Table: The effect of alcoholic beverage, ~ n g ethanol concentrations, 91ucotle solutions and ~ on gutrlc half emptying time (t(1/2), rain) of two sofld meals In minutes

Solid Wate~ E4% Beer Et0% Red wine G 5~,5 % O11,4% meal 220 Iw.,al 696.7 83 6.4" 86q06' 909.7* 969.1" 975.4* 929.8"

600 133,14,5 14208 143156 16615 170~13.4" 13018,9 15410.3 kcal n=5, mean SEM, E=Ethano~ (v,~), G=Gluc~e (wt'v), *p<0.05 vs. water

T1829

The Impact of B12 Treatment on Gastric Emptying I'ime in Patients with Helicobacter Pylori Infection Yuksel Gumurdulu, Ender Serin, Birol Ozer, Mehmet Aydin jr., Fazi[et Kayaselcuk St., Ugur Yilmaz Sr, Sedat Boyacioglu Sr, Sedat N~yacinglu Sr,

THE IMPACT OF B12 TREATMENT ON GASTRIC EMPTYING TIME IN PATIENTS WITH HELICOBACTER PYLORI INFECTION Yuksel Gumurduin, Ender Serin*, Bird Ozer ~, Meh- met Aydm ~, kIi Fuat Yapar 2, Fazilet Kayaselcuk ~, Ugur Yflmaz ~, Sedat Boyaciogiu 4 Goals: The role that ,gitamm B~2 deficiency plays in upper gastrointestimd motor dysfunction is not clear. The aim of this stud,,' was to determine whether B~ replacement therapy improves prolonged gastric emptying time in dyspeptic patients with Hdicobacter pylori infection. Material and Methods: The study' mduded 34 H. pylori-positive patients who had low serum levels of B2 but had no other factors associated wath altered gastric motility, Each patient underwent a radionudide gasmc emptying study betore and after 3 months of B,2 replacement therapy, Dyspepsia scores were calculated pre- and post-tfierapy using a semi-quantitatNe scale, k vitamin B:, preparation (1000 p.g/day) was given intramuscularly tor the first 10 days and then orally for 80 days. H. pylor~ eradmation therapy was delayed for 3 monflts until the post-treatment radionuclide study was completed. Results: The mean gastric empty- ing time betore B2 treatment was significantly longer than that after treatment (230 • 190 min vs 98 • 29 rain, respectwely; p<0.000l). The mean dyspepsia score was also significantly impm*~'d by treatment (5.4 • 1.0 vs 1,2 • 1.0, respectively-; p<O.0001). Conclusion: Vitamin Ba deficmncy appears to play an important role in the development of gastric dysmorifity and its clinical consequences. Replacement therapy will improve gastric emptying in some patients with dyspepsia Key Words: Vitamin B2, Hdicobacter pylori, Gastric emptying time

T1830

Gastric Emptying and Diabetic Autonomic Neuropathy in Asymptomatic PatienLs Patrizia Bom/zzL Ivano Lorenzmi, Massimo Boemi, Cristina Sirolla, Stelano Cenerelh, Renalto Galeazzi

Background and Aim. Delayed gastric emptying is a trequent dy'sfunction in diabetic patients. The aetiology of this complication is still under debate but autonomic nervous impairment seems one of the major determinants. Aim of this study was to evaluate if the presence of cardiovascular autonomic neuropathy (CAN') is an explanatory varkable of alterations of gastric emptying in diabetic patients. Materials and Methods In 33 consecutree diabetic patients (22 ~y'pe f and II type 2) without gastric dysmotflity symptoms, standardised cardiovascular reflex test where peribrmed to assess the presence of CAN (defined as a score wdue > 5). 13C octanoic acid breath test was carried m~t to assess gastric emptying of solids. Regression analysis was appfied to evaluate the relationship between gastric emptying parameters CI(1/2), T(lag) and GEC) and impaired autonomic tPnctional test adjusting for sex, age, diabetes duration, smoking habit, body mass index and glycated haemoglobin. Results CAN was diagnosed in 14 patients (10 type 1 and 4 type 2). in these subjects T(I/ 2) was 786 plusminus 31.3 rain.; T(lag) was 44.4 plusminns 25.5 toni and GEC 3.15 pInsminus 0.96 T(l/2) was 97.4 plnsminus 50.8 rain; T(lag) was 58.3 plnsmtnus 33.9 rain and GEC 2.90 plusmtnus 0,52 respectively in subjects without CAN The differences between the two groups were not sigmficant. The regression analysis showed the 20sence of relation- ship between gastric emptying parameters and CAN after adtustmg Conclusions. We did not Observe a link between C4N scores and solid gastric emptying This result could depend on a low accuracy of CAN Lest in detecting earl), autonomic involvement or on a multitactorml etiology of gastric impairment in asy~mptorcmtic diabetic patients

T1831

Effects of Posture on Transpyloric Flow and Appetite in Healthy Subjects Deirdre G, O'Donovan, Prygve Hausken, Antonietta Russo, Yong Let Michael Horowitz, Karen L Jones

Previous studies have established that posture has relatively" little effect on gastric emptying of high nutrient liquids; these studies have, however, only' assessed overall rates of gastric emptying. In heahhy sublects perceptions of appetite, such as hunger, are inversely related to antra/area and content; trance, changes in intragastric distnhution induced by posture may affect appetite The ain:ts of this study were to evaluate the effects of posture on patterns of transpylorlc flow, gasmc emptying, antral area and perceptions of appetite. 8 healthy subjects (SM, 3P; age 24 +/,. 2yr, BMI 21,8 +/- 0,6 k&/rn2) were studied twice in random order i e sitting and lying Aher consuming 600ml of water with 75g glucose labeled with 20 MBq #* Tc-sulphur colloid, the following measurements were performed: (f) transpyloric tlow dunng consumption of the drink (Doppler ultrasound), (it) gastric emptying (scintigra- phy), (iii) antral area at -5 and 30min (ultrasound) and (iv) perceptions of appetite (v%ual analog scales) Resuhs are shown as means + / S E M During drink ingestion tbe rate of transpyloric flow was greater in the sitting when compared with the lying position (9,4 +/- 13 6cm/s~s vs 1 8 +/-0,gcm/Js: P = 0.05); there was no difference m the time taken to consume the drink between the two postures (sitting: 113 +/-32s vs lying 126 +/-20s), Posture affected intragasmc distribution; more of the drink was retained in the distal stomach in the sitting position (P = 0,0002), but had no eltect on the overafi rate of gastric emptying. Antral areas at -5rain (P=O 02) and 30rain (P=0,003) were greater in the sitting position. Scores for

hunger (P = 0.009) and prospective consumption (P = 0.003) were less in the sitting position from t = 45rain. Ti~ere was an inverse relationship between hunger and antral area at 30min (r-0.53, P = 0.05). We conclude that posture influences initial transpyloric flow and intragas- tric distribution, but not the overall rate of gastric emptying, of a large volume nutrient liquid. The increase in antral area and content in the sitting position is associated v~th a reduction in hunger.

Sitting Lying P valu e Proximal Stomach retention at 30nfln (%) 58+/-4 68+/-4 0,01 [Ymtal stomach retention at 30 min (%) 29+/-3 12+/-3 0~000t Total stomach rat.cation at 30 rain (%) 87+/-4 80~'-3 ns Antral area at 30 min (cn~ 17+k2 10+#2 0,003 Hun~ler at 45rain (nun) 37+/-10 50+/-10 0.009

T1832

Mosapride 15 rag TID Improves Symptoms and Gastric Emptying in Gastroparesis Ying Chen, Geoffrey Coates, William Paterson, Christian Dallaire, Pierre Pare, Michel Boivin, Main Warier, Sandra Daniels, Nicholas Dlamant, Gervais Tougas

Background: Gastroparesis (GP) is frequently associated with dy, spepric symptoms. Effective therapy is lacking for symptomatic GP, This randomized, double blind, placebo controlled, multiple dose, crossover study examined the efficacy of a new prokinetic, Mosapride, in symptomatic GP. Methods: 21 patients (4 men, 17 women) with chronic GP (diabetic or idiopathic) were enrolled from 7 centers. In random order, patients received placebo and 2 of 3 doses (Mosapride 7.5, 15 and 30 mg TIDY for 2-week periods separated by 1-week washouts. Gastric emptying was assessed by seintigraphy at the end of each treatment period, using a ~'~'Tc labeled meal. Gastric retention (%RET) was measured at 1, 2 and 3 hours. Symptoms (anorexia, nausea, vomiting, discomfort/bloating, abdominal pain, early satiety) were assessed using a 4-point scale C0 = None, 1 = Mild, 2 = Moderate, 3 = Severe). $)Taptom improvement/deterioration was assessed by measunng changes in symptom scores over placebo in the last 3 days of each period. Results: Mosapride 15 mg TID and 30 mg TID improved %RET (15 rag, p < 0.05 at 1 and 3 hours and 30 rag, p < 0,0001 at 1,2 and 3 hours). Mosapride 7,5 mg TID did not improve gastric emptying, There was sigmficant correlation (p < 0.05) between improved gastric emptying and several symptoms, indudmg anorexia (15 mg and 30 mg), early satiety (15 mg and 30 rag), and vomiting (30 mg only). Abdominal pain was significantly improved by' Mosapride 7.5 mg T1D (p< 0.04) and 15 rag TID (p < 0,009) but not 30 mg T1D. There was no clear effect of Mosapride on bloating at any dose. Nausea was worsened by Mosapride 30 mg TID (p < 0.02) but unaffected by other doses. Conclusions: Mosapride is a promising drug in the treatment of symptomatic gastroparesis as it improves gastric emptying and dyspeptic symptoms including votmting, anorexia, early satiety and abdominal pain without adverse symptomatic deterioration except nausea at higher doses. The use of a cross over design in gastroparesis trials can detect significant symptomatic differences with rdatlvely few patients. Larger, mulricentre truls will be required to determine the place of prokinetic such as Mosapnde in the treatmem of symptomatic gastroparesis.

T1833

Reversal of Hyperglycemia-Evoked Gastric Slow Wave Dysrhythmias by Augmented Nitric Oxide Activity in Healthy Humans: Possible Nitrergic Dysfunction in a Model of Diabetic Gastropathy Radoslav Coleski, 8utep Gonlachanvit, William L Hasler

Diabetic gastropathy is associated with gastric dysrhythmias (tachy-, bradygastria). Defective nitric oxide (NO) pathways may underlie tunctional detects in this condition. NO activity is enhanced by giving NO donors or preventirg phospbodiesterase breakdown of NO- activated second messengers. We hypothesized that augmentation of NO activity, with the NO donor nitroglycerin or the phosphodiesterase inhibitor sildenafil reverses gastnc dysrbythmm evoked by acute hyperglycemia in healthy humans. 10 subjects underwent electrogastrogra- phy (EGG) for I hr then IV saline or 20% dextrose to produce plasma glucoses of 250 rag dl was begun. EGGs were recorded for 1 hr then extended release nitroglycerin 9 ingot sildenafil 100 rag po was given. EGGs were recorded for 2 more hrs with continued IV saline or dextrose. EGGs were analyzed t0r % time in bradygasma (0.75-2 cydes per ram), normal rhythm (2-4 cpm), and tachygastna (4-9 cpm). Hyperglycemia increased tachygastria (7 -+ 3 to 28 -+ 8%) and decreased normal rhythnr (82 -+ 6 to 62 -+ 9%)(P<0,01). After a latency of 59 +- 18 ram, nitroglycerin reduced tachygastria (15 _+ 8%) and increased normal rhythm (77 -+ 8%) during hyperglycemia (P<0.05)~ Similarly', silderLafil reduced tachygastm (6 +-3%) and increased normal rhythm (84-+ 4%) during hyperglycemia after a latency of 87 • 24 iron (P<0.05). Neither nitroglycerni nor sildenafil affected tachygastria (2 • 1 vs. 6 -+ 3%) or normal rhythm (92 • 4 vs. 89 -+ 5%) during saline. In conclusion, the NO donor nitroglycerin reverses gastric dysrhythmias evoked by hyperglycemia in healthy human; The phosphodiesterase inhibitor sildenafil has identical effects presumably" by enhancm4 the effects of endogenous NO. This suggests that defective NO pathways may contribute to the dysrhythmic effects of hyperglycemia. These findings provide insight into the role of nitrergtc pathways in diabetic gastropathy and suggest possible new directions in therapy

T1834

High Incidence of Bezoars in Cystic Fibrosis Patients after Lung Transplantation San)ib Mohanty, Douglas Morgan, Ken Davis, Robert Arts

BACKGROUND: The gastrointestinal manifestations of cystic fibrosis include fat malabso~ tion, pancreatitis, small bowel obstruction and meeonnim ilens in inJures. The GI complica- tions fonowing lung transplantation are less defined. METHODS: We performed a retrospec- ttve analysis of 165 patients who underwent lung transplantation over a ten year period from December 1992 to August 2002 in our tertiary care hospital. Cystic fibrosis (CF) ~

AGA Abstracts A-576