Paracetamol as a Post Prandial Marker for Gastric Emptying, A Food-Drug Interaction on Absorption

Abstract

The use of paracetamol as tool to determine gastric emptying was evaluated in a cross over study. Twelve healthy volunteers were included and each of them consumed two low and two high caloric meals. Paracetamol was mixed with a liquid meal and administered by a nasogastric feeding tube. The post prandial paracetamol plasma concentration time curve in all participants and the paracetamol concentration in the stomach content in six participants were determined. It was found that after paracetamol has left the stomach, based on analysis of the stomach content, there was still a substantial rise in the plasma paracetamol concentration time curve. Moreover, the difference in gastric emptying between high and low caloric meals was missed using the plasma paracetamol concentration time curve. The latter curves indicate that (i) part of the paracetamol may leave the stomach much quicker than the meal and (ii) part of the paracetamol may be relatively slowly absorbed in the duodenum. This can be explained by the partition of the homogenous paracetamol-meal mixture in the stomach in an aqueous phase and a solid bolus. The aqueous phase leaves the stomach quickly and the paracetamol in this phase is quickly absorbed in the duodenum, giving rise to the relatively steep increase of the paracetamol concentration in the plasma. The bolus leaves the stomach relatively slowly, and encapsulation by the bolus results in relatively slow uptake of paracetamol from the bolus in the duodenum. These findings implicate that paracetamol is not an accurate post prandial marker for gastric emptying. The paracetamol concentration time curve rather illustrates the food-drug interaction on absorption, which is not only governed by gastric emptying.Trial RegistrationClinicalTrials.gov NCT01335503 Nederlands Trial Register NTR2780

Health effects of resistant starch

“…Furthermore, paracetamol is suggested not to be an accurate measure of gastric emptying (Bartholomé et al . ). The effect of RS on GER is therefore unclear at present.…”

“…However, the test meals were also higher in b-glucan, a soluble fibre (Nilsson et al 2008). Furthermore, paracetamol is suggested not to be an accurate measure of gastric emptying (Bartholom e et al 2015). The effect of RS on GER is therefore unclear at present.…”

Pharmacokinetics in Morbid Obesity: Influence of Two Bariatric Surgery Techniques on Paracetamol and Caffeine Metabolism

“…Paracetamol (acetaminophen), the most commonly used non-opioid analgesic, and caffeine were chosen to study how gastric emptying and liver function are altered by bariatric surgery, respectively. In the case of paracetamol, its absorption is negligible in the stomach but very rapid from the small intestine, the rate of absorption, therefore, depends on the rate of gastric emptying [4][5][6][7].…”

The chronic administration of two novel long‐acting Xenopus glucagon‐like peptide‐1 analogs xGLP159 and XGLP296 potently improved systemic metabolism and glycemic control in rodent models

“…The paracetamol AUC 0-60 min further proved that the effect of xGLP159 on gastric emptying was slightly better than liraglutide (P , 0.05). Considering that the paracetamol absorption test is an indirect assessment of gastric emptying, sometimes the results may not be fully accurate (36,37). To strengthen our gastric emptying evaluation, a solid-phase gastric emptying study was also performed, and the gastric emptying rate was calculated as the weight of dry stomach contents relative to the weight of food intake in the presence of saline, liraglutide, xGLP159, and xGLP296.…”