דו״ח מאומת

Gastric mixing is a complex process that is governed by meal properties, such as food buffering capacity, physical properties, and the rate of breakdown as well as physiological factors, such as the rate of gastric secretions, gastric emptying, and gastric motility. Gastric mixing processes have been studied through the use of experimental and computational methods. Gastric mixing impacts the intragastric pH distribution and residence time in the stomach for ingested materials. Development of a fundamental understanding of the advective and diffusion processes and their roles in gastric mixing will be important in furthering our understanding of food breakdown, microbial survival, and drug dissolution during gastric digestion.…

PMID: 28125347

Knowledge of the disintegration of solid foods in human stomach is essential to assess the bioavailability of nutrients in the gastrointestinal (GI) tract. A comprehensive review of food gastric digestion, focusing on disintegration of solid foods, is presented. Most of the research reviewed in this paper is contained in the medical, pharmaceutical, food, and nutritional literature. Stomach physiology is briefly introduced, including composition and rheological properties of gastric contents, stomach wall motility in fed/fasted states, and hydrodynamic and mechanical forces that act on the ingested food. In vivo and in vitro methods used for studying food and drug digestion in GI are summarized. Stomach emptying rate, which controls the rate of absorption of nutrients, is highly related to the disintegration of foods. This topic is highlighted with focus on the important mechanisms and the influence of chemical and physical properties of foods. Future research in this area is identified to increase our fundamental understanding of the food digestion process in the stomach as related to the food composition, material properties such as texture and microstructure, and chemical characteristics. This information is necessary to develop new guidelines for seeking innovative processing methods to manufacture foods specifically targeted for health.…

PMID: 18577009

Gastric mixing is a complex process that is governed by meal properties, such as food buffering capacity, physical properties, and the rate of breakdown as well as physiological factors, such as the rate of gastric secretions, gastric emptying, and gastric motility. Gastric mixing processes have been studied through the use of experimental and computational methods. Gastric mixing impacts the intragastric pH distribution and residence time in the stomach for ingested materials. Development of a fundamental understanding of the advective and diffusion processes and their roles in gastric mixing will be important in furthering our understanding of food breakdown, microbial survival, and drug dissolution during gastric digestion.…

PMID: 28125347

Drugs are usually given orally. They are not absorbed to any extent from the stomach but may be absorbed very rapidly from the small intestine. Thus factors influencing the rate of gastric emptying may alter the rate of absorption of most if not all orally administered drugs. Food, hormones, posture, peritoneal irritation, severe pain, gastric ulcer, diabetes and other metabolic diseases, as well as drugs such as alcohol, anticholinergics, narcotic analgesics, ganglion blocking drugs, antacids and metoclopramide all influence the rate of gastric emptying and they will, in turn, change the rate of absorption of another drug. In most instances, increasing the rate of gastric emptying and gastro-intestinal motility increases the rate of absorption of a drug but, for digoxin and riboflavin, increased gastrointestinal motility is associated with a decrease in the rate of absorption. Delayed drug absorption due to altered gastric emptying usually results in therapeutic failure, especially if the drug has a short biological half-life. At present it is not possible to predict accurately the magnitude and clinical relevance of all drug absorption interactions.…

PMID: 797497

Diabetic gastroparesis (DGP) is a chronic and frequently underrecognized complication of diabetes mellitus, characterized by delayed gastric emptying in the absence of mechanical obstruction. It represents a clinically significant manifestation of diabetic autonomic neuropathy and arises from a complex interplay of sustained hyperglycemia, oxidative and nitrosative stress, advanced glycation end-product accumulation, impaired insulin/IGF-1 signaling, lipid dysmetabolism, and inflammatory activation. These mechanisms converge to damage autonomic and enteric neurons, reduce interstitial cells of Cajal density, and disrupt gastric smooth muscle function, ultimately leading to impaired and unpredictable gastric motility. Beyond gastrointestinal symptoms, DGP profoundly affects metabolic control. The altered timing and variability of gastric emptying disturb the physiological coordination between nutrient absorption and insulin pharmacokinetics, generating a temporal mismatch that predisposes patients to early postprandial hypoglycemia followed by late hyperglycemia. This pattern increases glycemic variability, complicates insulin dose adjustment, and contributes to oxidative stress and vascular risk. In this narrative review, we examine the current understanding of DGP pathophysiology and its clinical implications for insulin therapy. We discuss diagnostic strategies, nutritional interventions, and pharmacological treatments, with particular attention to insulin timing modulation. We also analyze the emerging role of diabetes technologies, including continuous glucose monitoring and automated insulin delivery systems, as well as future perspectives such as glucose-responsive insulins and regenerative approaches targeting gastric neuromuscular dysfunction. A mechanism-based, personalized therapeutic strategy may improve metabolic stability and patient outcomes.…

PMID: 42334698

Approximately 1 in 6 capsule endoscopies (CEs) does not visualize the entire small bowel at completion of the examination because of limited battery life. To determine whether chewing gum can reduce the small-bowel transit time and increase CE completion rates. Prospective, single-blind, randomized, controlled trial. A tertiary university-affiliated hospital. Consecutive patients 19 years of age and older undergoing outpatient small-bowel CE from October 2010 to July 2012 were assessed for eligibility. Those with previous gastric or small-bowel surgery or ileostomy, dysphagia prohibiting capsule ingestion, diabetes mellitus with evidence of end-organ damage, use of narcotics or prokinetics within 5 days before the procedure, clinical hyper-/hypothyroidism, and symptoms suggestive of acute bowel obstruction were excluded. Gum chewing for at least 20 minutes every 2 hours starting at the time of capsule ingestion. Small-bowel transit time, gastric transit time, and completion rate were measured. Chewing gum did not have any significant effect on gastric transit time (rate ratio 1.06; 95% CI, 0.73-1.55; P = .75), small-bowel transit time (rate ratio 0.91; 95% CI, 0.62-1.35; P = .65), or completion rate (91.67% chewing gum vs 88.71% control, P = .58) of CE. Single-center study involving relatively healthy subjects. Procedures were done on an outpatient basis so participants were not monitored for adherence to protocol. Chewing gum does not speed up capsule transit or increase completion rate of CE in patients without risk factors for incomplete studies. ( NCT01241825.).…

PMID: 24112594

A high rate of complete colon capsule endoscopy (CCE) investigations is required for a more widespread use of CCE. The objective of this study was to assess if coffee or chewing gum can increase excretion of the colon capsule within battery life time (excretion rate). One hundred eighty six screening participants with a positive immunochemical fecal occult blood test were included in this single-centre randomized controlled trial with blinding of the investigators to the randomization. Participants received instant coffee, chewing gum or nothing in addition to the standard bowel preparation. The intention was to include 57 participants in the coffee group, 61 in the chewing gum group and 60 in the control group, on 8 participants data were missing. A total of 165 participants were included in a per protocol analysis. Exclusion was due to not receiving the allocated intervention (8 coffee, 4 chewing gum) and technical failure of the capsule (1 coffee). The excretion rate was 58% in the coffee group (n = 48), 63% in the chewing gum group (n = 57) and 55% in the control group (n = 60, p > 0.2). Transit times were similar in all groups. The excretion rate was low in participants who had transit times over 10 h (14%). A strong correlation was found between adequate cleansing and excretion of the capsule. There were no serious adverse events related to the interventions or CCE investigations. Chewing gum and coffee did not improve excretion rate in this study. An effect of chewing gum could not be proven, possibly due to sample size. Since chewing gum might improve excretion rates, is cheap and has no known side effects, it needs to be considered in future bowel preparation trials for CCE. NCT02303756 , registered on December 1st 2014.…

PMID: 29940864

The timing and technique of anaesthesia are challenging in patients with a history of recent food intake. The presence of gastric contents increases the risk of aspiration, potentially resulting in acute lung injury, pneumonia, or death. Delayed gastric emptying complicates the estimation of aspiration risk. Surprisingly, there are no fasting guidelines for emergency surgery. Point-of-care gastric ultrasound is a time-efficient, cost-efficient and accurate bedside tool with which to estimate residual gastric content and to guide decision-making in airway management and timing of general anaesthesia. This review summarises the prevailing concepts of ultrasound-guided gastric content assessment for emergency surgery. Medline and Embase databases were searched for studies using ultrasound for the evaluation of gastric content in adults scheduled for emergency surgery. Five prospective observational studies representing 793 emergency surgery patients showed that the incidence of 'full stomach' was between 18 and 56% at the time of induction. Risk factors for a full stomach before emergency surgery were abdominal or gynaecological/obstetric surgery, high body mass index and morphine consumption. No correlation between preoperative fasting time and the presence of a full/empty stomach was found. No deaths due to aspiration were reported. The preoperative presence of gastric content before emergency surgery is high and the estimates used for clinical management are unreliable. This review demonstrates that gastric ultrasound is a valuable tool for evaluating gastric content. A flow chart for medical decision-making using gastric ultrasound before emergency surgery was developed to assist in clinical decision-making. The validity and practical applicability should be assessed in future studies.…

PMID: 39917072