- Brener W et al, 1983, Regulation of the gastric emptying of glucose PubMed
- Varón AR et al, 2010, From the physiology of gastric emptying to the understanding of gastroparesis SciELO
- Little TJ et al, The release of GLP-1 and ghrelin, but not GIP and CCK, by glucose is dependent upon the length of small intestine exposed American Journal of Physiology Endocrinology and Metabolism
- Marathe CS et al, 2011, Effects of GLP-1 and Incretin-Based Therapies on Gastrointestinal Motor Function PubMed Central
- Young RL et al, 2011, Sensing via Intestinal Sweet Taste Pathways PubMed Central
- Collins PJ et al, 1991, Role of the proximal and distal stomach in mixed solid and liquid meal emptying Gut
- Horowitz M et al, 1993, Relationship between oral glucose tolerance and gastric emptying in normal healthy subjects PubMed
- Khoo J et al, 2010, Gastrointestinal hormonal dysfunction in gastroparesis and functional dyspepsia Wiley Online Library
- Murray CDR et al, 2005, Ghrelin enhances gastric emptying in diabetic gastroparesis: a double blind, placebo controlled, crossover study PubMed
- Parkman HP et al, 2004, American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis Gastroenterology
- Ouyang C, 1996, The Clinical Significance of gastric dysrhythmias Baishideng Publishing Group
- Tarling MM et al, 1997, A model of gastric emptying using paracetamol absorption in intensive care patients Springer Link
- Parkman HP et al, 2011, Gastroparesis and Functional Dyspepsia: Excerpts from the AGA/ANMS Meeting PubMed Central
- Fried M et al, 1991, Role of cholecystokinin in the regulation of gastric emptying and pancreatic enzyme secretion in humans. Studies with the cholecystokinin-receptor antagonist loxiglumide PubMed
- Levein NG et al, 1999, Dopamine delays gastric emptying and prolongs orocaecal transit time in volunteers PubMed
- Kristinsson JO et al, 2007, Gastroparesis in patients with inactive Crohn’s disease: a case series BioMed Central
- Davison JS, 1970, GASTRIC EMPTYING TIME IN LATE PREGNANCY AND LABOUR Wiley Online Library
- Somatostatin Colorado State University
- Jonderko G et al, 1989, Effect of somatostatin-14 on gastric emptying and on gastrin and insulin release after ingestion of a mixed solid-liquid meal in man PubMed
- Abu-Hamdah R et al, 2009, The Extrapancreatic Effects of Glucagon-Like Peptide-1 and Related Peptides PubMed Central
- Salehi M et al, 2008, Regulation of Islet Hormone Release and Gastric Emptying by Endogenous Glucagon-Like Peptide 1 after Glucose Ingestion Endocrine Society
- Schmitz O et al, 1999, Aspects of secretion and actions of amylin: interplay between amylin and other hormones PubMed
- Samson M et al, 2000, Pramlintide, an amylin analog, selectively delays gastric emptying: potential role of vagal inhibition American Journal of Physiology Endocrinology and Metabolism
- Ebert R, 1988, Control of gastric emptying by regulatory peptides PubMed
- Yarandi SS, 2011, Diverse roles of leptin in the gastrointestinal tract: modulation of motility, absorption, growth, and inflammation PubMed
- Thor PJ et al, 2007, MELATONIN AND SEROTONIN EFFECTS ON GASTROINTESTINAL MOTILITY Journal of Physiology and Pharmacology
- McCallum RW et al, 2007, Clinical trial: effect of mitemcinal (a motilin agonist) on gastric emptying in patients with gastroparesis – a randomized, multicentre, placebo-controlled study Wiley Online Library
- Schmidt PT et al, 2013, A Role for Pancreatic Polypeptide in the Regulation of Gastric Emptying and Short-Term Metabolic Control Endocrine Society
- KLeibeuker JH et al, 1988, Retardation of gastric emptying of solid food by secretin PubMed
- Bateman DN et al, 1982, EFFECTS OF MEAL TEMPERATURE AND VOLUME ON THE EMPTYING OF LIQUID FROM THE HUMAN STOMACH PubMed Central
- Endocrine Regulation of Glucose Metabolism Rose-Hulman
- Byars A et al, 2010, The influence of a pre-exercise sports drink (PRX) on factors related to maximal aerobic performance PubMed Central
- Horowitz M et al, 1989, Relationships between gastric emptying of solid and caloric liquid meals and alcohol absorption PubMed
- Murray R et al, 1999, A comparison of the gastric emptying characteristics of selected sports drinks PubMed
- Vist GE, 1994, Gastric emptying of ingested solutions in man: effect of beverage glucose concentration PubMed
- Guss JL et al, 1994, American Journal of Physiology, Regulatory, Integrative and Comparative Physiology
- Franke A et al, 2004, Effect of ethanol and some alcoholic beverages on gastric emptying in humans PubMed
- Zachwieja JJ et al, 1992, The effects of a carbonated carbohydrate drink on gastric emptying, gastrointestinal distress, and exercise performance PubMed
- Holt S et al, 1982, Gastric emptying of solids in man Gut
- Wong CA et al, 2002, Gastric emptying of water in term pregnancy PubMed
- Sadiya A, 2012, Nutritional therapy for the management of diabetic gastroparesis: clinical review PubMed Central
- Kwiatek MA et al, 2009, Effect of meal volume and calorie load on postprandial gastric function and emptying: studies under physiological conditions by combined fiber-optic pressure measurement and MRI American Journal of Physiology, Gastrointestinal and Liver Physiology
- Moore JG et al, 1990, Exercise increases solid meal gastric emptying rates in men PubMed
- Neufer PD et al, 1989, Gastric emptying during walking and running: effects of varied exercise intensity PubMed
- Cammack J et al, 1982, Effect of prolonged exercise on the passage of a solid meal through the stomach and small intestine PubMed Central
- Carrió I et al, 1989, Gastric emptying in marathon runners Gut
- Kadota K et al, 2010, Effects of smoking cessation on gastric emptying in smokers PubMed
- Schvarcz E et al, 1997, Physiological hyperglycemia slows gastric emptying in normal subjects and patients with insulin-dependent diabetes mellitus PubMed
- Russo A et al, 2005, Insulin-Induced Hypoglycemia Accelerates Gastric Emptying of Solids and Liquids in Long-Standing Type 1 Diabetes Endocrine Society
- Camilleri M et al, 2010, Epidemiology, Mechanisms and Management of Diabetic Gastroparesis PubMed
- Bharucha AE et al, 2011, GASTRIC MOTOR DISTURBANCES IN PATIENTS WITH IDIOPATHIC RAPID GASTRIC EMPTYING PubMed Central
- Lunding JA et al, 2006, Rapid initial gastric emptying and hypersensitivity to gastric filling in functional dyspepsia: effects of duodenal lipids PubMed
- Kusano M et al, 2011, Rapid gastric emptying, rather than delayed gastric emptying, might provoke functional dyspepsia PubMed
- Harasawa S et al, 1979, Gastric emptying in normal subjects and patients with peptic ulcer: a study using the acetaminophen method PubMed
- Peterson JM et al, 1989, Sucralfate delays gastric emptying of liquids and solids in duodenal ulcer patientsPubMed
- RosaE-Silva L et al, 2007, Factors associated with abnormal gastric emptying in alcohol-related chronic pancreatitis PubMed
- Dumping syndrome Aboutgutmotility.org
- Behrns KE et al, 1994, Diagnosis and management of gastric emptying disorders PubeMed
- Wang G et al, 2012, Accelerated gastric emptying but no carbohydrate malabsorption 1 year after gastric bypass surgery (GBP) PubMed
- Dumping syndrome National Institute of Diabetes and Digestive and Kidney Diseases
- Kanth R, Dumping syndrome Emedicine
- Lawal A et al, 2007, Rapid gastric emptying is more common than gastroparesis in patients with autonomic dysfunction PubMed
- Hejazi RA et al, 2010, Spectrum of gastric emptying patterns in adult patients with cyclic vomiting syndrome
PubMed - Hejazi RA et al, 2011, Review article: cyclic vomiting syndrome in adults – rediscovering and redefining an old entity Wiley Online Library
- Middleton SJ et al, 2012, Idiopathic accelerated gastric emptying presenting in adults with post-prandial diarrhea and reactive hypoglycemia: a case series PubMed Central
- Alam U et al, 2010, Diabetic gastroparesis therapeutic options PubMed Central
- Sachdeva P et al, 2011, Gastric emptying of solids and liquids for evaluation for gastroparesis PubMed
- Gurvits GE et al, 2013, Video capsule endoscopy and CT enterography in diagnosing adult hypertrophic pyloric stenosis PubMed Central
- Meissner W et al, 2011, Enteral naloxone reduces gastric tube reflux and frequency of pneumonia in critical care patients during opioid analgesia PubMed
- Cucchiara S et al, 1996, Ultrasound measurement of gastric emptying time in patients with cystic fibrosis and effect of ranitidine on delayed gastric emptying PubMed
- Ohita Y et al, 1993, Effects of various histamine H2-receptor antagonists on gastrointestinal motility and gastric emptying PubMed
- Takahashi Y et al, 2006, Influence of acid suppressants on gastric emptying: cross-over analysis in healthy volunteers PubMed
- Parikh R, 1994, Ranitidine bismuth citrate and ranitidine do not affect PubMed Central
- Parkman HP et al, 1998, Effect of gastric acid suppressants on human gastric motility PubMed Central
- Tack J et al, 2009, Pathophysiology, diagnosis and management of postoperative dumping syndrome Europe PubMed Central
- Papathanasopoulos A et al, 2010, Dietary Fiber Supplements: Effects in Obesity and Metabolic Syndrome and Relationship to Gastrointestinal Functions PubMed Central
- 2004, American Gastroenterological Association Technical Review on the Diagnosis and Treatment of Gastroparesis Perelman School of Medicine at University of Pennsylvania
- Foster C, 1993, Gastric emptying during exercise: Influence of carbohydrate concentration, carbohydrate source and exercise intensity National Academic Press
- Foster C, 1993, Gastric emptying during exercise: Influence of carbohydrate concentration, carbohydrate source and exercise intensity National Academic Press
- Foster C, 1993, Gastric emptying during exercise: Influence of carbohydrate concentration, carbohydrate source and exercise intensity National Academic Press
- Maughan RJ et al, 2003, Gastric emptying and fluid availability after ingestion of glucose and soy protein hydrolysate solutions in man Wiley Online Library
- Urbain JL et al, 1989, Effect of solid-meal caloric content on gastric emptying kinetics of solids and liquids
PubMed - Mackie A et al, 2012, High fat food increases gastric residence and thus thresholds for objective symptoms in allergic patients PubMed
- Gentilcore D et al, 2013, Effects of Fat on Gastric Emptying of and the Glycemic, Insulin, and Incretin Responses to a Carbohydrate Meal in Type 2 Diabetes Endocrine Society
- Olausson EA et al, 2013, Small particle size of a solid meal increases gastric emptying and late postprandial glycaemic response in diabetic subjects with gastroparesis DrugLib
- Holt S et al, 1982, Gastric emptying of solids in man PubMed Central
- Collins PJ et al, 1983, Gastric emptying in normal subjects a reproducible technique using a single scintillation camera and computer system PubMed Central
- Hunt JN et al, 1975, THE VOLUME AND ENERGY CONTENT OF MEALS AS DETERMINANTS OF GASTRIC EMPTYING PubMed Central
- Bonner JJ et al, Does age affect gastric emptying time? A model-based meta-analysis of data from premature neonates through to adults PubMed
- Borovicka J et al, 2000, Role of lipase in the regulation of postprandial gastric acid secretion and emptying of fat in humans: a study with orlistat, a highly specific lipase inhibitor Gut
- Pilichiewicz A et al, 2003, Effect of Lipase Inhibition on Gastric Emptying of, and the Glycemic and Incretin Responses to, an Oil/Aqueous Drink in Type 2 Diabetes Mellitus Endocrine Society
- Hunt J et al, 1968, relation between the chain length of fatty acids and the slowing of gastric emptying Wiley Online Library
- McLaughlin J et al, Fatty acid chain length determines cholecystokinin secretion and effect on human gastric motility PubMed
- Sakamoto Y et al, 2011, Mosapride Accelerates the Delayed Gastric Emptying of High-Viscosity Liquids: A Crossover Study Using Continuous Real-Time 13C Breath Test (BreathID System) PubMed Central
- Marciani L et al, 2001, Effect of meal viscosity and nutrients on satiety, intragastric dilution, and emptying assessed by MRI American Journal of Physiology, Gastrointestinal and Liver Physiology
- Guar gum Drugs.com
- Lucena AF et al, 2011, Influence of acute brain injuries on gut motility PubMed
- Benini L et al, 2003, Gastric emptying of a solid meal is accelerated by the removal of dietary fibre naturally present in food PubMed Central
- Patterson D et al, 1999, A double-blind multicenter comparison of domperidone and metoclopramide in the treatment of diabetic patients with symptoms of gastroparesis PubMed
- Glucomannan Drugs.com
- Juvonen KR et al, Viscosity of Oat Bran-Enriched Beverages Influences Gastrointestinal Hormonal Responses in Healthy Humans The Journal of Nutrition
- Collares EF et al, 1981, Gastric emptying in children. I. Influence of the temperature of a hydration solution for oral use PubMed
- Franke A et al, 2005, THE EFFECT OF ETHANOL AND ALCOHOLIC BEVERAGES ON GASTRIC EMPTYING OF SOLID MEALS IN HUMANS Alcohol and Alcoholism
- Inamori M et al, 2009, Aperitif effects on gastric emptying: a crossover study using continuous real-time 13C breath test (BreathID System) PubMed
- Hasler WL, 2012, Gastroparesis Medscape
- Shafer RB et al, 1985, Do calories, osmolality, or calcium determine gastric emptying? American Journal of Physiology, Regulatory, Integrative and Comparative Physiology
- Cheng C, 2006, Gastric emptying The Chinese University of Hong Kong
- Jolliffe DM, 2009, Practical gastric physiology Continuing Education in Anaesthesia, Critical care & Pain
- Leiper JB et al, 2005, The effect of intermittent high-intensity running on gastric emptying of fluids in man PubMed
- Ryan AJ et al, 1998, Effect of hypohydration on gastric emptying and intestinal absorption during exercise Journal of Applied Physiology
- Nieuwenhoven MA et al, 2000, Effect of dehydration on gastrointestinal function at rest and during exercise in humans PubMed
- Neufer PD et al, 1989, Gastric emptying during exercise: effects of heat stress and hypohydration PubMed
- Islas Andrade S et al, 1989, Effect of fever on gastric emptying and on serum gastrin levels PubMed
- Sallam HS et al, 2011, Gastric emptying and intestinal transit of various enteral feedings following severe burn injury PubMed
- Kashyap P et al, 2010, Diabetic Gastroparesis: what we have learned and had to unlearn in the past 5 years PubMed Central
- Woerle HJ et al, 2008, Impaired Hyperglycemia-Induced Delay in Gastric Emptying in Patients With Type 1 Diabetes Deficient for Islet Amyloid Polypeptide PubMed Central
- Troncon LE et al, 1993, Abnormal progression of a liquid meal through the stomach and small intestine in patients with Chagas’ disease PubMed
- Kebede D et al, 1987, Transient gastroparesis associated with cutaneous herpes zoster PubMed
- Cagir B, Ileus clinical presentation Emedicine
- Walsh RM et al, 2009, Current therapies to shorten postoperative ileus Cleveland Clinic Journal of Medicine
- Kapoor KP, Vagotomy Emedicine
- Malagelada JR et al, 1980, Gastric motor abnormalities in diabetic and postvagotomy gastroparesis: effect of metoclopramide and bethanechol PubMed
- Pfab F et al, 2011, Acupuncture in Critically Ill Patients Improves Delayed Gastric Emptying: A Randomized Controlled Trial PubMed Central
- Kojecky J et al, 2008, Prevalence and determinants of delayed gastric emptying in hospitalised Type 2 diabetic patients PubMed Central
- Gonlachanvit S et al, 2003, Ginger Reduces Hyperglycemia-Evoked Gastric Dysrhythmias in Healthy Humans: Possible Role of Endogenous Prostaglandins The Journal of Pharmacology and Experimental Therapeutics
- Rayner CK et al, 2006, Gastrointestinal motility and glycemic control in diabetes: the chicken and the egg revisited? PubMed Central
- Lacigová S et al, 2000, Gastric emptying in diabetics PubMed
- Chang J et al, 2012, A 25-Year Longitudinal Evaluation of Gastric Emptying in Diabetes Diabetes Care
- Aranha GV et al, 2003, Zero mortality after 152 consecutive pancreaticoduodenectomies with pancreaticogastrostomy PubMed
- Soykan I et al, 1998, Demography, clinical characteristics, psychological and abuse profiles, treatment, and long-term follow-up of patients with gastroparesis PubMed
- Caballero-Plasencia AM et al, Altered gastric emptying in patients with irritable bowel syndrome, 1999, PubMed
- Burnet RB et al, 2004, Gastric emptying is slow in chronic fatigue syndrome PubMed Central
- Waseem S et al, 2009, Gastroparesis: Current diagnostic challenges and management considerations PubMed Central
- Tosetti C et al, 2000, Gastric emptying and dyspeptic symptoms in patients with nonautoimmune fundic atrophic gastritis PubMed
- Bais JE et al, 2001, Impact of Delayed Gastric Emptying on the Outcome of Antireflux Surgery PubMed Central
- McCallum RW et al, 1981, Gastric emptying in patients with gastroesophageal reflux PubMed
- Engler-Pinto P et al, 1995, Gastric emptying of 99mTc tagged solid food in gastric and duodenal ulceration PubMed
- Kurosaki I et al, 2005, Clinical and surgical factors influencing delayed gastric emptying after pyloric-preserving pancreaticoduodenectomy PubMed
- Gastroparesis IFFGD
- Barkin JS et al, 1986, Pancreatic carcinoma is associated with delayed gastric emptying PubMed
- Arts J et al, 2006, Influence of intrapyloric botulinum toxin injection on gastric emptying and meal-related symptoms in gastroparesis patients PubMed
- Marciani L et al, 2005, Gallbladder contraction, gastric emptying and antral motility: single visit assessment of upper GI function in untreated celiac disease using echo-planar MRI PubMed
- Perri F et al, 2000, Gastric emptying of solids is delayed in celiac disease and normalizes after gluten withdrawal PubMed
- Rigaud D et al, 1988, Delayed gastric emptying in anorexia nervosa is improved by completion of a renutrition program PubMed
- Kanth R Dumping syndrome treatment and management Emedicine
- Schoonjars R et al, 2002, Gastric emptying of solids in cirrhotic and peritoneal dialysis patients: influence of peritoneal volume load PubMed
- Larson JM et al, 2010, Advantages of Azithromycin Over Erythromycin in Improving the Gastric Emptying Half-Time in Adult Patients With Gastroparesis PubMed
- Gastroparesis National Institute of Diabetes and Digestive and Kidney Diseases
- Masaoka T et al, 2009, Gastroparesis: Current Concepts and Management PubMed Central
- Parkman HP et al, 2010, Gastroparesis and functional dyspepsia: excerpts from the AGA/ANMS meeting American Neurogastroenterology and Motility Society
- Medications that Delay Gastric Emptying Family Practice Notebook
- Miller G et al, 1989, Smoking delays gastric emptying of solids Gut
- Gritz ER et al, 1988, The effect of nicotine on the delay of gastric emptying Wiley Online Library
- Borg J et al, 2012, Oxytocin prolongs the gastric emptying time in patients with diabetes mellitus and gastroparesis, but does not affect satiety or volume intake in patients with functional dyspepsia PubMed Central
- Sanaka M et al, 2010, Effects of proton pump inhibitors on gastric emptying: a systematic review PubMed
- Adams BK et al, 2004, Prolonged gastric emptying half-time and gastric hypomotility after drug overdose PubMed
- Jaup BH et al, 1981, The effect of pirenzepine and L-hyoscyamine on gastric emptying and salivary secretion in healthy volunteers PubMed
- Linnebjerg H et al, Effect of exenatide on gastric emptying and relationship to postprandial glycemia in type 2 diabetes Europe PubMed Central
- Ramsbottom N et al, 1970, Studies of the effect of metoclopramide and apomorphine on gastric emptying and secretion in man PubMed
- Cuomo R et al, 2011, The role of a pre-load beverage on gastric volume and food intake: comparison between non-caloric carbonated and non-carbonated beverage PubMed Central
- Pouderoux P et al, 1997, Effect of carbonated water on gastric emptying and intragastric meal distribution PubMed
- Kroop HS et al, 1979, Effect of water and fat on gastric emptying of solid meals PubMed
- Franke A et al, 2008, Postprandial Walking but not Consumption of Alcoholic Digestifs or Espresso Accelerates Gastric Emptying in Healthy Volunteers Journal of Gastrointestinal and Liver Diseases
- Wu KL et al, 2008, Effects of ginger on gastric emptying and motility in healthy humans PubMed
- Hu ML et al, 2011, Effect of ginger on gastric motility and symptoms of functional dyspepsia PubMed Central
- McCallum RW et al, 1983, A multicenter placebo-controlled clinical trial of oral metoclopramide in diabetic gastroparesis PubMed
- Madsen JL et al, 2008, Effects of the H2-receptor antagonist ranitidine on gastric motor function after a liquid meal in healthy humans PubMed
- Salbe AD et al, 2009, Vinegar lacks antiglycemic action on enteral carbohydrate absorption in human subjects PubMed
- Brighenti F et al, 1995, Effect of neutralized and native vinegar on blood glucose and acetate responses to a mixed meal in healthy subjects PubMed
- Coon JT, 2002, Herbal medicinal products for non-ulcer dyspepsia Wiley Online Library
- Sakamoto Y et al, 2011, Change of Gastric Emptying With Chewing Gum: Evaluation Using a Continuous Real-Time 13C Breath Test (BreathID System), PubMed Central
- Attila P et al, 2005, Feasibility and safety of endoscopic evaluation of gastric emptying PubMed
- Bolvig L et al, 1990, Final gastric emptying of solid food in healthy subjects: determined by X-ray examination and radionuclide imaging PubMed
- Abrahamsson H et al, 2007, Treatment options for patients with severe gastroparesis PubMed Central
- Sturm A et al, 1999, Prokinetics in patients with gastroparesis: a systematic analysis PubMed Central
- Keld R et al, 2011, Pathogenesis, investigation and dietary and medical management of gastroparesis Wiley Online Library
- Buchholz V et al, 2013, Gastric emptying is not prolonged in obese patients PubMed
- Verdich C et al, 2000, Effect of obesity and major weight reduction on gastric emptying International Journal of Obesity
- Gastroparesis American Diabetes Association
- Jones KL et al, 2001, Predictors of Delayed Gastric Emptying in Diabetes Diabetes Care
- Bielefeldt K et al, 2009, Different faces of gastroparesis PubMed Central
- Lacy BE et al, 2004, The treatment of diabetic gastroparesis with botulinum toxin injection of the pylorus PubMed
- Abell TL et al, 2006, Nutrition aspects of gastroparesis and therapies for drug-refractory patients PubMed
- Janssens J et al, 1990, Improvement of Gastric Emptying in Diabetic Gastroparesis by Erythromycin — Preliminary Studies The New England Journal of Medicine
Gastric Emptying
Normal Stomach Emptying
The rate of normal gastric emptying ranges from 1 to 4.5 Calories per minute [1,2,3,4]. Nutrients (carbohydrates, fats and proteins) that empty from the stomach into the duodenum trigger negative feedback via the vagus nerve, which delays gastric emptying and thus adjusts the amount of food that can be released from the stomach to the absorptive capacity of the small intestine [5].
The upper part of the stomach (fundus) has a main role in emptying of solids and the lower one (antrum) in emptying of liquids [6].
Factors that STIMULATE Gastric Emptying
1. Food Factors
- The volume of either solid or liquid foods [40,41,42].
- Small particle size of solid foods [85,86].
2. Body Factors
- Moderate exercise, like walking [43,44] or moderate cycling [45]
- Hypoglycemia [48,49]
- Functional dyspepsia [51,52,53]
- Duodenal ulcer [54,55]
- Alcoholic neuropathy [56]
- Certain gastric (stomach) operations, such as partial surgical removal of the stomach (gastrectomy) [57] or vagotomy [58], or gastric bypass (bariatric surgery) [59] or gastrin-secreting pancreatic tumor causing multiple gastric ulcers (Zollinger-Ellison syndrome) [60]
- Dysfunction of the autonomic nervous system [62]
- Cyclic vomiting syndrome in adults [63,64]
3. Drugs
Drugs that stimulate gastric emptying: azithromycin, beta blockers [10], bethanecol, cisapride, clarithromycin, diazepam, domperidone, erythromycin, metoclopramide, naloxone (used to stimulate gastric emptying in critically ill individuals treated with opioids) [11,69], prostaglandine E2 [11], pyridostigmine (used in treatment of diabetic gastroparesis) [11,66].
H2 antagonists ranitidine, famotidine and nizatidine may or may not stimulate gastric emptying [70,71,72,73,74,167].
Stopping smoking can be associated with faster gastric emptying and thus with decreased satiety [47].
Symptoms of Rapid Gastric Emptying (Dumping Syndrome)
Early symptoms (10-30 minutes after meals) include bloating, nausea, vomiting, abdominal cramps and explosive diarrhea [60].
Late symptoms (1-3 hours after meals), which result from reactive hypoglycemia, include flushing, pale, clammy skin, dizziness upon standing (orthostatic hypotension), headache, impaired consciousness, increased heart rate, palpitations, hunger, tremor, fatigue and sleepiness [57,60,61,75].
Diet in Rapid Gastric Emptying
To avoid: easily digesting carbohydrates (sugars, baked goods from white bread, potatoes, white rice), milk and other dairy products; also avoid liquids within 30 minutes after meals [57,145].
To add into the diet: dietary fiber that slows gastric emptying: pectin, guar gum, glucomannan [76,96,145].
Factors That SLOW Gastric Emptying
1. Food Factors
- Calorie content [81,82] and caloric density (calories per gram) of a meal [87,88].
- Fatty foods, such as chocolate [83], delay gastric emptying, probably due to their high calorie content [84]; solid fats delay emptying more than liquid fats (oils, milk) [41]. A drug orlistat, which inhibits the enzyme lipase and thus slows the digestion of fats to fatty acids, increases gastric emptying rate in healthy individuals by about 50% [90] and increases blood glucose levels after liquid oil-glucose meals by 35% [91]. Long-chain fatty acids with 12 or more C atoms delay gastric emptying but short- and medium-chain fatty acids with less than 10 C atoms do not [92,93].
- Viscosity of the food. Non-viscous fluids are emptied fastest, followed by viscous fluids, pureed foods, solid foods and finally, poorly chewed solid foods [16,41,94,95]. Certain viscous soluble fiber, such as guar gum (in doses >5 g) [76,96], pectin (in doses >10 g) [76], agar and glucomannan [100,101] can delay gastric emptying.
- Alcohol. Beer and red wine can delay gastric emptying of solid foods [103] and a Japanese aperitif umeshu (14% abv) can delay emptying of liquids [104].
- Calcium supplements slow gastric emptying [106].
2. Physiological Factors
- Factors that stimulate sympathetic nerves, such as anxiety, fear, stress and pain [107,108]
- Physical exercise above 70% intensity or in a hot environment (120 °F or 49° C) [109,110,111,112]
- Pregnancy, probably due to high progesterone levels [16,17,107]
3. Health Conditions
ACUTE health conditions:
- Fever [113]
- Severe trauma [94] or burns [114]
- Hyperglycemia in some, but not all, diabetics [115,116]
- Brain tumor or trauma associated with elevated intracranial pressure [97]
- Abdominal surgery can be followed by a temporary paralysis of the bowel (ileus) [119,120]. Resection of the vagus nerve (vagotomy) may temporarily reduce gastric emptying rate [16,121,122]. Anxiousness before surgery and immobilization after surgery may result in severely prolonged gastric emptying (>10 hours) [123].
- Radiation therapy [105]
CHRONIC health conditions:
- Diabetes type 1 and 2 [124]; NOTE: Some individuals with diabetes type 1 or 2 may have rapid gastric emptying due to dysfunction of the vagus nerve (autonomic neuropathy) or other causes [50]. Chronic hyperglycemia [16,48,125] and to a much lesser extent autonomic neuropathy [124,126] are associated with slow gastric emptying in individuals with poorly controlled diabetes. The severity of symptoms (nausea, bloating) does not necessary correlate with the extent of the gastric emptying delay [124,127]. The rate of gastric emptying does not change much in a course of diabetes in a certain individual [128].
- Surgery: gastric surgery, gastric bypass, pancreatic resection [129], gallbladder removal, lung or heart transplantation [10,16,130].
- Idiopathic gastroparesis is delayed gastric emptying without a known cause [16,65]. Individuals officially diagnosed with functional dyspepsia, irritable bowel syndrome (IBS) [16,131] or chronic fatigue syndrome (CFS) [132] can actually have delayed gastric emptying. Emptying of liquids is rarely delayed even in severe gastroparesis [133].
- Depression [16,112]
- Anorexia nervosa [144]
- Gastric and duodenal disorders: duodenal adhesions, amyloidosis, atrophic gastritis with or without pernicious anemia or achlorhydria [134], bezoar, cancer, caustic injury, gastric reflux – GERD [135,136], peptic ulcer [54,137], polymyositis, polyps, scleroderma, systemic lupus erythematosus (SLE) [16,138,139]
- Cancers: gastric, duodenal, pancreatic [16,139,140], paraneoplastic syndrome associated with small-cell lung carcinoma [16]
- Celiac disease [142,143], Crohn’s disease [16]
- Congenital disorders: cystic fibrosis [16], myotonic muscular dystrophy [16], hypertrophic pyloric stenosis [68], Turner’s syndrome [16]
- Hormonal disorders: adrenal insufficiency (Addison’s disease), hyperthyroidism, hypothyroidism [16]
- Liver cirrhosis, chronic pancreatitis [16,146]
- Neurological disorders: brain tumor, multiple sclerosis, Parkinson’s disease, brain stem stroke, neuropathy (damage of the vagus nerve) [148], autonomic dysfunction [62]
- Physical or sexual abuse in women [130,149]
- Post-infectious gastroparesis, a common cause of “functional dyspepsia,” after infection with citomegalovirus (CMV), Epstein-Barr virus (EBV) (infectious mononucleosis), Herpes zoster (Varicella zoster), Rotavirus (stomach flu), Salmonella or Giardia (food poisoning), Borellia (Lyme disease), HIV/AIDS, Chagas disease (Trypanosoma cruzi), or after vaccination may last from several weeks to more than a year [13,16,117,118,150].
- Chronic renal insufficiency [16]
- Spinal cord injury (tetraplegics) [105]
4. Medications
- Analgesics: acetaminophen
- Anesthetics
- Anti-asthmatics: adrenaline or epinephrine, dobutamine, salbutamol
- Anti-cancer drugs: chemotherapy, interferon alpha
- Anticholinergics: atropine, bentyl, levsin, oxybutinin
- Antidepressants: tricyclic antideprtessants (amitriptyline, doxepin), SSRIs (fluoxetine, paxil)
- Anti-diabetics: exenatide, liraglutide
- Antiemetic ondansetron
- Anti-epileptics: carbamazepine
- Antihistamines: loratadine, diphenhydramine
- Anti-malarics: chloroquine
- Anti-parkinsonian drugs: L-dopa
- Antipsihotics: lithium
- Gastric acid-lowering drugs: antacids (aluminum hydroxide), H2 inhibitors (ranitidine), protein pump inhibitors (omeprazole), sucralfate (in individuals with duodenal ulcer) [55]
- Hormones: calcitonin, glucagon, octreoide, oxytocin, progesterone
- Intravenous nutrition
- Marijuana, nicotine
- Opioids: codeine, fentanyl, methadone, morphine, tramadol
- Potassium supplements
- Sedatives
- Vaccination for tetanus, hepatitis
- YGD (Yerba Mate leaves, Guarana seeds, Damiana leaves)
- References: [4,16,77,108,151,152,153,154,155,156,157,158]
Symptoms of Slow Gastric Emptying
Symptoms of delay gastric emptying occur soon after eating and can include early satiety, heartburn, frequent burping, acid reflux, nausea, abdominal pain after eating, constipation, diarrhea, unintentional weight loss [16,152,179,148,180], depression and anxiety [181]. Intensity of symptoms is not necessary related with the extent of gastric delay [182].
Complications of slow gastric emptying may include hypoglycemia in individuals with insulin-dependent diabetes [13] and malnutrition caused by irregular eating due to poor appetite [148,183].
Measures to Improve Digestion in Delayed Gastric Emptying
- Have smaller and more frequent meals, choose liquid rather than solid meals.
- Avoid solid fats (oils may be well tolerated), soluble fiber (beans, oats, barley, dried fruits), large amounts of alcohol
- Chew the food well.
- Avoid smoking and unnecessary stress.
- References: [10,16,150]
Medications to treat slow gastric emptying:
- Erythromycin [10,174,175,184]; tolerance can develop with time
- Metoclopramide [10,159,166,174,176,183] may not be very effective in reducing symptoms; it also has several side effects; it is intended for a short-term treatment [10].
- Mitemcinal [27]
- Domperidone has fewer side effects than metoclopramide [174,175,176,192] but is not approved by the U.S. Food and Drug Administration (FDA), though [183].
- Bethanechol [10]
- Mirtazapine and tricyclic antidepressants (in refractory cases) [10,176]
- Botulinus toxin injections [10]
- Gastric electric stimulation [10,182]
- Gastrostomy, jejunostomy or gastric resection [10]
- Botulinus toxin injected to pylorus (in diabetic gastroparesis) [141,182]
- Azithromycin [133,141]
Drugs to relieve nausea in delayed gastric emptying:
- Phenothiazines: prochlorperazine, trimethobenzamide, and promethazine [10]
- Ondansetron and benzodiazepines can help relieve nausea in individuals on chemotherapy [10]
- Antihistamines: diphenhydramine, dimenhydrinate and meclizine [10]
What May Not Affect Gastric Emptying
Foods:
- Carbonated beverages probably do not significantly affect gastric emptying, but this can vary greatly among individuals [38,160,161].
- The type of a macronutrient (carbohydrates, proteins or fats) [81,88]
- Water (up to 1 liter) taken with solid meals does not significantly accelerate stomach emptying [162].
- Alcohol digestifs (40% abv) may stimulate gastric emptying, but this may vary greatly among individuals [163].
- Espresso coffee [163]
- Ginger [164,165]
- Vinegar [168,169,170]
- Chewing gum [171]
Conditions:
- The body position [51]
- Age [89,107]
- Obesity [177,178]
Emptying of LIQUIDS
The faster the emptying of liquids from the stomach, the faster their absorption in the small intestine. A certain individual empties liquids of the same type, calorie content, amount and temperature at about the same rate [30].
What stimulates the gastric emptying of liquids: the volume of the liquid [31,32].
What slows gastric emptying of liquids:
- Solid foods [33]
- Carbohydrate content as low as 2.5%, but usually only when higher than 7%, and especially when higher than 10%, can slow gastric emptying of liquids [34,35,78,79].
- Glucose added to water slows gastric emptying more than galactose and this more than fructose [78].
- Liquids that are much colder than the body temperature (98.6 °F or 37 °C) can slow stomach emptying [102].
- Exercise at intensities greater than 60% can slow gastric emptying of water and carbohydrate solutions [80]. In trained marathon runners, running had no effect on the gastric emptying of solid meals [46].
- Fiber added to liquid meals slows their emptying from the stomach [98].
Half-emptying time of 500 mL of different beverages in 2 studies [36,37]:
- Water: 15-30 minutes
- Fructose solution (10%): 60 minutes
- Glucose solution (10%): 65-90 minutes
- Beer (4% abv): 40 minutes
- Red wine (10% abv): 75 minutes
- 125 mL of whiskey (40 vol% alcohol) followed by 125 mL water: 25 minutes
Emptying of SOLIDS
Solid foods can empty from the stomach in 3-6 hours [39,172,173]. Solids empty from the stomach when they are ground to less than 2 mm size particles [4,39].
Gastrointestinal Hormones that Regulate Gastric Emptying
Gastrointestinal hormones that stimulate gastric emptying: amylin (a pancreatic hormone), gastric inhibitory polypeptide (GIP) [7], ghrelin [8,9], motilin [8] and its synthetic analog mitemcinal [27].
Gastrointestinal hormones that (may) slow gastric emptying: amylin (a hormone secreted from the pancreas) [22] and its synthetic analog pramlintide [23] cholecystokinin (CKK) [8,13,14], glucagon [10,11], glucagon-like peptide-1 (GLP-1) [4,8,20,21], leptin [25], pancreatic polypeptide [28], peptide YY (PYY) [8], secretin [29] and somatostatin [18,19].
Other hormones that may slow gastric emptying: calcitonin [10,11], dopamine [12,15], enkephalins (endogenous opioids) [24], melatonin (in pharmacological doses) [26], octreoide [10] and progesterone [16,17].
Alcohol
- Alcohol chemical and physical properties
- Alcoholic beverages types (beer, wine, spirits)
- Denatured alcohol
- Alcohol absorption, metabolism, elimination
- Alcohol and body temperature
- Alcohol and the skin
- Alcohol, appetite and digestion
- Neurological effects of alcohol
- Alcohol, hormones and neurotransmitters
- Alcohol and pain
- Alcohol, blood pressure, heart disease and stroke
- Women, pregnancy, children and alcohol
- Alcohol tolerance
- Alcohol, blood glucose and diabetes
- Alcohol intolerance, allergy and headache
- Alcohol and psychological disorders
- Alcohol and vitamin, mineral and protein deficiency
- Alcohol-drug interactions
- Fructose
- Galactose
- Glucose
- Isomaltose
- Isomaltulose
- Lactose
- Maltose
- Mannose
- Sucrose
- Tagatose
- Trehalose
- Trehalulose
- Xylose
- Erythritol
- Glycerol
- Hydrogenated starch hydrolysates (HSH)
- Inositol
- Isomalt
- Lactitol
- Maltitol
- Mannitol
- Sorbitol
- Xylitol
- Fructo-oligosaccharides (FOS)
- Galacto-oligosaccharides (GOS)
- Human milk oligosaccharides (HMO)
- Isomalto-oligosaccharides (IMO)
- Maltotriose
- Mannan oligosaccharides (MOS)
- Raffinose, stachyose, verbascose
- SOLUBLE FIBER:
- Acacia (arabic) gum
- Agar-agar
- Algin-alginate
- Arabynoxylan
- Beta-glucan
- Beta mannan
- Carageenan gum
- Carob or locust bean gum
- Fenugreek gum
- Galactomannans
- Gellan gum
- Glucomannan or konjac gum
- Guar gum
- Hemicellulose
- Inulin
- Karaya gum
- Pectin
- Polydextrose
- Psyllium husk mucilage
- Resistant starches
- Tara gum
- Tragacanth gum
- Xanthan gum
- INSOLUBLE FIBER:
- Cellulose
- Chitin and chitosan
- FATTY ACIDS
- Saturated
- Monounsaturated
- Polyunsaturated
- Short-chain fatty acids (SCFAs)
- Medium-chain fatty acids (MCFAs)
- Long-chain fatty acids (LCFAs)
- Very long-chain fatty acids (VLCFAs)
- Monoglycerides
- Diglycerides
- Triglycerides
- Vitamin A - Retinol and retinal
- Vitamin B1 - Thiamine
- Vitamin B2 - Riboflavin
- Vitamin B3 - Niacin
- Vitamin B5 - Pantothenic acid
- Vitamin B6 - Pyridoxine
- Vitamin B7 - Biotin
- Vitamin B9 - Folic acid
- Vitamin B12 - Cobalamin
- Choline
- Vitamin C - Ascorbic acid
- Vitamin D - Ergocalciferol and cholecalciferol
- Vitamin E - Tocopherol
- Vitamin K - Phylloquinone
- Curcumin
- FLAVONOIDS:
- Anthocyanidins
- Flavanols: Proanthocyanidins
- Flavanones: Hesperidin
- Flavonols: Quercetin
- Flavones: Diosmin, Luteolin
- Isoflavones: daidzein, genistein
- Caffeic acid
- Chlorogenic acid
- Lignans
- Resveratrol
- Tannins
- Tannic acid
7 Responses to "Gastric Emptying"