hormone release.pdf

Effect of Intragastric or Intraduodenal Administration of a Polymeric Diet on Gallbladder Motility, Small-Bowel Transit Time, and Hormone Release Michiel Ledeboer, M.D., Ph.D., Ad A.M. Masclee, M.D., Ph.D., Iza?k Biemond, Ph.D., and Cornelis B.H.W. Lamers, M.D., Ph.D. Department of Gastroenterology-Hepatology, Leiden University Medical Center, Leiden, The Netherlands Objective: During postpyloric tube feeding, GI intol- erance is observed more frequently than during prepy- loric feeding, possibly by evoking a stronger GI re- sponse. Methods: We investigated the effect of intragastric and intraduodenal administration of a poly- meric diet (125 kcal/h) on gallbladder motility (by ultra- sonography), duodeno-cecal transit time (by lactulose H 2 breath test), and GI hormone release (including chole- cystokinin, pancreatic polypeptide, and gastrin). Six healthy subjects (two male, four female; mean age 22 yr, range 18–27 yr) were studied on two separate occasions in random order during 6 h of continuous administra- tion of the diet through either the gastric or duodenal port of a two-lumen tube. Results: Intraduodenal feeding resulted in a more rapid contraction of the gallbladder, from 32 6 4 to 23 6 4 cm3 at 10 min (p 0.05), reaching a minimum of 6 6 1 cm3, in contrast to intragastric feeding (31 6 4 to 19 6 3 cm3 at 60 min, p 0.05; minimum 14 6 1 cm3). The gallbladder remained con- tracted during the 6-h study period during both in- traduodenal and intragastric feeding. Small-bowel tran- sit time was significantly accelerated during intraduodenal compared with intragastric feeding (51 6 12 vs 81 6 9 min; p 5 0.003). Plasma cholecystokinin secretion was significantly (p 0.05) increased during intraduodenal compared with intragastric feeding (848 6 107 vs 279 6 89 pmol z L21 z 360 min). The same was true for pan- creatic polypeptide secretion. However, gastrin release was significantly (p 0.05) higher during intragastric feeding. Conclusions: Intraduodenal feeding e