Antropyloroduodenal, cholecystokinin and feeding responses to pulsatile and non-pulsatile intraduodenal lipid infusion

The definitive version is available at www.blackwell-synergy.comThe contribution of the pulsatile nature of gastric emptying to small intestinal feedback mechanisms modulating antropyloroduodenal motility and appetite is unknown. On separate days, eight healthy male volunteers (18-34 years) received randomized, single-blind, intraduodenal (ID) infusions of 10% Intralipid (2 kcal min(-1)), either continuously [CID], or in a pulsatile manner [PID] (5 s on/15 s off) and 0.9% saline (control) administered continuously, each at a rate of 1.8 mL min(-1) for 3 h. During each infusion, subjective ratings of appetite were assessed and antropyloroduodenal pressures recorded with a 16-lumen manometric assembly incorporating a pyloric sleeve sensor. Plasma cholecystokinin was measured from blood collected at regular intervals throughout the infusion. At the end of each infusion the manometric assembly was removed, subjects were offered a buffet meal and the energy and macronutrient content of the meal was measured. Both ID lipid infusions stimulated isolated pyloric pressure waves (IPPWs) (P 0.05, CID vs. PID). Both intraduodenal lipid infusions decreased hunger (P < 0.05), increased fullness (P < 0.05) and reduced energy intake (P < 0.05) when compared with controls; again there was no difference between CID and PID lipid. We conclude that at the infusion rate of similar 2 kcal min(-1), the acute effects of intraduodenal lipid on antropyloroduodenal pressures, plasma CCK concentration and appetite are not modified by a pulsatile mode of lipid delivery into the duodenum.R. Vozzo, Y-C. Su, R. J. Fraser, G. A. Wittert, M. Horowitz, C. H. Malbert,  A. Shulkes, T. Volombello & I. M. Chapma

GOR(D) and apnoea

Several mechanisms can contribute to respiratory manifestations in patients with gastro-oesophageal reflux (GOR), but pathological and causal relationship is uncommon. In most infants apnoea of short duration is a physiologic phenomenon occurring frequently in relation to an episode of GOR and a protective mechanism to prevent aspiration. Diagnostic gold standard, cut-off values and follow-up data are currently lacking making the relation between GOR or GOR disease and respiratory system difficult to clarify. When compared with pH monitoring, oesophageal impedance with simultaneous polysomnography can better demonstrate the temporal association in selected patients but should be reserved to severe or recurrent otherwise unexplained respiratory events. Empirical treatment for GOR is not recommended due to lack of evidence of efficacy and possible pharmacologically related adverse events