Postprandial osmotic and fluid changes in the upper jejunum after truncal vagotomy and drainage in man.

Temple, James; Birch, Alexander A.; Shields, R.

doi:10.1136/gut.16.12.957

Cited by 8 publications

(4 citation statements)

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“…Upon leaving the stomach, chyme may have a higher osmolarity than that of surrounding body fluids and tissues, which are generally maintained at ϳ285 mosmol/l in blood and interstitial fluids and within the 400 -700 mosmol/l range in small intestinal villi (34). Although compensatory mechanisms operate to restore osmotic equilibrium between hyperosmolar intestinal chyme and its surroundings (24), various mixed meals and hypertonic agents are capable of inducing a more sustained hyperosmolar milieu in the gastric and intestinal lumen (5,25,37,39,43,48,66,82,83).To assess directly the role of intestinal hyperosmolarity in postprandial ghrelin suppression, three studies were conducted in rats. In the first study, animals with duodenal cannulas received infusions, on different occasions, of agents (glucose, 3-O-methylglucose, or lactulose) selected to induce intestinal hyperosmolarity, but differing in route of digestion, absorption kinetics, caloric value, and insulin-stimulating effects (see…”

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confidence: 99%

Hyperosmolarity in the small intestine contributes to postprandial ghrelin suppression

Overduin

Tylee

Frayo

et al. 2014

American Journal of Physiology-Gastrointestinal and Liver Physi

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Plasma levels of the orexigenic hormone ghrelin are suppressed by meals with an efficacy dependent on their macronutrient composition. We hypothesized that heterogeneity in osmolarity among macronutrient classes contributes to these differences. In three studies, the impact of small intestinal hyperosmolarity was examined in Sprague-Dawley rats. In study 1, isotonic, 2.5ϫ, and 5ϫ hypertonic solutions of several agents with diverse absorption and metabolism properties were infused duodenally at a physiological rate (3 ml/10 min). Jugular vein blood was sampled before and at 30,60,90, 120, 180, 240, and 300 min after infusion. Plasma ghrelin was suppressed dose dependently and most strongly by glucose. Hyperosmolar infusions of lactulose, which transits the small intestine unabsorbed, and 3-O-methylglucose (3-O-MG), which is absorbed like glucose but remains unmetabolized, also suppressed ghrelin. Glucose, but not lactulose or 3-O-MG, infusions increased plasma insulin. In study 2, intestinal infusions of hyperosmolar NaCl suppressed ghrelin, a response that was not attenuated by coinfusion with the neural blocker lidocaine. In study 3, we reconfirmed that the low-osmolar lipid emulsion Intralipid suppresses ghrelin more weakly than isocaloric (but hypertonic) glucose. Importantly, raising Intralipid's osmolarity to that of the glucose solution by nonabsorbable lactulose supplementation enhanced ghrelin suppression to that seen after glucose. Hyperosmolar ghrelin occurred particularly during the initial 3 postinfusion hours. We conclude that small intestinal hyperosmolarity 1) is sufficient to suppress ghrelin, 2) may combine with other postprandial mechanisms to suppress ghrelin, 3) might contribute to altered ghrelin regulation after gastric bypass surgery, and 4) may inform dietary modifications for metabolic health.ghrelin; intestinal osmolarity; 3-O-methylglucose; lactulose; satiation GHRELIN IS THE ONLY KNOWN appetite-stimulating gastrointestinal hormone in humans and other vertebrates. Exogenous administration of this 28-amino-acid peptide increases short-term hunger, food intake, and motivation to eat, as well as body weight (14,16,17,67). Circulating ghrelin levels correlate with energy balance, i.e., they increase with weight loss or during meal anticipation and decrease with weight gain or after food intake. Ghrelin's orexigenic effects lend practical importance to a detailed understanding of its regulation by diet.The mechanisms underlying postmeal ghrelin suppression are incompletely understood, although some factors have been elucidated. First, the magnitude of ghrelin suppression correlates with the total caloric content of ingested food (8). Second, the nutrient sensors that initiate postprandial ghrelin suppression are not located in the stomach, i.e., the site of most ghrelin-producing cells, but more distally in the gastrointestinal tract and/or at postabsorptive sites (69, 91). Third, the magnitude of ghrelin suppression depends on the macronutrient composition of meals; e.g., ingested carbohyd...

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mentioning

confidence: 99%

Hyperosmolarity in the small intestine contributes to postprandial ghrelin suppression

Overduin

Tylee

Frayo

et al. 2014

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…The gradual fall in potassium concentration seen in all the subjects is only to be expected because, in the jejunum, this ion is governed by the concentration gradients across the jejunal mucosa (Turnberg, 1971). The fact that a greater fall is seen in both post-vagotomy groups when compared with contrast subjects at 60 minutes is probably the result of the greater dilution that occurs in the upper small bowel after a hypertonic meal at this time (Temple et al, 1975). There may also be some direct relationship between sodium and potassium concentration in the jejunum as this is the time period during which sodium concentration is rising very rapidly.…”

Section: Potassium Concentrationmentioning

confidence: 90%

“…In the case of patients with a gastroenterostomy, care was taken to ensure that the tube was directed into the efferent loop of the stoma. After a 12 hour fast, each subject drank a 300 ml fluid test meal ( Table 2), consisting of cow's milk containing 26 g sucrose (Temple et al, 1975). In general, the jejunal pH of post-vagotomy subjects was related to the results of the insulin test.…”

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confidence: 99%

Post-prandial changes in PH and electrolyte concentration, in the upper jejunum after truncal vagotomy and drainage in man.

Temple¹,

Birch²,

Shields³

1975

Gut

Self Cite

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SUMMARY The changes in pH and concentration of electrolytes in the jejunal lumen after a hypertonic fluid meal have been studied after truncal vagotomy and drainage, with and without diarrhoea. The results show that, in these respects, there are no specific changes in the jejunal contentassociated with post-vagotomy diarrhoea, but that these measurements are markedly affected by the completeness of vagotomy, as judged by the insulin test.

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“…In troduction of hypertonic solutions into the duodenum of normal individuals induces considerable water and electrolyte secretion which may be sufficient to produce a dump ing syndrome [ 16] or the diarrhoea observed after tube feeding with hypertonic solutions [8] , Jejunal instillation of hypertonic manni tol solutions produces injury both to the glucose-absorbing mechanism and to the biood-luminal barrier to glucose diffusion [9] . Although contradictory reports of jejunal osmolality changes following semi-elemental liquid meals [13,14], ordinary liquid meals (milk and sucrose) [18], and homogenized solid-liquid meals [2] have been published, it has generally been accepted [1,[5][6][7]17] that in normal man the post-prandial luminal contents become isotonic by the time they reach the upper jejunum, as found in the study of Fordtmn and Locklear [4], In their study, a single subject was studied on six occasions with sampling at various levels in the small intestine, whereas in the present study we report the results of jejuno-ileal intubation studies in 5 subjects. In the present study, the homogenised meal has a somewhat higher osmolality (705 mosm kg-1) than that used by Ford Iran and Lock lear [4] (635 mosm k g '1).…”

Section: Discussionmentioning

confidence: 99%

Post-Prandial Changes of Osmolality and Electrolyte Concentration in the Upper Jejunum of Normal Man

Ladas¹,

Isaacs²,

Sladen³

1983

Digestion

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The effect of an ordinary hyperosmolar solid/liquid meal (milk and doughnuts) on the osmolality, sodium and potassium concentrations in the upper jejunum was studied in 5 normal subjects. Though the meal was diluted three times when it reached the upper jejunum, the jejunal contents were consistently hyperosmolar ( > 300 mosm/kg) for more than 2 h. There was a linear correlation between gastric and jejunal osmolality (r = 0.89, p < 0.001), and gastric and jejunal potassium concentrations (r = 0.76, p < 0.001) but not between gastric and jejunal sodium concentrations (r = 0.25). The latter decreased after 30 min to 93 ± 10 mmol/l and returned to fasting levels (127 ± 12 mmol/l) after 3 h. These results show that the composition of upper jejunal contents after a meal reflects that of the gastric contents. Despite mixing with upper gastrointestinal secretions and transepithelial movement of fluid and electrolytes, osmotic and electrolytic equilibration of intestinal contents with plasma is not produced at this level up to 2 h following a meal.

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Postprandial osmotic and fluid changes in the upper jejunum after truncal vagotomy and drainage in man.

Cited by 8 publications

References 7 publications

Hyperosmolarity in the small intestine contributes to postprandial ghrelin suppression

Hyperosmolarity in the small intestine contributes to postprandial ghrelin suppression

Post-prandial changes in PH and electrolyte concentration, in the upper jejunum after truncal vagotomy and drainage in man.

Post-Prandial Changes of Osmolality and Electrolyte Concentration in the Upper Jejunum of Normal Man

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