Prokinetic therapy: What can be measured by gastric scintigraphy?

Linke, Rainer; Meier, Matthias; Muenzing, Wolfgang; Folwaczny, C; Schnell, Oliver; Tatsch, Klaus

doi:10.1097/00006231-200506000-00008

Cited by 18 publications

(7 citation statements)

References 16 publications

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“…Thereafter, blood samples were taken at 30-min intervals until 330 min. The scrambled eggs and Jell-O were labeled with 99m Tc-Sn-colloid at ϳ70 MBq for measurements of gastric emptying by high-resolution scintigraphy (20 images/min; Orbiter, Siemens, Erlangen, Germany) starting immediately after completion of the meal and continuing for the remainder of the experiment (14,15).…”

Section: Subjectsmentioning

confidence: 99%

Importance of changes in gastric emptying for postprandial plasma glucose fluxes in healthy humans

Woerle¹,

Albrecht²,

Linke³

et al. 2008

American Journal of Physiology-Endocrinology and Metabolism

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Objective: Regulation of postprandial (pp) plasma glucose excursions is complex. Insulin and glucagon are thought to play the predominant role. Nevertheless, only 50% of the variation in pp plasma glucose excursions is explained by variations by the latter. Theoretically, gastric emptying (GE) should be another important factor. However, its impact on pp glucose homeostasis is unknown. Research Design and Methods: We examined the consequences of pramlintide-induced delay in GE on pp glycemia and glucose fluxes, determined isotopically. GE was recorded by scintigraphy. Fourteen healthy subjects (8 men, 6 women; age 40 ± 3 yr, body mass index 27.8 ± 1.1 kg/m2) ate a mixed meal, and 30 μg of pramlintide (PRAM) or placebo (PBO) were injected subcutaneously. Results: At 60 min, greater proportions of the initial gastric contents remained in the stomach (PBO vs. PRAM). Thereafter, GE slopes paralleled until 240 min. Fifty percent retention times were lower when PBO was given ( P < 0.001). GE was greater from 240 min to the end of the PRAM experiments, so that only slightly greater proportions of the meal remained in the stomach at 330 min. Reductions of GE lowered pp glucose (7.5 ± 0.3 vs. 6.0 ± 0.2 mmol/l, P < 0.001), even though plasma insulin was lower with PRAM (164 ± 13 vs. 138 ± 13 pmol/ml, both P < 0.01). Reduction in total glucose appearance ( P < 0.001) was due to reduced meal-derived glucose appearance (10.2 ± 0.5 vs. 7.0 ± 0.4 μmol·kg−1·min−1, P < 0.001). Endogenous glucose appearance was greater with PRAM ( P < 0.001). Splanchnic glucose uptake was greater with PRAM (26.5 ± 1.6 vs. 32.5 ± 2.1%, P = 0.014). Conclusions: These data support the concept that GE is an important physiological regulator of pp glucose homeostasis in humans.

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Section: Subjectsmentioning

confidence: 99%

Importance of changes in gastric emptying for postprandial plasma glucose fluxes in healthy humans

Woerle¹,

Albrecht²,

Linke³

et al. 2008

American Journal of Physiology-Endocrinology and Metabolism

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“…Erythromycin, which interacts with the motilin receptor and accelerates gastric emptying, has been shown to be effective in systemic sclerosis when given acutely and in a single study when used for 1 month [54,55]. Cisapride, which is only available through a limited-access compassionate use program in the United States, has similarly shown some efficacy in acute studies [56,57]. Thus, current evidence supports the use of erythromycin, perhaps alternating with metoclopramide to prevent tachyphylaxis, as an adjunct to the dietary management of gastroparesis in systemic sclerosis.…”

Section: Gastric Manifestationsmentioning

confidence: 99%

Gastrointestinal Manifestations of Systemic Sclerosis

2007

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Systemic sclerosis is a chronic disorder of connective tissue that affects the gastrointestinal tract in more than 80% of patients. Changes in neuromuscular function with progressive fibrosis of smooth muscle within the muscularis propria impair normal motor function, which may secondarily alter transit and nutrient absorption. Esophageal manifestations with gastroesophageal reflux and dysphagia are the most common visceral manifestation of the disease, often requiring more intense acid-suppressive medication. Gastric involvement may lead to gastroparesis, which can be found in up to 50% of patients. Severe small bowel disease can present as chronic intestinal pseudo-obstruction with distended loops of small intestine, bacterial overgrowth, impaired absorption and progressive development of nutritional deficiencies. While not studied as extensively, systemic sclerosis often also affects colorectal function resulting in constipation, diarrhea or fecal incontinence. Nutritional support and prokinetics have been used with some success to manage gastric and small or large bowel involvement in patients with systemic sclerosis. Despite advances in management, significant gastrointestinal manifestations of systemic sclerosis still carry a poor prognosis with a five-year mortality exceeding 50%.

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“…Delayed gastric emptying is confirmed if more than 60% retention is present at 2 h or more than 10% is present at 4 h [41]. This investigation can be utilized both for diagnosis and monitoring of the effectiveness of prokinetic therapy [42]. A new, ambulatory method involves ingesting a radiotelemetry wireless capsule that measures luminal pH and pressure after being swallowed and transmits the data to a receiver worn by the patient (Smart Pill™, Buffalo, NY) [43].…”

Section: Diagnosis Of Gastroparesismentioning

confidence: 99%