Background: Delayed gastric emptying(DGE) is one of the most common complications after pancreaticoduodenectomy(PD). DGE represents impaired gastric motility without significant mechanical obstruction and is associate...Background: Delayed gastric emptying(DGE) is one of the most common complications after pancreaticoduodenectomy(PD). DGE represents impaired gastric motility without significant mechanical obstruction and is associated with an increased length of hospital stay, increased healthcare costs, and a high readmission rate. We reviewed published studies on various technical modifications to reduce the incidence of DGE. Data sources: Studies were identified by searching Pub Med for relevant articles published up to December 2022. The following search terms were used: “pancreaticoduodenectomy”, “pancreaticojejunostomy”, “pancreaticogastrostomy”, “gastric emptying”, “gastroparesis” and “postoperative complications”. The search was limited to English publications. Additional articles were identified by a manual search of references from key articles. Results: In recent years, various surgical procedures and techniques have been explored to reduce the incidence of DGE. Pyloric resection, Billroth II reconstruction, Braun's enteroenterostomy, and antecolic reconstruction may be associated with a decreased incidence of DGE, but more high-powered studies are needed in the future. Neither laparoscopic nor robotic surgery has demonstrated superiority in preventing DGE, and the use of staplers is controversial regarding whether they can reduce the incidence of DGE. Conclusions: Despite many innovations in surgical techniques, there is no surgical procedure that is superior to others to reduce DGE. Further larger prospective randomized studies are needed.展开更多
BACKGROUND Mortality rates after pancreaticoduodenectomy(PD)have significantly decreased in specialized centers.However,postoperative morbidity,particularly delayed gastric emptying(DGE),remains the most frequent comp...BACKGROUND Mortality rates after pancreaticoduodenectomy(PD)have significantly decreased in specialized centers.However,postoperative morbidity,particularly delayed gastric emptying(DGE),remains the most frequent complication following PD.AIM To identify risk factors associated with DGE after the PD procedure.METHODS In this retrospective,cross-sectional study,clinical data were collected from 114 patients who underwent PD between January 2015 and June 2018.Demographic factors,pre-and perioperative characteristics,and surgical complications were assessed.Univariate and multivariate analyses were performed to identify risk factors for post-PD DGE.RESULTS The study included 66 males(57.9%)and 48 females(42.1%),aged 33-83 years(mean:62.5),with a male-to-female ratio of approximately 1.4:1.There were 63 cases(55.3%)of PD and 51 cases(44.7%)of pylorus-preserving pancreatoduodenectomy.Among the 114 patients who underwent PD,33(28.9%)developed postoperative DGE.Univariate analysis revealed significant differences in four of the 14 clinical indexes observed:pylorus preservation,retrocolonic anastomosis,postoperative abdominal complications,and early postoperative albumin(ALB).Logistic regression analysis further identified postoperative abdominal complic-ations[odds ratio(OR)=4.768,P=0.002],preoperative systemic diseases(OR=2.516,P=0.049),and early postoperative ALB(OR=1.195,P=0.003)as significant risk factors.CONCLUSION Postoperative severe abdominal complications,preoperative systemic diseases,and early postoperative ALB are identified as risk factors for post-PD DGE.展开更多
Gastric emptying(GE)exhibits a wide inter-individual variation and is a major determinant of postprandial glycaemia in health and diabetes;the rise in blood glucose following oral carbohydrate is greater when GE is re...Gastric emptying(GE)exhibits a wide inter-individual variation and is a major determinant of postprandial glycaemia in health and diabetes;the rise in blood glucose following oral carbohydrate is greater when GE is relatively more rapid and more sustained when glucose tolerance is impaired.Conversely,GE is influenced by the acute glycaemic environment acute hyperglycaemia slows,while acute hypoglycaemia accelerates it.Delayed GE(gastroparesis)occurs frequently in diabetes and critical illness.In diabetes,this poses challenges for management,particularly in hospitalised individuals and/or those using insulin.In critical illness it compromises the delivery of nutrition and increases the risk of regurgitation and aspiration with consequent lung dysfunction and ventilator dependence.Substantial advances in knowledge relating to GE,which is now recognised as a major determinant of the magnitude of the rise in blood glucose after a meal in both health and diabetes and,the impact of acute glycaemic environment on the rate of GE have been made and the use of gut-based therapies such as glucagon-like peptide-1 receptor agonists,which may profoundly impact GE,in the management of type 2 diabetes,has become commonplace.This necessitates an increased understanding of the complex inter-relationships of GE with glycaemia,its implications in hospitalised patients and the relevance of dysglycaemia and its management,particularly in critical illness.Current approaches to management of gastroparesis to achieve more personalised diabetes care,relevant to clinical practice,is detailed.Further studies focusing on the interactions of medications affecting GE and the glycaemic environment in hospitalised patients,are required.展开更多
BACKGROUND:A number of definitions have been used for delayed gastric emptying(DGE) after pancreatoduodenectomy and the reported rates varied widely.The International Study Group of Pancreatic Surgery(ISGPS) definitio...BACKGROUND:A number of definitions have been used for delayed gastric emptying(DGE) after pancreatoduodenectomy and the reported rates varied widely.The International Study Group of Pancreatic Surgery(ISGPS) definition is the current standard but it is not used universally.In this comprehensive review,we aimed to determine the acceptance rate of ISGPS definition of DGE,the incidence of DGE after pancreatoduodenectomy and the effect of various technical modifications on its incidence.DATA SOURCE:We searched PubM ed for studies regarding DGE after pancreatoduodenectomy that were published from 1 January 1980 to 1 July 2015 and extracted data on DGE definition,DGE rates and comparison of DGE rates among different technical modifications from all of the relevant articles.RESULTS:Out of 435 search results,178 were selected for data extraction.The ISGPS definition was used in 80% of the studies published since 2010 and the average rates of DGE and clinically relevant DGE were 27.7%(range:0-100%;median:18.7%) and 14.3%(range:1.8%-58.2%;median:13.6%),respectively.Pylorus preservation or retrocolic reconstruction were not associated with increased DGE rates.Although pyloric dilatation,Braun’s entero-enterostomy and Billroth Ⅱ reconstruction were associated with significantly lower DGE rates,pyloric ring resection appears to be most promising with favorable results in 7 out of 10 studies.CONCLUSIONS:ISGPS definition of DGE has been used in majority of studies published after 2010.Clinically relevant DGE rates remain high at 14.3% despite a number of proposed surgical modifications.Pyloric ring resection seems to offer the most promising solution to reduce the occurrence of DGE.展开更多
BACKGROUND: Enhanced recovery after surgery(ERAS) has improved postoperative outcomes particularly in colorectal surgery. This study aimed to assess compliance with an ERAS protocol and evaluate its effect on posto...BACKGROUND: Enhanced recovery after surgery(ERAS) has improved postoperative outcomes particularly in colorectal surgery. This study aimed to assess compliance with an ERAS protocol and evaluate its effect on postoperative outcomes in patients undergoing pancreaticoduodenectomy. METHODS: Fifty patients who had received conventional peri operative management from 2005 to 2009(conventional group)were compared with 75 patients who had received perioperative care with an ERAS protocol(fast-track group) from 2010 to2014. Mortality, complications, readmissions and length of hospital stay were evaluated and compared in the groups.RESULTS: Compliance with each element of the ERAS pro tocol ranged from 74.7% to 100%. Uneventful patients had a significant higher adherence to the ERAS protocol(87.5% vs40.7%; P〈0.001). There were no significant differences in de mographics and perioperative characteristics between the two groups. Patients in the fast-track group had a shorter time to remove the nasogastric tube, start liquid diet and solid food pass flatus and stools, and remove drains. No difference was found in mortality, relaparotomy, readmission rates and over all morbidity. However, delayed gastric emptying and length of hospital stay were significantly reduced in the fast-track group. The independent effect of the ERAS protocol in reduc ing delayed gastric emptying and length of hospital stay was confirmed by multivariate analysis.CONCLUSION: ERAS pathway was feasible and safe in improving gastric emptying, yielding an earlier postoperative recovery, and reducing the length of hospital stay.展开更多
Background:Delayed gastric emptying(DGE)is the main complication after pancreaticoduodenectomy(PD),but the mechanism is still unclear.The aim of this study was to elucidate the role of complete resection of the gastri...Background:Delayed gastric emptying(DGE)is the main complication after pancreaticoduodenectomy(PD),but the mechanism is still unclear.The aim of this study was to elucidate the role of complete resection of the gastric antrum in decreasing incidence and severity of DGE after PD.Methods:Sprague-Dawley rats were divided into three groups:expanded resection(ER group),complete resection(CR group),and incomplete resection(IR group)of the gastric antrum.The tension(g)of remnant stomach contraction was observed.We analyzed the histological morphology of the gastric wall by different excisional methods after distal gastrectomy.Moreover,patients underwent PD at our department between January 2012 and May 2016 were included in the study.These cases were divided into IR group and CR group of the gastric antrum,and the clinical data were retrospectively analyzed.Results:The ex vivo remnant stomachs of CR group exhibited much greater contraction tension than others(P<0.05).The contraction tension of the remnant stomach increased with increasing acetylcholine concentration,while remained stable at the concentration of 10×10^(-5 )mol/L.Furthermore,174 consecutive patients were included and retrospectively analyzed in the study.The incidence of DGE was significantly lower(3.5%vs.21.3%,P<0.01)in CR group than in IR group.In addition,hematoxylin-eosin staining analyses of the gastric wall confirmed that the number of transected circular smooth muscle bundles were higher in IR group than in CR group(8.24±0.65 vs.3.76±0.70,P<0.05).Conclusions:The complete resection of the gastric antrum is associated with decreased incidence and severity of DGE after PD.Gastric electrophysiological and physiopathological disorders caused by damage to gastric smooth muscles might be the mechanism underlying DGE.展开更多
BACKGROUND Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy(CRSHIPEC)has shown promising results in improving the survival of ovarian cancer patients.Although the safety profiles of CRS-HIPEC exist,...BACKGROUND Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy(CRSHIPEC)has shown promising results in improving the survival of ovarian cancer patients.Although the safety profiles of CRS-HIPEC exist,more attention should be paid to gastrointestinal complications,as the procedure involves a considerable proportion of bowel resection and anastomosis.AIM To identify the risk factors for delayed gastric emptying in ovarian cancer treated with CRS-HIPEC.METHODS A cross-sectional study was conducted.According to the inclusion and exclusion criteria,we retrospectively analyzed 77 patients admitted between March 2014 and April 2018 with advanced and recurrent ovarian cancer treated with CRSHIPEC in Beijing Shijitan Hospital of Capital Medical University.Risk factors for delayed gastric emptying were analyzed using univariate analysis.All of the statistically significant variables in the univariate analysis were entered into the multivariable logistic regression model to determine factors independently associated with delayed gastric emptying.RESULTS Among the 77 included patients,36.4%(28/77)had delayed gastric emptying after CRS-HIPEC.The median age and body mass index of all patients were 59 years and 22.83 kg/m^(2),respectively.Preoperative chemotherapy was administered in 55 patients(71%).Sixty-two patients(81%)had a history of at least one previous pelvic surgery.The median operation time and intraoperative hemorrhage volume were 630 min and 600 mL,respectively.Omentectomy was performed in 32 cases of primary ovarian cancer and 24 cases of recurrence.The median peritoneal cancer index was 16.The risk factors for delayed gastric emptying from the univariate analysis were body mass index<23 kg/m2(X2=5.059,P=0.025),history of pelvic surgery(X^(2)=4.498,P=0.034),history of chemotherapy(X^(2)=4.334,P=0.037),operation time≥7 h(X2=4.827,P=0.047),and intraoperative hemorrhage≥800 mL(X^(2)=7.112,P=0.008).Multivariable analysis revealed that age≥70 years(HR=7.127;95%CI 1.122-45.264;P=0.037)and intraoperative hemorrhage≥800 mL(HR=3.416;95%CI 1.067-10.939;P=0.039)were independently associated with postoperative delayed gastric emptying after CRS-HIPEC.CONCLUSION Postoperative gastrointestinal management,including prolonged nasogastric intubation,should be promoted for patients over 70 years or those with intraoperative bleeding exceeding 800 mL.展开更多
Objective To study the effects of wrap-restraint stress and of CRF or CRF antagonist (a-belieal-CRF9-41 ) microinjection on gastric emptying, and the role of plasma motilin (Mot ). Methods The effects of wrap- restrai...Objective To study the effects of wrap-restraint stress and of CRF or CRF antagonist (a-belieal-CRF9-41 ) microinjection on gastric emptying, and the role of plasma motilin (Mot ). Methods The effects of wrap- restraint stress or CRF and CRF antagonist microinjection into paraventricular nucleus (PVN) on gastric empiring were determined by using dextran blue-2000 as a marker. The plasma level of Mot was determined by radioimmunoassay. Results Wrap-restraint stress inhibited gastric emptying. Microinjection of CRF into PVN inhibited gastric emptying dose-dependently. In normal condition, a-he- lical-CRF9-4l bilaterally microinjected into PVN didn’ t modify gastric emptying; however, a-belieal-CRF9-41 microinjection bilaterally into PVN 15min before wrap-restraint stress could significantly antagonize the effect of stress on gastric emptying. After 30min of stress or CRF microinjection into PVN, plasma levels of Mot significantly decreased, as compered with the normal control group. Conclusion Wrap-restraint stress can inhibit gastric emptying, and microinjection of CRF into PVN has the similar effect. The PVN is one of the speific sites for the action of CRF affecting on gastric emptying. Plasma Mot might partic ipate in the effects of stress and CRF-induced alteration of gastric emptying.展开更多
Background: Previous studies on fasting and gastrointestinal motility were reported with information lacking concerning prolonged continuous fasting and gastrointestinal motility. This study investigated the effect of...Background: Previous studies on fasting and gastrointestinal motility were reported with information lacking concerning prolonged continuous fasting and gastrointestinal motility. This study investigated the effect of prolonged fasting duration on gastrointestinal motility. Methods: Forty-five (45) male Wistar rats, with body weights between 180 - 200 g were used. They were randomly assigned into three (3) groups. Group1: control (rats fasted for 18 h—common duration of fasting for motility studies), groups 2 and 3 fasted for 48 and 72 h respectively. Five (5) rats per experiment and per group were considered. Blood glucose was determined by glucose oxidase method, gastric emptying was assessed by hydrated carbohydrate meal, intestinal motility by charcoal meal, and colonic motility was assessed using bead test. Data were reported in Mean ± SEM and analyzed with one-way ANOVA. Differences in results were considered significant at p ≤ 0.05. Results: There was no significant change in the blood glucose level (mmol/L) of rats in the 48 h group (2.94 ± 0.35) and 72 h group (3.20 ± 0.32) as compared with the control (3.62 ± 0.19). There was a significant decrease in the rate of gastric emptying (g) in the 72 h group (0.20 ± 0.08) compared with the control (0.64 ± 0.16). The intestinal transit (cm) in the 48 h group (67.54 ± 6.15) and 72 h group (72.10 ± 7.60) increased significantly when compared with the control (42.14 ± 3.14). There was a significant decrease in the colonic motility time (Sec.) in the 48 h group (2707 ± 864.1) and 72 h group (6363 ± 968.1) when compared with the control (263.8 ± 64.26). Conclusion: Extended fasting durations decrease the rate of gastric emptying and colonic motility. It suggests that extended fasting durations could be beneficial in intestinal spasms or where the gut is required to relax.展开更多
Gestational diabetes mellitus(GDM)represents one of the most common medical complications of pregnancy and is important to the well-being of both mothers and offspring in the short and long term.Lifestyle intervention...Gestational diabetes mellitus(GDM)represents one of the most common medical complications of pregnancy and is important to the well-being of both mothers and offspring in the short and long term.Lifestyle intervention remains the mainstay for the management of GDM.The efficacy of nutritional approaches(e.g.calorie restriction and small frequent meals)to improving the maternal-neonatal outcomes of GDM was attested to by Chinese population data,discussed in two articles in recent issues of this journal.However,a specific focus on the relevance of postprandial glycaemic control was lacking.Postprandial rather than fasting hyperglycaemia often represents the predominant manifestation of disordered glucose homeostasis in Chinese women with GDM.There is now increasing appreciation that the rate of gastric emptying,which controls the delivery of nutrients for digestion and absorption in the small intestine,is a key determinant of postprandial glycaemia in both health,type 1 and 2 diabetes.It remains to be established whether gastric emptying is abnormally rapid in GDM,particularly among Chinese women,thus contributing to a predisposition to postprandial hyperglycaemia,and if so,how this influences the therapeutic response to nutritional interventions.It is essential that we understand the role of gastric emptying in the regulation of postprandial glycaemia during pregnancy and the potential for its modulation by nutritional strategies in order to improve postprandial glycaemic control in GDM.展开更多
Objective:To evaluate the correlation between the incidence of delayed gastric emptying(DGE)in pancreaticoduodenectomy(PD)and the perioperative possible risk factors.Methods:We searched PubMed,Embase,Cochrane Library,...Objective:To evaluate the correlation between the incidence of delayed gastric emptying(DGE)in pancreaticoduodenectomy(PD)and the perioperative possible risk factors.Methods:We searched PubMed,Embase,Cochrane Library,and Medline for studies describing complications related to PD from 2018 to 2022.Statistical analysis was performed using Stata/SE16.0 software.Results:In 6 retrospective studies,1 systematic review,and 1 randomized controlled trial(RCT)experiment,12,419 patients(2174 and 10,245 patients,respectively,in DGE and no delayed gastric emptying[NDGE]groups).The preoperative American Society of Anesthesiologists(ASA)score between DGE and NDGE groups(log odds ratio[OR]=0.23,95%credible interval[CI]:0.11-0.35,P<.01),operation time(mean diff.=21.87,95%CI:15.96-27.78,P<.01),estimated intraoperative blood loss(EIBL;mean diff.=70.67,95%CI:17.75-123.58,P<.05),postoperative pancreatic fistula(POPF)(log OR=0.85,95%CI:0.24-1.46,P<.05)were statistically significant.No significant differences in preoperative body mass index(BMI),preoperative biliary drain-age,and pancreatic texture were observed(P>.05).Conclusion:The incidence of DGE is significantly correlated with the operation time,preoperative ASA score,POPF,and EIBL,which suggests that the surgeon should thoroughly evaluate the patient through adequate preoperative examination before the operation.Finally,standardized practice and perfect technology are undoubtedly necessary to reduce complications.展开更多
OBJECTIVE:To evaluate the effect of electroacupuncture on rapid gastric emptying by comparing the effectiveness of electroacupuncture at both Zusanli(ST36)and Zhongwan(CV12)(He-Mu acupoints)versus electroacupuncture a...OBJECTIVE:To evaluate the effect of electroacupuncture on rapid gastric emptying by comparing the effectiveness of electroacupuncture at both Zusanli(ST36)and Zhongwan(CV12)(He-Mu acupoints)versus electroacupuncture at Zhongwan(CV12)alone.METHODS:Sixty-five patients were randomly divided into two groups;33 patients in the He-Mu acupoints group received electroacupuncture at both Zusanli(ST36)and Zhongwan(CV12),while 32 patients in the single acupoint group received electroacupuncture only at Zhongwan(CV12).Both groups were treated once daily for 30 min,five times per week for 3 weeks.Before and after the 3-week treatment course,patients underwent gastric emptying scintigraphy and were assessed using the Traditional Chinese Medicine(TCM)symptom scale of gastrointestinal diseases.The two groups were compared regarding the percentages of gastric retention at 30 and 60 min and the TCM symptom scores.RESULTS:After the treatment course,the percentages of gastric retention at 30 and 60 min were significantly improved in both groups compared with the pre-treatment values(P<0.01).The improvement in the gastric retention was significantly better in the He-Mu acupoints group than the single acupoint group at 30 min(P<0.01)and 60 min(P<0.05).The TCM symptom score was significantly decreased after the treatment course in both groups(P<0.01).The improvement in the TCM symptom score was significantly better in the He-Mu acupoints group than the single acupoint group(P<0.01).The total effective rate was 93.55%(29/31)in the He-Mu acupoints group and 77.42%(24/31)in the single acupoint group.The treatment effect was better in the He-Mu acupoints group than the single acupoint group(P<0.05).CONCLUSIONS:Electroacupuncture at both Zusanli(ST36)and Zhongwan(CV12)or at Zhongwan(CV12)alone is effective in treating rapid gastric emptying.Furthermore,electroacupuncture at both Zusanli(ST36)and Zhongwan(CV12)is more effective than electroacupuncture at Zhongwan(CV12)alone.展开更多
The aims were to prospectively evaluate the association of glycemic control (HbAlc) with gastric emptying in newly diagnosed Type 1 diabetic patients and subjects with longterm diabetes mellitus. Furthermore, the day ...The aims were to prospectively evaluate the association of glycemic control (HbAlc) with gastric emptying in newly diagnosed Type 1 diabetic patients and subjects with longterm diabetes mellitus. Furthermore, the day to day variability of gastric emptying for solids should be assessed. Methods 13 C octanoic breath tests were performed in 15 type 1 diabetic subjects on two separate days within one week. The influence of metabolic control on gastric emptying was prospectively examined over a mean of 8 months in 14 patients with newly diagnosed type 1 diabetes and 44 long term diabetic patients (type 1: n=31; type 2: n=13).Patients with longterm diabetes were stratified according to their HbA 1c at follow up (group 1: HbA 1c U7.5%, n=17; group 2 HbA 1c >7.5%, n=27). 13 C octanoic breath tests were sampled with an isotope selective non dispersive infrared spectrometer. The gastric emptying parameters were calculated using nonlinear regression analysis of the time course of 13 CO 2 exhalation:half emptying time (t 1/2 ) and lag phase (t lag ). Results The intraindividuell coefficient of variation was 17.8% for t 1/2 , and 28.2% for t lag . Mean t 1/2 and t lag in newly diagnosed type 1 diabetics were normal at baseline and were significantly increased at follow up. In patients with longterm diabetes, gastric emptying was unchanged during follow up. Gastric emptying was significant delayed in group 2 compared with group 1 at baseline and follow up respectively. There was a significant correlation between HbA 1c and t 1/2 , t lag at follow up. Conclusions 13 C octanoic breath test has a relatively good reproducibility in patients with type 1 diabetes. Gastric emptying times are already significantly increased after few months in newly diagnosed type 1 diabetes. There is a more pronounced delay of gastric emptying in longterm diabetic subjects with poor compared to patients with good metabolic control.展开更多
Solid gastric emptying rates (GER) were determined with scintigraphic techniques in 20 patients with non-ulcer dyspepsia (NUD) and 9 healthy volunteers. GER were significantly decreased in NUD patients compared with c...Solid gastric emptying rates (GER) were determined with scintigraphic techniques in 20 patients with non-ulcer dyspepsia (NUD) and 9 healthy volunteers. GER were significantly decreased in NUD patients compared with controls , especially 45 min (P<0.05) , 60 and 90 min (P<0. 01) and 120 min (P<0. 05) after ingestion. In 13 out of 20 NUD patients who demonstrated lower GER, only 4 cases gave a lower GER at all stages throughout the determination, the other 9 showed their abnormal GER only after 60 min. In 3 cases who received repeated GER studies after cisapride therapy, 2 patients showed symptomatic relief accompanied by GER improvement. It is concluded that gastric emptying delay may be present with a high percentage in patients with non-ulcer dyspepsia. Scintigraphic gastric emptying test is a safe and reliable technique with good reproducibility. It may be helpful in quantitative study about gastric motion disorders.展开更多
Background:Jianqu has been used to alleviate symptoms in patients with functional dyspepsia,but its specific anti-functional dyspepsia effect is still unclear.Therefore,our study aimed to investigate the impact of Jia...Background:Jianqu has been used to alleviate symptoms in patients with functional dyspepsia,but its specific anti-functional dyspepsia effect is still unclear.Therefore,our study aimed to investigate the impact of Jianqu on functional dyspepsia in mice.Methods:The phytochemical profile of Jianqu was analyzed by UPLC-Q-TOF-MS.Subsequently,Kunming mice were fed a high-calorie or high-protein diet(HCHP)for 7 days,and then orally treated with vehicle or Jianqu(1.62 g/kg body weight(b.w.)and 3.25 g/kg b.w.)for 10 days.A carbon powder solution was used to detect the gastric emptying and intestinal transit rate.The pathological changes in stomach and duodenum were evaluated by hematoxylin-eosin staining.The occludin,claudin-1,ZO-1 and CD45 expression was measured by immunocytochemical staining.Importantly,the serum gastrointestinal hormones were detected by ELISA.In addition,the gut microbiota composition was determined using 16S rRNA gene sequencing.The cecal short chain fatty acids were assessed by gas chromatography.Results:In general,17 phytochemical compounds were identified from Jianqu,which significantly improved the gastric emptying rate and intestinal transit rate(p<0.01),increased the body weight and food intake(p<0.0001)in HCHP mice as well.Though HCHP did not cause significant pathological lesions in the gastrointestinal tract,increased the expression of CD45 in the duodenum(p<0.05)was observed.Notably,Jianqu attenuated this abnormal expression of CD45(p<0.05).The levels of serum gastrointestinal hormones were significantly normalized by Jianqu intervention(p<0.05).Moreover,Jianqu increased the relative abundance of Roseburia as well as short chain fatty acids levels in cecum(p<0.05).Conclusion:The present results showed that Jianqu alleviated dyspeptic symptoms in HCHP mice possibly through reducing the duodenal leukocyte infiltration,and regulating the expression of gastrointestinal hormones.These effects may be partly related to the increasing cecal short chain fatty acids levels probably via gut microbial modulation.展开更多
This editorial is stimulated by the article by Alqifari et al published in the World Journal of Diabetes(2024).Alqifari et al focus on practical advice for the clinical use of glucagon-like-peptide-1(GLP-1)receptor ag...This editorial is stimulated by the article by Alqifari et al published in the World Journal of Diabetes(2024).Alqifari et al focus on practical advice for the clinical use of glucagon-like-peptide-1(GLP-1)receptor agonists(GLP-1RAs)in the management of type 2 diabetes and this editorial provides complementary information.We initially give a brief historical perspective of the development of GLP-1RAs stimulated by recognition of the‘incretin effect’,the substantially greater insulin increase to enteral when compared to euglycaemic intravenous glucose,and the identification of the incretin hormones,GIP and GLP-1.In addition to stimulating insulin,GLP-1 reduces postprandial glucose levels by slowing gastric emptying.GLP-1RAs were developed because native GLP-1 has a very short plasma half-life.The majority of current GLP-1RAs are administered by subcutaneous injection once a week.They are potent in glucose lowering without leading to hypoglycaemia,stimulate weight loss in obese individuals and lead to cardiovascular and renal protection.The landscape in relation to GLP-1RAs is broadening rapidly,with different formulations and their combination with other peptides to facilitate both glucose lowering and weight loss.There is a need for more information relating to the effects of GLP-1RAs to induce gastrointestinal symptoms and slow gastric emptying which is likely to allow their use to become more effective and personalised.展开更多
AIM To establish a modified B-ultrasound method of measuring the antral section only to assess gastric motility in healthy people,and evaluate its application in guiding enteral nutrition(EN) in critically ill patient...AIM To establish a modified B-ultrasound method of measuring the antral section only to assess gastric motility in healthy people,and evaluate its application in guiding enteral nutrition(EN) in critically ill patients. METHODS First,30 healthy volunteers were selected. The modified B-ultrasound method and the traditional B-ultrasound method were applied to assess gastric function. The correlation of indices of gastric function between the two groups was analyzed statistically. In addition,64 critically ill patients were selected,and the modified B-ultrasound method and the gastric juice withdrawal method were applied to guide the implementation of EN. Daily caloric value,the time required to achieve complete EN,ICU stay,hospitalization time,and serum prealbumin and albumin levels were recorded and compared between the two groups. Kaplan-Meier survival curve was used to compare the complications of EN between the two groups. RESULTS In healthy subjects,there was a good correlation among gastric emptying time,antral contraction frequency andantral motility index between the two groups(r = 0.57,0.61 and 0.54,respectively). The study on critically ill patients also revealed that a better effect of EN was achieved in the modified B-ultrasound method group,in which patients had shorter ICU stay and hospitalization time and higher levels of serum prealbumin and albumin. The Kaplan-Meier survival analysis revealed that the improved B-ultrasound method was associated with significantly fewer EN complications(P = 0.031).CONCLUSION The modified B-ultrasound method can provide a good real-time assessment of gastric function and has a better effect than the traditional method in guiding EN in critically ill patients.展开更多
Summary: Gastric emptying time of liquid meal was detected by using ultrasonography in 28 gas- tric ulcer patients with continual or recurrent dyspepsia symptoms after the ulcer healing. Sixteen out of 28 patients (5...Summary: Gastric emptying time of liquid meal was detected by using ultrasonography in 28 gas- tric ulcer patients with continual or recurrent dyspepsia symptoms after the ulcer healing. Sixteen out of 28 patients (57. 1 % ) with a delay of gastric emptying time (T1/2) were randomly divided into two groups: 8 cases were treated with cisapride 5 mg three times a day and & cases with cisapride 10 mg three times a day respectively. The results showed that cisapride could relieve the symptoms with the effective rate being 68. 8 % in the two groups. T1/2 in the patients after treatment with cisapride was significantly shorter than before treatment (P<0. 001 ). It was concluded that there is a delay of T1/2 in some patients with gastric ulcer healing. Cisapride could promote gastric empty of liquid meal and relieve the symptoms efficiently. The effect of lower dose of cisapride is similar to that of higher dose.展开更多
BACKGROUND Oral intake is dependent on the gastric ability to accommodate the food bolus.Comparatively,neonates have a smaller gastric capacity than adults and this may limit the volume of their milk intake.Yet,we pre...BACKGROUND Oral intake is dependent on the gastric ability to accommodate the food bolus.Comparatively,neonates have a smaller gastric capacity than adults and this may limit the volume of their milk intake.Yet,we previously reported that the newborn rat gastric milk volume is greatest after birth and,when normalized to body weight,decreases with postnatal age.Such age-dependent changes are not the result of intake differences,but greater gastric accommodation and reduced emptying rate.AIM Hypothesizing that breastmilk-derived adiponectin is the factor regulating gastric accommodation in neonates,we comparatively evaluated its effects on the rat fundic muscle tone at different postnatal ages.METHODS In freshly dispersed smooth muscle cells(SMC),we measured the adiponectin effect on the carbachol-induced length changes.RESULTS Adiponectin significantly reduced the carbachol-stimulated SMC shortening independently of age.In the presence of the inhibitor iberiotoxin,the adiponectin effect on SMC shortening was suppressed,suggesting that it is mediated via largeconductance Ca^(2+)sensitive K^(+)channel activation.Lastly,we comparatively measured the newborn rat gastric milk curd adiponectin content in one-and twoweek-old rats and found a 50%lower value in the latter.CONCLUSION Adiponectin,a major component of breastmilk,downregulates fundic smooth muscle contraction potential,thus facilitating gastric volume accommodation.This rodent’s adaptive response maximizes breastmilk intake volume after birth.展开更多
Gastric and gallbladder emptying in 113 patients with functional dyspepsia (FD) were evaluated by real-time ultrasonography (RUS) after a liquid-fat meal by the patients, and compared with 15 healthy volunteers. The r...Gastric and gallbladder emptying in 113 patients with functional dyspepsia (FD) were evaluated by real-time ultrasonography (RUS) after a liquid-fat meal by the patients, and compared with 15 healthy volunteers. The results showed that in FD group 69 patients (61. 06%) had delayed gastric emptying,and 28 patients (24.77%) had gallbladder hypokinesia. Among them both delayed gastric ernptying and gallbladder hypokinesia were found in 11 patients (9.7%), 44 patients (38.93%)had normal gastric emptying and 85 patients (75.22%) had normal gallbladder emptying.展开更多
文摘Background: Delayed gastric emptying(DGE) is one of the most common complications after pancreaticoduodenectomy(PD). DGE represents impaired gastric motility without significant mechanical obstruction and is associated with an increased length of hospital stay, increased healthcare costs, and a high readmission rate. We reviewed published studies on various technical modifications to reduce the incidence of DGE. Data sources: Studies were identified by searching Pub Med for relevant articles published up to December 2022. The following search terms were used: “pancreaticoduodenectomy”, “pancreaticojejunostomy”, “pancreaticogastrostomy”, “gastric emptying”, “gastroparesis” and “postoperative complications”. The search was limited to English publications. Additional articles were identified by a manual search of references from key articles. Results: In recent years, various surgical procedures and techniques have been explored to reduce the incidence of DGE. Pyloric resection, Billroth II reconstruction, Braun's enteroenterostomy, and antecolic reconstruction may be associated with a decreased incidence of DGE, but more high-powered studies are needed in the future. Neither laparoscopic nor robotic surgery has demonstrated superiority in preventing DGE, and the use of staplers is controversial regarding whether they can reduce the incidence of DGE. Conclusions: Despite many innovations in surgical techniques, there is no surgical procedure that is superior to others to reduce DGE. Further larger prospective randomized studies are needed.
文摘BACKGROUND Mortality rates after pancreaticoduodenectomy(PD)have significantly decreased in specialized centers.However,postoperative morbidity,particularly delayed gastric emptying(DGE),remains the most frequent complication following PD.AIM To identify risk factors associated with DGE after the PD procedure.METHODS In this retrospective,cross-sectional study,clinical data were collected from 114 patients who underwent PD between January 2015 and June 2018.Demographic factors,pre-and perioperative characteristics,and surgical complications were assessed.Univariate and multivariate analyses were performed to identify risk factors for post-PD DGE.RESULTS The study included 66 males(57.9%)and 48 females(42.1%),aged 33-83 years(mean:62.5),with a male-to-female ratio of approximately 1.4:1.There were 63 cases(55.3%)of PD and 51 cases(44.7%)of pylorus-preserving pancreatoduodenectomy.Among the 114 patients who underwent PD,33(28.9%)developed postoperative DGE.Univariate analysis revealed significant differences in four of the 14 clinical indexes observed:pylorus preservation,retrocolonic anastomosis,postoperative abdominal complications,and early postoperative albumin(ALB).Logistic regression analysis further identified postoperative abdominal complic-ations[odds ratio(OR)=4.768,P=0.002],preoperative systemic diseases(OR=2.516,P=0.049),and early postoperative ALB(OR=1.195,P=0.003)as significant risk factors.CONCLUSION Postoperative severe abdominal complications,preoperative systemic diseases,and early postoperative ALB are identified as risk factors for post-PD DGE.
文摘Gastric emptying(GE)exhibits a wide inter-individual variation and is a major determinant of postprandial glycaemia in health and diabetes;the rise in blood glucose following oral carbohydrate is greater when GE is relatively more rapid and more sustained when glucose tolerance is impaired.Conversely,GE is influenced by the acute glycaemic environment acute hyperglycaemia slows,while acute hypoglycaemia accelerates it.Delayed GE(gastroparesis)occurs frequently in diabetes and critical illness.In diabetes,this poses challenges for management,particularly in hospitalised individuals and/or those using insulin.In critical illness it compromises the delivery of nutrition and increases the risk of regurgitation and aspiration with consequent lung dysfunction and ventilator dependence.Substantial advances in knowledge relating to GE,which is now recognised as a major determinant of the magnitude of the rise in blood glucose after a meal in both health and diabetes and,the impact of acute glycaemic environment on the rate of GE have been made and the use of gut-based therapies such as glucagon-like peptide-1 receptor agonists,which may profoundly impact GE,in the management of type 2 diabetes,has become commonplace.This necessitates an increased understanding of the complex inter-relationships of GE with glycaemia,its implications in hospitalised patients and the relevance of dysglycaemia and its management,particularly in critical illness.Current approaches to management of gastroparesis to achieve more personalised diabetes care,relevant to clinical practice,is detailed.Further studies focusing on the interactions of medications affecting GE and the glycaemic environment in hospitalised patients,are required.
文摘BACKGROUND:A number of definitions have been used for delayed gastric emptying(DGE) after pancreatoduodenectomy and the reported rates varied widely.The International Study Group of Pancreatic Surgery(ISGPS) definition is the current standard but it is not used universally.In this comprehensive review,we aimed to determine the acceptance rate of ISGPS definition of DGE,the incidence of DGE after pancreatoduodenectomy and the effect of various technical modifications on its incidence.DATA SOURCE:We searched PubM ed for studies regarding DGE after pancreatoduodenectomy that were published from 1 January 1980 to 1 July 2015 and extracted data on DGE definition,DGE rates and comparison of DGE rates among different technical modifications from all of the relevant articles.RESULTS:Out of 435 search results,178 were selected for data extraction.The ISGPS definition was used in 80% of the studies published since 2010 and the average rates of DGE and clinically relevant DGE were 27.7%(range:0-100%;median:18.7%) and 14.3%(range:1.8%-58.2%;median:13.6%),respectively.Pylorus preservation or retrocolic reconstruction were not associated with increased DGE rates.Although pyloric dilatation,Braun’s entero-enterostomy and Billroth Ⅱ reconstruction were associated with significantly lower DGE rates,pyloric ring resection appears to be most promising with favorable results in 7 out of 10 studies.CONCLUSIONS:ISGPS definition of DGE has been used in majority of studies published after 2010.Clinically relevant DGE rates remain high at 14.3% despite a number of proposed surgical modifications.Pyloric ring resection seems to offer the most promising solution to reduce the occurrence of DGE.
文摘BACKGROUND: Enhanced recovery after surgery(ERAS) has improved postoperative outcomes particularly in colorectal surgery. This study aimed to assess compliance with an ERAS protocol and evaluate its effect on postoperative outcomes in patients undergoing pancreaticoduodenectomy. METHODS: Fifty patients who had received conventional peri operative management from 2005 to 2009(conventional group)were compared with 75 patients who had received perioperative care with an ERAS protocol(fast-track group) from 2010 to2014. Mortality, complications, readmissions and length of hospital stay were evaluated and compared in the groups.RESULTS: Compliance with each element of the ERAS pro tocol ranged from 74.7% to 100%. Uneventful patients had a significant higher adherence to the ERAS protocol(87.5% vs40.7%; P〈0.001). There were no significant differences in de mographics and perioperative characteristics between the two groups. Patients in the fast-track group had a shorter time to remove the nasogastric tube, start liquid diet and solid food pass flatus and stools, and remove drains. No difference was found in mortality, relaparotomy, readmission rates and over all morbidity. However, delayed gastric emptying and length of hospital stay were significantly reduced in the fast-track group. The independent effect of the ERAS protocol in reduc ing delayed gastric emptying and length of hospital stay was confirmed by multivariate analysis.CONCLUSION: ERAS pathway was feasible and safe in improving gastric emptying, yielding an earlier postoperative recovery, and reducing the length of hospital stay.
基金supported by a grant from the National Natural Science Foundation of China(No.81870457)。
文摘Background:Delayed gastric emptying(DGE)is the main complication after pancreaticoduodenectomy(PD),but the mechanism is still unclear.The aim of this study was to elucidate the role of complete resection of the gastric antrum in decreasing incidence and severity of DGE after PD.Methods:Sprague-Dawley rats were divided into three groups:expanded resection(ER group),complete resection(CR group),and incomplete resection(IR group)of the gastric antrum.The tension(g)of remnant stomach contraction was observed.We analyzed the histological morphology of the gastric wall by different excisional methods after distal gastrectomy.Moreover,patients underwent PD at our department between January 2012 and May 2016 were included in the study.These cases were divided into IR group and CR group of the gastric antrum,and the clinical data were retrospectively analyzed.Results:The ex vivo remnant stomachs of CR group exhibited much greater contraction tension than others(P<0.05).The contraction tension of the remnant stomach increased with increasing acetylcholine concentration,while remained stable at the concentration of 10×10^(-5 )mol/L.Furthermore,174 consecutive patients were included and retrospectively analyzed in the study.The incidence of DGE was significantly lower(3.5%vs.21.3%,P<0.01)in CR group than in IR group.In addition,hematoxylin-eosin staining analyses of the gastric wall confirmed that the number of transected circular smooth muscle bundles were higher in IR group than in CR group(8.24±0.65 vs.3.76±0.70,P<0.05).Conclusions:The complete resection of the gastric antrum is associated with decreased incidence and severity of DGE after PD.Gastric electrophysiological and physiopathological disorders caused by damage to gastric smooth muscles might be the mechanism underlying DGE.
基金Supported by Beijing Natural Science Foundation,No.7202075 and“Beijing Hospitals Authority”Ascent Plan,No.DFL20190701.
文摘BACKGROUND Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy(CRSHIPEC)has shown promising results in improving the survival of ovarian cancer patients.Although the safety profiles of CRS-HIPEC exist,more attention should be paid to gastrointestinal complications,as the procedure involves a considerable proportion of bowel resection and anastomosis.AIM To identify the risk factors for delayed gastric emptying in ovarian cancer treated with CRS-HIPEC.METHODS A cross-sectional study was conducted.According to the inclusion and exclusion criteria,we retrospectively analyzed 77 patients admitted between March 2014 and April 2018 with advanced and recurrent ovarian cancer treated with CRSHIPEC in Beijing Shijitan Hospital of Capital Medical University.Risk factors for delayed gastric emptying were analyzed using univariate analysis.All of the statistically significant variables in the univariate analysis were entered into the multivariable logistic regression model to determine factors independently associated with delayed gastric emptying.RESULTS Among the 77 included patients,36.4%(28/77)had delayed gastric emptying after CRS-HIPEC.The median age and body mass index of all patients were 59 years and 22.83 kg/m^(2),respectively.Preoperative chemotherapy was administered in 55 patients(71%).Sixty-two patients(81%)had a history of at least one previous pelvic surgery.The median operation time and intraoperative hemorrhage volume were 630 min and 600 mL,respectively.Omentectomy was performed in 32 cases of primary ovarian cancer and 24 cases of recurrence.The median peritoneal cancer index was 16.The risk factors for delayed gastric emptying from the univariate analysis were body mass index<23 kg/m2(X2=5.059,P=0.025),history of pelvic surgery(X^(2)=4.498,P=0.034),history of chemotherapy(X^(2)=4.334,P=0.037),operation time≥7 h(X2=4.827,P=0.047),and intraoperative hemorrhage≥800 mL(X^(2)=7.112,P=0.008).Multivariable analysis revealed that age≥70 years(HR=7.127;95%CI 1.122-45.264;P=0.037)and intraoperative hemorrhage≥800 mL(HR=3.416;95%CI 1.067-10.939;P=0.039)were independently associated with postoperative delayed gastric emptying after CRS-HIPEC.CONCLUSION Postoperative gastrointestinal management,including prolonged nasogastric intubation,should be promoted for patients over 70 years or those with intraoperative bleeding exceeding 800 mL.
文摘Objective To study the effects of wrap-restraint stress and of CRF or CRF antagonist (a-belieal-CRF9-41 ) microinjection on gastric emptying, and the role of plasma motilin (Mot ). Methods The effects of wrap- restraint stress or CRF and CRF antagonist microinjection into paraventricular nucleus (PVN) on gastric empiring were determined by using dextran blue-2000 as a marker. The plasma level of Mot was determined by radioimmunoassay. Results Wrap-restraint stress inhibited gastric emptying. Microinjection of CRF into PVN inhibited gastric emptying dose-dependently. In normal condition, a-he- lical-CRF9-4l bilaterally microinjected into PVN didn’ t modify gastric emptying; however, a-belieal-CRF9-41 microinjection bilaterally into PVN 15min before wrap-restraint stress could significantly antagonize the effect of stress on gastric emptying. After 30min of stress or CRF microinjection into PVN, plasma levels of Mot significantly decreased, as compered with the normal control group. Conclusion Wrap-restraint stress can inhibit gastric emptying, and microinjection of CRF into PVN has the similar effect. The PVN is one of the speific sites for the action of CRF affecting on gastric emptying. Plasma Mot might partic ipate in the effects of stress and CRF-induced alteration of gastric emptying.
文摘Background: Previous studies on fasting and gastrointestinal motility were reported with information lacking concerning prolonged continuous fasting and gastrointestinal motility. This study investigated the effect of prolonged fasting duration on gastrointestinal motility. Methods: Forty-five (45) male Wistar rats, with body weights between 180 - 200 g were used. They were randomly assigned into three (3) groups. Group1: control (rats fasted for 18 h—common duration of fasting for motility studies), groups 2 and 3 fasted for 48 and 72 h respectively. Five (5) rats per experiment and per group were considered. Blood glucose was determined by glucose oxidase method, gastric emptying was assessed by hydrated carbohydrate meal, intestinal motility by charcoal meal, and colonic motility was assessed using bead test. Data were reported in Mean ± SEM and analyzed with one-way ANOVA. Differences in results were considered significant at p ≤ 0.05. Results: There was no significant change in the blood glucose level (mmol/L) of rats in the 48 h group (2.94 ± 0.35) and 72 h group (3.20 ± 0.32) as compared with the control (3.62 ± 0.19). There was a significant decrease in the rate of gastric emptying (g) in the 72 h group (0.20 ± 0.08) compared with the control (0.64 ± 0.16). The intestinal transit (cm) in the 48 h group (67.54 ± 6.15) and 72 h group (72.10 ± 7.60) increased significantly when compared with the control (42.14 ± 3.14). There was a significant decrease in the colonic motility time (Sec.) in the 48 h group (2707 ± 864.1) and 72 h group (6363 ± 968.1) when compared with the control (263.8 ± 64.26). Conclusion: Extended fasting durations decrease the rate of gastric emptying and colonic motility. It suggests that extended fasting durations could be beneficial in intestinal spasms or where the gut is required to relax.
文摘Gestational diabetes mellitus(GDM)represents one of the most common medical complications of pregnancy and is important to the well-being of both mothers and offspring in the short and long term.Lifestyle intervention remains the mainstay for the management of GDM.The efficacy of nutritional approaches(e.g.calorie restriction and small frequent meals)to improving the maternal-neonatal outcomes of GDM was attested to by Chinese population data,discussed in two articles in recent issues of this journal.However,a specific focus on the relevance of postprandial glycaemic control was lacking.Postprandial rather than fasting hyperglycaemia often represents the predominant manifestation of disordered glucose homeostasis in Chinese women with GDM.There is now increasing appreciation that the rate of gastric emptying,which controls the delivery of nutrients for digestion and absorption in the small intestine,is a key determinant of postprandial glycaemia in both health,type 1 and 2 diabetes.It remains to be established whether gastric emptying is abnormally rapid in GDM,particularly among Chinese women,thus contributing to a predisposition to postprandial hyperglycaemia,and if so,how this influences the therapeutic response to nutritional interventions.It is essential that we understand the role of gastric emptying in the regulation of postprandial glycaemia during pregnancy and the potential for its modulation by nutritional strategies in order to improve postprandial glycaemic control in GDM.
文摘Objective:To evaluate the correlation between the incidence of delayed gastric emptying(DGE)in pancreaticoduodenectomy(PD)and the perioperative possible risk factors.Methods:We searched PubMed,Embase,Cochrane Library,and Medline for studies describing complications related to PD from 2018 to 2022.Statistical analysis was performed using Stata/SE16.0 software.Results:In 6 retrospective studies,1 systematic review,and 1 randomized controlled trial(RCT)experiment,12,419 patients(2174 and 10,245 patients,respectively,in DGE and no delayed gastric emptying[NDGE]groups).The preoperative American Society of Anesthesiologists(ASA)score between DGE and NDGE groups(log odds ratio[OR]=0.23,95%credible interval[CI]:0.11-0.35,P<.01),operation time(mean diff.=21.87,95%CI:15.96-27.78,P<.01),estimated intraoperative blood loss(EIBL;mean diff.=70.67,95%CI:17.75-123.58,P<.05),postoperative pancreatic fistula(POPF)(log OR=0.85,95%CI:0.24-1.46,P<.05)were statistically significant.No significant differences in preoperative body mass index(BMI),preoperative biliary drain-age,and pancreatic texture were observed(P>.05).Conclusion:The incidence of DGE is significantly correlated with the operation time,preoperative ASA score,POPF,and EIBL,which suggests that the surgeon should thoroughly evaluate the patient through adequate preoperative examination before the operation.Finally,standardized practice and perfect technology are undoubtedly necessary to reduce complications.
基金Supported by the National Key Basic Research and Development Program(973 Program)Funded Project(No.2014CB543100)Key Research and Development Projects in Shandong Province(No.2015GSF18143)。
文摘OBJECTIVE:To evaluate the effect of electroacupuncture on rapid gastric emptying by comparing the effectiveness of electroacupuncture at both Zusanli(ST36)and Zhongwan(CV12)(He-Mu acupoints)versus electroacupuncture at Zhongwan(CV12)alone.METHODS:Sixty-five patients were randomly divided into two groups;33 patients in the He-Mu acupoints group received electroacupuncture at both Zusanli(ST36)and Zhongwan(CV12),while 32 patients in the single acupoint group received electroacupuncture only at Zhongwan(CV12).Both groups were treated once daily for 30 min,five times per week for 3 weeks.Before and after the 3-week treatment course,patients underwent gastric emptying scintigraphy and were assessed using the Traditional Chinese Medicine(TCM)symptom scale of gastrointestinal diseases.The two groups were compared regarding the percentages of gastric retention at 30 and 60 min and the TCM symptom scores.RESULTS:After the treatment course,the percentages of gastric retention at 30 and 60 min were significantly improved in both groups compared with the pre-treatment values(P<0.01).The improvement in the gastric retention was significantly better in the He-Mu acupoints group than the single acupoint group at 30 min(P<0.01)and 60 min(P<0.05).The TCM symptom score was significantly decreased after the treatment course in both groups(P<0.01).The improvement in the TCM symptom score was significantly better in the He-Mu acupoints group than the single acupoint group(P<0.01).The total effective rate was 93.55%(29/31)in the He-Mu acupoints group and 77.42%(24/31)in the single acupoint group.The treatment effect was better in the He-Mu acupoints group than the single acupoint group(P<0.05).CONCLUSIONS:Electroacupuncture at both Zusanli(ST36)and Zhongwan(CV12)or at Zhongwan(CV12)alone is effective in treating rapid gastric emptying.Furthermore,electroacupuncture at both Zusanli(ST36)and Zhongwan(CV12)is more effective than electroacupuncture at Zhongwan(CV12)alone.
文摘The aims were to prospectively evaluate the association of glycemic control (HbAlc) with gastric emptying in newly diagnosed Type 1 diabetic patients and subjects with longterm diabetes mellitus. Furthermore, the day to day variability of gastric emptying for solids should be assessed. Methods 13 C octanoic breath tests were performed in 15 type 1 diabetic subjects on two separate days within one week. The influence of metabolic control on gastric emptying was prospectively examined over a mean of 8 months in 14 patients with newly diagnosed type 1 diabetes and 44 long term diabetic patients (type 1: n=31; type 2: n=13).Patients with longterm diabetes were stratified according to their HbA 1c at follow up (group 1: HbA 1c U7.5%, n=17; group 2 HbA 1c >7.5%, n=27). 13 C octanoic breath tests were sampled with an isotope selective non dispersive infrared spectrometer. The gastric emptying parameters were calculated using nonlinear regression analysis of the time course of 13 CO 2 exhalation:half emptying time (t 1/2 ) and lag phase (t lag ). Results The intraindividuell coefficient of variation was 17.8% for t 1/2 , and 28.2% for t lag . Mean t 1/2 and t lag in newly diagnosed type 1 diabetics were normal at baseline and were significantly increased at follow up. In patients with longterm diabetes, gastric emptying was unchanged during follow up. Gastric emptying was significant delayed in group 2 compared with group 1 at baseline and follow up respectively. There was a significant correlation between HbA 1c and t 1/2 , t lag at follow up. Conclusions 13 C octanoic breath test has a relatively good reproducibility in patients with type 1 diabetes. Gastric emptying times are already significantly increased after few months in newly diagnosed type 1 diabetes. There is a more pronounced delay of gastric emptying in longterm diabetic subjects with poor compared to patients with good metabolic control.
文摘Solid gastric emptying rates (GER) were determined with scintigraphic techniques in 20 patients with non-ulcer dyspepsia (NUD) and 9 healthy volunteers. GER were significantly decreased in NUD patients compared with controls , especially 45 min (P<0.05) , 60 and 90 min (P<0. 01) and 120 min (P<0. 05) after ingestion. In 13 out of 20 NUD patients who demonstrated lower GER, only 4 cases gave a lower GER at all stages throughout the determination, the other 9 showed their abnormal GER only after 60 min. In 3 cases who received repeated GER studies after cisapride therapy, 2 patients showed symptomatic relief accompanied by GER improvement. It is concluded that gastric emptying delay may be present with a high percentage in patients with non-ulcer dyspepsia. Scintigraphic gastric emptying test is a safe and reliable technique with good reproducibility. It may be helpful in quantitative study about gastric motion disorders.
基金supported by the Traditional Chinese Medicine Science and technology research Project of Sichuan Province Science and Technology Department(grant number 2021MS113)"Xinglin Scholar"Talent Research Promotion Plan of Chengdu University of Traditional Chinese Medicine(grant number ZYTS2019022).
文摘Background:Jianqu has been used to alleviate symptoms in patients with functional dyspepsia,but its specific anti-functional dyspepsia effect is still unclear.Therefore,our study aimed to investigate the impact of Jianqu on functional dyspepsia in mice.Methods:The phytochemical profile of Jianqu was analyzed by UPLC-Q-TOF-MS.Subsequently,Kunming mice were fed a high-calorie or high-protein diet(HCHP)for 7 days,and then orally treated with vehicle or Jianqu(1.62 g/kg body weight(b.w.)and 3.25 g/kg b.w.)for 10 days.A carbon powder solution was used to detect the gastric emptying and intestinal transit rate.The pathological changes in stomach and duodenum were evaluated by hematoxylin-eosin staining.The occludin,claudin-1,ZO-1 and CD45 expression was measured by immunocytochemical staining.Importantly,the serum gastrointestinal hormones were detected by ELISA.In addition,the gut microbiota composition was determined using 16S rRNA gene sequencing.The cecal short chain fatty acids were assessed by gas chromatography.Results:In general,17 phytochemical compounds were identified from Jianqu,which significantly improved the gastric emptying rate and intestinal transit rate(p<0.01),increased the body weight and food intake(p<0.0001)in HCHP mice as well.Though HCHP did not cause significant pathological lesions in the gastrointestinal tract,increased the expression of CD45 in the duodenum(p<0.05)was observed.Notably,Jianqu attenuated this abnormal expression of CD45(p<0.05).The levels of serum gastrointestinal hormones were significantly normalized by Jianqu intervention(p<0.05).Moreover,Jianqu increased the relative abundance of Roseburia as well as short chain fatty acids levels in cecum(p<0.05).Conclusion:The present results showed that Jianqu alleviated dyspeptic symptoms in HCHP mice possibly through reducing the duodenal leukocyte infiltration,and regulating the expression of gastrointestinal hormones.These effects may be partly related to the increasing cecal short chain fatty acids levels probably via gut microbial modulation.
文摘This editorial is stimulated by the article by Alqifari et al published in the World Journal of Diabetes(2024).Alqifari et al focus on practical advice for the clinical use of glucagon-like-peptide-1(GLP-1)receptor agonists(GLP-1RAs)in the management of type 2 diabetes and this editorial provides complementary information.We initially give a brief historical perspective of the development of GLP-1RAs stimulated by recognition of the‘incretin effect’,the substantially greater insulin increase to enteral when compared to euglycaemic intravenous glucose,and the identification of the incretin hormones,GIP and GLP-1.In addition to stimulating insulin,GLP-1 reduces postprandial glucose levels by slowing gastric emptying.GLP-1RAs were developed because native GLP-1 has a very short plasma half-life.The majority of current GLP-1RAs are administered by subcutaneous injection once a week.They are potent in glucose lowering without leading to hypoglycaemia,stimulate weight loss in obese individuals and lead to cardiovascular and renal protection.The landscape in relation to GLP-1RAs is broadening rapidly,with different formulations and their combination with other peptides to facilitate both glucose lowering and weight loss.There is a need for more information relating to the effects of GLP-1RAs to induce gastrointestinal symptoms and slow gastric emptying which is likely to allow their use to become more effective and personalised.
基金Supported by Cangzhou Science and Technology Project,No.131302097
文摘AIM To establish a modified B-ultrasound method of measuring the antral section only to assess gastric motility in healthy people,and evaluate its application in guiding enteral nutrition(EN) in critically ill patients. METHODS First,30 healthy volunteers were selected. The modified B-ultrasound method and the traditional B-ultrasound method were applied to assess gastric function. The correlation of indices of gastric function between the two groups was analyzed statistically. In addition,64 critically ill patients were selected,and the modified B-ultrasound method and the gastric juice withdrawal method were applied to guide the implementation of EN. Daily caloric value,the time required to achieve complete EN,ICU stay,hospitalization time,and serum prealbumin and albumin levels were recorded and compared between the two groups. Kaplan-Meier survival curve was used to compare the complications of EN between the two groups. RESULTS In healthy subjects,there was a good correlation among gastric emptying time,antral contraction frequency andantral motility index between the two groups(r = 0.57,0.61 and 0.54,respectively). The study on critically ill patients also revealed that a better effect of EN was achieved in the modified B-ultrasound method group,in which patients had shorter ICU stay and hospitalization time and higher levels of serum prealbumin and albumin. The Kaplan-Meier survival analysis revealed that the improved B-ultrasound method was associated with significantly fewer EN complications(P = 0.031).CONCLUSION The modified B-ultrasound method can provide a good real-time assessment of gastric function and has a better effect than the traditional method in guiding EN in critically ill patients.
文摘Summary: Gastric emptying time of liquid meal was detected by using ultrasonography in 28 gas- tric ulcer patients with continual or recurrent dyspepsia symptoms after the ulcer healing. Sixteen out of 28 patients (57. 1 % ) with a delay of gastric emptying time (T1/2) were randomly divided into two groups: 8 cases were treated with cisapride 5 mg three times a day and & cases with cisapride 10 mg three times a day respectively. The results showed that cisapride could relieve the symptoms with the effective rate being 68. 8 % in the two groups. T1/2 in the patients after treatment with cisapride was significantly shorter than before treatment (P<0. 001 ). It was concluded that there is a delay of T1/2 in some patients with gastric ulcer healing. Cisapride could promote gastric empty of liquid meal and relieve the symptoms efficiently. The effect of lower dose of cisapride is similar to that of higher dose.
基金Supported by Canadian Institutes of Health Research,No.CIA310955.
文摘BACKGROUND Oral intake is dependent on the gastric ability to accommodate the food bolus.Comparatively,neonates have a smaller gastric capacity than adults and this may limit the volume of their milk intake.Yet,we previously reported that the newborn rat gastric milk volume is greatest after birth and,when normalized to body weight,decreases with postnatal age.Such age-dependent changes are not the result of intake differences,but greater gastric accommodation and reduced emptying rate.AIM Hypothesizing that breastmilk-derived adiponectin is the factor regulating gastric accommodation in neonates,we comparatively evaluated its effects on the rat fundic muscle tone at different postnatal ages.METHODS In freshly dispersed smooth muscle cells(SMC),we measured the adiponectin effect on the carbachol-induced length changes.RESULTS Adiponectin significantly reduced the carbachol-stimulated SMC shortening independently of age.In the presence of the inhibitor iberiotoxin,the adiponectin effect on SMC shortening was suppressed,suggesting that it is mediated via largeconductance Ca^(2+)sensitive K^(+)channel activation.Lastly,we comparatively measured the newborn rat gastric milk curd adiponectin content in one-and twoweek-old rats and found a 50%lower value in the latter.CONCLUSION Adiponectin,a major component of breastmilk,downregulates fundic smooth muscle contraction potential,thus facilitating gastric volume accommodation.This rodent’s adaptive response maximizes breastmilk intake volume after birth.
文摘Gastric and gallbladder emptying in 113 patients with functional dyspepsia (FD) were evaluated by real-time ultrasonography (RUS) after a liquid-fat meal by the patients, and compared with 15 healthy volunteers. The results showed that in FD group 69 patients (61. 06%) had delayed gastric emptying,and 28 patients (24.77%) had gallbladder hypokinesia. Among them both delayed gastric ernptying and gallbladder hypokinesia were found in 11 patients (9.7%), 44 patients (38.93%)had normal gastric emptying and 85 patients (75.22%) had normal gallbladder emptying.