Delay of gastric emptying by duodenal intubation: sensitive measurement of gastric emptying by the paracetamol absorption test

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Abstract
Aims : To examine the influence of duodenal intubation on gastric emptying measured by the paracetamol absorption test using a new algorithm developed to estimate emptying parameters, and to determine the sensitivity of this test. Methods : A caloric liquid meal with paracetamol as marker of emptying was administered orally to eight healthy volunteers during phase I and phase II of the migrating motor complex (MMC) and without intubation on 3 separate days, and to 10 patients with partial gastrectomy. Results : Healthy subjects: With duodenal tube, time until 25% of the meal had emptied (t25%) was 24 ± 7 (phase I, P < 0.02) and 21 ± 6 min (phase II, P < 0.02) compared with 14 ± 4 min for meal intake without intubation. Time until 50% of the meal had emptied (t50%) was 45 ± 8 (phase I, P < 0.001) and 35 ± 8 min (phase II, P < 0.02) compared with 26 ± 9 min for meal intake without intubation. Intraduodenal instillation of 10–20 mL of the liquid meal was reliably detected. Patients: In 9 out of 10 patients with partial gastrectomy t25% was below the lower limit of the range for healthy controls, and t25% detected accelerated emptying with a higher degree of sensitivity than the commonly applied pharmacokinetic parameters Cmax and Tmax. Conclusions : A duodenal tube delays gastric emptying of a caloric liquid meal. The paracetamol absorption test emerges as a sensitive method suitable for detecting both delayed and accelerated gastric emptying of caloric liquid meals.