Pooled-data analysis identifies pyloric pressures and plasma cholecystokinin concentrations as major determinants of acute energy intake in healthy, lean men

Background: The interaction of nutrients with the small intestine modulates gastropyloroduodenal motility, stimulates the release of gut hormones, and suppresses appetite and energy intake. Objective: We evaluated which, if any, of these variables are independent determinants of acute energy intake in healthy, lean men. Design: We pooled data from 8 published studies that involved a total of 67 healthy, lean men in whom antropyloroduodenal pressures, gastrointestinal hormones, and perceptions were measured during intraduodenal nutrient or intravenous hormone infusions. In all of the studies, the energy intake at a buffet lunch was quantified immediately after the infusions. To select specific motor, hormone, or perception variables for inclusion in a multivariable mixed-effects model for determination of independent predictors of energy intake, we assessed all variables for collinearity and determined within-subject correlations between energy intake and these variables by using bivariate analyses adjusted for repeated measures. Results: Although correlations were shown between energy intake and antropyloroduodenal pressures, plasma hormone concentrations, and gastrointestinal perceptions, only the peak number of isolated pyloric-pressure waves, peak plasma cholecystokinin concentration, and area under the curve of nausea were identified as independent predictors of energy intake (all P < 0.05), so that increases of 1 pressure wave, 1 pmol/L, and 1 mm · min were associated with reductions in energy intake of 36, 88, and 0.4, respectively. Conclusion: We identified specific changes in gastrointestinal motor and hormone functions (ie, stimulation of pyloric pressures and plasma cholecystokinin) and nausea that are associated with the suppression of acute energy intake.Radhika V Seimon, Kylie Lange, Tanya J Little, Ixchel M Brennan, Amelia N Pilichiewicz, Kate L Feltrin, Astrid J Smeets, Michael Horowitz and Christine Feinle-Bisse

The Rome III Criteria for the Diagnosis of Functional Dyspepsia in Secondary Care Are Not Superior to Previous Definitions

BACKGROUND & AIMS: Although the Rome III criteria for functional dyspepsia were defined 7 years ago, they have yet to be validated in a rigorous study. We addressed this issue in a secondary-care population. METHODS: We analyzed complete symptom, upper gastrointestinal (GI) endoscopy, and histology data from 1452 consecutive adult patients with GI symptoms at 2 hospitals in Hamilton, Ontario, Canada. Assessors were blinded to symptom status. Individuals with normal upper GI endoscopy and histopathology findings from analyses of biopsy specimens were classified as having no organic GI disease. The reference standard used to define the presence of true functional dyspepsia was epigastric pain, early satiety or postprandial fullness, and no organic GI disease. Sensitivity, specificity, and positive and negative likelihood ratios (LRs), with 95% confidence intervals (CIs), were calculated. RESULTS: Of the 1452 patients, 722 (49.7%) met the Rome III criteria for functional dyspepsia. Endoscopy showed organic GI disease in 170 patients (23.5%) who met the Rome III criteria. The Rome III criteria identified patients with functional dyspepsia with 60.7% sensitivity, 68.7% specificity, a positive LR of 1.94 (95% CI, 1.69-2.22), and a negative LR of 0.57 (95% CI, 0.52-0.63). In contrast, the Rome II criteria identified patients with functional dyspepsia with 71.4% sensitivity, 55.6% specificity, a positive LR of 1.61 (95% CI, 1.45-1.78), and a negative LR of 0.51 (95% CI, 0.45-0.58). The area under a receiver operating characteristics curves did not differ significantly for any of the diagnostic criteria for functional dyspepsia. CONCLUSIONS: In a validation study of 1452 patients with GI symptoms, the Rome III criteria performed only modestly in identifying those with functional dyspepsia, and were not significantly superior to previous definitions

Endogenous amylin and glucagon-like peptide-1 concentrations are not associated with gastric emptying in critical illness

This is the pre-peer reviewed version of the following article: Summers, Matthew J.; Di Bartolomeo, Anna; Zaknic, Antony V.; Chapman, Marianne J.; Nguyen, Nam; Zacharakis, Betty; Rayner, Chris Keith; Horowitz, Michael; Deane, Adam Matthew, Endogenous amylin and glucagon-like peptide-1 concentrations are not associated with gastric emptying in critical illness, Acta Anaesthesiologica Scandinavica, 2014; 58(2):235-242, which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1111/aas.12252/abstract.BACKGROUND: In health, the hormones amylin and glucagon-like peptide-1 (GLP-1) slow gastric emptying (GE) and modulate glycaemia. The aims of this study were to determine amylin and GLP-1 concentrations in the critically ill and their relationship with GE, glucose absorption and glycaemia. METHODS: In fasted critically ill and healthy subjects (n = 26 and 23 respectively), liquid nutrient, containing 100 mg (13) C-sodium octanoate and 3 g 3-O-methlyglucose (3-OMG), was administered via a nasogastric tube. Amylin, GLP-1, glucose and 3-OMG concentrations were measured in blood samples taken during fasting, and 30 min and 60 min after the 'meal'. Breath samples were taken to determine gastric emptying coefficient (GEC). Intolerance to intragastric feeding was defined as a gastric residual volume of ≥ 250 ml and/or vomiting within the 24 h prior to the study. RESULTS: Although GE was slower (GEC: critically ill 2.8 ± 0.9 vs. health, 3.4 ± 0.2; P = 0.002), fasting blood glucose was higher (7.0 ± 1.9 vs. 5.7 ± 0.2 mmol/l; P = 0.005) and overall glucose absorption was reduced in critically ill patients (3-OMG: 9.4 ± 8.0 vs. 17.7 ± 4.9 mmol/l.60 min; P < 0.001), there were no differences in fasting or postprandial amylin concentrations. Furthermore, although fasting [1.7 (0.4-7.2) vs. 0.7 (0.3-32.0) pmol/l; P = 0.04] and postprandial [3.0 (0.4-8.5) vs. 0.8 (0.4-34.3) pmol/l; P = 0.02] GLP-1 concentrations were increased in the critically ill and were greater in feed intolerant when compared with those tolerating feed [3.7 (0.4-7.2) vs. 1.2 (0.7-4.6) pmol/l; P = 0.02], there were no relationships between GE and fasting amylin or GLP-1 concentrations. CONCLUSION: In the critically ill, fasting GLP-1, but not amylin, concentrations are elevated and associated with feed intolerance. Neither amylin nor GLP-1 appears to substantially influence the rate of GE.M. J. Summers, A. E. Di Bartolomeo, A. V. Zaknic, M. J. Chapman, N. Q. Nguyen, B. Zacharakis, C. K. Rayner, M. Horowitz and A. M. Dean

Gastroparesis and functional dyspepsia: excerpts from the AGA/ANMS meeting

Despite the relatively high prevelance of gastroparesis and functional dyspepsia, the aetiology and pathophysiology of these disorders remain incompletely understood. Similarly, the diagnostic and treatment options for these two disorders are relatively limited despite recent advances in our understanding of both disorders.This manuscript reviews the advances in the understanding of the epidemiology, pathophysiology, diagnosis, and treatment of gastroparesis and functional dyspepsia as discussed at a recent conference sponsored by the American Gastroenterological Association (AGA) and the American Neurogastroenterology and Motility Society (ANMS). Particular focus is placed on discussing unmet needs and areas for future research.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78690/1/j.1365-2982.2009.01434.x.pd

Factors involved in the regulation of gastrointestinal motility, hormone release, symptoms and energy intake in health and patients with functional dyspepsia.

This thesis presents studies relating to effects of different macronutrients, predominantly fat and carbohydrate, on gastrointestinal motility, hormone release/suppression, appetite and energy intake in healthy subjects, and on symptom generation in patients with functional dyspepsia. The three broad areas that have been investigated in these studies are: (i) the effect of load, and duration, of small intestinal nutrient exposure on gastric motility, gastrointestinal hormone release/suppression, appetite and energy intake in healthy subjects, (ii) the dietary factors that may contribute to symptom generation in patients with functional dyspepsia, through analysis of diet diaries and acute nutrient challenges, and (iii) the effects of the herbal medication, Iberogast®, on gastric motility in healthy subjects. The ingestion of nutrients, triggers a number of gastrointestinal responses, including the modulation of antropyloroduodenal motility, gastrointestinal hormone release/suppression, and the suppression of appetite and energy intake, resulting in a slowing of gastric emptying to an average rate of 1 - 3 kcal/min, which is required for efficient nutrient digestion and absorption. Additionally, the rate at which glucose enters the small intestine influences postprandial glycaemia and incretin responses. These responses have been demonstrated in animals to be dependent on the length, and region, of the small intestine exposed to fat and glucose, however, this has not been directly investigated in humans. Functional dyspepsia is a clinical condition, characterised by chronic upper abdominal symptoms, such as nausea, bloating and early fullness, without a known cause, which affects approximately 11 - 29 % of the population. Many studies have reported that disturbed gastric motor activity may be the cause of these symptoms, but patients frequently experience symptoms following ingestion of food, and some patients report to eat smaller meals more frequently and avoid fatty and spicy foods. In addition, laboratory-based studies have indicated that functional dyspepsia patients may be hypersensitive to fat, but not carbohydrate. To date, the treatments used to reduce symptoms are frequently directed at the normalisation of gastroduodenal motility, using prokinetics. However, the beneficial effect of these drugs is relatively small and variable, and their adverse effects can be substantial. Herbal drug preparations have recently received considerable interest as an alternative treatment option in functional dyspepsia. A commercially available herbal preparation, Iberogast® which contains nine plant extracts, has been reported to improve upper abdominal symptoms in functional dyspepsia and to decrease fundic tone, increase antral contractility and decrease afferent nerve sensitivity in experimental animals. The effects of Iberogast® in the human gastrointestinal tract have not been investigated. The first three studies presented in this thesis have focused on the effects of delivering fat and glucose into the small intestine at different loads (Chapter 5, 6 and 7), lower, comparable to, and higher than gastric emptying normally occurs, and at different durations of infusion (but still at similar caloric loads - Chapter 5, fat only), on gastrointestinal motility, plasma hormone release/suppression, glycaemia, and energy intake in healthy male subjects. The study in Chapter 5 demonstrated that antral pressure waves and pressure wave sequences were suppressed, and basal pyloric pressure, isolated pyloric pressure waves, and plasma cholecystokinin and peptide YY stimulated, during both the low (1.33 kcal/min for 50 min: 67 kcal/min), and high (4 kcal/min for 50 min: 200 kcal), loads of lipid. The effect of the 4 kcal/min load was sustained so that the suppression of antral pressure waves and pressure wave sequences and increase in peptide YY remained evident after cessation of the infusion. The prolonged lipid infusion (1.33 kcal/min for 150 min: 200 kcal) suppressed antral pressure waves, stimulated cholecystokinin and peptide YY and basal pyloric pressure and tended to stimulate isolated pyloric pressure waves when compared with saline throughout the entire infusion period. These results indicate that both the load, and duration, of small intestinal lipid have an influence on antropyloroduodenal motility and patterns of cholecystokinin and peptide YY release. Chapter 6 demonstrated that lipid loads lower than gastric emptying normally occurs (0.25 kcal/min for 50 min: 12.5 kcal) transiently stimulated isolated pyloric pressure waves and cholecystokinin release and suppressed pressure wave sequences and hunger scores. Loads comparable to (1.5 kcal/min for 50 min: 75 kcal) and higher (4 kcal/min for 50 min: 200 kcal), than the normal rate of gastric emptying, were required to stimulate basal pyloric tone and peptide YY release and suppress antral and duodenal pressure waves. Only the 4 kcal/min load suppressed energy intake. The effects of lipid on all parameters, with the exception of hunger, were load-dependent. In addition, there were relationships between antropyloroduodenal motility and cholecystokinin and peptide YY concentrations with energy/food intake. The study in Chapter 7 demonstrated that loads of glucose lower than (1 kcal/min for 120 min: 120 kcal), comparable to (2 kcal/min for 120 min: 240 kcal) and higher than (4 kcal/min for 120 min: 480 kcal) the rate gastric emptying normally occurs, stimulated blood glucose, plasma insulin, glucagon-like peptide-1, glucose-dependent insulinotropic polypeptide and cholecystokinin concentrations and suppressed the number of antral pressure waves, 2 and 4 kcal/min loads were required for the suppression of duodenal pressure waves and pressure wave sequences and the stimulation of basal pyloric pressure and suppression of energy intake only after the 4 kcal/min loads. There were also relationships between glucagon-like peptide-1 and glucose-dependent insulinotropic peptide with basal pyloric tone, and food/energy intake with pyloric pressures. The studies presented in the subsequent three chapters investigated the contribution of dietary factors on the generation of symptoms in patients with functional dyspepsia when compared with healthy subjects (Chapter 8 and 9) and the effect of Iberogast® on motility in the healthy gastrointestinal tract (Chapter 10). The effects of equi-caloric high-carbohydrate vs. high-fat yoghurt preloads on symptom generation, plasma hormone concentrations, antral area and energy intake were compared between functional dyspepsia patients and healthy subjects (Chapter 8). Nausea and pain were greater in patients after the high-fat, when compared with high-carbohydrate and control, preloads and with healthy subjects. Discomfort was greater after all preloads in patients when compared with healthy subjects. Fasting cholecystokinin and stimulation of cholecystokinin by the high-fat preload were greater in patients, while fasting and postprandial peptide YY were lower in patients than in healthy subjects, with no differences in fasting, or postprandial, plasma ghrelin between patients and healthy subjects. Fasting antral area was greater in patients, with no differences postprandially between patients and healthy subjects. There were no differences in energy intake between the two groups. The relationship between the effect of dietary intake and eating behaviour over a 7-day period on the occurrence and severity of abdominal symptoms was compared between patients and healthy subjects (Chapter 9). The symptoms experienced by the patients included nausea, fullness discomfort, bloating and upper abdominal, and epigastric, pain, of a modest severity, which occurred within 30 min of eating. The number of “meals” ingested was significantly less in functional dyspepsia patients and there was a trend for total energy and fat intake to be less. The occurrence of these symptoms was also statistically related to the ingestion of fat and energy intake. The results of these studies indicate that diet, particularly the ingestion of fat, influences the development of symptoms in a subgroup of patients with functional dyspepsia. The study in Chapter 10 evaluated the effect of the herbal drug Iberogast® on gastric motility in the gastrointestinal tract. Iberogast® increased proximal gastric volume, increased antral pressure waves without affecting pyloric or duodenal pressures, and slightly increased the retention of liquid in the total stomach, but had no effect on gastric emptying of solids or intragastric distribution. These results demonstrate that Iberogast® affects gastric motility in humans, and the stimulation of gastric relaxation and antral motility may contribute to the reported therapeutic efficacy of Iberogast® in functional dyspepsia. The studies reported in this thesis provide new information about the regulation of gastric motility, hormone release/suppression, appetite and energy intake, by varying the loads of lipid and glucose infused into the small intestine in healthy subjects, which may have implications in patients with altered gastric motor functions, such as obese, type-2 diabetes and functional dyspepsia patients. In addition, studies in functional dyspepsia patients revealed that diet, in particular the ingestion of fat, contribute to the cause of their symptoms, and these findings may have important implications for the development of diet-based therapies for the treatment of functional dyspepsia. Furthermore, functional dyspepsia patients with impaired gastric relaxation and antral dysmotility may benefit from the effects of Iberogast® as demonstrated in the healthy gastrointestinal tract.Thesis (Ph.D.) - University of Adelaide, School of Medicine, 200

On the foundations of the 21st century university in a humanistic perspective. The function of academic variable space

The article is an attempt to answer the following question: is the university’s function subject to change in the globalizing, digitized and commercialized world? The concept of function (as a relation and as a specific action to meet needs) is analyzed both within and outside the context of university. The article presents different types of relations in the university space, emphasizing lack of the university’s autonomy against external factors, but also reminds us of the fact that the university finds its best expression in the fundamental relationship between the student and the teacher. The text draws on architectural comparisons, Malinowski's concepts, as well as on reflections of other humanists over the university walls covered with ivy.KAMIL K. PILICHIEWICZ – mgr, doktorant w Katedrze Badań Filologicznych „Wschód – Zachód” Uniwersytetu w Białymstoku. Badacz literatury, w szczególności XIX i XX wieku, zajmujący się problematyką doświadczeń granicznych, prozą autobiograficzną, kulturoznawca. Autor między innymi prac: Samotność metafizyczna Popiela w I Rapsodzie „Króla-Ducha” Juliusza Słowackiego; Kilka uwag na temat wiary w prozie Michała Głowińskiego; Na granicy wyobraźni literackiej – doświadczenia autora i jego odbiorcy. Pracuje w Książnicy Podlaskiej im. Łukasza Górnickiego w Białymstoku.Katedra Badań Filologicznych „Wschód – Zachód”, Uniwersytetu w BiałymstokuAlarcón J. J., Jaka tożsamość uniwersytetu?, przeł. P. Roszak, „Człowiek w kulturze” 2009/2010, nr 21, s. 7-18.Andrzejewski B., Wilhelm von Humboldt, Warszawa 1989.Bogucka I., Funkcja jako relacja, „Folia Philosophica” 1997, nr 15, s. 135-145.Brzeziński J., Etos akademicki – między tradycją i wyzwaniami współczesności, „Teksty Drugie” 2010, nr 5, s. 227-235.Głowiński M., Kręgi obcości. Opowieść autobiograficzna, Kraków 2010.Jaroszyński P., O autorytet nauczyciela, „Człowiek w Kulturze” 2011/2012, nr 22, s. 5-17.Kożuchowski J., Uniwersytet jako miejsce kultury, „Studia Elbląskie” 2003, nr 5, s. 293-313.Malinowski B., Czym jest kultura?, [w:] Antropologia kultury, red. A. Mencwel, Warszawa 2005.Malinowski B., Kultura jako wyznacznik zachowania się [Culture as a Decisive Factor of Behaviour], przeł. J. Piotrowski, odczyt z okazji otrzymania dyplomu doctora honoris causa z okazji trzechsetlecia Fundacji Harvarda, Harvard University 1937, „Ruch Prawniczy, Ekonomiczny i Socjologiczny” 1937, nr 17, s. 101-127.Markowski M. P., Humanistyka: niedokończony projekt, „Teksty Drugie” 2011, nr 6, s. 13-28.Meyer-Blanck M., O nowy neohumanizm. Uniwersytet w czasach post-bolońskich, „Studia z Teorii Wychowania: półrocznik Zespołu Teorii Wychowania Komitetu Nauk Pedagogicznych PAN” 2015, nr 6/1, s. 11-17.Miluska J., Uniwersytet wobec zmiany kulturowej w Polsce, „Pedagogika Szkoły Wyższej” 2013, nr 2, s. 11-23.Rorty R., Edukacja bez dogmatu, „ER(R)GO. Teoria-Literatura-Kultura” 2006, nr 1, s. 95-105.Twardowski K., O dostojeństwie uniwersytetu, Poznań 1933.4035436

In Search of Irony and Modern Grotesque. Michał Głowiński And Roman Jaworski: Researcher and Creator

This article is dedicated to the notion of irony and modern grotesque. Referring to the commentaries of two well-known literary figures, Roman Jaworski and Michał Głowiński, who used to explore certain common spaces, I try to demonstrate some universality in the above: irony and grotesque beyond the misty, outlined framework of modernism.KAMIL K. PILICHIEWICZ – mgr, doktorant w Katedrze Badań Filologicznych „Wschód – Zachód” Uniwersytetu w Białymstoku. Badacz literatury, w szczególności XX wieku, zajmujący się problematyką doświadczeń granicznych, prozą autobiograficzną; również kulturoznawca. Autor między innymi prac: Samotność metafizyczna Popiela w I Rapsodzie „Króla-Ducha” Juliusza Słowackiego; Kilka uwag na temat wiary w prozie Michała Głowińskiego; Na granicy wyobraźni literackiej – doświadczenia autora i jego odbiorcy. Przygotował rozprawę doktorską na temat prozy autobiograficznej Michała Głowińskiego.Uniwersytet w BiałymstokuNycz R, Michał Głowiński i duch nowoczesności, „Teksty Drugie” 1994, nr 5/6.Tomasik W., Źródła i ujścia modernizmu. O historycznoliterackich zainteresowaniach Michała Głowińskiego, „Teksty Drugie” 1994, nr 5/6.Głowiński M., Sztuczne awantury, w: R. Jaworski, Historie maniaków, Kraków 1978.Kitrasiewicz P., Wstęp, w: R. Jaworski, Historie maniaków, Warszawa 2004.Szwagrzyk A., Gra w nowoczesność czy gra nowoczesnością? Uwagi o „Weselu Hrabiego Orgaza” Romana Jaworskiego, „Polisemia” 2013, nr 2.879