Gastric secretion and emptying after ordinary meals in duodenal ulcer.

We have studied the gastric response to an ordinary solid-liquid meal in 12 patients with active duodenal ulcer and 8 healthy volunteers. Our method employs gastric and duodenal markers to quantify acid, pepsin, and volume outputs in response to the meal, without manipulating intragastric pH. Intragastric volume, rate of gastric emptying, delivery of acid into the duodenum, and serum gastrin response were also measured simultaneously. On a separate day, peak acid output in response to betazole (1.5 mg per kg subcutaneously) was determined. Our results indicate an inappropriately prolonged gastric secretory response to meals in duodenal ulcer disease, without a concomitant increase in peak postprandial secretory rates or an increase in serum immunoreactive gastrin levels. Further, the stomach in duodenal ulcer disease did not "retain" the additional acid secreted in the later postprandial period, and abnormally high rates of acid delivery into the duodenum occurred. Our data are consistent with a dual defect in the duodenal mechanisms regulating both acid secretion and acid delivery into the duodenum.     

Gastric emptying of solid food in patients with gastroesophageal reflux

While delayed gastric emptying of solid food has been reported in patients with symptoms of gastroesophageal reflux, the study populations were not defined by 24-h intraesophageal pH monitoring. Moreover, the influence that the gastric emptying rate may have on patterns of reflux during the day or night, as well as on esophagitis, is not known. In this study, we compared the gastric emptying rate of solid food (in vivo intracellular labeled chicken liver) observed in asymptomatic control volunteers (n = 15) with that of symptomatic patients with an abnormal 24-h pH record who had either the presence (n = 22) or absence (n = 11) of endoscopic esophagitis. We found no significant difference in the gastric emptying rate between the asymptomatic control volunteers and the symptomatic patients with and without esophagitis. Moreover, there was no significant correlation between the gastric emptying rate and the degree of daytime or nighttime distal esophageal acid exposure found during 24-h intraesophageal pH monitoring. Only 6% of the symptomatic patients had a gastric emptying rate that exceeded the mean value plus 2 SD of that found in the asymptomatic control volunteers. We believe these support a de-emphasis of the role that delayed gastric emptying of solid food may play in the pathophysiology of gastroesophageal reflux in most patients.     

Gastric emptying of solid meals in achalasic patients after successful pneumatic dilatation of the cardia

Gastric emptying of a solid meal was measured by ultrasound scanning in 16 achalasic patients following successful pneumatic dilatation of the lower esophageal sphincter. The data were compared with those of a control group of 15 healthy subjects. Fasting and maximal postcibal antral sections were very similar in the two groups. On the contrary, the time interval before maximal antral dilatation, and the time necessary for the emptying of half or of the whole meal were significantly longer in the achalasic patients than in the controls. Half of the achalasic patients had longer emptying times than the upper normal limit. The percentage of the meal retained in the antrum at each hourly interval was significantly higher in the achalasic group. The finding of a high prevalence of gastric emptying disturbances suggests that the functional derangement in achalasia is not limited to the esophagus.     

Gastric emptying of solid meals after truncal vagotomy and pyloroplasty in human subjects

Gastric emptying of isotopically labelled solid meals was studied in normal human subjects and in patients at different intervals after truncal vagotomy and Heineke-Mikulicz pyloroplasty.One to four weeks after vagotomy and pyloroplasty gastric emptying was delayed grossly in some patients regardless of the completeness of vagotomy. Patients with gross delay had symptoms of gastric retention. Eight weeks later emptying had returned towards normal and one or more years after vagotomy and pyloroplasty emptying was within the normal range.A subthreshold dose of carbachol injected during the course of emptying of a meal in some of the postvagotomy patients had no detectable influence on the rate of emptying of the meal.     

Gastric emptying of oil from solid and liquid meals

Digestion of fat in pancreatic insufficiency (PI) is strongly affected by how rapidly fat enters the duodenum. We postulated that: (1) oil empties faster in PI than in normals and (2) in both, it empties in a load-dependent fashion. We used a gamma camera to test these ideas by comparing gastric emptying of iodine-123 iodinated oil in normal and pancreatic-insufficient subjects after 15 g of free oil were ingested in a small spaghetti meal and 60 g of oil were ingested in a large spaghetti meal and in a milk emulsion. Indium-113m marked gastric emptying of water in the milk. In both groups after all meals, oil emptied fastest initially, slowing later; and oil emptied three to four times faster when 60 g vs 15 g were ingested. There were no significant differences between the groups of subjects with respect to gastric emptying of the spaghetti meals, but the pancreatic-insufficient subjects emptied both oil and water faster from the milk emulsion than did the normal subjects. The slower emptying of oil in the normal subjects was associated with significantly more layering of oil to the top of the intragastric milk emulsion.     

Gastric emptying of combined liquid-solid meals in healed duodenal ulcer

The gastric emptying rates of combined liquid and solid radioisotopically labeled meals in 47 healed duodenal ulcer subjects and 17 healthy control subjects are compared. No significant differences were found between the groups in emptying slopes and the emptying half-times or in the percent retention values at any of the counting intervals for either the liquid or solid meals. These results are compatible with the observation that the rapid gastric emptying in many patients with duodenal ulcer is associated with the disease and that healing results in a return to normal gastric emptying rates. However, since gastric empyting rates during active ulceration were not determined in our patients, a more definitive interpretation awaits a study comparing emptying rates obtained during and after healing of active ulceration in the same patient.The authors wish to acknowledge the support of the Veterans Administration Medical Research Service and the G.D. Searle Co. for providing support for this study.     

Gastric emptying and pancreatic polypeptide response to carbohydrate meals

This study examined pancreatic polypeptide responses to isocaloric meals of radioactively labeled glucose or starch in six normal and seven vagotomized subjects. Liquid glucose meals were ingested with the subject both erect and supine and starch meals were ingested in the upright posture as a solution and as solid balls. In normal subjects, each meal left the stomach at a similar rate and the resultant pancreatic polypeptide responses were not significantly different from one another. Emptying rates varied markedly in vagotomized subjects depending upon the physical consistency of the carbohydrate ingested and the patient's posture. Despite these differences, pancreatic polypeptide responses to each meal were almost identical. These studies demonstrate that the pancreatic polypeptide response to carbohydrate meals is still present several years after vagotomy and is unaffected by alterations in the rate of gastric emptying after vagotomy and by the physical consistency and chemical nature of the carbohydrate ingested.     

Sieving of solid food by the canine stomach and sieving after gastric surgery.

Present concepts on the gastric emptying of solid materials derive from experiments with plastic spheres now known to be emptied differently than food. Accordingly, experiments were undertaken with radiolabeled chicken liver to assess (a) the size of meat particles passed by the normal canine stomach and (b) the effects of ulcer surgery on the rate of emptying and the size of emptied meat particles. Control or ulcer-operated dogs were prepared with chronic duodenal fistulas from which chyme was collected after a standard meal of beefsteak + radioliver + water. Collected chyme was sieved over a stack of sieves of decreasing pore size, and the percent of radioactivity recovered on each sieve was determined each postcibal hour for 5 hr. Control dogs emptied the meal slowly, and virtually all recovered meat was emptied in particles equal to or less than 2.0 mm. Dogs with vagotomy (V), pyloroplasty (P), vagotomy + pyloroplasty (V + P), or antrectomy with end-to-end (A-BI) or end-to-side (A-BII) gastroduodenostomy did not empty the meal faster than the control dogs. In all ulcer-operated dogs except those with P, there were significant upward shifts in the size of meat particles emptied from the stomach; but changes were marked only dogs with V + P or A-BII. Although the experiments verify the antral sieving mechanism noted in earlier work with plastic spheres, the trituration of solid food is probably more complex than previously envisioned.     

Gastric emptying rate for solid and for liquid test meals in patients with dyspeptic symptoms after partial gastrectomy and after vagotomy followed by partial gastrectomy

BACKGROUND/AIMS: Gastric emptying rate for solid and for liquid test meals was investigated retrospectively in patients with longstanding epigastric distress after partial gastrectomy, either as primary treatment or after failure of vagotomy for peptic ulcer in order to find an explanation for the postoperative symptoms. METHODOLOGY: Radionuclide-labeled liquid and solid test meals were used to evaluate gastric emptying rate, at least one year after surgery. RESULTS: The lag phase for liquid test meals disappeared in all operated patients. Partial gastrectomy usually lead to fast emptying but this resective procedure, if performed after vagotomy, lead to stasis in a significant number of patients. Gastric emptying rate for solids increased in only a few of these symptomatic patients. In most of them however, there was a normal to decreased emptying rate. If a vagotomy had preceded the resective procedure, gastric emptying rate decreased significantly. CONCLUSIONS: In all these symptomatic patients, gastric emptying had been disturbed for at least one type of test meal. This makes investigation for both meals necessary, especially since there is a lack of correlation. Furthermore, if vagotomy fails to prevent ulcer recurrence, one should carefully consider all options before performing partial gastrectomy since gastric emptying rate after these consecutive procedures worsens considerably.     

Gastric, pancreatic, and biliary responses to meals in hyperthyroidism.

Upper gastrointestinal function in response to a mixed nutrient meal was evaluated in hyperthyroid patients, both before and after therapy, and in healthy controls. Gastric secretion, gastric emptying, and pancreatic secretion were all normal and normally integrated postprandially in the hyperthyroid patients. Bile acid output was reduced (P less than 0.05) in this group of patients relative to healthy controls. Duodenal bile acid concentrations, however, were above the critical micellar concentration in most of the hyperthyroid patients, and the bile acid output and concentration remained unchanged in all patients three months after treatment. After radioactive iodine therapy, when gastrointestinal symptoms were returning toward normal, a small but statistically significant increase in gastric secretion was observed. However, gastric emptying and pancreatic secretion, like biliary secretion, remained unchanged. Abnormalities responsible for the diarrhoea and steatorrhoea in hyperthyroidism appear to reside primarily distal to the duodenum. However, reduced bile acid output may be a contributory factor in some patients.     

Gastric emptying in control subjects and patients with duodenal ulcer before and after vagotomy.

The emptying of a solid meal labelled with Indium 113mDTPA from the stomach was studied with a gamma camera in 26 normal subjects, 27 patients with duodenal ulcer, on 41 occasions after truncal vagotomy and pyloroplasty and 38 times after highly selective vagotomy. Applying the method of principal component analysis to the results, differences were detected between control and duodenal ulcer subjects and two probable subgroups of duodenal ulcer were observed. Half emptying times did not reveal these patterns. After vagotomy, delayed emptying was general at one week. At one month, patients after highly selective vagotomy had a more normal result than those with truncal vagotomy and pyloroplasty (TV), but by six months no significant difference in overall emptying rate was found, although changes in the pattern of gastric emptying persisted in some patients after TV.     

Gastric emptying for solids in patients with duodenal ulcer before and after highly selective vagotomy

In a series of 31 duodenal ulcer patients (23 males and 8 females), who underwent a highly selective vagotomy, gastric emptying characteristics of a solid meal, labeled with [su99mTc]stannous colloid, were assessed before, two weeks and six months after operation. The clinical diagnosis was confirmed by endoscopy and x-ray; failure of treatment with H₂ antagonists or antacids during 1–18 (mean 5) years was the direct indication for operative treatment. A temporary delay in gastric emptying is noted two weeks after operation (T 1/2: 124 vs 57 min). After six months, gastric emptying time has practically normalized. It appears that this is the result of the preservation of the antropyloric vagal nerve supply. In these patients, a 10% recurrence rate is noted, comparable to the results in the literature. Highly selective vagotomy proves to be a safe and effective procedure with few side effects. It does not impair gastric motility.     

功能性消化不良患者的胃排空和胃内食物分布

目的:探讨功能性消化不良(FD)患者的胃排空、胃内食物分布情况及其与消化不良症状之间的关系．方法:采用双核素标记试餐SPECT检测FD患者和正常对照组(HC)胃排空功能及胃内食物分布情况,并对60例FD患者的症状进行分级评分．结果:23例(38％)FD患者的固体及液体排空时间同时延迟,40例(67％)FD患者至少存在一项胃内固体食物分布参数异常,液体食物近端胃半排空时间较对照组延长,而在远端胃内的分布两组十分相似．胃排空正常和延迟的FD两组之间各症状积分相似,而在餐后胃内食物分布异常的FD组,恶心和早饱两种症状积分明显高于胃内食物分布正常的FD组．结论:部分FD患者存在胃排空和/或胃内食物分布异常,其中胃内食物分布异常与消化不良症状的严重程度之间存在一定的关系．     

Gastric emptying rates of solid food in relation to body size

The relationship of body size to rates of gastric emptying of solid food was investigated in order to obtain data that may allow this variable to be considered when populations of varying size are studied. Rates of gastric emptying were measured using a beef stew meal to which were added pieces of chicken liver tagged with [99mTc]sulfur colloid, and following the passage of the isotope through the gastrointestinal tract with intermittent gamma-imaging. Results showed an inverse linear relationship between gastric emptying rates and body surface area, and between gastric emptying rates and body weight. The variable of body size must be taken into account when measurements of gastric emptying of solid food are measured.