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: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
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
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
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
Starch digestion rate and location in the gastrointestinal tract(GIT)are critical for human health.This review aims to present a comprehensive summary on our current understanding of physiological,biochemical,anatomic...Starch digestion rate and location in the gastrointestinal tract(GIT)are critical for human health.This review aims to present a comprehensive summary on our current understanding of physiological,biochemical,anatomical and geometrical factors of human digestive system that are related to in vivo starch digestibility.It is shown that all digestive compartments including mouth,stomach,small intestine,and large intestine play critical roles in regulating the overall starch digestion process.A proper investigation of starch digestion pattern should thus be based on the consideration of all these compartments.Main biological factors are summarized as oral mastication and salivation,gastric emptying and motility,small intestinal enzymes and motility,large intestinal resistant starch(RS)-microbiota interactions and gut-brain feedback control,as well as glucose adsorption and hormonal feedback control.However,connections among these biological factors in determining starch digestive behaviors remain elusive.This is due to the inherent complexity of human GIT anatomy,motility and biochemical conditions,as well as ethical,financial and technical issues in conducting clinical studies.Much technological and scientific efforts from both clinical studies and in vitro simulation models are required for a better understanding of in vivo starch digestion behaviors.展开更多
Gastroparesis(Gp)is a chronic disease characterized by a delayed gastric emptying in the absence of mechanical obstruction.Although this condition has been reported in the literature since the mid-1900s,only recently ...Gastroparesis(Gp)is a chronic disease characterized by a delayed gastric emptying in the absence of mechanical obstruction.Although this condition has been reported in the literature since the mid-1900s,only recently has there been renewed clinical and scientific interest in this disease,which has a potentially great impact on the quality of life.The aim of this review is to explore the pathophysiological,diagnostic and therapeutical aspects of Gp according to the most recent evidence.A comprehensive online search for Gp was carried out using MEDLINE and EMBASE.Gp is the result of neuromuscular abnormalities of the gastric motor function.There is evidence that patients with idiopathic and diabetic Gp may display a reduction in nitrergic inhibitory neurons and in interstitial cells of Cajal and/or telocytes.As regards diagnostic approach,99-Technetium scintigraphy is currently considered to be the gold standard for Gp.Its limits are a lack of standardization and a mild risk of radiation exposure.The C13 breath testing is a valid and safe alternative method.13C acid octanoic and the 13C Spirulina platensis recently approved by the Food and Drug Administration are the most commonly used diagnostic kits.The wireless motility capsule is a promising technique,but its use is limited by costs and scarce availability in many countries.Finally,therapeutic strategies are related to the clinical severity of Gp.In mild and moderate Gp,dietary modification and prokinetic agents are generally sufficient.Metoclopramide is the only drug approved by the Food and Drug Administration for Gp.However,other older and new prokinetics and antiemetics can be considered.As a second-line therapy,tricyclic antidepressants and cannabinoids have been proposed.In severe cases the normal nutritional approach can be compromised and artificial nutrition may be needed.In drug-unresponsive Gp patients some alternative strategies(endoscopic,electric stimulation or surgery)are available.展开更多
AIM: To correlate gastric contractility, gastrointestinal transit, and hormone levels in non-pregnant(estrous cycle) and pregnant rats using noninvasive techniques. METHODS: Female rats(n = 23) were randomly divided i...AIM: To correlate gastric contractility, gastrointestinal transit, and hormone levels in non-pregnant(estrous cycle) and pregnant rats using noninvasive techniques. METHODS: Female rats(n = 23) were randomly divided into(1) non-pregnant,(contractility, n =6; transit, n = 6); and(2) pregnant(contractility, n = 5; transit, n = 6). In each estrous cycle phase or at 0, 7, 14, and 20 d after the confirmation of pregnancy, gastrointestinal transit was recorded by AC biosusceptometry(ACB), and gastric contractility was recorded by ACB and electromyography. After each recording, blood samples were obtained for progesterone and estradiol determination. RESULTS: In the estrous cycle, despite fluctuations of sex hormone levels, no significant changes in gastrointestinal motility were observed. Days 7 and 14 of pregnancy were characterized by significant changes in the frequency of contractions(3.90 ± 0.42 cpm and 3.60 ± 0.36 cpm vs 4.33 ± 0.25 cpm) and gastric emptying(168 ± 17 min and 165 ± 15 min vs 113 ± 15 min) compared with day 0. On these same days, progesterone levels significantly increased compared with control(54.23 ± 15.14 ng/m L and 129.96 ± 30.52 ng/mL vs 13.25 ± 6.31 ng/mL). On day 14, we observed the highest level of progesterone and the lowest level of estradiol compared with day 0(44.3 ± 15.18 pg/mL vs 24.96 ± 5.96 pg/mL). CONCLUSION: Gastrointestinal motility was unaffected by the estrous cycle. In our data, high progesterone and low estradiol levels can be associated with decreased contraction frequency and slow gastric emptying.展开更多
Diarrhea is a prevalent gastrointestinal problem associated with fatal implications.It is a huge public health concern that requires better alternatives to current drugs.This study investigated the mechanisms involved...Diarrhea is a prevalent gastrointestinal problem associated with fatal implications.It is a huge public health concern that requires better alternatives to current drugs.This study investigated the mechanisms involved in the antidiarrheal activity of Anacardium occidentale(Ao) stem bark extract,a plant commonly used in the management of diarrhea in Nigeria.Methanolic stem bark extract of the plant was partitioned into three fractions:hexane fraction,ethyl acetate fraction(Ao EF) and methanol fraction.In vitro studies on the effect of these fractions on guinea pig ileum(GPI) strips,as well as the modulatory effect of Ao EF on standard agonists-and antagonists-induced GPI contraction and relaxation,revealed Ao EF as the most active fraction.In vivo studies to assess the effect of Ao EF on the dopaminergic,muscarinic,and serotonergic pathways were carried out using gastric emptying(GE) and gastrointestinal transit(GT) as experimental end points.Ao EF was subjected to GC-MS analysis,while the identified compounds were docked with the muscarinic acetylcholine receptor M3(CHRM3) using Autodock Vina.Results indicated that Ao EF inhibited GE and GT via inhibition of CHRM3.In addition,GC-MS analysis revealed the presence of 24 compounds in Ao EF,while docking indicated that octadecanoic acid 2-(2-hydroxylethoxy)ethyl ester exhibited the highest binding affinity to CHRM3.This study indicated that the antidiarrheal activity of Ao is through its antimotility effect via the inhibition of the muscarinic pathway.And since none of the identified compounds exhibited higher binding affinity to CHRM3 relative to loperamide,the antimotility activity of these phytoconstituents may be via synergism.展开更多
Background: Endoscopic bariatric therapies can help address widening management gaps in obesity. Their ability to facilitate weight loss is largely tied to influences on appetite through perturbations of gastric empty...Background: Endoscopic bariatric therapies can help address widening management gaps in obesity. Their ability to facilitate weight loss is largely tied to influences on appetite through perturbations of gastric emptying and accommodation. As these tools gain traction in obesity therapy, their physiologic underpinnings require exploration, which may enhance efficacy, tolerance, and patient-tailored care.Methods: We prospectively assessed consecutive subjects with fluid-filled intragastric balloons (IGBs) (n = 18) placed between October 2016 and June 2017 or underwent endoscopic sleeve gastroplasty (ESG) (n = 23) from March 2018 to June 2018. Patients underwent physiologic appraisal at 3 months with13C-spirulina-based gastric emptying breath test to determine time to half emptying (T50), as well as maximum tolerated volume (MTV) of a standard nutrient drink test. Changes in T50 and MTV at 3 months were compared with percent total body weight loss (%TBWL) at 3 and 6 months using best-fit linear regression.Results: The change in T50 at 3 months correlated with %TBWL at 3 months for IGB (P = 0.01) and ESG (P = 0.01) but with greater impact on %TBWL in IGB compared to ESG (R2 = 0.42vs. 0.26). Change in T50 at 3 months was predictive of weight loss at 6 months for IGB (P = 0.01) but not ESG (P = 0.11). ESG was associated with greater decrease in MTV compared to IGB (340.25 ± 297.97 mLvs. 183.00 ± 217.13 mL,P = 0.08), indicting an enhanced effect on satiation through decreased gastric accommodation. Changes in MTV at 3 months did not correlate with %TBWL for either IGB (P = 0.26) or ESG (P = 0.49) but trended toward significance for predicting %TBWL at 6 months for ESG (P = 0.06) but not IGB (P = 0.19).Conclusion: IGB and ESG both induce weight loss but likely through distinct gastric motor function phenotypes, and gastric emptying may predict future weight loss in patients with IGB.展开更多
Background:A growing body of evidence supports the use of laparoscopic pancreaticoduodenectomy(LPD)as an efficient and feasible surgical technique.However,few studies have investigated its applicability in pancreatic ...Background:A growing body of evidence supports the use of laparoscopic pancreaticoduodenectomy(LPD)as an efficient and feasible surgical technique.However,few studies have investigated its applicability in pancreatic ductal adenocarcinoma(PDAC),and the long-term efficacy of LPD on PDAC remains unclear.This study aimed to compare the short-and long-term outcomes between LPD and open pancreaticoduodenectomy(OPD)for PDAC.Methods:The data of patients who had OPD or LPD for PDAC between January 2013 and September 2017 were retrieved.Their postoperative outcomes and survival were compared after propensity score matching.Results:A total of 309 patients were included.After a 2:1 matching,93 cases in the OPD group and 55 in the LPD group were identified.Delayed gastric emptying(DGE),particularly grade B/C DGE,occurred less frequently in the LPD group than in the OPD group(1.8%vs.36.6%,P<0.001;1.8%vs.22.6%,P=0.001).The overall complication rates were significantly lower in the LPD group than in the OPD group(49.1%vs.71.0%,P=0.008),whereas the rates of major complications were similar(10.9%vs.14.0%,P=0.590).In addition,the median overall survival was comparable between the two groups(20.0 vs.18.7 months,P=0.293).Conclusion:LPD was found to be technically feasible with efficacy similar to OPD for patients with PDAC.展开更多
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.
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.
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.
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.
基金financial support from National Natural Science Foundation of China(32001646)Natural Science Foundation of Jiangsu Province(BK20190906)+2 种基金Jiangsu Yangzhou Key Research and Development Program(SSF2018000008)Jiangsu Provincial Entrepreneurial and Innovation Phd ProgramYangzhou Lvyangjinfeng Talent Program。
文摘Starch digestion rate and location in the gastrointestinal tract(GIT)are critical for human health.This review aims to present a comprehensive summary on our current understanding of physiological,biochemical,anatomical and geometrical factors of human digestive system that are related to in vivo starch digestibility.It is shown that all digestive compartments including mouth,stomach,small intestine,and large intestine play critical roles in regulating the overall starch digestion process.A proper investigation of starch digestion pattern should thus be based on the consideration of all these compartments.Main biological factors are summarized as oral mastication and salivation,gastric emptying and motility,small intestinal enzymes and motility,large intestinal resistant starch(RS)-microbiota interactions and gut-brain feedback control,as well as glucose adsorption and hormonal feedback control.However,connections among these biological factors in determining starch digestive behaviors remain elusive.This is due to the inherent complexity of human GIT anatomy,motility and biochemical conditions,as well as ethical,financial and technical issues in conducting clinical studies.Much technological and scientific efforts from both clinical studies and in vitro simulation models are required for a better understanding of in vivo starch digestion behaviors.
文摘Gastroparesis(Gp)is a chronic disease characterized by a delayed gastric emptying in the absence of mechanical obstruction.Although this condition has been reported in the literature since the mid-1900s,only recently has there been renewed clinical and scientific interest in this disease,which has a potentially great impact on the quality of life.The aim of this review is to explore the pathophysiological,diagnostic and therapeutical aspects of Gp according to the most recent evidence.A comprehensive online search for Gp was carried out using MEDLINE and EMBASE.Gp is the result of neuromuscular abnormalities of the gastric motor function.There is evidence that patients with idiopathic and diabetic Gp may display a reduction in nitrergic inhibitory neurons and in interstitial cells of Cajal and/or telocytes.As regards diagnostic approach,99-Technetium scintigraphy is currently considered to be the gold standard for Gp.Its limits are a lack of standardization and a mild risk of radiation exposure.The C13 breath testing is a valid and safe alternative method.13C acid octanoic and the 13C Spirulina platensis recently approved by the Food and Drug Administration are the most commonly used diagnostic kits.The wireless motility capsule is a promising technique,but its use is limited by costs and scarce availability in many countries.Finally,therapeutic strategies are related to the clinical severity of Gp.In mild and moderate Gp,dietary modification and prokinetic agents are generally sufficient.Metoclopramide is the only drug approved by the Food and Drug Administration for Gp.However,other older and new prokinetics and antiemetics can be considered.As a second-line therapy,tricyclic antidepressants and cannabinoids have been proposed.In severe cases the normal nutritional approach can be compromised and artificial nutrition may be needed.In drug-unresponsive Gp patients some alternative strategies(endoscopic,electric stimulation or surgery)are available.
基金Supported by Fundacao de Amparo à Pesquisa do Estado de Sao Paulo(Fapesp),No.2010/14845-4 and No.2015/14923-9Conselho Nacional de Desenvolvimento Científico e Tecnológico(CNPq),No.150456/2009-3
文摘AIM: To correlate gastric contractility, gastrointestinal transit, and hormone levels in non-pregnant(estrous cycle) and pregnant rats using noninvasive techniques. METHODS: Female rats(n = 23) were randomly divided into(1) non-pregnant,(contractility, n =6; transit, n = 6); and(2) pregnant(contractility, n = 5; transit, n = 6). In each estrous cycle phase or at 0, 7, 14, and 20 d after the confirmation of pregnancy, gastrointestinal transit was recorded by AC biosusceptometry(ACB), and gastric contractility was recorded by ACB and electromyography. After each recording, blood samples were obtained for progesterone and estradiol determination. RESULTS: In the estrous cycle, despite fluctuations of sex hormone levels, no significant changes in gastrointestinal motility were observed. Days 7 and 14 of pregnancy were characterized by significant changes in the frequency of contractions(3.90 ± 0.42 cpm and 3.60 ± 0.36 cpm vs 4.33 ± 0.25 cpm) and gastric emptying(168 ± 17 min and 165 ± 15 min vs 113 ± 15 min) compared with day 0. On these same days, progesterone levels significantly increased compared with control(54.23 ± 15.14 ng/m L and 129.96 ± 30.52 ng/mL vs 13.25 ± 6.31 ng/mL). On day 14, we observed the highest level of progesterone and the lowest level of estradiol compared with day 0(44.3 ± 15.18 pg/mL vs 24.96 ± 5.96 pg/mL). CONCLUSION: Gastrointestinal motility was unaffected by the estrous cycle. In our data, high progesterone and low estradiol levels can be associated with decreased contraction frequency and slow gastric emptying.
文摘Diarrhea is a prevalent gastrointestinal problem associated with fatal implications.It is a huge public health concern that requires better alternatives to current drugs.This study investigated the mechanisms involved in the antidiarrheal activity of Anacardium occidentale(Ao) stem bark extract,a plant commonly used in the management of diarrhea in Nigeria.Methanolic stem bark extract of the plant was partitioned into three fractions:hexane fraction,ethyl acetate fraction(Ao EF) and methanol fraction.In vitro studies on the effect of these fractions on guinea pig ileum(GPI) strips,as well as the modulatory effect of Ao EF on standard agonists-and antagonists-induced GPI contraction and relaxation,revealed Ao EF as the most active fraction.In vivo studies to assess the effect of Ao EF on the dopaminergic,muscarinic,and serotonergic pathways were carried out using gastric emptying(GE) and gastrointestinal transit(GT) as experimental end points.Ao EF was subjected to GC-MS analysis,while the identified compounds were docked with the muscarinic acetylcholine receptor M3(CHRM3) using Autodock Vina.Results indicated that Ao EF inhibited GE and GT via inhibition of CHRM3.In addition,GC-MS analysis revealed the presence of 24 compounds in Ao EF,while docking indicated that octadecanoic acid 2-(2-hydroxylethoxy)ethyl ester exhibited the highest binding affinity to CHRM3.This study indicated that the antidiarrheal activity of Ao is through its antimotility effect via the inhibition of the muscarinic pathway.And since none of the identified compounds exhibited higher binding affinity to CHRM3 relative to loperamide,the antimotility activity of these phytoconstituents may be via synergism.
文摘Background: Endoscopic bariatric therapies can help address widening management gaps in obesity. Their ability to facilitate weight loss is largely tied to influences on appetite through perturbations of gastric emptying and accommodation. As these tools gain traction in obesity therapy, their physiologic underpinnings require exploration, which may enhance efficacy, tolerance, and patient-tailored care.Methods: We prospectively assessed consecutive subjects with fluid-filled intragastric balloons (IGBs) (n = 18) placed between October 2016 and June 2017 or underwent endoscopic sleeve gastroplasty (ESG) (n = 23) from March 2018 to June 2018. Patients underwent physiologic appraisal at 3 months with13C-spirulina-based gastric emptying breath test to determine time to half emptying (T50), as well as maximum tolerated volume (MTV) of a standard nutrient drink test. Changes in T50 and MTV at 3 months were compared with percent total body weight loss (%TBWL) at 3 and 6 months using best-fit linear regression.Results: The change in T50 at 3 months correlated with %TBWL at 3 months for IGB (P = 0.01) and ESG (P = 0.01) but with greater impact on %TBWL in IGB compared to ESG (R2 = 0.42vs. 0.26). Change in T50 at 3 months was predictive of weight loss at 6 months for IGB (P = 0.01) but not ESG (P = 0.11). ESG was associated with greater decrease in MTV compared to IGB (340.25 ± 297.97 mLvs. 183.00 ± 217.13 mL,P = 0.08), indicting an enhanced effect on satiation through decreased gastric accommodation. Changes in MTV at 3 months did not correlate with %TBWL for either IGB (P = 0.26) or ESG (P = 0.49) but trended toward significance for predicting %TBWL at 6 months for ESG (P = 0.06) but not IGB (P = 0.19).Conclusion: IGB and ESG both induce weight loss but likely through distinct gastric motor function phenotypes, and gastric emptying may predict future weight loss in patients with IGB.
基金This study was supported by Technology Program of Zhejiang Province,China(2015C03049)
文摘Background:A growing body of evidence supports the use of laparoscopic pancreaticoduodenectomy(LPD)as an efficient and feasible surgical technique.However,few studies have investigated its applicability in pancreatic ductal adenocarcinoma(PDAC),and the long-term efficacy of LPD on PDAC remains unclear.This study aimed to compare the short-and long-term outcomes between LPD and open pancreaticoduodenectomy(OPD)for PDAC.Methods:The data of patients who had OPD or LPD for PDAC between January 2013 and September 2017 were retrieved.Their postoperative outcomes and survival were compared after propensity score matching.Results:A total of 309 patients were included.After a 2:1 matching,93 cases in the OPD group and 55 in the LPD group were identified.Delayed gastric emptying(DGE),particularly grade B/C DGE,occurred less frequently in the LPD group than in the OPD group(1.8%vs.36.6%,P<0.001;1.8%vs.22.6%,P=0.001).The overall complication rates were significantly lower in the LPD group than in the OPD group(49.1%vs.71.0%,P=0.008),whereas the rates of major complications were similar(10.9%vs.14.0%,P=0.590).In addition,the median overall survival was comparable between the two groups(20.0 vs.18.7 months,P=0.293).Conclusion:LPD was found to be technically feasible with efficacy similar to OPD for patients with PDAC.
