The stomach stores food and starts digesting protein and fat. Lipids, sugars, certain amino acids, and nutrients of high osmolality trigger sensory mechanisms from the intestine which inhibit gastric emptying. Food rich in carbohydrates leaves the stomach slower than protein-rich food, and emptying is slowest after a meal containing lipid. For carbohydrate beverages, the gastric emptying rate is primarily determined by the volume, caloric content, and osmolality of fluid ingested. Gastric emptying rates vary among isocaloric beverages of different type (e.g., sucrose, fructose, galactose) or forms (e.g., maltodextrins, starches) of carbohydrate. For instance, gastric emptying is faster for a fructose solution compared with isocaloric glucose and galactose solutions. A maltodextrin or a sucrose solution empties faster than a glucose solution. This is possibly due to the greater inhibitory feedback associated with the introduction of glucose in the duodenum. In addition, fruit juices contain soluble fibers which further modulate the gastric emptying. Noninvasive methods to study gastric emptying have recently been developed. The pattern of the myoelectric activity of the gastric contraction and the effect of meals on this pattern can now be recorded by cutaneous electrodes. In healthy children ingesting different juices, the myoelectric pattern of the stomach (indicator of the gastric emptying) correlates with the carbohydrate absorption (measured by breath hydrogen excretion). Fast gastric emptying was associated with greater production of breath hydrogen. The malabsorption of juice carbohydrates may in part be related to their effect on gastric motility.
In a selected group of otherwise healthy children and adolescents over 10.5 yr and above 34 kg, 1-day oral NaP solution was more acceptable than 3-day magnesium citrate with an enema, and both regimens were found to be safe and efficacious.
Ascites accumulation is the product of a complex process involving hepatic, renal, systemic, hemodynamic, and neurohormonal factors. The main pathophysiologic theories of ascites formation include the "underfill," "overflow," and peripheral arterial vasodilation hypotheses. These theories are not necessarily mutually exclusive and are linked at some level by a common pathophysiologic thread: The body senses a decreased effective arterial blood volume, leading to stimulation of the sympathetic nervous system, arginine-vasopressin feedback loops, and the renin-angiotensin-aldosterone system. Cornerstones of ascites management include dietary sodium restriction and diuretics. Spironolactone is generally tried initially, with furosemide added if clinical response is suboptimal. More refractory patients require large-volume paracentesis (LVP) accompanied by volume expansion with albumin. Placement of a transjugular intrahepatic portosystemic shunt is reserved for individuals with compensated liver function who require very frequent sessions of LVP. Peritoneovenous shunts are not used in contemporary ascites management. Liver transplantation remains the definitive therapy for refractory ascites. Although treatment of ascites fails to improve survival, it benefits quality of life and limits the development of such complications as spontaneous bacterial peritonitis.
Juices have a different rate of gastric emptying than other foods. This may alter the rate of delivery of carbohydrates to the small bowel for absorption. The aim of the study is to demonstrate that faster gastric emptying is associated with greater production of hydrogen through a randomized, crossover study of 39 healthy children. The electrogastrography (indicator of the gastric myoelectric activities) and breath hydrogen tests (indicator of carbohydrate malabsorption) were performed at baseline and after ingestion of 240 to 330 mL of grape or pear juice given in a random order. The cutaneous electrogastrogram was analyzed by running spectral analysis to compute pre- and postprandial period dominant power (PDP) and running spectrum total power (RSTP). Postprandial PDP and RSTP were higher (p < 0.02) in the pear juice group than in the grape juice group, suggesting higher antral myoelectric activities. Twenty three percent of the subjects had significant movement artifacts that suggested discomfort after drinking pear juice compared to 5% after grape juice (p < 0.03). Breath hydrogen test was more frequently positive (increase >20 part per million [ppm] above baseline) after pear juice (52.2%; mean, 36 +/- 33 ppm) than after grape juice (4.3%, 6 +/- 6 ppm). In a multiple regression analysis, the most predictive independent variable of hydrogen concentration was found to be either postprandial PDP (r2 = 0.24; p < 0.002), or RSTP (r2 = 0.37; p < 0.001). Juices affect gastric myoelectric activity. Grape juice induces lower antral myoelectric activities and is better absorbed. The malabsorption of carbohydrates of juices is in part related to their effect on the gastric physiology.
Simple quantitative esophageal histological morphometric parameters are reliably measurable on suction biopsies from infants using a light microscope fitted with an ocular micrometer, even by nonpathologists.
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