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1.
Arq. gastroenterol ; 58(2): 180-184, Apr.-June 2021. tab
Article in English | LILACS | ID: biblio-1285315

ABSTRACT

ABSTRACT BACKGROUND: Bowel preparation with mannitol is a well-established method in Brazil. However, factors that interfere with the gastric emptying time period are yet to be known. Knowing these factors may favor the examination scheduling logistics and the individualized orientation for each patient. OBJECTIVE: Know the factors that can contribute to the gastric emptying time after intestinal preparation with express mannitol. METHODS: This is a prospective observational study to know factors that may contribute on the gastric emptying timing: predominant type of diet, comorbidities, medication usage, previous surgeries, number of evacuation per week, bearer of bowel obstipation, fecal type, diet type, number of evacuations after the home usage of bisacodyl before the ingestion of mannitol and number of evacuations after the ingestion of mannitol until reaching a proper bowel preparation. Before starting the colonoscopy exam, an upper digestive endoscopy exam was made to aspirate the gastric content. RESULTS: Sample was composed of 103 patients, 55 (53.4%) women, medium age 61 (±12.1) years, medium weight 75.3 (±14.1) kg, medium height 1.7 (±10) m and medium BMI of 26.6 (±3.9) kg/m2. Average gastric residual volume was 120.9 (0-900) mL. Gastric residual volume (GRV) below 100 mL (GRV ≤100 mL) occurred in 45 (43.6%) patients, 24 (53.3%) women, medium age of 61.0 years and medium BMI of 26.7 kg/m2. Gastric residual volume above 100 mL (GRV >100 mL) occurred on 58 (56.3%) patients, 29 (50%) women, medium age of 61.0 years and medium BMI of 26.2 kg/m2. Comparing both groups, average fasting time period after the ingestion of mannitol was significantly higher on the group with GRV ≤100 mL than group with GRV >100 mL, 123.1 (60-246) vs 95.3 (55-195) minutes, respectively. There was also statistical significance concerning the usage of ezetimibe 6 (13.7%) in the group with GRV ≤100 mL and statistical significance in the group with GRV >100 mL concerning the usage of paroxetine 3 (6.7%) and tadalafil 3 (6.7%) and surgical history of prostatectomy 3 (6.7%) and bridle withdrawal 3 (6.7%). CONCLUSION: We may conclude in this study that the usage of ezetimibe and fasting above 2 hours after the ingestion of mannitol decrease significantly the incidence of a GRV >100 mL. The usage of paroxetine, tadalafil and surgical history of prostatectomy or bridle withdrawal may contribute to increase de incidence of a GRV >100 mL.


RESUMO CONTEXTO: O preparo intestinal com manitol é um método bem estabelecido no Brasil. No entanto, os fatores que interferem no tempo de esvaziamento gástrico ainda não são conhecidos. O conhecimento desses fatores pode favorecer a logística de agendamento do exame e a orientação individualizada para cada paciente. OBJETIVO: Estudar os fatores que podem contribuir para o tempo de esvaziamento gástrico após o preparo intestinal com manitol expresso. MÉTODOS: Trata-se de um estudo observacional prospectivo com o objetivo de conhecer os seguintes fatores que podem contribuir no tempo de esvaziamento gástrico: tipo de dieta predominante, comorbidades, uso de medicamentos, cirurgias anteriores, número de evacuações por semana, portador de obstipação intestinal, tipo fecal, tipo de dieta, número de evacuações após o uso domiciliar de bisacodil antes da ingestão de manitol e número de evacuações após a ingestão de manitol até atingir o preparo intestinal adequado. Antes de iniciar o preparo intestinal, os pacientes responderam a um questionário clínico. O endoscópio foi introduzido para aspirar o conteúdo gástrico, antes de iniciar a colonoscopia. RESULTADOS: A amostra foi composta por 103 pacientes, sendo 55 mulheres, com média de idade de 61 anos, peso médio de 75,3 kg, altura média de 1,7 m e IMC médio de 26,6 kg/m2. O volume residual gástrico médio medido foi 120,9 (0-900) mL. Volume residual gástrico inferior a 100 mL (VRG ≤100 mL) foi encontrado em 45 (43,6%) pacientes, sendo 24 (53,3%) mulheres, com média de idade de 61,0 anos e IMC médio de 26,7 kg/m2. Volume residual gástrico acima de 100 mL (VRG >100 mL) ocorreu em 58 (56,3%) pacientes, sendo 29 (50%) mulheres, com idade média de 61,0 anos e IMC médio de 26,2 kg/m2. Comparando os dois grupos, notou-se que o tempo médio de jejum após a ingestão de manitol foi significativamente maior no grupo com VRG ≤100 mL do que no grupo com VRG> 100 mL, 123,1 (60-246) vs 95,3 (55-195) minutos, respectivamente. Também houve significância estatística em relação ao uso de ezetimiba 6 (13,7%), sendo maior no grupo com VRG ≤100 mL. Além disso, houve significância estatística no grupo com VRG >100 mL quanto ao uso de paroxetina 3 (6,7%) e tadalafil 3 (6,7%) e história cirúrgica de prostatectomia 3 (6,7%) e retirada de bridas 3 (6,7%). CONCLUSÃO: Podemos concluir neste estudo que o uso de ezetimiba e o jejum acima de 2 horas após a ingestão de manitol diminuem significativamente a incidência de um VRG> 100 mL. O uso de paroxetina, tadalafil e história cirúrgica de prostatectomia ou retirada de bridas podem contribuir para o aumento da incidência de um VRG >100 mL.


Subject(s)
Humans , Male , Female , Stomach , Mannitol , Residual Volume , Gastric Emptying , Gastrointestinal Contents , Middle Aged
2.
Rev. Assoc. Med. Bras. (1992) ; 66(12): 1725-1730, Dec. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1143678

ABSTRACT

SUMMARY OBJECTIVE: Bronchoaspiration of gastric content is associated with high morbidity and mortality, but evaluating this complication is a difficult task. However, gastric ultrasonography can safely assess gastric content and prevent bronchoaspiration. Therefore, a systematic review was performed in order to verify the efficacy of ultrasonography in the qualitative and quantitative analyses of gastric content. METHODS: A literature review of articles published between 2009 and 2019 in the PubMed and LILACS databases was conducted using combinations of the keywords "gastric ultrasound," "gastric emptying," and "gastric content." RESULTS: Of the 20 articles found, 19 chose the antral region as the best site for qualitative analysis of the gastric content. Regarding quantitative measurement, the most commonly used method to calculate the gastric volume in eight articles was the formula "Gastric Volume = 27 + (14.6 × ATAG) − (1.28 × Age)," in which the area of the transverse section of the gastric antrum (ATAG) could also be calculated by the largest antral diameters or by free tracing. CONCLUSION: An efficient evaluation of the gastric content can be performed by ultrasonography of the antral region, contributing to greater safety in the clinical management of patients with increased risk for bronchoaspiration during airway management.


RESUMO OBJETIVO: A broncoaspiração do conteúdo gástrico associa-se à alta morbimortalidade, porem a avaliação desta complicação é tarefa dificil. Por outro lado, a ultrassonografia gástrica avalia o conteúdo gástrico com segurança, podendo evitar a broncoaspiração. Portanto, foi realizada revisão sistemática com objetivo de verificar a aplicabilidade da ultrassonografia na análise qualitativa e quantitativa do conteúdo gástrico. MÉTODOS: Revisão de literatura de artigos publicados entre 2009 e 2019 nas bases de dados PubMed e LILACS usando combinações das palavras chave: "Gastric ultrasound", "gastric emptying" e "gastric content". RESULTADOS: Foram encontrados 20 artigos. A região antral foi escolhida em 19 artigos como melhor local do ponto de vista qualitativo para analisar o conteúdo gástrico. A respeito da mensuração quantitativa, o método mais utilizado para cálculo do volume gástrico, escolhido em 8 artigos, foi através da fórmula Volume gástrico = 27 + (14,6 x ATAG) - (1,28 x Idade), em que a Área da Secção Transversa do Antro Gástrico (ATAG) pode ser igualmente calculada pelos maiores diâmetros antrais ou pelo seu traçado livre. CONCLUSÃO: A ultrassonografia da região antral permite boa avaliação do conteúdo gástrico, trazendo maior segurança ao manejo clínico de pacientess com risco aumentado para broncoaspiração no manejo da via aerea.


Subject(s)
Humans , Pyloric Antrum/diagnostic imaging , Gastrointestinal Contents/diagnostic imaging , Prospective Studies , Ultrasonography , Gastric Emptying
3.
Arq. gastroenterol ; 57(4): 428-433, Oct.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1142331

ABSTRACT

ABSTRACT BACKGROUND: Electrogastrography (EGG) is a noninvasive technique for the assessment of gastric myoelectrical activity using electrodes placed on the abdominal surface. Changes in gastric myoelectrical activity may be associated with diseases such as gastroparesis, functional dyspepsia, nausea, and recurrent vomiting. In Brazil, no studies to date have assessed gastric myoelectrical activity using multichannel EGG in healthy individuals. OBJECTIVE: To establish normal values of transcutaneous multichannel EGG in healthy Brazilian individuals. METHODS: This was a prospective study including 20 healthy individuals who underwent EGG. Recording was performed during two periods: a preprandial recording was performed for 30 minutes, and a postprandial recording was performed for 30 minutes after a soft-solid meal of 400 kcal (20 grams of proteins, 60 grams of carbohydrates, and 9 grams of fat). RESULTS: We assessed dominant frequency (DF) parameters, %DF distribution, the instability coefficient, and the power ratio (PR). A total of 20 individuals (11 women and 9 men) with a mean age of 39.5±7.4 years were included. Mean DF (95%CI) ranged from 2.4 to 3.1 cpm in the resting phase and 2.6 to 3.2 cpm in the postprandial period. The %DF in normogastria range was >70% in all healthy individuals. We identified that only one individual did not present a positive response to the test meal, and the other 19 individuals showed a PR greater than 1. The instability coefficient did not change significantly with meal intake. CONCLUSION: Multichannel EGG may be applied in future studies to evaluate gastric motility disorders in the Brazilian population.


RESUMO CONTEXTO: Eletrogastrografia (EGG) é técnica não invasiva que avalia a atividade miolétrica gástrica utilizando eletrodos localizados na superfície abdominal. Alterações na atividade miolétrica gástrica podem estar associadas a distúrbios como gastroparesia, dispepsia funcional, náuseas e vômitos recorrentes. No Brasil, não há estudos até o momento que tenham avaliado a atividade miolétrica gástrica pela EGG multicanal transcutânea em indivíduos saudáveis. OBJETIVO: Estabelecer valores de normalidade da EGG multicanal transcutânea em indivíduos brasileiros saudáveis. MÉTODOS: Este foi um estudo prospectivo, incluindo 20 indivíduos saudáveis submetidos a EGG. O registro foi realizado em dois períodos: um período pré-prandial foi registrado por 30 minutos, e um período pós-prandial por 30 minutos após a ingesta de uma dieta de prova com consistência sólida e pastosa de 400 kcal (20 gramas de proteínas, 60 gramas de carboidratos e 9 gramas de gordura). RESULTADOS: Foram avaliados os parâmetros de frequência dominante (FD), distribuição da % de FD, coeficiente de instabilidade e "power ratio" (PR). Foram incluídos 20 indivíduos (11 mulheres e 9 homens) com idade média de 39,5 +/- 7,4 anos. A FD média (95%CI) variou de 2,4 a 3,1 cpm no período de basal (pré-prandial) e de 2,6 a 3,2 cpm no período pós-prandial. A % da FD na faixa de normogastria foi >70% em todos os indivíduos saudáveis. Identificamos que apenas um indivíduo não apresentou resposta positiva a refeição de prova, e os outros 19 indivíduos apresentaram PR>1. O coeficiente de instabilidade não mudou significativamente com a ingesta da refeição de prova. CONCLUSÃO: A EGG multicanal transcutânea pode ser aplicada em estudos futuros para a avaliar distúrbios da motilidade gástrica na população brasileira.


Subject(s)
Humans , Male , Female , Adult , Electromyography , Stomach , Brazil , Prospective Studies , Dyspepsia , Gastric Emptying , Middle Aged
4.
Pesqui. vet. bras ; 40(4): 289-292, Apr. 2020. tab
Article in English | ID: biblio-1135619

ABSTRACT

Gastric emptying and plasma glucose were evaluated in young and adult dogs, fed with dry and wet food, submitted to different periods of pre-anesthetic fasting (6, 8, and 12 hours). Forty healthy dogs were selected, which were segmented into four groups according to the age group and type of diet. It was evaluated the gastric emptying by ultrasound and serum glycemia. Only 17.5% presented complete gastric emptying, and no significant differences were found between the 6 and 8-hour fasting evaluations, or between the age groups and the diets, considering significance level p<0.05. Mean plasma glucose values from the groups indicated normal glycemia at all times of evaluation. A significant difference was found between the means of glycemia in young and adult dogs, with the 8-hour fasting with wet diet (p=0.03) and with 12 hours with dry diet (p=0.04). Healthy young and adult dogs, in physiological equilibrium, maintain average values of plasma glucose despite prolonged periods of pre-anesthetic fasting, which may be necessary, since 8-hour fasting for solid food is not enough to provide complete gastric emptying.(AU)


Avaliou-se o esvaziamento gástrico e a glicemia plasmática em cães jovens e adultos, alimentados com ração seca e úmida, submetidos a diferentes períodos de jejum pré-anestésico (6, 8 e 12 horas). Foram selecionados 40 cães hígidos, os quais foram segmentados em 4 grupos de acordo com a faixa etária e o tipo de dieta administrada. Foi avaliado o esvaziamento gástrico por ultrassonografia e a glicemia sérica. Apenas 17,5% apresentaram completo esvaziamento gástrico, não sendo encontradas diferenças significativas entre as avaliações com 6 e 8 horas de jejum, ou entre as faixas etárias e dietas, considerando nível de significância p<0,05. Os valores médios da glicose plasmática dos grupos indicaram normoglicemia em todos os momentos de avaliação. Foi encontrada diferença significativa entre as médias da glicemia dos cães jovens e adultos, no período de 8 horas de jejum com dieta úmida (p=0,03) e com 12 horas nos animais com dieta seca (p=0,04). Conclui-se que cães hígidos jovens e adultos, em equilíbrio fisiológico, mantêm valores normais de glicemia plasmática apesar de períodos prolongados de jejum pré-anestésico, os quais podem ser necessários, tendo em vista que 8 horas de jejum alimentar de sólidos não é suficiente para proporcionar completo esvaziamento gástrico.(AU)


Subject(s)
Animals , Dogs , Blood Glucose/analysis , Fasting , Gastric Emptying , Hypoglycemia/veterinary , Anesthesia/veterinary , Diet/veterinary
5.
Article in Chinese | WPRIM | ID: wpr-826730

ABSTRACT

OBJECTIVE@#To explore the clinical therapeutic effect of herb-partitioned moxibustion at point in patients of diabetic gastroparesis differentiated as spleen and stomach deficiency and retention of turbid dampness as well as its effect mechanism.@*METHODS@#A total of 134 patients with diabetic gastroparesis were randomized into an observation group and a control group, 67 cases in each one. In the observation group, herb-partitioned moxibustion at point was adopted, 40 min each time, once a day for 5 times a week. In the control group, itopride hydrochloride tablets were prescribed for oral administration, 50 mg each time, three times a day. A total of 6 weeks of treatment was required in the two groups. Before and after treatment, the gastroparesis cardinal symptom index (GCSI) scores, 4-hour gastric emptying rate, TCM symptom score, as well as the levels of plasma motilin and serum gastrin were observed in the patients of the two groups. Additionally, the clinical therapeutic effect was evaluated in the two groups.@*RESULTS@#After treatment, the score of every item of GCSI, TCM symptom scores and the levels of plasma motilin and serum gastrin were all reduced as compared with those before treatment in the patients of the two groups (<0.05), and those in the observation group were lower than the control group (<0.05). Regarding 4-hour gastric emptying rates, which were increased as compared with those before treatment in the two group (<0.05), and the rate in the observation group was higher remarkably than that in the control group (<0.05). The total effective rate was 92.5% (62/67) in the observation group, higher than 74.6% (50/67) in the control group (<0.05).@*CONCLUSION@#Herb-partitioned moxibustion at point relieves the clinical symptoms in the patients with diabetic gastroparesis and increases the gastric emptying rate, which is probably related to the regulation of the levels of plasma motilin and serum gastrin.


Subject(s)
Acupuncture Points , Diabetes Mellitus , Gastric Emptying , Gastrins , Blood , Gastroparesis , Therapeutics , Humans , Motilin , Blood , Moxibustion
6.
ABCD arq. bras. cir. dig ; 33(3): e1548, 2020. graf
Article in English | LILACS | ID: biblio-1152623

ABSTRACT

ABSTRACT Background: Gastrointestinal disorders are frequently reported in patients with Parkinson's disease whose disorders reduce the absorption of nutrients and drugs, worsening the clinical condition of patients. However, the mechanisms involved in modifying gastrointestinal pathophysiology have not yet been fully explained. Aim: To evaluate its effects on gastrointestinal motility and the involvement of the vagal and splanchnic pathways. Methods: Male Wistar rats (250-300 g, n = 84) were used and divided into two groups. Group I (6-OHDA) received an intrastriatal injection of 6-hydroxydopamine (21 µg/animal). Group II (control) received a saline solution (NaCl, 0.9%) under the same conditions. The study of gastric emptying, intestinal transit, gastric compliance and operations (vagotomy and splanchnotomy) were performed 14 days after inducing neurodegeneration. Test meal (phenol red 5% glucose) was used to assess the rate of gastric emptying and intestinal transit. Results: Parkinson's disease delayed gastric emptying and intestinal transit at all time periods studied; however, changes in gastric compliance were not observed. The delay in gastric emptying was reversed by pretreatment with vagotomy and splanchnotomy+celiac gangliectomy, thus suggesting the involvement of such pathways in the observed motor disorders. Conclusion: Parkinson's disease compromises gastric emptying, as well as intestinal transit, but does not alter gastric compliance. The delay in gastric emptying was reversed by truncal vagotomy, splanchnotomy and celiac ganglionectomy, suggesting the involvement of such pathways in delaying gastric emptying.


RESUMO Racional: Distúrbios gastrintestinais são frequentemente relatados em pacientes com doença de Parkinson cujos distúrbios reduzem a absorção de nutrientes e fármacos, agravando o quadro clínico dos pacientes. No entanto, os mecanismos envolvidos na alteração da fisiopatologia gastrintestinal ainda não foram totalmente elucidados. Objetivo: Avaliar os seus efeitos sobre a motilidade gastrintestinal e o envolvimento das vias vagal e esplâncnica. Métodos: Ratos Wistar machos (250-300 g, n=84) foram utilizados e divididos em dois grupos. O grupo I (6-OHDA) recebeu injeção intraestriatal de 6-hidroxidopamina (21 µg/animal). O grupo II (controle) recebeu solução salina (NaCl, 0,9%) nas mesmas condições. O estudo do esvaziamento gástrico, trânsito intestinal, complacência gástrica e operações (vagotomia e esplancnotomia) foram realizadas 14 dias após a indução da neurodegeneração. Refeição teste (vermelho de fenol+glicose 5%) foi utilizada para avaliar a taxa de esvaziamento gástrico e o trânsito intestinal. Resultados: A doença de Parkinson retardou o esvaziamento gástrico e o trânsito intestinal em todos os tempos estudados; porém, alterações da complacência gástrica não foram observadas. O retardo do esvaziamento gástrico foi revertido por pré-tratamento com vagotomia e esplancnotomia+gangliectomia celíaca, sugerindo assim, o envolvimento de tais vias nos distúrbios motores observados. Conclusão: A doença de Parkinson compromete o esvaziamento gástrico, bem como o trânsito intestinal, mas não altera a complacência gástrica. O retardo do esvaziamento gástrico foi revertido pela vagotomia troncular, esplancnotomia e gangliectomia celíaca, sugerindo o envolvimento de tais vias no retardo do esvaziamento gástrico.


Subject(s)
Humans , Animals , Male , Rats , Parkinson Disease , Vagotomy/adverse effects , Gastric Emptying/physiology , Gastrointestinal Motility/physiology , Gastrointestinal Transit/physiology , Rats, Wistar
7.
Rev. colomb. anestesiol ; 47(4): 219-225, Oct-Dec. 2019. tab
Article in English | LILACS, COLNAL | ID: biblio-1042732

ABSTRACT

Abstract Background: The administration of perioperative fluids is a controversial issue that can be associated with the development of postoperative pancreatic fistula (POPF) after Whipple procedure. Objective: To evaluate whether intraoperative fluid management along with Enhanced Recovery after Surgery (ERAS) protocols affect outcomes following major pancreatic resection. Methods: A retrospective cohort study was conducted from January 2012 to January 2017, collecting all patients scheduled for duodenopancreatectomy (DP). Patients were divided into 2 groups according to the use of ERAS protocols and the use of a fluid therapy algorithm. Results: A total of 67 patients were analyzed, 49.3% of which were females. The most frequent diagnoses were Pancreatic Cancer n:48 (71.6%), followed by intraductal papillary mucinous neoplasm n:6 (9%). The majority of patients were in the ERAS group n:46 (68.7%); 80.4% and 95.7% of them did not develop pancreatic fistula or delayed gastric emptying (DGE) respectively, and the incidence for both was 11.94%. Fluid therapy was below 5000 mL (P=0.001) with blood loss less 300 mL (P = 0.001) in the ERAS group. The length of stay was shorter in the ERAS group (7 days, interquartilel range 5-12, P < 0.001). No differences in 30 days mortality were found. Conclusion: The implementation of ERAS protocols in DP did show a decrease in intraoperative blood loss, intravenous fluids therapy, need for transfusion, DGE, or total hospital stay. However, intraoperative fluid restriction in DP did not show a reduction in the development of POPF.


Resumen Introducción: La administración de fluidos durante el perioperatorio es un tema controvertido que puede asociarse a complicaciones como la fístula pancreática después de realizar el procedimiento de Whipple. Objetivo: Evaluar si los protocolos de manejo de líquidos dentro de las recomendaciones de recuperación acelerada después de cirugía (ERAS) afectan los desenlaces después de intervención pancreática mayor. Materiales y métodos: Se realizó un estudio de cohorte retrospectivo entre enero de 2012 y enero de 2017. Se recopilaron todos los pacientes a quienes se les practicó duodenopancreatectomía. Se dividieron en dos grupos según el uso de protocolos ERAS y el uso de algoritmos para terapia hídrica. Resultados: Se analizaron 67 pacientes, el 49,3% correspondió al sexo femenino. Los diagnósticos más frecuentes fueron cáncer de páncreas n: 48 (71,6%), seguido de neoplasia mucinosa papilar intraductal n: 6 (9%). La mayoría de los pacientes se encontraban en el Grupo ERAS n:46(68,7%).En dicho grupo, el 80,4% y el 95,7% no desarrollaron fístula pancreática o retraso del vaciamiento gástrico y la incidencia fue del 11,94%, respectivamente. La terapia hídrica estuvo por debajo de 5000 ml (p = 0,001) con una pérdida sanguínea inferior a 300 ml (p=0,001) en el grupo ERAS. La estancia hospitalaria fue más corta en el grupo ERAS (7 días, rango intercuartil [RIC] 5-12, p =<0,001). No hubo diferencias en la mortalidad a 30 días. Conclusión: La implementación de protocolos ERAS en la duodenopancreatectomía mostró una menor pérdida sanguínea, menor terapia hídrica, menor necesidad de transfusión, menor retraso del vaciamiento gástrico y menor estancia hospitalaria. Sin embargo, la terapia hídrica restrictiva no redujo el desarrollo de fístula pancreática postoperatoria.


Subject(s)
Humans , Postoperative Complications , Pancreaticoduodenectomy , Fluid Therapy , Pancreatic Neoplasms , Cohort Studies , Mortality , Pancreatic Fistula , Protocols , Gastric Emptying , Enhanced Recovery After Surgery , Length of Stay , Neoplasms
8.
Rev. bras. anestesiol ; 69(2): 115-121, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1003401

ABSTRACT

Abstract Background and objectives: Preoperative fasting may lead to undesirable effects in the surgical patient in whom there is a stimulus to ingesting clear liquids until 2 hours before anesthesia. The aim of this study was to evaluate the gastric emptying of two different solutions using ultrasound. Methods: In a prospective, randomized, blind study, 34 healthy volunteers ingested 200 mL of two solutions without residues in two steps: an isotonic solution with carbohydrates, electrolytes, osmolarity of 292 mOsm.L-1, and 36 kcal; and other nutritional supplementation with carbohydrates, proteins, electrolytes, osmolarity of 680 mO.L-1, and 300 kcal. After 2 hours, a gastric ultrasound was performed to assess the antrum area and gastric volume, and the relation of gastric volume to weight (vol.w-1), whose value above 1.5 mL.kg-1 was considered a risk for bronchoaspiration. A p-value <0.05 was considered statistically significant. Results: There was a significant difference between all parameters evaluated 2 hours after the ingestion of nutritional supplementation compared to fasting. The same occurred when the parameters between isotonic solution and nutritional supplementation were compared 2 hours after ingestion. Only one patient had vol.w-1 <1.5 mL.kg-1 2 hours after ingestion of nutritional supplementation; and only one had vol.w-1 >1.5 mL.kg-1 after ingestion of isotonic solution. Conclusion: This study demonstrated that gastric emptying of equal volumes of different solutions depends on their constitution. Those with high caloric and high osmolarity, and with proteins present, 2 hours after ingestion, increased the gastric volumes, which is compatible with the risk of gastric aspiration.


Resumo Justificativa e objetivos: O jejum pré-operatório pode levar a efeitos indesejáveis no paciente cirúrgico, em que há um estimulo à ingestão de líquidos sem resíduos até 2 horas antes da anestesia. O objetivo deste estudo foi avaliar o esvaziamento gástrico de duas soluções diferentes por meio da ultrassonografia. Métodos: Em um estudo prospectivo, randomizado, cego, 34 voluntários saudáveis ingeriram 200 mL de duas soluções sem resíduos, em duas etapas: uma solução isotônica com carboidratos, eletrólitos, osmolaridade de 292 mOsm.L-1 e 36 kcal; e outra suplementação nutricional, com carboidratos, proteínas, eletrólitos, osmolaridade de 680 mOs.L-1 e 300 kcal. Após 2 horas, fez-se ultrassonografia gástrica com avaliação da área do antro e volume gástrico e relação do volume gástrico sobre o peso (vol.p-1), cujo valor acima de 1,5 mL.kg-1 foi considerado risco para broncoaspiração. Considerou-se p< 0,05 como estatisticamente significativo. Resultados: Houve diferença significativa entre todos os parâmetros avaliados 2 horas após a ingestão de suplementação nutricional em relação ao jejum. O mesmo ocorreu quando foram comparados os parâmetros entre solução isotônica e suplementação nutricional 2 horas após a ingestão. Apenas um paciente apresentou vol.p-1< 1,5 mL.kg-1 2 horas após a ingestão de suplementação nutricional; e apenas um apresentou vol.p-1 > 1,5 mL.kg-1, após a ingestão de solução isotônica. Conclusão: Este estudo demonstrou que o esvaziamento gástrico de volumes iguais de diferentes soluções depende de sua constituição. Aqueles com alto valor calórico e alta osmolaridade, e com proteínas presentes, 2 horas após a ingestão, aumentaram os volumes gástricos, compatíveis com o risco de aspiração gástrica.


Subject(s)
Humans , Male , Female , Adult , Young Adult , Ultrasonography/methods , Dietary Supplements , Gastric Emptying/physiology , Isotonic Solutions/administration & dosage , Osmolar Concentration , Stomach/diagnostic imaging , Energy Intake/physiology , Carbohydrates/administration & dosage , Proteins/administration & dosage , Prospective Studies , Fasting/psychology , Electrolytes/administration & dosage
9.
Journal of Gastric Cancer ; : 365-371, 2019.
Article in English | WPRIM | ID: wpr-764494

ABSTRACT

The role of surgical intervention in patients with diabetic gastroparesis is unclear. We report a case of a 37-year-old man with a history of recurrent episodes of vomiting and long-standing type 2 diabetes mellitus. Esophagogastroduodenoscopy did not reveal any findings of reflux esophagitis or obstructive lesions. A gastric emptying time scan showed prolonged gastric emptying half-time (344 minutes) indicating delayed gastric emptying. Laboratory tests revealed elevated fasting serum glucose and glycosylated hemoglobin (HbA1c, 12.9%) and normal fasting C-peptide and insulin levels. We performed Roux-en-Y reconstruction after subtotal gastrectomy to treat gastroparesis and improve glycemic control, and the patient showed complete resolution of gastrointestinal symptoms postoperatively. Barium swallow test and gastric emptying time scan performed at follow-up revealed regular progression of barium and normal gastric emptying. Three months postoperatively, his fasting serum glucose level was within normal limits without the administration of insulin or oral antidiabetic drugs with a reduced HbA1c level (6.9%). Long-limb Roux-en-Y reconstruction after subtotal gastrectomy may be useful to treat severe diabetic gastroparesis by improving gastric emptying and glycemic control.


Subject(s)
Adult , Barium , Blood Glucose , C-Peptide , Diabetes Mellitus , Diabetes Mellitus, Type 2 , Endoscopy, Digestive System , Esophagitis, Peptic , Fasting , Follow-Up Studies , Gastrectomy , Gastric Emptying , Gastroparesis , Glycated Hemoglobin A , Humans , Hypoglycemic Agents , Insulin , Vomiting
10.
Article in Korean | WPRIM | ID: wpr-761586

ABSTRACT

The prevalence of small bowel cancer is relatively low. The abdominal pain that patients with small bowel cancer present as a symptom is non-specific and often interpreted as a normal finding on radiographic studies. To prevent delayed diagnosis of small bowel cancer, practitioners must maintain a certain level of suspicion. We report a case of delayed diagnosis of jejunal cancer as it was misdiagnosed as gastroparesis. A 69-year-old woman complained of recurrent nausea and vomiting. At the beginning of her hospitalization, we could not diagnose mechanical obstruction through esophagogastroduodenoscopy and abdominal computed tomography. A gastric emptying study revealed delayed gastric emptying. Although the patients received treatments, including administration of prokinetics and botulinum toxin injection, for gastroparesis, her symptoms aggravated. Subsequently, plain radiography of the abdomen revealed a double-bubble sign. Abdominal computed tomography was performed under the suspicion of small bowel obstruction; however, the diagnosis was not clear. Consequently, exploratory laparoscopy was performed. She underwent surgical management, including small bowel segmental resection and duodenojejunostomy, due to the jejunal mass with involvement of the stomach, pancreatic head, and mesentery of the transverse colon. The postoperative pathological results revealed a moderately differentiated adenocarcinoma of the jejunum.


Subject(s)
Abdomen , Abdominal Pain , Adenocarcinoma , Aged , Botulinum Toxins , Colon, Transverse , Delayed Diagnosis , Diagnosis , Endoscopy, Digestive System , Female , Gastric Emptying , Gastroparesis , Head , Hospitalization , Humans , Jejunal Neoplasms , Jejunum , Laparoscopy , Mesentery , Nausea , Prevalence , Radiography , Stomach , Vomiting
12.
Article in English | WPRIM | ID: wpr-765970

ABSTRACT

BACKGROUND/AIMS: Association between symptoms, quality of life and gastric emptying in dyspepsia is inconsistent in the literature. The aim of our study is to investigate if gastric emptying is associated with specific symptoms and quality of life in dyspeptic patients. METHODS: We reviewed retrospectively gastric emptying measured by ¹³C-labelled octanoate breath testing for more than 6 hours in 198 consecutive patients with dyspepsia complaints. Gastrointestinal symptoms were assessed using a 5-points Likert scale and by a symptomatic composite score, whereas quality of life was measured by the GIQLI. RESULTS: In our cohort, 90 patients (45%) had a delayed gastric emptying (half emptying time above 166 minutes when assessed over 6–8 hours). There was no difference in symptoms or quality of life between patients with or without delayed gastric emptying. However, patients with severely delayed gastric emptying (half emptying time above 200 minutes) had increased postprandial fullness (P = 0.012), abdominal pain (P = 0.026), bloating (P = 0.044), early satiety (P = 0.018), symptomatic composite score (P = 0.005), and a lower quality of life (P = 0.018). This association was no longer observed if the calculation of gastric emptying was limited to the first 4-hour samples. CONCLUSIONS: There is no association between symptoms, quality of life and gastric emptying in an overall dyspeptic population. However, there is an association between symptoms, quality of life of delayed gastric emptying in the subgroup of patients with severely delayed gastric emptying. An 8-hour measurement of gastric emptying should be recommended.


Subject(s)
Abdominal Pain , Breath Tests , Cohort Studies , Dyspepsia , Gastric Emptying , Gastroparesis , Humans , Quality of Life , Retrospective Studies
13.
Article in English | WPRIM | ID: wpr-765963

ABSTRACT

BACKGROUND/AIMS: Gastrointestinal (GI) symptoms may develop when we fail to adapt to various stressors of our daily life. Central oxytocin (OXT) can counteract the biological actions of corticotropin-releasing factor (CRF), and in turn attenuates stress responses. Administration (intracerebroventricular) of OXT significantly antagonized the inhibitory effects of chronic complicated stress (CCS) on GI dysmotility in rats. However, intracerebroventricular administration is an invasive pathway. Intranasal administration can rapidly deliver peptides to the brain avoiding stress response. The effects of intranasal OXT on hypothalamus-pituitary-adrenal axis and GI motility in CCS conditions have not been investigated. METHODS: A CCS rat model was set up, OXT 5, 10, or 20 μg were intranasal administered, 30 minutes prior to stress loading. Central CRF and OXT expression levels were analyzed, serum corticosterone and OXT concentrations were measured, and gastric and colonic motor functions were evaluated by gastric emptying, fecal pellet output, and motility recording system. RESULTS: Rats in CCS condition showed significantly increased CRF expression and corticosterone concentration, which resulted in delayed gastric emptying and increased fecal pellet output, attenuated gastric motility and enhanced colonic motility were also recorded. OXT 10 μg or 20 μg significantly reduced CRF mRNA expression and the corticosterone concentration, OXT 20 μg also helped to restore GI motor dysfunction induced by CCS. CONCLUSION: Intranasal administration of OXT has an anxiolytic effect and attenuates the hypothalamus-pituitary-adrenal axis in response to CCS, and gave effects which helped to restore GI dysmotility, and might be a new approach for the treatment of stress-induced GI motility disorders.


Subject(s)
Administration, Intranasal , Animals , Anti-Anxiety Agents , Brain , Colon , Corticosterone , Corticotropin-Releasing Hormone , Gastric Emptying , Gastrointestinal Motility , Models, Animal , Oxytocin , Peptides , Rats , RNA, Messenger
14.
Article in English | WPRIM | ID: wpr-765955

ABSTRACT

BACKGROUND/AIMS: Delayed gastric emptying (GE) is associated with high morbidity and mortality in subjects with diabetes. The aim of this study is to investigate associations between GE time and the major cardiovascular events (coronary heart diseases and ischemic stroke) in diabetic subjects with upper gastrointestinal (UGI) symptoms. METHODS: Among 259 subjects with chronic UGI symptoms who underwent gastric emptying study (GES) over 13 years, 122 diabetic subjects without gastric surgery and/or rapid GE were enrolled in this study. We also gathered data about baseline demographics, clinical characteristics, estimated GE half-time (GE T(1/2)) and incidence of cardiovascular events following GES. RESULTS: The mean age of subjects was 64.0 ± 17.4 years. There were 86 women and 104 subjects with type 2 diabetes. There were 52 (42.6%) subjects with normal GE, 50 (41.0.%) subjects with mild delayed GE, and 20 (16.4%) subjects with marked delayed GE. During follow-up (median, 207 weeks), cardiovascular events occurred in 7 (13.5%) subjects with normal GE, 4 (8.0%) subjects with mild delayed GE and 7 (35.0%) subjects with marked GE (P = 0.015). Univariate analysis showed that GE T(1/2) was significantly associated with incidence of cardiovascular events (crude OR, 1.74; 95% CI, 1.12–2.69; P = 0.014). In a multivariate model, association between GE T(1/2) and incidence of cardiovascular events remained statistically significant after adjustment for baseline characteristics and comorbidities (adjusted OR, 1.94; 95% CI, 1.21–3.12; P = 0.006). CONCLUSION: A delay of GE was associated with an increased incidence of cardiovascular events in diabetic subjects with chronic UGI symptoms.


Subject(s)
Cardiovascular Diseases , Comorbidity , Coronary Disease , Demography , Diabetes Mellitus , Female , Follow-Up Studies , Gastric Emptying , Heart Diseases , Humans , Incidence , Mortality , Stroke
15.
Article in English | WPRIM | ID: wpr-765932

ABSTRACT

BACKGROUND/AIMS: Current evidence suggests the presence of motility or functional abnormalities in one area of the gastrointestinal tract increases the likelihood of abnormalities in others. However, the relationship of gastroparesis to chronic constipation (slow transit constipation and dyssynergic defecation) has been incompletely evaluated. METHODS: We retrospectively reviewed the records of all patients with chronic dyspeptic symptoms and constipation who underwent both a solid gastric emptying scintigraphy and a high-resolution anorectal manometry at our institution since January 2012. When available, X-ray defecography and radiopaque marker colonic transit studies were also reviewed. Based on the gastric emptying results, patients were classified as gastroparesis or dyspepsia with normal gastric emptying (control group). Differences in anorectal and colonic findings were then compared between groups. RESULTS: Two hundred and six patients met the inclusion criteria. Patients with gastroparesis had higher prevalence of slow transit constipation by radiopaque marker study compared to those with normal emptying (64.7% vs 28.1%, P = 0.013). Additionally, patients with gastroparesis had higher rates of rectocele (88.9% vs 60.0%, P = 0.008) and intussusception (44.4% vs 12.0%, P = 0.001) compared to patients with normal emptying. There was no difference in the rate of dyssynergic defecation between those with gastroparesis vs normal emptying (41.1% vs 42.1%, P = 0.880), and no differences in anorectal manometry findings. CONCLUSIONS: Patients with gastroparesis had a higher rate of slow transit constipation, but equal rates of dyssynergic defecation compared to patients with normal gastric emptying. These findings argue for investigation of possible delayed colonic transit in patients with gastroparesis and vice versa.


Subject(s)
Colon , Constipation , Defecation , Defecography , Dyspepsia , Gastric Emptying , Gastrointestinal Tract , Gastroparesis , Humans , Intussusception , Manometry , Pelvic Floor Disorders , Prevalence , Radionuclide Imaging , Rectocele , Retrospective Studies
16.
Article in English | WPRIM | ID: wpr-765930

ABSTRACT

BACKGROUND/AIMS: Postoperative ileus increases healthcare costs and reduces the postoperative quality of life (QOL). The aim of this study is to investigate effects and mechanisms of electroacupuncture (EA) at ST36 and PC6 on gastrointestinal motility in rat model of postoperative ileus. METHODS: Laparotomy was performed in 24 rats (control [n = 8], sham-EA [n = 8], and EA [n = 8]) for the implantation of electrodes in the stomach and mid-jejunum for recording of gastric and small intestinal slow waves. Electrodes were placed in the chest skin for electrocardiogram (ECG). Intestinal manipulation (IM) was performed in Sham-EA and EA rats after surgical procedures. Small intestinal transit (SIT), gastric emptying (GE), postoperative pain, and plasma TNF-α were evaluated in all rats. RESULTS: (1) Compared with sham-EA, EA accelerated both SIT (P < 0.05) and GE (P < 0.05) and improved regularity of small intestinal slow waves. (2) Compared with the control rats (no IM), IM suppressed vagal activity and increased sympathovagal ratio assessed by the spectral analysis of heart rate variability from ECG, which were significantly prevented by EA. (3) EA significantly reduced pain score at 120 minutes (P < 0.05, vs 15 minutes) after the surgery, which was not seen with sham-EA. (4) Plasma TNF-α was increased by IM (P = 0.02) but suppressed by EA (P = 0.04) but not sham-EA. CONCLUSION: The postoperative ileus induced by IM, EA at ST36 and PC6 exerts a prokinetic effect on SIT and GE, a regulatory effect on small intestinal slow waves and an analgesic effect on postoperative pain possibly mediated via the autonomic-cytokine mechanisms.


Subject(s)
Animals , Electroacupuncture , Electrocardiography , Electrodes , Gastric Emptying , Gastrointestinal Motility , Health Care Costs , Heart Rate , Ileus , Inflammation , Laparotomy , Models, Animal , Pain, Postoperative , Plasma , Quality of Life , Rats , Skin , Stomach , Thorax
17.
Article in English | WPRIM | ID: wpr-761794

ABSTRACT

Mosapride accelerates gastric emptying by acting on 5-hydroxytryptamine type 4 (5-HT₄) receptor and is frequently used in the treatment of gastrointestinal (GI) disorders requiring gastroprokinetic efficacy. We tested the effect of mosapride on 5-hydroxytryptamine type 3 (5-HT₃) receptor currents because the 5-HT₃ receptors are also known to be expressed in the GI system and have an important role in the regulation of GI functions. Using the whole-cell voltage clamp method, we compared the currents of the 5-HT₃ receptors when 5-HT was applied alone or was co-applied with mosapride in cultured NCB-20 cells known to express 5-HT₃ receptors. The 5-HT₃ receptor current amplitudes were inhibited by mosapride in a concentration-dependent manner. Mosapride blocked the peak currents evoked by the application of 5-HT in a competitive manner because the EC₅₀ shifted to the right without changing the maximal effect. The rise slopes of 5-HT₃ receptor currents were decreased by mosapride. Pre-application of mosapride before co-application, augmented the inhibitory effect of mosapride, which suggests a closed channel blocking mechanism. Mosapride also blocked the opened 5-HT₃ receptor because it inhibited the 5-HT₃ receptor current in the middle of the application of 5-HT. It accelerated desensitization of the 5-HT₃ receptor but did not change the recovery process from the receptor desensitization. There were no voltage-, or use-dependency in its blocking effects. These results suggest that mosapride inhibited the 5-HT₃ receptor through a competitive blocking mechanism probably by binding to the receptor in closed state, which could be involved in the pharmacological effects of mosapride to treat GI disorders.


Subject(s)
Gastric Emptying , Methods , Serotonin
19.
Article in Korean | WPRIM | ID: wpr-739855

ABSTRACT

PURPOSE: This study was conducted to evaluate the effect of breast milk olfactory stimulation on physiological responses, oral feeding progression, and body weight in preterm infants. METHODS: A repeated measures design with nonequivalent control group was used. The participants were healthy, preterm infants born at a gestational age of 28~32 weeks; 12 in the experimental group and 16 in the control group. Data were collected prospectively in the experimental group, and retrospectively in the control group, by the same methods. Breast milk olfactory stimulation was provided 12 times over 15 days. The data were analyzed using the chi-square test, Mann-Whitney U test, Wilcoxon signed rank test and linear mixed models using SPSS 19. RESULTS: The gastric residual volume (GRV) of the experimental group was significantly less than that of the control group. The heart rate, oxygen saturation, respiration rate, transition time to oral feeding, and body weight were not significantly different between the two groups. CONCLUSION: These findings indicate that breast milk olfactory stimulation reduces GRV and improves digestive function in preterm infants without inducing distress.


Subject(s)
Body Weight , Breast , Gastric Emptying , Gestational Age , Heart Rate , Humans , Infant, Newborn , Infant, Premature , Milk, Human , Oxygen , Prospective Studies , Residual Volume , Respiratory Rate , Retrospective Studies , Smell , Vital Signs
20.
Neonatal Medicine ; : 67-71, 2019.
Article in Korean | WPRIM | ID: wpr-741661

ABSTRACT

Pylorospasm is a cause of delayed gastric emptying in young infants. As in patients with hypertrophic pyloric stenosis, most pylorospasm patients present with projectile vomiting. However, unlike that in case of hypertrophic pyloric stenosis, no persistent pyloric stenotic lesions are present. As such, follow-up using serial gastrointestinal fluoroscopy or ultrasonography can be helpful in diagnosing patients with clinical signs of gastroparesis. Most cases can be treated conservatively, but some patients require pharmacologic treatment. Antispasmodics have been proposed as a treatment for pylorospasm, but their use in neonates and infants has rarely been reported. Herein, we present a case of pylorospasm diagnosed in the neonatal period and successfully treated with intravenous atropine.


Subject(s)
Atropine , Fluoroscopy , Follow-Up Studies , Gastric Emptying , Gastroparesis , Humans , Infant , Infant, Newborn , Parasympatholytics , Pyloric Stenosis, Hypertrophic , Pylorus , Spasm , Ultrasonography , Vomiting
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