Anna Maria Bucceri

Influence of Aging on Gastrointestinal Transit Time: An Ultrasonographic and Radiologic Study

RATIONALE AND OBJECTIVES To assess and compare gastrointestinal (GI) rates in young and aged men under homogeneous conditions of weight and dietetic habits. METHODS Gastric emptying time was evaluated by ultrasound. GI transit time was studied radiologically using radiopaque markers. RESULTS Final gastric emptying time in elderly subjects was 335 +/- 31 minutes (mean +/- SD) versus 245 +/- 25 minutes in young subjects (P < 0.001). Total GI transit time showed no significant difference between the two groups. Intestinal transit time includes both small bowel and colonic transit; small bowel and colonic transit was not separated in this study. CONCLUSIONS Delayed gastric emptying of solid foods could result from progressive autonomic nerve dysfunction occurring with aging. The stomach does not seem to be the segment of the digestive tract that is primarily responsible for the alteration of total GI time.

Gastric emptying rates of solid food in relation to body mass index: an ultrasonographic and scintigraphic study

Gastric emptying can be modified by different physiologic conditions such as aging, menstrual cycle and pregnancy. Few studies in the literature have compared the gastric emptying rate of solid meals in normal subjects of varying size. The purpose of this work is to evaluate the gastric emptying rate of solid meals to determine whether body mass index (BMI) and gastric emptying rate correlate. Both ultrasonographic and scintigraphic techniques have been employed. Twenty-four healthy male subjects, divided into two groups, participated in the study. Our results demonstrate a significant correlation between gastric emptying and BMI. We conclude that variability of BMI must be taken in account when measurements of gastric emptying of solid food are performed.

Radioisotopic assessment of gastric emptying of solids in elderly subjects

Backgrounds and aims: Few studies in literature have investigated the gastric emptying of solids in elderly subjects. We assessed the differences between young and elderly subjects in the gastric emptying rate of solids by a radioisotopic method. Methods: Two groups of 15 elderly male subjects (mean age 68.20 years and 77.26 years, respectively) and a group of young male subjects (mean age 30.23 years) underwent a radioisotopic study of gastric emptying after eating a radiolabeled solid meal. Half-time of gastric emptying (T½) and emptying index (EI), i.e. rate of gastric emptying at 120 min, were measured with two opposing detectors connected to a computerized rate-meter. Results are expressed as means ± SD. Results: Significantly different values were obtained in the two groups both at T½ (183±88 and 195±75, respectively) and EI (0A0±0.3 and 0.36±0.4), compared with young subjects (T½=53±23; EI=1.10±0.3) (p<0.0001). Conclusions: Gastric emptying of solids is significantly delayed in elderly men; this variable must be taken into account when studies on gastric emptying rates are performed.

Gallbladder and gastric emptying: relationship to cholecystokininemia in diabetics

Background: Impaired gastrointestinal and gallbladder motility, as a complication of long-lasting diabetes mellitus, has been ascribed to the possible development of autonomic neuropathy, although the intervention of hormonal factors may not completely be excluded. In this regard, cholecystokinin (CCK), a gut hormone known to regulate pancreatic exocrine secretion, gallbladder contraction, and bowel motility in response to a meal, is impaired in patients with diabetes mellitus. This prompted us to evaluate the relationship between the plasma levels of CCK and gallbladder and gastric emptying in neuropathy-free diabetic patients treated with insulin (group A) or with oral hypoglycemic agents (group B) under basal conditions and in response to a standard test meal. Methods: Plasma CCK was measured by radioimmunoassay. Gastric and gallbladder emptying were evaluated ultrasonographically. Results: Plasma CCK levels were significantly lower in both groups of diabetics than in healthy controls during a fast and in response to a standard meal. However, meal ingestion was able to evoke a pattern of CCK response in both groups of diabetic patients similar to that seen in controls. Fasting gallbladder volume was higher in patients with diabetes than in controls, whereas the percentage of emptying was lower in patients of both groups. Gastric final emptying time was significantly longer in both groups of diabetics than in controls. Conclusion: This study shows that patients with diabetes have lower plasma levels of CCK, which may explain their relatively hypotonic gallbladder and reduced gastric motility.

Gastric clearance of radiopaque markers in the evaluation of gastric emptying rate

Background: The study of gastric emptying rate of solids using radiopaque indigestible solid markers has been a poorly employed technique because some kinds of markers do not leave the stomach at the same time as the meal but during the interdigestive migrating motor complex (IMMC). The aim of this study was to evaluate whether markers of particular shape and size can be successfully employed for this purpose. Methods: Twenty-eight non-ulcer dyspeptic (NUD) patients and 20 healthy volunteers received a standard solid meal (790 Kcal) together with 20 small polyethylene radiopaque cylinders (5 mm × 2 mm in diameter). Gastric emptying rate was evaluated by ultrasound while the emptying of markers was simultaneously followed by X-rays using a brilliance intensifier. Results: Final emptying time (FET = time when the antrum area returns to fasting size) of digestible solids was 355 ± 35 min in NUD patients versus 265 ± 20 min in controls (P < 0.001). The gastric emptying curve of digestible solids correlated with emptying of markers both in NUD patients (r = +0.96) and in controls (r = +0.93). Conclusions: The assessment of gastric clearance of radiopaque cylinders of 2 mm × 5 mm in size is a reliable tool for the study of gastric emptying rate of digestible solids. This is a readily available and easily performed test in any radiology unit.

Pattern of Gastric Emptying in Functional Dyspepsia. An Ultrasonographic Study

We assessed the ultrasonographic pattern of gastric emptying in patients with functional dyspepsia, evaluating its relationship with symptoms. Twenty dyspeptic patients, with slight (group A) and severe (group B) symptoms, and 10 controls (group C) underwent ultrasonographic study of gastric emptying by measuring postprandial variations of the antral area at regular intervals. The time at which the antral area returned to the basal value was assumed to be the final emptying time. The final emptying time was significantly longer in both group A (294 ± 42 min) and group B (340 ± 36 min) compared to controls (244 ± 21 min), but no significant difference was observed between them. A significantly (P<0.05) greater dilation of the antral area was found at 50 min in group B compared to group A patients. A different pattern of antral motor function rather than a delay of gastric emptying correlates with the severity of symtoms in dyspeptic patients.

Ultrasonographic Study of Gallbladder Wall Thickness and Emptying in Cirrhotic Patients without Gallstones

Background and Aim. Gallbladder wall thickening and impaired contractility are currently reported in cirrhotic patients and often related to portal hypertension and hepatic failure. The purpose of this work was to evaluate, by ultrasonographic method, gallbladder wall thickness and gallbladder emptying after a standard meal in normal subjects and in patients with compensated liver cirrhosis without gallstones. Methods. Twenty-three patients with Child-Pugh class A liver cirrhosis and twenty healthy controls were studied. Gallbladder wall thickness (GWT), gallbladder fasting volume (FV), residual volume (RV), and maximum percentage of emptying (%E) were calculated. Measurements of mean portal velocity, portal vein flow, and serum albumin were performed too. Statistical analysis was assessed by Students “t test” for unpaired data. Results. GWT was 0.60 ± 0.22 cm in cirrhotic patients and 0.21 ± 0.06 cm in controls (P < .0001). FV and RV were, respectively, 37.8 ± 3.7 cm3 and 21.8 ± 3 cm3 in cirrhotic patients, 21.9 ± 4.2 cm3 and 4.6 ± 2.2 cm3 in healthy volunteers (P < .0001). %E was smaller in cirrhotics (42.6 ± 7.8) as compared to controls (80.3 ± 7.2; P < .0001). Conclusions. In patients with compensated liver cirrhosis without gallstones gallbladder wall thickness is increased whereas its contractility is reduced. These early structural and functional alterations could play a role in gallstone formation in more advanced stages of the disease.

Sonographic study of postprandial gallbladder emptying and common bile duct changes in patients with diabetes or cholelithiasis

The aim of our study was to evaluate postprandial emptying of the gallbladder and common bile duct (CBD) in 20 patients with gallstones and in 20 diabetic patients with or without autonomic neuropathy. Gallbladder fasting volume was significantly increased in patients with multiple stones. Diabetics with autonomic neuropathy showed a decreased gallbladder emptying rate. CBD size did not show any significant change in all groups examined.

Ultrasound Demonstration of Gallbladder Wall Thickening as a Method to Differentiate Cirrhotic Ascites from Other Ascites

RATIONALE AND OBJECTIVES Gallbladder wall thickness was measured by ultrasound in 16 patients with ascites caused by liver cirrhosis and in 16 noncirrhotic patients with ascites. This study was performed to evaluate if gallbladder wall thickening could differentiate cirrhotic ascites from ascites due to other causes. METHODS Gallbladder thickness was measured by duplex ultrasound in 16 cirrhotic patients with ascites and in 16 noncirrhotic patients with ascites. Measurements of portal vein flow and serum albumin also were performed. RESULTS Gallbladder wall thickness was 0.76 +/- 0.21 cm in cirrhotic patients and 0.24 +/- 0.09 in noncirrhotic patients (P < 0.001, Students t test for unpaired data). Gallbladder wall thickening was significantly more frequent in patients with cirrhotic ascites than in patients with noncirrhotic ascites (P < 0.001, chi-square test). CONCLUSIONS The authors feel that the ultrasound finding of gallbladder wall thickening in patients with ascites is highly predictive of liver cirrhosis diagnosis.

Common bile duct caliber following cholecystectomy: A two-year sonographic survey

The aim of this study was to evaluate the size of the common bile duct (CBD) in patients with gallstones, before and after cholecystectomy. Ten female patients (22–61 years) were examined in whom gallstones were shown by ultrasound. The caliber of CBD was measured before cholecystectomy and then 6, 12, 18, and 24 months after cholecystectomy. No significant change of CBD caliber in each interval prior to or following cholecystectomy was observed.