The effect of posture on the gastric emptying of solid meals in normal subjects and patients after vagotomy

Abstract

SUMMARYThe effect of posture on gastric emptying of et al., 1973). Measurements of gastric emptying rates have produced conflicting results, partly because of the variable conditions under which the tests have been carried out. Variables of particular importance are the composition of the meal, the posture adopted by the subject during the test and the method of measurement. There is some evidence to suggest that liquids normally leave the stomach more rapidly than solids (Heading et al., 1971), and in dogs this is more marked after vagotomy (Wilbur and Kelly, 1973). The effect of posture has been studied only with liquid meals, which in patients after vagotomy leave the stomach more rapidly when the subject is seated than when he is lying on the left side (McKelvey, 1970).Our understanding of the effects of various types of vagotomy on gastric emptying of solid meals might inff uence the choice of operation and a knowledge of the effect of posture might affect the management of the sequelae. In this study the effect of truncal vagotomy and pyloroplasty and of highly selective vagotomy (Johnson and Wilkinson, 1970) on the rate of emptying of solid meals is reported. The effect of posture on the emptying rate is reported in normal individuals and in patients after both types of vagotomy. A solid meal was labelled with radioactive 51Cr and the rate of emptying measured with a gamma camera. Materials and methodsThe subjects studied were 10 healthy volunteers, 5 patients within 3 months after truncal vagotomy and pyloroplasty and 5 patients within 3 months after highly selective vagotomy. The rate of gastric emptying was studied on two occasions in each subject; once while lying down and once while standing. The mean time interval between tests was 7 days for normal subjects and 5 days for each group of postvagotomy patients. In postoperative patients the order in which the two tests were carried out was randomized to eliminate the effect of recovery which occurs within the first 3 months after truncal vagotomy (Cowley et al., 1972).The method chosen was a modification of that described by Jones et al. (1970). A standard meal was labelled with W r and a record of the rate at which it left the stomach was made by continuous monitoring with a gamma camera. The meal consisted of half a cupful of instant porridge (Ready Brek), 250ml of milk, half of which was used to make the porridge and one thick slice of lightly buttered bread and marmalade; 200 pCi of 51Cr as sodium chromate were mixed with the porridge during its preparation. The meal was eaten whilst the subject was seated, and after finishing the meal he lay supine under the gamma camera in one test or stood against the camera in the other. During recording in the recumbent position the subject lay in the same position for 90 minutes. In the standing test, recordings were taken for 24 minutes at intervals of 7 minutes, so that the subject could move between recordings. The camera was centred over the stomach with the aid of an oscilloscope display, and by placi...

The effect of metoclopramide on gastric emptying of solid meals

“…Posture may be important, since McKelvey (1970) showed that liquids emptied more quickly after vagotomy when the patient was standing than when he lay on his left side. We have made similar observations with solid meals (Hancock, Bowen-Jones, Dixon, Testa, Dymock, and Cowley, 1974). It must be emphasized that in the present study all subjects were tested in the supine position throughout the observation period.…”

National Survey of Radionuclide Gastric Emptying Studies

“…Centres also differ in their imaging techniques, with patients being studied in a variety of positions. Body posture may influence pace of gastric emptying (26), though some authors have not found this (27). Different acquisition types are used, namely dynamic imaging, where gamma counts are continuously measured, or static imaging, where counts are intermittently measured.…”