC). RESULTS: Fasting antral cross sectional area and AUC (gastric emptying) were similar in both groups. Antral postprandial expansion tended to be lower in AIDS patients compared to controls (mean+/-S.D.): 288+/-84 versus 397+/-156%; P=0.08. In AIDS patients the symptom score of dyspepsia showed a positive correlation (r=0.55; P<0.05) with fasting antral area and a negative correlation (r=-0.62; P<0.05) with postprandial expansion. No signs of autonomic neuropathy were to be found in the AIDS patients tested in this study. CONCLUSION: A wider fasting antral cross sectional area and an impaired antral postprandial expansion are related to dyspeptic symptoms in AIDS patients. This suggests the same relationship between dyspeptic symptoms and disturbed antral distension as seen in other patients with functional dyspepsia.     

Ultrasonic evaluation of gallbladder emptying with ceruletide: comparison to oral cholecystography with fatty meal

Assessment of gallbladder function is required prior to nonsurgical treatment of gallstones. In order to develop a practical and reproducible method of evaluation, gallbladder emptying was studied by ultrasound (US) in 55 gallstone patients after intramuscular administration of ceruletide (0.3 g/kg). In 27 of these subjects, the US procedure was compared to oral cholecystography (OCG) with fatty meal. Maximal percent gallbladder contraction was reached 30 min after ceruletide in all patients. Maximal percent contractions were 47.5±27.7 during US with ceruletide and 33.9±16.3 during OCG with fatty meal (p = 0.03). A significant linear relationship was found between the results obtained with the two different procedures (r=0.57; p = 0.002). Serial US determinations of gallbladder emptying were performed in 16 patients. Individual variation was below 20% in 11 subjects, and in five subjects it ranged between 20 and 40%. Minor, self-limiting side effects were observed in 13 patients. US determination of gallbladder emptying after ceruletide appears to be a practical and reliable method to assess gallbladder function.     

Prevalence of delayed gastric emptying in diabetic patients and relationship to dyspeptic symptoms: a prospective study in unselected diabetic patients

OBJECTIVE: Data on the prevalence of abnormal gastric emptying in diabetic patients are still lacking. The relation between gastric emptying and dyspeptic symptoms assessed during gastric emptying measurement has not yet been investigated. The aim was to investigate the prevalence of delayed gastric emptying in a large cohort of unselected diabetic patients and to investigate the relation between gastric emptying and gastrointestinal sensations experienced in the 2 weeks before and during the test meal, prospectively. RESEARCH DESIGN AND METHODS: Gastric emptying was evaluated in 186 patients (106 with type 1 diabetes, mean duration of diabetes 11.6 +/- 11.3 years) using 100 mg (13)C-enriched octanoic acid added to a solid meal. RESULTS: Gastric emptying was significantly slower in the diabetic subjects than in the healthy volunteers (T(50): 99.5 +/- 35.4 vs. 76.8 +/- 21.4 min, P < 0.003; Ret(120 min): 30.6 +/- 17.2 vs. 20.4 +/- 9.7%, P < 0.006). Delayed gastric emptying was observed in 51 (28%) diabetic subjects. The sensations experienced in the 2 weeks before the test were weakly correlated with the sensation scored during the gastric emptying test. Sensations assessed during the gastric emptying test did predict gastric emptying to some extent (r = 0.46, P < 0.0001), whereas sensations experienced in the previous 2 weeks did not. CONCLUSIONS: This prospective study shows that delayed gastric emptying can be observed in 28% of unselected patients with diabetes. Upper gastrointestinal sensations scored during the gastric emptying tests do predict the rate of gastric emptying to some extent and sensation experienced during daily life does not.     

Impaired gallbladder function in spinal cord injury on quantitative Tc-99m DISIDA cholescintigraphy

Background: Patients with spinal cord injury (SCI) have increased prevalences of gallstones and acute acalculous cholecystitis. A possible explanation for the increased prevalence of gallstone disease in SCI patients is decreased gallbladder motility causing gallbladder stasis, a known risk factor for gallstone disease. We investigated gallbladder function in SCI. Methods: Twenty-five normal control subjects and 50 SCI patients were included in this study. Gallbladder function was measured by technium 99m–labeled imino-diacetic acid analogue (Tc-99m DISIDA) cholescintigraphy and represented by the filling fraction (FF) and the ejection fraction (EF). The SCI patients were assigned to subgroups: old versus young, female versus male, high- versus low-level injury, and long versus short injury duration. Results: Forty-two percent of SCI patients had abnormal FFs and 54% of SCI patients had abnormal EFs. Significantly decreased FF and EF values were found in SCI patients, especially in those who were female and had high-level injuries. Conclusion: With the use of quantitative Tc-99m DISIDA cholescintigraphy, we found that SCI can significantly impair gallbladder function.     

Disorders of bile acid metabolism in cholesterol gallstone disease.

The aim of the study was to evaluate the metabolism of individual bile acids in patients with cholesterol gallstone disease. Therefore, we determined pool size and turnover of deoxycholic (DCA), cholic (CA), and chenodeoxycholic acid (CDCA) in 23 female gallstone patients classified according to their gallbladder function and in 15 healthy female controls. Gallstone patients had normal hepatic bile acid synthesis, but, depending on gallbladder function, differed with respect to turnover and size of the bile acid pools: Patients with well-emptying gallbladder (group A, n = 9) had enhanced turnover and reduced pools of CA (-46%; P less than 0.01 vs. controls) and CDCA (-24%; P less than 0.05), but normal input and size of the DCA pool. With reduced gallbladder emptying (less than 50% of volume; group B, n = 6), turnover and pools of CA, CDCA, and DCA were similar as in controls. Patients with loss of gallbladder reservoir (group C, n = 8) had increased input (+100%; P less than 0.01) and pool size of DCA (+45%; P = 0.07) caused by rapid conversion of CA to DCA, while the pools of CA (-71%; P less than 0.001 vs. controls) and CDCA (-36%; P less than 0.05) were reduced by enhanced turnover. Thus, in patients with cholesterol gallstones, the pools of primary bile acids are diminished, unless gallbladder emptying is reduced. Furthermore, in a subgroup of gallstone patients, who had completely lost gallbladder function, the CA pool is largely replaced by DCA owing to rapid transfer of CA to the DCA pool. This probably contributes to supersaturation of bile with cholesterol.     

A 25-Year Longitudinal Evaluation of Gastric Emptying in Diabetes

OBJECTIVE

To evaluate the natural history of gastric emptying in diabetes.

RESEARCH DESIGN AND METHODS

Thirteen patients with diabetes (12, type 1; 1, type 2) had measurements of gastric emptying, blood glucose levels, glycated hemoglobin, upper gastrointestinal symptoms, and autonomic nerve function at baseline and after 24.7 ± 1.5 years.

RESULTS

There was no change in gastric emptying of either solids (% retention at 100 min) (baseline 58.5 ± 5% vs. follow-up 51.9 ± 8%; P = 0.35) or liquids (50% emptying time) (baseline 29.8 ± 3 min vs. follow-up 34.3 ± 6 min; P = 0.37). Gastric emptying of solid at follow-up was related to emptying at baseline (r = 0.56, P < 0.05). At follow-up, blood glucose concentrations were lower (P = 0.006), autonomic function deteriorated (P = 0.03), and gastrointestinal symptoms remained unchanged (P = 0.17).

CONCLUSIONS

In unselected patients with diabetes, gastric emptying appears remarkably stable over 25 years.There is limited information about the natural history of gastric emptying in diabetes (1–3). We have reported that gastric emptying and symptoms changed little after 12 years of follow-up, possibly because a deterioration in autonomic function was counteracted by better glycemic control (4). We reexamined patients from the same cohort after 25 years.     

Association between gastric emptying rate and nutritional status in patients treated with continuous ambulatory peritoneal dialysis.

OBJECTIVE: To estimate gastric emptying rate in continuous ambulatory peritoneal dialysis (CAPD) patients, with or without indwelling dialysate, and to evaluate if there is an association between gastric motility and nutritional status. DESIGN: Single-center cross-sectional study. SETTING: Peritoneal Dialysis Unit, Medical Faculty, Jagiellonian University Hospital, Krakow, Poland. PATIENTS AND METHODS: 20 end-stage renal disease patients [11 F, 9 M; mean age 50.1 +/- 11 years; treated with CAPD for median 13.5 (2-61) months] were studied. All patients were nondiabetic and had no comorbidity that might influence gastric motility; nor were they receiving any prokinetic drugs. Gastric emptying rate was estimated with dynamic abdominal scintigraphy, started immediately after complete ingestion of a standard 200-kcal solid meal injected with 99mTc-labeled colloid, activity 40 MBq. Scintigraphy was performed at the rate of 23 images in 4-minute intervals for 92 minutes. Two consecutive procedures--with and without PD fluid--were performed at weekly intervals. As nutritional parameters, protein catabolic rate (PCR) and lean body mass (LBM) (based on urea and creatinine kinetics, respectively), body mass Index (BMI), and serum albumin were measured. RESULTS: All analyzed gastric emptying parameters, measured with or without dialysis fluid, were markedly prolonged in patients compared to values accepted as normal in the local scintigraphy unit. Gastric emptying half-time (T(1/2)) and percent of initial activity in minute 46 and in minute 92 were 60.5 +/- 25.0 minutes, 57.19% +/- 17.5%, and 33.8% +/- 20.9% with a full peritoneal cavity, and 63.9 +/- 28.2 minutes, 59.1% +/- 23.9%, and 33.9% +/- 24.3% with an empty peritoneal cavity. The T(1/2) and percent of initial activity after 46 and 92 minutes for healthy subjects were 39 +/- 9 minutes, 45% +/- 11%, and 15% +/- 6%, respectively. T(1/2) without dialysis fluid revealed a negative correlation with LBM and BMI values (r = -0.5, p < 0.05, and r = -0.56, p < 0.01; respectively). Patients with dialysate-free T(1/2) > 40 minutes were characterized by significantly lower serum albumin level compared to subjects with T(1/2) < 40 minutes (39.2 +/- 2.9 vs 42.9 +/- 3.6 g/L, p < 0.05). The values of all gastric emptying parameters measured for an empty abdomen were prolonged in subjects with BMI < 25 kg/m2. No difference was found between patients with and without PD fluid. CONCLUSIONS: Gastric emptying is markedly impaired in CAPD patients compared to healthy subjects. However, the presence of dialysate does not influence it significantly. Gastric emptying rate was negatively associated with the nutritional status of treated subjects. This association can be demonstrated when gastric motility is measured with an empty peritoneal cavity.     

Gastric acidity and duodenogastric reflux during nasojejunal tube feeding in mechanically ventilated patients

Objective: In order to prevent gastric microbial overgrowth, which may complicate nasogastric feeding, administration of nutrients more distally into the gut has been advocated in intensive care patients, as it offers the advantage of keeping the stomach empty and acid. In this study, we assessed the impact of jejunal feeding upon gastic pH in a group of mechanically ventilated, critically ill patients, with special focus on duodenogastric reflux as a possible cause of gastric alkalinization during jejunal nutrition. Design: Prospective experimental study. Setting: Multidisciplinary intensive care unit of a university hospital. Patients and methods: Gastric pH was recorded by continuous pHmetry over a 4-h period of fasting followed by a 4-h period of nasojejunal feeding at 100 kcal/h in 21 mechanically ventilated, critically ill patients. To determine the contribution of duodenogastric reflux to modifications of gastric acidity, the diet was traced with [¹¹¹In] DTPA (pentetic acid) in 11 of these 21 patients; gastric contents were aspirated every 30 min, then analysed for measurement of radioactivity, glucose, and bile acid concentration. Measurements and results: Median intragastric pH increased slightly from 1.59 (1.20–2.73; interquartile range) (fasting) to 2.33 (1.65–4.64) (feeding) (p = 0.013), and the length of time that the pH was 4 or above increased from 1 (0–24) to 9 (0–142) min (p = 0.026). The variability of pH values and the number of acute alkalinization episodes did not change between the two phases. In 10 of 11 patients in which the diet was labeled with [¹¹¹In] DTPA, reflux was documented at a given time of the feeding period. Bile acid concentrations in the stomach increased from 392 (61–1076) (fasting) to 1446 (320–2770) μmol/l (feeding) (p = 0.010) and mean glucose concentration increased from 59 (28–95) to 164 (104–449) mg/dl (p = 0.006). Conclusion: Duodenogastric reflux is common in mechanically ventilated critically ill patients with nasojejunal feeding tubes. It occurs both during fasting and during nasojejunal feeding. During nasojejunal feeding, moderate alkalinization of the gastric contents occurs as a result of bile and nutrient reflux. Received: 24 August 1998 Accepted: 18 February 1999     

Role of the gastric phase in fat-induced gallbladder contraction and cholecystokinin secretion in humans

The present study was undertaken to investigate the role of the gastric phase of fat-induced gallbladder contraction and endogenous cholecystokinin (CCK) secretion in humans. Gallbladder emptying, measured by cholescintigraphy, and endogenous CCK secretion, measured by radioimmunoassay, were studied in healthy subjects after both intragastric and intra-intestinal administration of corn oil. In addition, patients with partial gastrectomy were investigated to study the effect of accelerated gastric emptying. In the healthy subjects, intragastric administration of fat resulted in a significantly (P less than 0.05) later increase in plasma CCK levels (20 +/- 2 min) compared to intraintestinal fat (5 +/- 1 min). Similarly, the onset of gallbladder emptying was significantly (P less than 0.05) delayed after intragastric fat (20 +/- 2 min) compared to intestinal fat (10 +/- 1 min). In the healthy subjects the integrated plasma CCK response to intragastric fat was significantly (P less than 0.005-P less than 0.01) reduced from 10 to 30 min. In the patients with partial gastrectomy the rise in plasma CCK (10 +/- 1 min) and the onset of gallbladder emptying (15 +/- 2 min) were in the same range after intra-intestinal and intragastric fat. No significant differences in plasma CCK levels, integrated CCK response or gallbladder emptying were found in the patients according to the site of fat application. It is concluded that endogenous CCK secretion and gallbladder emptying in response to intragastric fat are significantly delayed in healthy subjects but not in patients with partial gastrectomy, in whom gastric emptying is accelerated.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of Intraduodenal Glutamine on Incretin Hormone and Insulin Release,the Glycemic Response to an Intraduodenal Glucose Infusion,and Antropyloroduodenal Motility in Health and Type 2 Diabetes

OBJECTIVE

Glutamine reduces postprandial glycemia when given before oral glucose. We evaluated whether this is mediated by stimulation of insulin and/or slowing of gastric emptying.

RESEARCH DESIGN AND METHODS

Ten healthy subjects were studied during intraduodenal (ID) infusion of glutamine (7.5 or 15 g) or saline over 30 min, followed by glucose (75 g over 100 min), while recording antropyloroduodenal pressures. Ten patients with type 2 diabetes mellitus (T2DM) were also studied with 15 g glutamine or saline.

RESULTS

ID glutamine stimulated glucagon-like peptide 1 (GLP-1; healthy: P < 0.05; T2DM: P < 0.05), glucose-dependent insulinotropic polypeptide (GIP; P = 0.098; P < 0.05), glucagon (P < 0.01; P < 0.001), insulin (P = 0.05; P < 0.01), and phasic pyloric pressures (P < 0.05; P < 0.05), but did not lower blood glucose (P = 0.077; P = 0.5).

CONCLUSIONS

Glutamine does not lower glycemia after ID glucose, despite stimulating GLP-1, GIP, and insulin, probably due to increased glucagon. Its capacity for pyloric stimulation suggests that delayed gastric emptying is a major mechanism for lowering glycemia when glutamine is given before oral glucose.Postprandial glycemic control represents a major focus of type 2 diabetes mellitus (T2DM) management (1). The rate of gastric emptying and the release of “incretin” hormones, glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), are both important determinants of postprandial glycemic excursions (2). Glucose empties from the stomach in health in the range of 1–4 kcal/min, regulated by inhibitory small-intestinal feedback via stimulation of pyloric motility and suppression of antral and duodenal contractions (3). Differences in gastric emptying account for about one-third of the variation in postprandial blood glucose levels after oral glucose (4).Glutamine reduces glucose excursions when given before oral glucose in T2DM (5), potentially by stimulating GLP-1 secretion (6) and/or slowing gastric emptying (7). The purpose of the current study was to determine whether glutamine retains its capacity to lower glycemia when glucose is delivered directly into the duodenum, thereby removing any influence of gastric emptying, while measuring antropyloroduodenal motility, gut hormones, and insulin.     

双源CT双能量成像在体分析胆囊结石成分研究

目的 探讨双源CT（DSCT）双能量成像分析体内胆囊结石成分的应用价值。方法 对200例胆囊结石患者于胆囊切除术前行DSCT双能量扫描,分析80 kV、140 kV图像对胆囊阴性结石的检出率。以显微红外光谱分析结果为判断结石成分的金标准,比较不同成分结石间80 kV图像CT值、140 kV图像CT值、CT值差值及CT值比值的差异;以ROC曲线评价不同指标鉴别胆固醇与非胆固醇成分胆囊结石的效能。结果 80 kV图像、140 kV图像及联合应用80 kV和140 kV图像对胆囊阴性结石的检出率分别为88.89%（80/90）、76.67%（69/90）和100%（90/90）。胆固醇成分结石的80 kV 图像CT值、140 kV图像 CT值、CT值差值、CT值比值均低于胆红素钙及罕见成分结石（P均<0.05）,胆红素钙与罕见成分结石间差异均无统计学意义（P均>0.05）。以80 kV图像 CT值62 HU和CT值差值-2 HU为临界值,诊断胆固醇与非胆固醇成分胆囊结石的敏感度和特异度均为100%。结论 DSCT双能量成像可准确鉴别胆固醇结石与非胆固醇成分胆囊结石。     

Evaluation of Gastric Emptying in Diabetic Gastropathy by an Ultrasonic Whole Stomach Cylinder Method

In order to explore the accuracy of ultrasonic whole stomach cylinder measurement (UWSCM) in the evaluation of gastric emptying, we measured the gastric emptying times (ET) at 25% (T1), 50% (T2) and 75% (T3) of healthy subjects and patients with diabetic gastropathy by UWSCM and scintigraphy. The ET of patients were compared with their clinical symptom scores. We found that the ET measured by UWSCM showed no significant difference with scintigraphy (p > 0.05). The correlation between them was good, and the correlation coefficient of T3 reached 0.744 (p < 0.05). All emptying times in the diabetic patients were longer than those in the healthy subjects (p < 0.05). The T3 in the diabetic group measured by UWSCM had the best correlation with the symptom index (r = 0.469, p < 0.05). We conclude that ET measured by UWSCM is accurate and T3 combining the symptoms index provides an accurate clinical basis for gastropathy.     

实时超声对功能性消化不良患者的胃及胆囊运动的研究

１１３例功能性消化不良（ＦＤ）及１５名健康对照者，口服液体脂餐４００ｍｌ后，用Ｂ超测定胃及胆囊排空功能。结果显示：ＦＤ组中６９例（６１．０６％）有胃排空延迟，２８例（２４．７７％）有胆囊排空不足，其中１１例（９．７％）既有胃排空延迟，又有胆囊排空不足。４４例（３８．９３％）胃排空时间正常；８５例（７５．２２％）胆囊排空正常。液体脂餐后Ｂ超测定胃及胆囊排空为一方便、无创，准确之检测方法。     

A model of gastric emptying using paracetamol absorption in intensive care patients

Objectives: To describe the range and factors which may affect gastric emptying in the ICU patient. Design: Validation sample. Setting: The adult Intensive Care Unit (ICU) of a teaching hospital. Patients: Twenty-seven ICU patients, aged 18–65 years were studied within 3 days of their ICU admission. All patients had normal hepatic and renal chemistry and had no contraindications to enteral feeding. Measurements and main results: The area under the concentration curve from 0–60 min (AUC₆₀) of a paracetamol absorption test was used as the measure of gastric emptying. The variables of the presence or absence of bowel sounds, volume of gastric aspirate ( > 50 ml or < 50 ml), an estimated risk of death (ROD), an APACHE II score calculated 24 h before the study, a pHi measurement, the use of dopamine (2.5–5 μg/kg , yes or no) and of opioids were included in a multiple regression analysis. Using Pearson correlation, AUC₆₀ was positively correlated with the estimated ROD (r = 0.50, p < 0.05). There was a statistically significant difference in the mean AUC₆₀ between those patients who did, and those who did not, receive dopamine (t = 3.06, p < 0.005). On multiple regression analysis the only variable which was significantly associated with AUC₆₀ was estimated ROD, which accounted for 25 % of the variance in AUC₆₀. Conclusion: The results suggest that there is a wide range in gastric emptying in critically ill patients. The results may be due to the case mix of the patients. The use of dopamine may adversely affect gastric emptying and requires further investigation in the ICU patient. Prediction of gastric emptying is difficult in these patients and further investigation is necessary in order to improve our understanding of this process. Received: 6 October 1995 Accepted: 31 October 1996