Gastric emptying of solids in cirrhotic and peritoneal dialysis patients: influence of peritoneal volume load

Schoonjans, Renaat; Vlem, Bruno Van; Vandamme, Wouter; Vlierberghe, H. Van; Heddeghem, Nathalie Van; Biesen, Wim Van; Mast, A; Sas, Steven; Vanholder, Raymond; Lameire, Norbert; Vos, Martine De

doi:10.1097/00042737-200204000-00010

Cited by 35 publications

(26 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In our series 50% of patients with cirrhosis were found to have delayed gastric emptying which is in line with results previously presented from our group [74] and others [75][76][77]. However, the increased proximal stomach relaxation observed in our patients does not seem to be associated with delayed gastric emptying.…”

Section: Gastric Sensorimotor Dysfunction (Ii)supporting

confidence: 93%

“…Transit studies in patients with liver cirrhosis have shown contradictory results for gastric emptying [74][75][76][77][78][79][80][81]. In our series 50% of patients with cirrhosis were found to have delayed gastric emptying which is in line with results previously presented from our group [74] and others [75][76][77].…”

Section: Gastric Sensorimotor Dysfunction (Ii)supporting

confidence: 87%

“…In patients with liver cirrhosis, gastric emptying has been found to be delayed [74][75][76][77], normal [78][79][80], or accelerated [81]. Several factors may account for the divergence of results hitherto published, including selection of patient groups with different characteristics, selection of small patient groups or small control groups and use of different measurement methods.…”

Section: Gastric Emptyingmentioning

confidence: 99%

“…Manometry studies have described altered gut motility [88,193] in cirrhotics, whereas gastric emptying has been found to be delayed [74][75][76][77], normal [78][79][80] or accelerated [81]. Gastric accommodation has been reported to be impaired in patients with alcoholic cirrhosis [61] and cirrhotics with ascites [62] compared to healthy controls.…”

Section: Pathophysiology Of Gi Symptoms In Cirrhosis (Ii Iii)mentioning

confidence: 99%

See 3 more Smart Citations

Intestinal permeability in cirrhotic patients with and without ascites

Kalaitzakis

Johansson

Bjarnason³

et al. 2006

Scandinavian Journal of Gastroenterology

View full text Add to dashboard Cite

Malnutrition is a common finding in patients with liver cirrhosis. Malnutrition has been shown to be associated with increased morbidity and mortality. Its pathogenesis remains unclear but both poor dietary intake and increased energy expenditure have been reported.Spontaneous bacterial peritonitis is an important clinical problem in cirrhotics. It may occur as a consequence of repeated access of bacteria from the intestinal lumen (translocation) to the mesenteric lymph nodes. One of the mechanisms proposed to explain bacterial translocation in cirrhosis includes increased intestinal permeability.The aims of the present study were to evaluate GI symptoms in cirrhotic patients and their possible relation to nutritional status, to assess whether gastric sensorimotor dysfunction or metabolic disturbances are associated with reduced food intake, and to investigate the role of ascites in intestinal permeability in patients with liver cirrhosis.Gastrointestinal symptoms and health-related quality of life (HRQOL) were assessed with the aid of two questionnaires. Gastric sensorimotor function was measured by means of an electronic barostat. Food intake, as assessed with a food diary, was related to fasting and postprandial glucose, insulin, leptin, and ghrelin concentrations. Intestinal permeability was evaluated by a 51 Cr-EDTA permeability test. Cirrhotics were found to have increased severity of GI symptoms compared with reference values from the general population. A relationship between GI symptoms and compromised HRQOL as well as weight loss was observed.Proximal stomach relaxation to a meal was increased in patients with liver cirrhosis as compared with healthy controls but the relation between gastric accommodation and energy intake was found to be disturbed in these patients. Gastric sensitivity to distension was shown to be related to GI symptom severity and to liver cirrhosis severity scores.Patients with liver cirrhosis exhibited higher postprandial insulin and glucose concentrations compared to controls. Cirrhotics had higher fasting leptin that fell significantly postmeal and they showed an attenuated increase of ghrelin before the next expected meal. Altered glucose and hormonal levels in patients with cirrhosis were associated with poor food intake.Only a few patients with cirrhosis had increased intestinal permeability, as assessed by a 51 Cr-EDTA test, which was not influenced to a major extent by ascites. Conclusions: In patients with liver cirrhosis GI symptom severity is high and it is associated with impaired HRQOL and weight loss. Gastric accommodation is not involved in the poor food intake observed in cirrhotics and gastric sensitivity seems to be a relevant factor for GI symptom generation in these patients. Altered postprandial glucose, leptin, and ghrelin levels are correlated to reduced energy intake in this patient group. Increased intestinal permeability is probably of limited importance in the pathophysiology of bacterial infections in patients with liver cirrhosis and ascites.

show abstract

Section: Gastric Sensorimotor Dysfunction (Ii)supporting

confidence: 93%

Section: Gastric Sensorimotor Dysfunction (Ii)supporting

confidence: 87%

Section: Gastric Emptyingmentioning

confidence: 99%

Section: Pathophysiology Of Gi Symptoms In Cirrhosis (Ii Iii)mentioning

confidence: 99%

See 2 more Smart Citations

Intestinal permeability in cirrhotic patients with and without ascites

Kalaitzakis

Johansson

Bjarnason³

et al. 2006

Scandinavian Journal of Gastroenterology

View full text Add to dashboard Cite

show abstract

“…A relação entre o retardo no EG e a diálise peritoneal e o volume e a composição do líquido de diálise tem sido objeto de muitos estudos clínicos 18 . Existe consenso quanto a existência de retardo em pacientes com IRC em diálise peritoneal 4,19,10 e de que este retardo não está relacionado ao volume do líquido infundido18 mas à absorção de substâncias presentes no líquido de diálise 21 .…”

Section: Discussionunclassified

Esvaziamento gástrico nos pacientes com insuficiência renal crônica submetidos à hemodiálise

Hirata¹,

Mesquita²,

Camargo³

et al. 2008

ABCD, arq. bras. cir. dig.

View full text Add to dashboard Cite

INTRODUÇÃOQueixas dispépticas são comuns em pacientes com insuficiência renal crônica (IRC). As mais frequentemente relatadas são anorexia, náusea, vômito, sensação de plenitude gástrica e dor epigástrica 20 . A possibilidade destes sinais e sintomas estarem associadas a retardo no esvaziamento gástrico (EG) é atraente 8 e não faltam, no paciente urêmico, causas para explicar esta disfunção: acidose metabólica, anemia 16 e neuropatia 2 . Desde a observação de Goldstein, de retardo no EG em urêmicos em 1986, vários trabalhos têm apresentado resultados bastante conflitantes 5 . Falta de padronização das refeições testes, da gravidade e do tipo de tratamento da IRC e do método de estudo do EG poderiam explicar os diferentes resultados encontrados na literatura.A importância do EG em anestesia pode ser resumida em um de seus aspectos principais: o jejum pós-operatório. Retardo pode causar estase gástrica, predispondo ao risco de vômito e aspiração 12 . A importância clínica pode ser entendida se nos detivermos ao grande enfoque que se tem dado aos transplantes renais, como principal forma de tratamento da IRC. Medidas especiais na indução e recuperação da anestesia são recomendadas, com o intuito de evitar as graves complicações pulmonares que podem ocorrer nas situações de distúrbios do EG 7 .O objetivo deste estudo foi estudar o EG em pacientes com IRC em tratamento hemodialítico e compará-lo a um grupo de individuo sadios, utilizando-se o método da cintilografia gástrica. MÉTODOEste trabalho foi aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Ciências Médicas da Unicamp com o termo de consentimento tendo sido assinado na entrevista, quando o paciente era convidado a participar da pesquisa, após esclarecimentos sobre o estudo Foram estudados 14 pacientes com IRC em tratamento hemodialítico há mais de seis meses no Hospital das Clíni-cas da Unicamp (Grupo THD). Os critérios de exclusão foram presença de diabete melito, amiloidose, doenças do colágeno, úlcera péptica, cirurgia gástrica prévia e gravidez. Nenhum deles estava em uso de medicações que pudessem afetar a motilidade gastrintestinal.O grupo-controle (CTL) foi constituído por 18 vol- Trabalho realizado no Hospital de Clínicas da Faculdade de Ciências Médicas da Universidade Estadual de Campinas -UNICAMP, Campinas, SP, Brasil C o r re s p o n d ê n c i a : E u n i c e S i z u e H i r a t a , e -m a i l :eshirata@hotmail.com ABCDDV/607

show abstract