Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 5 uppsatser.

nÃo hà / A perda de peso à uma queixa comum dos pacientes com doenÃa de Crohn, estando a desnutriÃÃo presente em 30-80% dos portadores dos casos. Foi demonstrado que pacientes com doenÃa de Crohn em inatividade apresentam sintomas dispÃpticos relacionados com alteraÃÃo no esvaziamento gÃstrico. No entanto, a correlaÃÃo da atividade da doenÃa com os parÃmetros antropomÃtricos, nutricionais e de saciedade ainda à objeto de investigaÃÃo. Portanto, o objetivo do nosso estudo foi correlacionar a atividade da doenÃa com o estado nutricional, sintomas dispÃpticos, esvaziamento gÃstrico, saciedade e nÃveis de grelina em pacientes com doenÃa de Crohn. Trata-se de um estudo transversal, analÃtico e quantitativo realizado em vinte pacientes com doenÃa de Crohn, classificados segundo um Ãndice de Atividade de DoenÃa de Crohn (Crohnâs Disease Activity Index â CDAI). Os pacientes foram submetidos a uma avaliaÃÃo nutricional, que se fundamentou na utilizaÃÃo de mÃtodos duplamente indiretos (Ãndice de massa corporal, dobra cutÃnea tricipital e circunferÃncia do braÃo). AlÃm disso, nos pacientes foi avaliado o consumo alimentar atravÃs de um recordatÃrio alimentar. Estes foram tambÃm submetidos a uma anÃlise do tempo de esvaziamento gÃstrico por teste respiratÃrio usando o 13C - Ãcido octanÃico ligado a uma refeiÃÃo sÃlida - e responderam a um questionÃrio validado (QuestionÃrio Porto Alegre de Sintomas DispÃpticos) para avaliar os sintomas dispÃpticos. Outro teste realizado foi o teste de saciedade(drinking test), no qual o paciente ingeriu 15 ml de uma bebida lÃquida padrÃo(Nutridrink), e era lhe perguntado o nÃvel de saciedade atravÃs de uma escala analÃgica. Durante o teste respiratÃrio, foram realizadas coletas de amostras de sangue para dosagem de grelina: basal( jejum) e pÃs-prandial. Os dados foram analisados estatisticamente pelos testes: t de Student, exato de Fisher, Mann-Whitney e correlaÃÃo de Spearman. Observou-se que os parÃmetros CDAI e IMC (p=0,0185) e CB (p=0,023) foram inversamente proporcionais, porÃm nÃo houve diferenÃa estatÃstica entre as correlaÃÃes do CDAI com prega cutÃnea tricipital( p=0,0543). Os pacientes nÃo apresentaram correlaÃÃo da atividade da doenÃa com o esvaziamento gÃstrico ( t Â- p=0,2533; t lag-p=0,3079). Entretanto, houve correlaÃÃo significativa do CDAI com todos os sintomas dispÃpticos (p=0,005). NÃo se verificou correlaÃÃo da atividade da doenÃa e o volume de lÃquido suportado. Entretanto, a atividade da doenÃa influenciou os nÃveis de grelina no pÃs-prandial (p=0,04). CONCLUSÃO: A atividade da doenÃa correlaciona-se com o estado nutricional, a presenÃa de sintomas dispÃpticos e nÃveis de grelina de pacientes portadores de doenÃa de Crohn. Entretanto nÃo existe correlaÃÃo com alteraÃÃes no esvaziamento gÃstrico e saciedade sugerindo que outros mecanismos possam estar envolvidos.

Orientadores: Edgard Ferro Collares, Alba Regina Monteiro Souza Brito / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-05T21:01:46Z (GMT). No. of bitstreams: 1 Vinagre_AdrianaMendes_M.pdf: 520546 bytes, checksum: 8639e020093258b50bba40d8d83f839c (MD5) Previous issue date: 2005 / Resumo: A úlcera péptica acomete cerca de 10% da população mundial; inseridos dentro dessa porcentagem estão milhares de brasileiros. Essa patologia é causada por um desbalanço entre os mecanismos protetores e agressores da mucosa, e é resultado da associação de diversos fatores agressores endógenos (ácido, pepsina e bile), fatores exógenos predisponentes às condições de vida (estresse, fumo, álcool, uso continuo de drogas antiflamatórias não esteróides, ingestão de determinados alimentos e a presença do Helicobacter pylori) e a predisposição genética. Atualmente, as terapêuticas utilizadas no tratamento das lesões são: antiácidos, anticolinérgicos, antagonistas de receptores H2 para histamina, inibidores da bomba de próton, antibióticos e mais raramente alguns procedimentos cirúrgicos. A aplicação de qualquer esquema terapêutico com emprego de uma ou mais destas drogas ou procedimento cirúrgico pode ocasionar alguns efeitos colaterais e não obrigatoriamente é eficaz. A utilização de plantas medicinais no tratamento de doenças vem se desenvolvendo na última década. Algumas plantas têm atividade antiulcerogênica. Há evidências que a alga Chlorella vulgaris pode modificar a resposta imune celular, tem atividade antitumoral, antimetastática e antiulcerogênica. O objetivo do presente estudo foi avaliar a atividade antiulcerogênica da alga Chlorella vulgaris em modelos agudos e um modelo crônico de indução de úlceras. Ratos Wistar foram utilizados para determinação do esvaziamento gástrico (EG) e modelos de úlcera induzida por etanol e ácido acético, enquanto camundongos swiss foram utilizados para os modelos de úlcera através de ligadura do piloro e piroxicam. Para avaliar o efeito sobre o esvaziamento gástrico (EG) do extrato de Chlorella vulgaris (ECV) foi utilizada uma refeição de prova (RP) liquida com extrato nas concentrações de 50mg/mL e 100mg/mL do ECV. Para o estudo dos modelos agudos de ligadura do piloro, etanol e piroxicam e do modelo crônico, foram utilizadas as doses de 250, 500 e 1000mg/kg de ECV para a prevenção e o tratamento das lesões. No modelo crônico também foi utilizada a fração acetato obtida do ECV na dose de 5mg/100g e foi dosada a quantidade de fator de crescimento epidermal (EGF) produzido na região da úlcera. O estudo da toxicidade do ECV foi realizado através da medida de ganho de peso dos ratos e peso dos órgãos como rins, pulmões, fígado e coração, visto que os primeiros sinais da toxicidade dada por um extrato é a perda de peso corporal e dos órgãos.O ECV, nas concentrações empregadas, não interferiu no EG quando preparado como uma RP liquida em comparação com o veículo (água). O extrato não alterou nenhum dos parâmetros bioquímicos como pH, quantidade de H+ e peso do suco gástrico, no modelo de ligadura do piloro. O ECV não preveniu a formação de úlceras no modelo de piroxican, mas evitou a formação de lesões causadas por etanol nas doses de 500 e 1000 mg/kg. Esse efeito desapareceu quando o etanol foi empregado duas horas após o pré-tratamento com ECV na dose de 1000 mg/kg. No modelo de úlcera crônica o ECV, nas doses de 500 e 1000 mg/kg, foi capaz de diminuir significativamente as lesões causadas pelo ácido acético, não alterando no entanto, a quantidade de EGF produzida na zona de cicatrização, quando comparados ao controle água. Além disso, o tratamento prolongado com o ECV na dose de 500 mg/kg alterou significativamente a evolução do ganho de peso desses animais. Em conclusão, o ECV, como complemento alimentar, pode ser uma alternativa no tratamento da úlcera péptica gástrica / Abstract: About 10%of the world¿s population suffer from peptic ulcer, within this percentage we find thousands of Brazilians. This pathology is caused by an unbalance between the protection and attack mechanisms of the stomach lining, and is the result of the association of various endogenous attack factors (pepsin, acid, bile), exogenous factors pertaining to life style (stress, smoking, alcohol intake, continuous use of non-steroidal anti-inflammatory drugs, ingestion of certain types of food and the presence of Helicobacter Pylori) and genetic predisposition. Nowadays, the therapeutic methods used for the treatment of the lesions are: Anti-acids, anti-cholinergic, antagonist H2 receptors for histamine, proton bombs; certain surgical procedures are also applied, though much less frequently. Any therapeutic method that involves the use of one or more of the drugs and/or procedures above mentioned may cause some side effects and is not necessarily effective. The use of medicinal plants in the treatment of diseases has been developing over the past decade. Some plants have an anti-ulcer activity. There is evidence that the Chlorella vulgaris algae may modify cellular immune response, and there is also evidence to its anti-tumor, anti-metastasis, anti-ulcer activity. The objective of this present study was to evaluate the anti-ulcer activity of the Chlorella vulgaris algae acute models of ulcer induction and also in one chronic model of ulcer induction. Wistar rats were used to determine gastric emptying (GE) and in models of ulcer induced by ethanol and acetic acid, while swiss mice were used for the piloro ligature and piroxicam ulcer induction models. In order to evaluate the effect of the Chlorella vulgaris extract (ECV) on gastric emptying (GE) a liquid proof meal (PM) with the extract in the concentration of 50mg/l and 100mg/l was usedIn the study of the acute piloro ligature, ethanol and piroxicam models, and in the chronic model, dosages of 250, 500 and 1000mg/kg of ECV were used in the prevention and treatment of the lesions. In the chronic model the fraction of acetate obtained from the ECV in the dosage of 5mg/100g was also used, and the amount of epidermal growth factor (EGF) produced in the region of the ulcer was measured. The toxicity study of the ECV was done by measuring the weight gain of the rats and the weight of their organs i.e. kidneys, lungs, liver, and heart, once the first signs of toxicity by an extract are loss of body and organ weight. The ECV, in the concentration used, did not interfere with the GE when prepared as a liquid PM in comparison to the vehicle (water). The extract did not alter any of the biochemical parameters such as pH, amount of H+ and weight of the gastric juice in the piloro ligature model. The ECV did not prevent the formation of ulcer in the piroxicam model, but it prevented the formation of lesions caused by ethanol in the dosage of 500 and 1000mg/kg. This effect disappeared when ethanol was ministered two hours after the pre-treatment with ECV in the dosage of 1000mg/kg. The chronic ulcer induction model the ECV, in the dosage of 500 and 1000mg/kg, was able to significantly lessen the lesions caused by acetic acid, not altering, however, the amount of EGF produced in the scar tissue area when compared to the water control. Furthermore, the long-term treatment with ECV in the dosage of 500mg/kg significantly altered the evolution of weight gain of these animals. In conclusion, the ECV, as a dietary complement, may be an alternative in the treatment of gastric peptic ulcer / Mestrado / Fisiologia / Mestre em Biologia Funcional e Molecular

No description available.

The purpose of this study was to examine whether any environmental benefits were obtained when the emptying of sludge from septic tanks were carried out with a dewatering technique using polymers compared to complete pump-out. The mean value of transport distance, fuel consumption, CO2 emissions and the weight of waste per septic tank emptying was calculated for each emptying method. For this, data on transport distance, fuel consumption, CO2 emissions per liter of fuel and number of emptied septic tanks were used. An energy audit over a sewage treatment plant was used to calculate the energy consumption for the treatment of the waste from the two emptying techniques. The environmental impact of the use of polymers and the returning of reject water to the septic tank was examined by studying the literature in the research field. The result showed that emptying with a dewatering technique compared to complete pump-out resulted in shorter transports, less fuel consumption, lower CO2 emissions, less waste and a lower energy consumption for waste treatment. The use of polymers in sludge dewatering should not have any adverse effects on aquatic organisms or health impacts if the dosage and the design of the treatment plant is correct. It is not established whether the return of reject water have any environmental effects. In conclusion this report shows that the emptying of septic tanks with a dewatering technique is better than complete pump-out from an environmental point of view.

O presente estudo teve como objetivo avaliar o esvaziamento gástrico e o trânsito intestinal em 31 pacientes (sendo 10 controle e 21 com vômitos) após cirurgia bariátrica de DGYR e a relação das alterações destas duas variáveis entre si e com quadro sintomático e ainda tentar definir o tempo de esvaziamento gástrico desejável. O esvaziamento gástrico e o trânsito gastrintestinal foram avaliados mediante cintilografia, segundo técnicas padronizadas e previamente empregadas em outros estudos. A análise das imagens obtidas e armazenadas foi feita mediante o delineamento de regiões de interesse (ROI, da expressão, em Lingua Inglesa, region of interest) correspondendo ao coto gástrico, para a quantificação do esvaziamento gástrico, e para este segmento e também para as porções proximal e distal do intestino delgado e para a região ileocecal, para o trânsito gastrintestinal. A mesma região de interesse foi utilizada para as contagens de todas as imagens consecutivas, para a mesma projeção e para o mesmo paciente. Para a determinação do esvaziamento gástrico, a atividade em cada momento do estudo foi expressa pela média geométrica das contagens das imagens anteriores e posteriores, para correção do efeito da eventual movimentação intragástrica das partículas do radiotraçador (30, 60, 90 e 120 minutos após ingerir a refeição). Foi feita também correção adicional das contagens para compensar o declínio físico do 99m Tecnécio. Ambas as correções foram feitas automaticamente pelo equipamento. As contagens corrigidas permitiram a construção, para cada sujeito do estudo, da correspondente curva de esvaziamento gástrico, expressa como porcentuais de retenção intragástrica do radiotraçador ingerido, em cada um dos momentos de aquisição das imagens. Foi considerado como tempo inicial o momento em que se deu o término da ingestão da refeição contendo o radioisótopo, que corresponderia idealmente a um estado caracterizado por retenção intragástrica alimentar de todo o ingerido (100%). Após a realização da cintilografia, as imagens permaneceram armazenadas num sistema computadorizado acoplado à gama câmara e, no momento da análise, foram então definidas manualmente as ROI correspondentes ao estômago, ao jejuno, ao íleo e à região ileocecal. Em todos os casos, atentou-se para que as áreas destas ROI fossem semelhantes, o que foi feito levando-se em conta o número de pixels englobado por cada uma das regiões. Foi feita uma subdivisão do grupo com sintomas em 2 subgrupos: 8 pacientes com quadro de vômitos e exames de imagem alterados (EDA e seriografia) e 11 pacientes com quadro de vômitos e exames de imagem normais.O teste de Mann-Whitney bicaudal foi utilizado para comparações entre os dois grupos e entre os dois subgrupos. Os resultados foram apresentados como mediana e percentis, com significância de p < 0,05. Para a verificação das correlações entre esvaziamento gástrico e trânsito intestinal foi utilizado o coeficiente de correlação de Spearman, com significância de p < 0,05: não houve diferença significativa entre os dois grupos nos diversos tempos estudados (30, 60, 90 e 120 minutos) com relação ao esvaziamento gástrico. Também não houve diferença significativa com relação ao trânsito intestinal de acordo com o centro geométrico nos tempos 0, 30, 60, 90 e 120 minutos. Entretanto, houve diferença significativa entre os dois subgrupos extraídos do grupo com sintomas em todos os tempos do esvaziamento gástrico e nos tempos 0, 30, 60 e 90 minutos do trânsito intestinal (centro geométrico). Não houve diferença significativa entre os subgrupos no tempo 120 e na progressão do centro geométrico. Descritores: esvaziamento gástrico, trânsito intestinal, DGYR. / The objective of the present study was to assess gastric emptying and intestinal transit in 31 patients (10 controls and 21 with vomiting as a symptom) after bariatric surgery by RYGB and the relation of the alterations of these two variables between them and with the signs and symptoms, and also to try to define the desirable time of gastric emptying. Gastric emptying and gastrointestinal transit were evaluated by scintigraphy according to standardized techniques previously employed in other studies. The images obtained and stored were analyzed by delineating the regions of interest (ROI) corresponding to the gastric stump for the quantitation of gastric emptying and also for the proximal and distal portions of the small bowel and for the ileocecal region, for the gastrointestinal transit. The same ROI was used to count all the consecutive images for the same projection and for the same patient. For the determination of gastric emptying, the activity at each time point in the study was expressed as the geometric mean of the counts of the anterior and posterior images, for the correction of the effect of eventual intragastric movement of the radiotracer particles (30, 60, 90 and 120 minutes after meal ingestion). The counts were also additionally corrected to compensate for the physical decline of 99m Technetium. Both corrections were automatically made by the equipment. The corrected counts permitted the construction for each subject of the corresponding gastric emptying curve, expressed as percentage of intragastric retention of the ingested radiotracer at each time of image acquisition. The initial time was considered to be the moment when the ingestion of the meal containing the radioisotope occurred, which would ideally correspond to a state characterized by intragastric retention of all the food ingested (100%). After scintigraphy, the images were stored in a computerized system coupled to the gamma camera and, at the time of analysis, the ROI corresponding to the stomach, jejunum, ileum and ileocecal region were defined manually. In all cases, an attempt was made for these ROI to be similar, by taking into account the number of pixels included in each region. The group with symptoms was divided into 2 subgroups: 8 patients with vomiting and altered imaging exams (UDE and seriography) and 11 patients with vomiting and normal imaging exams. The two-tailed Mann-Whitney test was used to compare the two groups and the two subgroups. Data are reported as median and interquartile range, with significance set at p < 0.05. The Spearman correlation coefficient was used to determine the correlations between gastric emptying and intestinal transit, with significance set at p < 0.05. There was no significant difference between the two groups at the various time points studied (30, 60, 90 and 120 minutes) regarding gastric emptying. Also, there was no significant difference regarding intestinal transit according to the geometric center at 0, 30, 60, 90 and 120 minutes. However, there was a significant difference between the two subgroups extracted from the group with symptoms at all times of gastric emptying and at times 0, 30, 60 and 90 minutes of intestinal transit (geometric center). There was no significant difference between subgroups at 120 minutes or in the progression of the geometric center.

Transpyloric flow is the final step in gastric emptying prior to intestinal absorption of nutrients and medications. The details of this process are still incompletely understood. Transpyloric flow is bi-directional, contrasting with the general perception of solely forward flow implied by studies of gross gastric emptying. The degree to which the patterns of bi-directional transpyloric flow reflect emptying of meals of varied physicochemical composition, its mechanical determinants and effect on delivery of oral medications have been evaluated by the studies presented in this thesis.

The human stomach is a complex organ with sophisticated function. – The control of delivery of nutrients to the small intestine is tightly regulated, and the patterns and determinants of the associated processes are numerous, complex and interrelated. The presence of nutrients in the small intestine stimulates the release of a number of gastrointestinal hormones, including glucagon-like peptide-1 (GLP-1). Exogenous GLP-1 reduces fasting and postprandial glucose concentrations, and this is thought to be via a slowing of gastric emptying (GE). The effects of endogenous GLP-1 on GE and glycaemia were evaluated using exendin(9-39), a GLP-1 antagonist, in healthy subjects, in a randomised, placebo-controlled study, in Chapter 5. Exendin(9-39) increased postprandial glycaemia through an acceleration of GE; these findings support the putative role of GLP-1 as an enterogastrone. The capacity to measure GE has greatly increased the understanding of normal and disordered gastric physiology. 30 – 50 % of patients with longstanding diabetes have delayed GE. Scintigraphy remains the ‘gold standard’ in the measurement of GE, however, it is associated with a radiation burden. Recently, three-dimensional (3D) ultrasonography was validated against scintigraphy in healthy subjects. In Chapter 6, GE was measured concurrently by 3D ultrasonography and scintigraphy in patients with diabetic gastroparesis, and good correlation and agreement was found between both techniques. Glycaemic control represents one of the main pathogenetic factors of diabetic gastroparesis. Hyperglycaemia slows, while hypoglycaemia accelerates, GE in healthy subjects and patients with uncomplicated type 1 diabetes. Chapter 7 reports a study investigating the effects of insulin-induced hypoglycaemia vs. euglycaemia on GE in longstanding type 1 diabetes. Hypoglycaemia accelerated GE of a mixed solid/liquid meal; the magnitude of this acceleration was greater when GE during euglycaemia was slower. In contrast to glucose, the effects of intravenous (iv) fructose (used widely in the diabetic diet) on GE are less well understood. The comparative effects of iv fructose, glucose and saline on GE and antropyloroduodenal motility in healthy males are reported in Chapter 8. Compared with saline, fructose infusion was associated with a slowing of GE and suppression of antral waves, the magnitude of which was comparable to glucose. Treatment for the management of gastroparesis is currently suboptimal and there is a need for novel prokinetic agents. Itopride has demonstrated prokinetic activity in dogs. The effects of itopride on GE, glycaemia and upper gastrointestinal symptoms were studied in patients with longstanding diabetes in a randomised, placebo-controlled trial (Chapter 9). There was a trend for itopride to accelerate both solid and liquid GE. 48 % of patients had delayed solid and/or liquid GE on placebo, and in this group, itopride accelerated liquid, but not solid, GE. Autonomic neuropathy represents another pathogenetic factor of diabetic gastroparesis, and delayed GE is more prevalent in patients with autonomic dysfunction. There is evidence that C-peptide improves autonomic nerve function (ANF) in type 1 diabetes. The effects of C-peptide on GE and ANF were studied in patients with longstanding type 1 diabetes in randomised, placebo-controlled design, in Chapter 10. C-peptide had no effect on solid or liquid GE, or ANF. Gastroparesis, particularly in patients with diabetes, represents an important clinical problem. The studies presented in this thesis have provided fundamental insights into the measurement and determinants of gastric motor function and postprandial glycaemia, and treatment of gastroparesis, however, further studies which assess the complex pathogenesis and pathophysiology of gastroparesis, and which include a larger cohort of patients, are warranted. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1456472 / Thesis (Ph.D.) -- University of Adelaide, School of Medicine, 2009

The human stomach is a complex organ with sophisticated function. – The control of delivery of nutrients to the small intestine is tightly regulated, and the patterns and determinants of the associated processes are numerous, complex and interrelated. The presence of nutrients in the small intestine stimulates the release of a number of gastrointestinal hormones, including glucagon-like peptide-1 (GLP-1). Exogenous GLP-1 reduces fasting and postprandial glucose concentrations, and this is thought to be via a slowing of gastric emptying (GE). The effects of endogenous GLP-1 on GE and glycaemia were evaluated using exendin(9-39), a GLP-1 antagonist, in healthy subjects, in a randomised, placebo-controlled study, in Chapter 5. Exendin(9-39) increased postprandial glycaemia through an acceleration of GE; these findings support the putative role of GLP-1 as an enterogastrone. The capacity to measure GE has greatly increased the understanding of normal and disordered gastric physiology. 30 – 50 % of patients with longstanding diabetes have delayed GE. Scintigraphy remains the ‘gold standard’ in the measurement of GE, however, it is associated with a radiation burden. Recently, three-dimensional (3D) ultrasonography was validated against scintigraphy in healthy subjects. In Chapter 6, GE was measured concurrently by 3D ultrasonography and scintigraphy in patients with diabetic gastroparesis, and good correlation and agreement was found between both techniques. Glycaemic control represents one of the main pathogenetic factors of diabetic gastroparesis. Hyperglycaemia slows, while hypoglycaemia accelerates, GE in healthy subjects and patients with uncomplicated type 1 diabetes. Chapter 7 reports a study investigating the effects of insulin-induced hypoglycaemia vs. euglycaemia on GE in longstanding type 1 diabetes. Hypoglycaemia accelerated GE of a mixed solid/liquid meal; the magnitude of this acceleration was greater when GE during euglycaemia was slower. In contrast to glucose, the effects of intravenous (iv) fructose (used widely in the diabetic diet) on GE are less well understood. The comparative effects of iv fructose, glucose and saline on GE and antropyloroduodenal motility in healthy males are reported in Chapter 8. Compared with saline, fructose infusion was associated with a slowing of GE and suppression of antral waves, the magnitude of which was comparable to glucose. Treatment for the management of gastroparesis is currently suboptimal and there is a need for novel prokinetic agents. Itopride has demonstrated prokinetic activity in dogs. The effects of itopride on GE, glycaemia and upper gastrointestinal symptoms were studied in patients with longstanding diabetes in a randomised, placebo-controlled trial (Chapter 9). There was a trend for itopride to accelerate both solid and liquid GE. 48 % of patients had delayed solid and/or liquid GE on placebo, and in this group, itopride accelerated liquid, but not solid, GE. Autonomic neuropathy represents another pathogenetic factor of diabetic gastroparesis, and delayed GE is more prevalent in patients with autonomic dysfunction. There is evidence that C-peptide improves autonomic nerve function (ANF) in type 1 diabetes. The effects of C-peptide on GE and ANF were studied in patients with longstanding type 1 diabetes in randomised, placebo-controlled design, in Chapter 10. C-peptide had no effect on solid or liquid GE, or ANF. Gastroparesis, particularly in patients with diabetes, represents an important clinical problem. The studies presented in this thesis have provided fundamental insights into the measurement and determinants of gastric motor function and postprandial glycaemia, and treatment of gastroparesis, however, further studies which assess the complex pathogenesis and pathophysiology of gastroparesis, and which include a larger cohort of patients, are warranted. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1456472 / Thesis (Ph.D.) -- University of Adelaide, School of Medicine, 2009

Diss. (sammanfattning) Linköping : Univ., 2001. / Härtill 5 uppsatser.