Effect of Aging on Transpyloric Flow, Gastric Emptying, and Intragastric Distribution In Healthy Humans—Impact on Glycemia
The aims of this study were to evaluate (i) the relationship between transpyloric flow (TF) assessed by Doppler ultrasonography and scintigraphy, (ii) the effects of healthy aging on TF and gastric emptying (GE), and (iii) the relationship between the glycemic response to oral glucose and TF. Ten healthy “young” (7 M, 3 F) and 8 “older” (4 M, 4 F), subjects had simultaneous measurements of TF, GE, and blood glucose after a 600-ml drink (75 g glucose labeled with 20 MBq 99mTc-sulfur colloid) while seated. TF measured by ultrasound was measured during drink ingestion and for 30 min thereafter. GE was measured scintigraphically for 180 min after drink ingestion. Blood glucose was measured before the drink and at regular intervals until 180 min. During drink ingestion, TF was greater (P < 0.05) and GE faster (retention at 60 min: 70.8 ± 3.3 vs. 83.8 ± 4.6%; P < 0.05) in young compared to older subjects. There was no difference in fasting blood glucose between the two groups but the magnitude of the rise in blood glucose was greater in the young compared to the older subjects; (at 15 min 2.4 ± 0.3 vs. 1.5 ± 0.5 mmol/L; P < 0.05). In contrast, after 90 min blood glucose concentrations were higher in the older subjects. There were significant relationships between the early blood glucose concentration and both TF (e.g., at 15 min: r = 0.56, P < 0.05) and GE (e.g., at 15 min: r = −0.51, P < 0.05). In conclusion, the results of this study indicate that (i) TF is initially less, and GE slower, in older compared to young subjects; (ii) the initial glycemic response to oral glucose is related to TF; and (iii) measurements of TF by ultrasound and scintigraphy correlate significantly.
Keywordsgastric emptying transpyloric flow elderly blood glucose
Anvari M, Dent J, Malbert C, Jamieson GG: Mechanics of pulsatile transpyloric flow in the pig. J Physiol 488(Pt 1):193–202, 1995PubMedGoogle Scholar
King PM, Adam RD, Pryde A, McDicken WN, Heading RC: Relationships of human antroduodenal motility and transpyloric fluid movement: non-invasive observations with real-time ultrasound. Gut 25:1384–1391, 1984PubMedGoogle Scholar
Horowitz M, Edelbroek MAL, Wishart JM, Straathof JW: Relationship between oral glucose tolerance and gastric emptying in normal healthy subjects. Diabetologia 36:857–862, 1993CrossRefPubMedGoogle Scholar
Christian PE, Datz FL, Sorenson JA, Taylor A: Technical factors in gastric emptying studies. J Nucl Med 24:264–268, 1983PubMedGoogle Scholar
Horowitz M, Cook DJ, Collins PJ, Harding PE, Shearman DJ: The application of techniques using radionuclides to the study of gastric emptying. Surg Gynecol Obstet 155:737–744, 1982PubMedGoogle Scholar
Kaplan JM, Spector AC, Grill HJ: Dynamics of gastric emptying during and after stomach fill. Am J Physiol 263:R813–819, 1992PubMedGoogle Scholar
Hausken T, Gilja OH, Undeland KA, Berstad A: Timing of postprandial dyspeptic symptoms and transpyloric passage of gastric contents. Scand J Gastroenterol 33:822–827, 1998PubMedGoogle Scholar
Horowitz M, Edelbroek MAL, Wishart J, Straathof J: Relationship between oral glucose tolerance and gastric emptying in normal healthy subjects. Diabetologia 36:857–862, 1993CrossRefPubMedGoogle Scholar
Hausken T, Odegaard S, Matre K, Berstad A: Antroduodenal motility and movements of luminal contents studied by duplex sonography. Gastroenterology 102:1583–1590, 1992PubMedGoogle Scholar
Horowitz M, et al.
: Changes in gastric emptying rates with age. Clin Sci (Lond) 67:213–218, 1984Google Scholar
Nakae Y, Onouchi H, Kagaya M, Kondo T: Effects of aging and gastric lipolysis on gastric emptying of lipid in liquid meal. J Gastroenterol 34:445–449, 1999PubMedGoogle Scholar
Brogna A, Ferrara R, Bucceri AM, Lanteri E, Catalano F: Influence of aging on gastrointestinal transit time. An ultrasonographic and radiologic study. Invest Radiol 34:357–359, 1999PubMedGoogle Scholar
Gainsborough N, et al.
: The association of age with gastric emptying. Age Ageing 22:37–40, 1993PubMedGoogle Scholar
Moore JG, Tweedy C, Christian PE, Datz FL: Effect of age on gastric emptying of liquid–solid meals in man. Dig Dis Sci 28:340–344, 1983PubMedGoogle Scholar
Clarkston WK, et al.
: Evidence for the anorexia of aging: gastrointestinal transit and hunger in healthy elderly vs. young adults. Am Physiol 272:R243–R248, 1997Google Scholar
OMahoney D, OLeary P, Quigley EMM: Aging and intestinal motility—A review of factors that affect intestinal motility in the aged. Drug Aging 19:515–527, 2002Google Scholar
Evans MA, Triggs EJ, Cheung M, Broe GA, Creasey H: Gastric emptying rate in the elderly: implications for drug therapy. J Am Geriatr Soc 29:201–205, 1981PubMedGoogle Scholar
Cook CG, et al.
: Effects of small intestinal nutrient infusion on appetite and pyloric motility are modified by age. Am J Physiol 273:R755–R761, 1997PubMedGoogle Scholar
Rayner CK, MacIntosh CG, Chapman IM, Morley JE, Horowitz M: Effects of age on proximal gastric motor and sensory function. Scand J Gastroenterol 35:1041–1047, 2000PubMedGoogle Scholar
Beckoff K, et al.
: Effects of glucose supplementation on gastric emptying, blood glucose homeostasis, and appetite in the elderly. Am J Physiol Regul Integr Comp Physiol 280:R570–R576, 2001PubMedGoogle Scholar
Hausken T, Gilja OH, Odegaard S, Berstad A: Flow across the human pylorus soon after ingestion of food, studied with duplex sonography—Effect of glyceryl trinitrate. Scand J Gastroenterol 33:484–490, 1998PubMedGoogle Scholar
Collins PJ, Horowitz M, Cook DJ, Harding PE, Shearman DJC: Gastric emptying in normal subjects. A reproducible technique using a single scintillation camera and computer system. Gut 24:1117–1125, 1983PubMedGoogle Scholar
Horowitz M, et al.
: Gastrointestinal motor function in diabetes mellitus: relationship to blood glucose concentrations. J Gastroenterol Hepatol 13:S239–S245, 1998Google Scholar
Jones KL, et al.
: Rate of gastric emptying is a determinant of postprandial hypotension in non insulin-dependent diabetes mellitus. Clin Sci 94:65–70, 1998PubMedGoogle Scholar
Jones KL, et al.
: Guar gum reduces postprandial hypotension in older people. J Am Geriatr Soc 49:162–167, 2001CrossRefPubMedGoogle Scholar
Ewing DJ, Clarke BF: Diagnosis and management of diabetic autonomic neuropathy. Br Med J (Clin Res Ed) 285:916–918, 1982CrossRefGoogle Scholar
Piha SJ: Cardiovascular autonomic reflex tests: normal responses and age-related reference values. Clin Physiol 11:277–290, 1991PubMedGoogle Scholar
King PM, Pryde A, Heading RC: Transpyloric fluid movement and antroduodenal motility in patients with gastro-oesophageal reflux. Gut 28:545–548, 1987PubMedGoogle Scholar
Heading RC, King PM: Gastric emptying and transpyloric flow. In
Gastro-pyloro-duodenal Coordination. Akkermans (ed). Petersfield, UK, Wrightson Biomedical, stared on next page 1990, pp 185–195Google Scholar
Malbert CH, Mathis C: Antropyloric modulation of transpyloric flow of liquids in pigs. Gastroenterology 107:37–46, 1994PubMedGoogle Scholar
Collins PJ, Horowitz M, Chatterton BE: Proximal, distal and total stomach emptying of a digestible solid meal in normal subjects. Br J Radiol 61:12–18, 1988PubMedCrossRefGoogle Scholar
Tougas G, et al.
: Standardization of a simplified scintigraphic methodology for the assessment of gastric emptying in a multicenter setting. Am J Gastroenterol 95:78–86, 2000PubMedGoogle Scholar
Holt S, Cervantes J, Wallace JHK, Wilkinson AA: Measurement of gastric emptying rate in man by real time ultrasound. Gastroenterology 90:918–923, 1986PubMedGoogle Scholar
Hausken T, Mundt M, Samsom M: Low antroduodenal pressure gradients are responsible for gastric emptying of a low-caloric liquid meal in humans. Neurogastroenterol Motil 14:97–105, 2002PubMedGoogle Scholar
Chassagne P, et al.
: Does age influence the gastric emptying of solids? Am J Gastroenterol 98:1659–1661, 2003PubMedGoogle Scholar
O’Mahony D, O’Leary P, Quigley EM: Aging and intestinal motility: a review of factors that affect intestinal motility in the aged. Drugs Aging 19:515–527, 2002PubMedGoogle Scholar
Kao CH, Lai TL, Wang SJ, Chen GH, Yeh SH: Influence of age on gastric emptying in healthy Chinese. Clin Nucl Med 19:401–404, 1994PubMedGoogle Scholar
Berry MK, et al.
: Effect of solid meal on gastric emptying of, and glycemic and cardiovascular responses to, liquid glucose in older subjects. Am J Physiol Gastrointest Liver Physiol 284:G655–G662, 2003PubMedGoogle Scholar
Smout AJPM, et al.
: Gastric emptying and postprandial symptoms after Billroth II resection. Surgery 101:27–34, 1987PubMedGoogle Scholar
Hebbard GS, Sun WM, Bochner F, Horowitz M: Pharmacokinetic considerations in gastrointestinal motor disorders. Clin Pharmacokinet 28:41–66, 1995CrossRefPubMedGoogle Scholar
Rayner CK, Samsom M, Jones KL, Horowitz M: Relationships of upper gastrointestinal motor and sensory function with glycemic control. Diabetes Care 24:371–381, 2001PubMedGoogle Scholar
Jones KL, et al.
: Gastric emptying in early noninsulin-dependent diabetes mellitus. J Nucl Med 37:1643–1648, 1996PubMedGoogle Scholar
Schwartz JG, Guan D, Green GM, Phillips WT: Treatment with an oral proteinase inhibitor slows gastric emptying and acutely reduces glucose and insulin levels after a liquid meal in Type-II diabetic patients. Diabetes Care 17:255–262, 1994PubMedGoogle Scholar
O’Donovan D, Feinle C, Tonkin A, Horowitz M, Jones KL: Postprandial hypotension in response to duodenal glucose delivery in healthy older subjects. J Physiol 540:673–679, 2002CrossRefPubMedGoogle Scholar
Ranganath L, Sedgwick I, Morgan L, Wright J, Marks V: The ageing entero-insular axis. Diabetologia 41:1309–1313, 1998PubMedGoogle Scholar
Korosi J, et al.
: Effect of aging and diabetes on the enteroinsular axis. J Gerontol A Biol Sci Med Sci 56:M575–M579, 2001PubMedGoogle Scholar
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