Physiological hyperglycemia slows gastric emptying in normal subjects and patients with insulin-dependent diabetes mellitus
Abstract
BACKGROUND & AIMS: Marked hyperglycemia slows and hypoglycemia accelerates gastric emptying. The aim of this study was to determine the effect of physiological changes in blood glucose gastric emptying. METHODS: In 8 healthy subjects and 9 patients with insulin-dependent diabetes mellitus (IDDM) without gastrointestinal tract symptoms or evidence of neuropathy, gastric emptying of a mixed meal was measured by scintigraphy. Using an insulin-glucose clamp, the blood glucose concentration was stabilized at 4 and 8 mmol/L on 2 separate days. RESULTS: The intragastric retention of the solid meal component at 100 minutes was 55.2% +/- 4.5% at 8 mmol/L vs. 36.7% +/- 5.5% at 4 mmol/L (P = 0.004) in normal subjects and 44.2% +/- 4.2% vs. 35.7% +/- 4.2% (P = 0.004) in patients with IDDM. The time taken for 50% emptying of the liquid meal was 57.0 +/- 10.8 minutes at 8 mmol/L vs. 32.2 +/- 12.6 minutes at 4 mmol/L (P = 0.002) in normal subjects and 41.3 +/- 3.4 minutes vs. 29.1 +/- 3.5 minutes (P = 0.002) in patients with IDDM. CONCLUSIONS: Changes in blood glucose within the normal postprandial range have a significant impact on gastric emptying in both normal subjects and patients with IDDM. (Gastroenterology 1997 Jul;113(1):60-6)
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Rapid gastric emptying during pregnancy in a rat model
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Pregnant women's experience of undergoing an oral glucose tolerance test: A cross-sectional study
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Delayed gastric emptying following distal pancreatectomy: incidence and predisposing factors
2022, HPBCitation Excerpt :However, DGE can occur also after hepatectomy.5 Primary DGE may be the consequence of postoperative physiological stress with increased blood levels of catecholamines and/or glycemic disorders.27 Postoperative analgesia may also play a role.
Delayed gastric emptying (DGE) following elective distal pancreatectomy (DP) is poorly known. This study aimed to report incidence of DGE following DP, to identify its predisposing factors, and to assess its impact on hospital stay.
Patients who had elective DP without additional organ or vascular resection (2012–2017) in two academic hospitals were included. Factors predisposing to DGE, defined according to the International Study Group of Pancreatic Surgery, were identified by multivariate analysis. A systematic review was performed to evaluate DGE incidence following elective DP.
311 elective DPs were performed. Three perioperative mortalities (1.0%) were unrelated to DGE. DGE occurred in 31 (10.0%) patients (grade A = 21, grade B = 7, grade C = 3) with a median hospital stay of 16 (13–22) days versus 10 (7–14) without DGE (p < 0.001). In multivariate analysis, predisposing factors of DGE were age>75 years (OR = 4.32 [1.53–12.19]; p = 0.006), open approach (OR = 2.97 [1.1–8]; p = 0.031) and POPF grade B–C (OR = 2.54 [1.05–6.1]; p = 0.038). The systematic review identified 7 series including 876 patients with an overall 8.1% DGE incidence.
DGE complicates around 10% of elective DP. Laparoscopic approach and prevention of POPF should be encouraged to reduce DGE incidence.
When to ask for a gastric emptying scintigraphy in patients with clinical symptomatology of gastroparesis?
2022, Medecine des Maladies MetaboliquesLa gastroparésie est une pathologie dont la prévalence est sous-évaluée. Sa symptomatologie digestive est non spécifique et peu concordante avec les résultats de la scintigraphie de vidange gastrique. Nous avons souhaité analyser la prévalence des anomalies de vidange gastrique sur la scintigraphie au CHRU de Nancy entre avril 2017 et décembre 2020 et déterminer si certains symptômes de gastroparésie pouvaient orienter la prescription de cet examen en apportant des éléments de réflexion et améliorer les connaissances et les pratiques.
Gastroparesis is a pathology whose prevalence is underestimated. Its digestive symptomatology is non-specific and not always consistent with the results of gastric emptying scintigraphy. We wanted to analyze the prevalence of gastric emptying abnormalities on scintigraphy at the University Hospital of Nancy between April 2017 and December 2020 and to determine whether some symptoms of gastroparesis could guide the prescription of this exam, providing elements for reflection and to improve knowledge and practices.
Was it something I ate? Understanding the bidirectional interaction of migraine and appetite neural circuits
2021, Brain ResearchMigraine attacks can involve changes of appetite: while fasting or skipping meals are often reported triggers in susceptible individuals, hunger or food craving are reported in the premonitory phase. Over the last decade, there has been a growing interest and recognition of the importance of studying these overlapping fields of neuroscience, which has led to novel findings. The data suggest additional studies are needed to unravel key neurobiological mechanisms underlying the bidirectional interaction between migraine and appetite. Herein, we review information about the metabolic migraine phenotype and explore migraine therapeutic targets that have a strong input on appetite neuronal circuits, including the calcitonin gene-related peptide (CGRP), the pituitary adenylate cyclase-activating polypeptide (PACAP) and the orexins. Furthermore, we focus on potential therapeutic peptide targets that are involved in regulation of feeding and play a role in migraine pathophysiology, such as neuropeptide Y, insulin, glucagon and leptin. We then examine the orexigenic - anorexigenic circuit feedback loop and explore glucose metabolism disturbances. Additionally, it is proposed a different perspective on the most reported feeding-related trigger - skipping meals - as well as a link between contrasting feeding behaviors (skipping meals vs food craving). Our review aims to increase awareness of migraine through the lens of appetite neurobiology in order to improve our understanding of the earlier phase of migraine, encourage better studies and cross-disciplinary collaborations, and provide novel migraine-specific therapeutic opportunities.