Proceedings: Gastric emptying rate measurement in man: a method for simultaneous study of solid and liquid phases.
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Biomedical subjects
Publications and source records attributed to R C Heading.
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The rate of paracetamol absorption depends on the rate of gastric emptying. Propantheline delayed gastric emptying and markedly slowed the absorption of paracetamol in six convalescent hospital patients. Conversely, the absorption of paracetamol in five healthy volunteers was accelerated by metoclopramide, a drug which stimulates gastric emptying. The total 24-hour urinary excretion of paracetamol was not influenced by propantheline or metoclopramide. Other similar absorption interactions probably occur since drugs are poorly absorbed from the stomach and many therapeutic agents influence gastrointestinal motility.
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1. The rate of gastric emptying was measured directly in 14 convalescent hospital patients and paracetamol absorption was studied following an oral dose of 1.5 g.2. Rapid gastric emptying was associated with the early appearance of high peak plasma paracetamol concentrations whereas peak concentrations were low and occurred late when gastric emptying was slow.3. There was a significant correlation between the rate of gastric emptying and the 0-4 and 0-24 h urinary excretion of paracetamol and its metabolites.4. In five patients with abnormally slow gastric emptying the mean maximum plasma concentration and 0-4 and 0-24 h urinary excretion of paracetamol were significantly lower than in seven patients with normal gastric emptying rates while the time taken to reach maximum plasma concentrations was longer.5. Individual differences in the rate of gastric emptying may contribute to variable absorption of many drugs.
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Gastro-esophageal reflux disease encompasses a spectrum of disorders in which gastric reflux leads to symptoms and/or damage to the esophageal mucosa. Although a common problem in clinical practice, our understanding of the pathophysiology of the condition has not been matched by our knowledge of its epidemiology and natural history. This review examines some of the difficulties inherent in epidemiological studies with particular emphasis on the nature and variety of reflux symptoms and their relationship to esophagitis, the natural history and complications of reflux disease, Barrett's esophagus, and the possible role of gastroesophageal reflux in lung disease, especially asthma.
Although upper gastrointestinal endoscopy is generally a safe procedure, it is known to be associated with arterial oxygen desaturation. We studied 82 patients undergoing diagnostic upper gastrointestinal endoscopy following a standard premedication consisting of xylocaine throat spray and intravenous midazolam. The mean duration of endoscopy was 8.5 +/- 0.42 min and the mean dose of midazolam was 6.3 +/- 0.15 mg. The baseline SaO2 was 94.91 +/- 0.27% and it decreased after pre-medication to 92.84 +/- 0.40% (p < 0.001) and after intubation to 91.21 +/- 0.40% (p < 0.001). A fall greater than 4% saturation occurred for 15.68% of the total endoscopy time. SaO2 < 90% was seen for 16.7% and SaO2 < 85% occurred for 2.33% total endoscopy time. In patients > 65 years old, hemoglobin < 10 g/dl, or body mass index > 28, the baseline saturation was significantly lower and a reduced SaO2 was seen throughout the procedure. We identify old age, anemia, and obesity as independent risk factors for arterial oxygen desaturation. We recommend continuous monitoring before sedation, and giving supplemental oxygen to patients with these risk factors from the outset of upper gastrointestinal endoscopy.