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Influence of the content of liquid test meals on gastric emptying
AJG – September, Suppl., 2003
116 DISTAL ESOPHAGEAL COMPETENCE: DOES IT EXPLAIN PAUCITY OF BARRETT’S AND RARITY OF ESOPHAGEAL ADENOCARCINOMA IN AFRICAN AMERICANS (AA)? Vlado Simko, M.D.*, Folusakin Ayoade, M.D. Brooklyn Campus VA NY Harbor HCS, Brooklyn, NY. Purpose: Our previous reports confirmed paucity of Barrett’s esophagus — 2/43 patients and of esophageal adenocarcinoma — 3/51 in AA patients. Similar observations were also made by others in America and in subSaharan Africa. Properties of the phrenoesophageal support and of the LES may vary among ethnic groups, affecting the presence of hiatus hernia (HH), esophageal reflux and GERD-related diseases. Methods: Horizontal size (diameter) of HH was determined during EGD scope retroflexion, with the tip of the scope 5 cm from the cardia. Maximum size of HH was recorded while the scope was rotated 360 degrees and expressed in cm, using the shaft of the scope (1 cm) as a scale. All patients sequentially undergoing an EGD were recruited with exception of pathological and postoperative gastroesophageal changes and use of motility agents. Results: In this all-male study, 115 AA, age 65.4 (1.1) years, mean (1 SEM) were compared with 129 Caucasians (C) age 68.7 (1.0) and with 24 Hispanics (H), age 63.4 (2.7) using a t-test in SPSS 10.0 software. HH in cm in AA was 1.03 (0.10), in C it was 1.65 (0.14) and in H it was 1.39 (0.33). The difference was significant between AA and C and between AA and H, both p⬍0.01. While no HH was present in 34.9 % AA and in 22.5 % C, HH was 2cm or larger in 20.3 % AA, in 37.3 % C and in 29.2 % H. Conclusions: The incidence of a large HH was surprisingly large in all ethnic groups. Although AA have smaller incidence and size of HH compared to C, presence of a large HH in 20 % of AA makes it unlikely that distal esophageal competence can explain rarity of Barrett’s esophagus and of esophageal adenocarcinoma in AA.
117 INFLUENCE OF THE CONTENT OF LIQUID TEST MEALS ON GASTRIC EMPTYING Yoshihisa Urita, Yoshinori Kikuchi, Kazuo Hike, Naotaka Torii, Eiko Kanda, Masahiko Sasajima, Kazumasa Miki*. Toho University, Tokyo, Japan. Purpose: 13C-acetate breath test (ABT) has been proposed as a noninvasive and nonradioactive technique for measuring gastric emptying. A variety of test meals have been used for the ABT. Since a standardized test meal that is easily prepared and inexpensive would be helpful for using ABT as a clinical test, we use a liquid test meal in screening for gastrointestinal motility disorders. Studies comparing ABT results after administrating a variety of liquid test meals are lacking. The aims of this study were to compare the gastric emptying indexes obtained by ABT after ingestion of three kinds of test meals with different fat and caloric content. Methods: Ten healthy subjects, 8 women and 2 men, aged 25– 48 years, volunteered for this study. None of them complained of gastrointestinal symptoms, was taking any drugs or was a smoker. Each subject was studied three times, with a 1-week interval between tests. RACOL (Otsuka, Co.Ltd., 200 kcal, protein 8.76g, fat 4.46g, glucose 31.24g), Ensure Liquid (Dinabot, Co.Ltd., 200 kcal, protein 7.04g, fat 7.04g, glucose 27.4g), and Ensure Hi (Dinabot, Co.Ltd., 300 kcal, protein 10.56g, fat 10.56g, glucose 41.2g) were given in randomized order. Breath samples were collected at 5, 10, 15, 20, 30, 40, 50, 60, 75, 90, 105, 120, 135, 150, 165, 180, 210, and 240 min. 13C was measured as the 13CO2/12CO2 isotope ratio and was expressed as delta over baseline per mil. The results of ABT, gastric emptying, were expressed as the time of peak excretion (Tmax) and half emptying time (T1/2) calculated using the Solver procedure in Excel 2000 (Microsoft). Results: The mean values of Tmax were 0.99, 0.85, and 1.05 hours after ingestion of RACOL, Ensure Liquid, and Ensure Hi, respectively. The
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mean values of T1/2 were 1.53, 1.35, and 1.65 hours, respectively. Increasing the meal caloric content resulted in significantly longer half emptying time, whereas increasing the fat content had little effect on gastric emptying assessed by ABT using liquid test meals. Conclusions: In healthy subjects, caloric intake is a major determinant of gastric emptying rate.
118 THE WATER LOAD TEST IN PATIENTS WITH FUNCTIONAL GASTROINTESTINAL DISORDERS Chien-Lin Chen, M.D.*, Hsien-Hong Lin, M.D., Ming-Chieh Chen, M.D. Buddhist Tzu Chi Medical Center and University School of Medicine, Hualien, Taiwan. Purpose: Hypersensitivity to gastric distension has been reported in functional dyspepsia (FD). The water load test (WLT) is a noninvasive and provocative test of stomach capacity and sensation. The aim of this study was to assess the perception to gastric distension using WLT and its relationship to dyspeptic symptoms in FD, GERD, and symptomatic type II diabetes. Methods: We used a 5-min WLT to evaluate sensitivity of gastric distension in 40 healthy subjects (31M/9F, mean 40 yrs), 61 GERD (30M/31 F, mean 45 yrs), 37 FD (17M/20F, mean 37 yrs), and 30 symptomatic diabetic patients (15M/15F, mean 30 yrs). A dyspepsia symptom scale was obtained from all subjects and its relationship with the WLT was determined. Results: The water intake by healthy controls was 597 ⫾ 33 mL (mean ⫾ SEM) which was statistically greater than that of FD (422 ⫾ 22 mL, P⬍0.001), GERD (504 ⫾ 23 mL, P⬍0.02), and symptomatic diabetic patients (445 ⫾ 34 mL, P⬍0.001). The between-group comparison in the water intake didn’t reveal any statistically significant difference among the patient groups. The water intake correlated well with nausea (r⫽⫺0.49, P⬍0.01) and fullness (r⫽⫺0.33, P⬍0.05) in FD patients, and also correlated well with nausea (r⫽⫺0.49, P⬍0.01) in diabetic subjects. Male subjects ingested more water than female in healthy controls (P ⬍0.01), GERD (P⬍0.05), diabetic subjects (P⬍0.01), but not FD (P⫽NS). Conclusions: Different results of the WLT were observed in the patients with FD, GERD, and symptomatic diabetes comparing to healthy controls, indicating that these patients might have abnormal visceral perception. The WLT correlated well with dyspeptic symptmos (nausea and/or fullness) in FD and symptomatic diabetes, suggesting that WLT is a simple and applicable test for the assessment of gastric sensation and prediction of dyspetic symptoms in FD and symptomatic diabetes.
119 RAPID GASTRIC PH IMPROVEMENT FROM NPO TO ENTERAL-FED PERIOD WITH INTERMITTENT INTRAVENOUS (IV) PANTOPRAZOLE (P) VS. CONTINUOUSLY INFUSED CIMETIDINE (C) J. Stanley Smith, M.D., Robyn G. Karlstadt, M.D.*. The Pennsylvania State University College of Medicine, Hershey, PA and Wyeth Pharmaceuticals, Radnor, PA. Purpose: IVP, a proton pump inhibitor, has been shown to be more effective in raising percent time pHⱖ4.0 in enterally fed intensive care unit (ICU) patients vs continuous infusion C (Smith, ACG 2002). H2RAs have been previously reported as having difficulty maintaining pH elevation in enterally fed ICU patients (Rigaud, 1996). In a multicenter study of ICU patients, intermittent IVP was compared with the standard recommended regimen of continuously infused C to evaluate the change in pH with the onset of enteral feed from the NPO state. Methods: Eligible adult ICU patients at risk for UGIH were randomly assigned to 1 of 6 IV regimens (P40mgQD; P40mgBID; P80mgQD; P80mgBID; P80mgTID; C300mg bolus then 50mg/hr) and stratified at study start based on investigator prediction of feeding status on day 2. All
116 DISTAL ESOPHAGEAL COMPETENCE: DOES IT EXPLAIN PAUCITY OF BARRETT’S AND RARITY OF ESOPHAGEAL ADENOCARCINOMA IN AFRICAN AMERICANS (AA)? Vlado Simko, M.D.*, Folusakin Ayoade, M.D. Brooklyn Campus VA NY Harbor HCS, Brooklyn, NY. Purpose: Our previous reports confirmed paucity of Barrett’s esophagus — 2/43 patients and of esophageal adenocarcinoma — 3/51 in AA patients. Similar observations were also made by others in America and in subSaharan Africa. Properties of the phrenoesophageal support and of the LES may vary among ethnic groups, affecting the presence of hiatus hernia (HH), esophageal reflux and GERD-related diseases. Methods: Horizontal size (diameter) of HH was determined during EGD scope retroflexion, with the tip of the scope 5 cm from the cardia. Maximum size of HH was recorded while the scope was rotated 360 degrees and expressed in cm, using the shaft of the scope (1 cm) as a scale. All patients sequentially undergoing an EGD were recruited with exception of pathological and postoperative gastroesophageal changes and use of motility agents. Results: In this all-male study, 115 AA, age 65.4 (1.1) years, mean (1 SEM) were compared with 129 Caucasians (C) age 68.7 (1.0) and with 24 Hispanics (H), age 63.4 (2.7) using a t-test in SPSS 10.0 software. HH in cm in AA was 1.03 (0.10), in C it was 1.65 (0.14) and in H it was 1.39 (0.33). The difference was significant between AA and C and between AA and H, both p⬍0.01. While no HH was present in 34.9 % AA and in 22.5 % C, HH was 2cm or larger in 20.3 % AA, in 37.3 % C and in 29.2 % H. Conclusions: The incidence of a large HH was surprisingly large in all ethnic groups. Although AA have smaller incidence and size of HH compared to C, presence of a large HH in 20 % of AA makes it unlikely that distal esophageal competence can explain rarity of Barrett’s esophagus and of esophageal adenocarcinoma in AA.
117 INFLUENCE OF THE CONTENT OF LIQUID TEST MEALS ON GASTRIC EMPTYING Yoshihisa Urita, Yoshinori Kikuchi, Kazuo Hike, Naotaka Torii, Eiko Kanda, Masahiko Sasajima, Kazumasa Miki*. Toho University, Tokyo, Japan. Purpose: 13C-acetate breath test (ABT) has been proposed as a noninvasive and nonradioactive technique for measuring gastric emptying. A variety of test meals have been used for the ABT. Since a standardized test meal that is easily prepared and inexpensive would be helpful for using ABT as a clinical test, we use a liquid test meal in screening for gastrointestinal motility disorders. Studies comparing ABT results after administrating a variety of liquid test meals are lacking. The aims of this study were to compare the gastric emptying indexes obtained by ABT after ingestion of three kinds of test meals with different fat and caloric content. Methods: Ten healthy subjects, 8 women and 2 men, aged 25– 48 years, volunteered for this study. None of them complained of gastrointestinal symptoms, was taking any drugs or was a smoker. Each subject was studied three times, with a 1-week interval between tests. RACOL (Otsuka, Co.Ltd., 200 kcal, protein 8.76g, fat 4.46g, glucose 31.24g), Ensure Liquid (Dinabot, Co.Ltd., 200 kcal, protein 7.04g, fat 7.04g, glucose 27.4g), and Ensure Hi (Dinabot, Co.Ltd., 300 kcal, protein 10.56g, fat 10.56g, glucose 41.2g) were given in randomized order. Breath samples were collected at 5, 10, 15, 20, 30, 40, 50, 60, 75, 90, 105, 120, 135, 150, 165, 180, 210, and 240 min. 13C was measured as the 13CO2/12CO2 isotope ratio and was expressed as delta over baseline per mil. The results of ABT, gastric emptying, were expressed as the time of peak excretion (Tmax) and half emptying time (T1/2) calculated using the Solver procedure in Excel 2000 (Microsoft). Results: The mean values of Tmax were 0.99, 0.85, and 1.05 hours after ingestion of RACOL, Ensure Liquid, and Ensure Hi, respectively. The
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mean values of T1/2 were 1.53, 1.35, and 1.65 hours, respectively. Increasing the meal caloric content resulted in significantly longer half emptying time, whereas increasing the fat content had little effect on gastric emptying assessed by ABT using liquid test meals. Conclusions: In healthy subjects, caloric intake is a major determinant of gastric emptying rate.
118 THE WATER LOAD TEST IN PATIENTS WITH FUNCTIONAL GASTROINTESTINAL DISORDERS Chien-Lin Chen, M.D.*, Hsien-Hong Lin, M.D., Ming-Chieh Chen, M.D. Buddhist Tzu Chi Medical Center and University School of Medicine, Hualien, Taiwan. Purpose: Hypersensitivity to gastric distension has been reported in functional dyspepsia (FD). The water load test (WLT) is a noninvasive and provocative test of stomach capacity and sensation. The aim of this study was to assess the perception to gastric distension using WLT and its relationship to dyspeptic symptoms in FD, GERD, and symptomatic type II diabetes. Methods: We used a 5-min WLT to evaluate sensitivity of gastric distension in 40 healthy subjects (31M/9F, mean 40 yrs), 61 GERD (30M/31 F, mean 45 yrs), 37 FD (17M/20F, mean 37 yrs), and 30 symptomatic diabetic patients (15M/15F, mean 30 yrs). A dyspepsia symptom scale was obtained from all subjects and its relationship with the WLT was determined. Results: The water intake by healthy controls was 597 ⫾ 33 mL (mean ⫾ SEM) which was statistically greater than that of FD (422 ⫾ 22 mL, P⬍0.001), GERD (504 ⫾ 23 mL, P⬍0.02), and symptomatic diabetic patients (445 ⫾ 34 mL, P⬍0.001). The between-group comparison in the water intake didn’t reveal any statistically significant difference among the patient groups. The water intake correlated well with nausea (r⫽⫺0.49, P⬍0.01) and fullness (r⫽⫺0.33, P⬍0.05) in FD patients, and also correlated well with nausea (r⫽⫺0.49, P⬍0.01) in diabetic subjects. Male subjects ingested more water than female in healthy controls (P ⬍0.01), GERD (P⬍0.05), diabetic subjects (P⬍0.01), but not FD (P⫽NS). Conclusions: Different results of the WLT were observed in the patients with FD, GERD, and symptomatic diabetes comparing to healthy controls, indicating that these patients might have abnormal visceral perception. The WLT correlated well with dyspeptic symptmos (nausea and/or fullness) in FD and symptomatic diabetes, suggesting that WLT is a simple and applicable test for the assessment of gastric sensation and prediction of dyspetic symptoms in FD and symptomatic diabetes.
119 RAPID GASTRIC PH IMPROVEMENT FROM NPO TO ENTERAL-FED PERIOD WITH INTERMITTENT INTRAVENOUS (IV) PANTOPRAZOLE (P) VS. CONTINUOUSLY INFUSED CIMETIDINE (C) J. Stanley Smith, M.D., Robyn G. Karlstadt, M.D.*. The Pennsylvania State University College of Medicine, Hershey, PA and Wyeth Pharmaceuticals, Radnor, PA. Purpose: IVP, a proton pump inhibitor, has been shown to be more effective in raising percent time pHⱖ4.0 in enterally fed intensive care unit (ICU) patients vs continuous infusion C (Smith, ACG 2002). H2RAs have been previously reported as having difficulty maintaining pH elevation in enterally fed ICU patients (Rigaud, 1996). In a multicenter study of ICU patients, intermittent IVP was compared with the standard recommended regimen of continuously infused C to evaluate the change in pH with the onset of enteral feed from the NPO state. Methods: Eligible adult ICU patients at risk for UGIH were randomly assigned to 1 of 6 IV regimens (P40mgQD; P40mgBID; P80mgQD; P80mgBID; P80mgTID; C300mg bolus then 50mg/hr) and stratified at study start based on investigator prediction of feeding status on day 2. All