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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.

Thesis (M.S. )--University of Tennessee Health Science Center, 2007. / Title from title page screen (viewed on April 18, 2008 ). Research advisor: Mona N. Wicks, Ph.D., RN. Document formatted into pages (xi, 109 p. : ill.). Vita. Abstract. Includes bibliographical references (p. 79-86).

Orientador: Edgard Ferro Collares / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T00:13:29Z (GMT). No. of bitstreams: 1 Vinagre_AdrianaMendes_D.pdf: 6789809 bytes, checksum: 05de43a9be5ce48b46cb5b0b6ab54ec7 (MD5) Previous issue date: 2011 / Resumo: O esvaziamento gástrico (EG) é um processo de transferência do conteúdo gástrico para o intestino delgado, resultante da ação de mecanismos inibidores e estimuladores que controlam a atividade motora do estômago, piloro e duodeno. A dipirona, um derivado da fenilpirazolona, por via intravenosa (iv) e intra-cérebro-ventricular (icv), em ratos, retarda o esvaziamento gástrico (EG) de uma refeição líquida (salina). Quando administrada por via iv, o fenômeno foi abolido pela vagotomia sub-diafragmática e lesão eletrolítica do núcleo para-ventricular do hipotálamo. Em observação adicional, foi demonstrado que este efeito foi bloqueado pela injeção icv de baclofen, um agonista de receptores GABAB. O derivado fenilpirazolônico antipirina injetado iv também retarda o EG de líquido e este efeito foi reduzido significativamente pela vagotomia sub-diafragmática e abolido pela injeção icv de baclofen. Adicionalmente, demonstramos que a administração iv de 4-aminoantipirina (um metabólito da dipirona) diminui o EG de líquido em ratos e, da mesma forma que com a antipirina, foi reduzido significativamente pela vagotomia sub-diafragmática e abolido pela injeção icv de baclofen. Em situações em que há alteração no EG, a participação do estômago no processo pode ser inferida através da determinação in vivo do volume e da complacência gástrica, como indicadores do tônus gástrico. O tônus desta região é resultado, em grande parte, da atividade do nervo vago. Demonstramos que, para as condições de estudo as três drogas aumentam a complacência gástrica. O conjunto destes estudos sugere a participação do sistema nervoso central (SNC) e do nervo vago no fenômeno de retardo do EG induzido por estas drogas. Como somente a dipirona induziu o mesmo efeito quando administrada icv e o retardo do EG induzido pelas três drogas iv foi abolido pela vagotomia sub-diafragmática, em continuidade especulamos que o estímulo inibitório do EG, quando da administração por via iv, chegue ao SNC através de vias aferentes. A capsaicina é uma neurotoxina que administrada a ratos recém nascidos resulta em degeneração irreversível da maioria dos neurônios aferentes periféricos com axônios não mielinizados (fibras C) e de uma minoria de fibras escassamente mielinizadas (fibras A?). Constatamos que a administração desta neurotoxina, no período neonatal, a ratos, aboliu o efeito destas três drogas administradas iv, mas não da dipirona icv, sugerindo a participação das vias aferentes no fenômeno e de que o mecanismo (ou mecanismos) envolvido no efeito da administração dipirona no SNC difere daquele quando a droga é administrada iv. Embora os estudos relacionados ao efeito dos derivados fenilpirazolônicos sobre o EG, indicarem a participação do nervo vago no fenômeno, sabe-se que os efeitos do sistema nervoso simpático e parassimpático sobre os sistemas podem ser sinérgicos, exclusivos e até mesmo concomitantes. O sistema nervoso simpático, que tem efeito inibitório sobre o EG, libera norepinefrina nas terminações pós-ganglionares. Foram identificados subtipos de "alfa"- e ß-adrenoceptores em diferentes níveis do trato gastrointestinal que podem ter participação importante no controle da motricidade gástrica. Há evidências que neurônios aferentes e eferentes do nervo vago possuam beta-adrenoceptores, sendo que o subtipo ß2-adrenoceptor parece ser o predominante. Avaliando a participação do sistema adrenérgico no retardo do EG, os resultados do estudo sugerem: 1) que a simpatectomia química ou o pré-tratamento com propranolol (antagonista não seletivo ß-adrenérgico) aboliram o efeito da dipirona e antipirina e reduziram o da 4-aminoantipirina sobre o EG; 2) como pouco provável que retardo do EG induzido por estas drogas ocorra por ativação de "alfa"1-, "alfa"2-, ß1- , ß2- e ß3-adrenoceptores periféricos. Estes últimos resultados aventam a possibilidade que no efeito destas drogas haja envolvimento da ativação de receptores ß1- e/ou ß2-adrenérgicos no SNC e, que o mesmo, não ocorra em grande parte do efeito da 4-aminoantipirina / Abstract: Gastric emptying (GE) is the process of transfer of the gastric contents to small intestine, as result of inhibitory and stimulatory mechanisms that control the stomach, pylorus and duodenum motor activity. Dipyrone, a phenylpyrazole derivative, administrated intravenously (iv) and intracerebroventricularly (icv), in rats, slows the gastric emptying (GE) of a liquid meal (saline). When administrated iv, this phenomenon was abolished by sub-diaphragm vagotomy and electrolytic lesion of the hypothalamus paraventricular nucleus. In an additional study, it was demonstrated that this effect was blocked by icv injection of baclofen, a GABAB receptor agonist. The phenylpyrazole derivative antipyrine when injected by iv slows the GE of liquid also, and this effect was significantly decreased by sub-diaphragm vagotomy and abolished by bacloflen icv injection. Moreover, we demonstrated that the 4-aminoantipyrine (a dipyrone metabolite) administration iv decrease the GE of liquids in rats and as antipyrine, it was significantly reduced by subdiaphragm vagotomy and abolished by bacloflen icv injection. When happen alterations on GE, the stomach activity in this process can be inferred by in vivo determination of gastric volume and complacency, as indicators of gastric tone. The tone of this region is a result, mostly, of vagus nerve activity. We showed that in our studies conditions, the three drugs increased gastric complacence. Putting these results together we suggested the action of central nervous system (CNS) and vagus nerve in the GE retardation induced by these drugs. Taking into account that only dipyrone induced the same effect when administrated icv and that GE retardation induced by the three drugs was abolished by sub-diaphragm vagotomy, we speculated whether the GE inhibitory stimulus, when the drugs were administrated iv, reach the CNS through afferent pathway. The capsaicin is a neurotoxin which when administrated to new born rats, results in irreversible degeneration of the most part of peripheral afferent neurons with unmyelinated axons (fiber C) and a minority of thinly myelinated fibers (fiber A"sigma"). Our studies showed that the administration of this neurotoxin, during neonatal period, nullify the effect of these three drugs when administrated by iv, but didn't when dipyrone was gave by icv, what suggests the role of afferent pathways in this phenomenon and that the mechanism (or mechanisms) involved in the effect of dipyrone administration on CNS id different when the drug is administrated by iv. Although the studies related to phenylpyrazole derivative effects on the GE indicated the action of vagus nerve on this phenomenon, we know that the effects of sympathetic and parasympathetic system on the systems can be synergics, exclusives and to concomitant. The sympathetic nervous system, which has inhibitory effect on the GE, releases norepinephrine in the postganglionic endings. It was identified subtypes of "alfa"- and ß- adrenoreceptors in different sites in gastrointestinal tract that may have important roles in the control of gastric motor. It's evidences that afferent and efferent neurons of vagus nerve have beta-adrenoreceptors and the subtype ß2-adrenoreceptor seems to be the predominant. Evaluating the participation of adrenergic system on the GE retardation, the results of our study suggest: 1) the chemistry sympathectomy or the early treatment with propanolol (ß-adrenergic non selective antagonist) abolished the effect of dipyrone and antipyrine and reduced the effect of 4-aminoantipyrine on the GE; 2) it's almost unlikely that the slow GE induce by these drugs occur by activation of "alfa"1-, "alfa"2-, ß1- , ß2- e ß3- peripherics adrenoreceptors. The last results suggest the possibility that in this drugs effects have involvement of receptor ß1- and/or ß2-adrenergics activation on the CNS and that this don't occur at mostly of 4-aminoantipyrine effect / Doutorado / Doutor em Farmacologia

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Tendo em vista que o comportamento motor do trato gastrointestinal parece ter intima relaÃÃo com a atividade do sistema cardiovascular, decidimos verificar se a redistribuiÃÃo do volume sanguÃneo atravÃs de fistula aorto-caval com agulhas de calibres (21, 23 ou 26G) afeta a motilidade do trato gastrintestinal em ratos acordados. Ratos machos albinos (230 a 280g) foram divididos em grupos falso-operado (FO) ou com fÃstula designados (F), alÃm disso, tiveram grupos fÃstula+sangria (FS), fÃstula+vagotomia (FV) bem como fÃstula+esplancnotomia (FE), todos estudados com 24 horas apÃs a confecÃÃo da fistula com agulha (21G). Os parÃmetros hemodinÃmicos de pressÃo arterial mÃdia (PAM), freqÃÃncia cardÃaca (FC), e pressÃo venosa central (PVC) foram monitorados continuamente e o dÃbito cardÃaco (DC) determinado por termo-diluiÃÃo. ApÃs os procedimentos cirÃrgicos os ratos FO e os (F) tiveram os parÃmetros hemodinÃmicos e o esvaziamento gÃstrico (EG) estudados nos tempos pÃs-prandial (10, 20 ou 30min.). A PA dos ratos (F) tiveram valores inferiores (p < 0,05) quando comparados aos FO (116,3  3,5 vs 101,3  3,3mmHg). Por outro lado, nos ratos (F) houve aumento (p < 0,05) nos valores da PVC (1,9  0,4 vs 5,8  0,6cmH2O) da FC (365,0  7,0 vs 417,0  7,0bpm) e do DC (119,9  9,6 vs 172  5,3ml/min) quando comparados aos ratos FO. Em relaÃÃo ao FO ocorreu uma retenÃÃo gÃstrica nos ratos (F) nos tempos pÃs-prandial 10, 20 e 30min (45,6 Â3,6 vs 57,5  2,1%; 36,4  2,7 vs 50,5  3,3 % e 33,3  2,7 vs 44,7  3,0 %, respectivamente). Os ratos do grupo (FS), apresentaram valores de (EG) inferiores aos animais (F) (36,5  3,2 vs 50,5  3,3%, p<0,05), mas similares aos FO (36,4  2,7%). Em relaÃÃo à vagotomia (FV), a mesma reverteu o retarde no (EG) induzido pela FÃstula (F) (40,4  2,3 vs 50,5  3,3%), em contrapartida, os ratos submetidos a esplancnotomia (FE) nÃo apresentaram diferenÃas com os (F) (50,5  3,3 e 50,1  1,4%). AlÃm do mais, nÃo foi encontrada participaÃÃo da secreÃÃo Ãcida no retarde do (EG) apÃs fÃstula. Portanto, a sobrecarga cardÃaca advinda de fÃstula arteriovenosa com agulhas de calibre (21, 23 ou 26G) alÃm de promover alteraÃÃes nos parÃmetros hemodinÃmicos, induz retarde no (EG) e interfere no trÃnsito intestinal de lÃquidos em ratos acordados. Tal retarde no (EG) inclusive foi abolido apÃs sangria ou vagotomia subdiafragmÃtica prÃvias, mas nÃo havendo alteraÃÃo apÃs esplancnotomia. / In view that the behaviour of gastrointestinal tract seems to have intimate relationship with the activity of the cardiovascular system, we decided to verify whether the redistribution of blood volume through fistula aorto-caval with sizes of needles (21, 23 or 26G) affect the motility of the gastrointestinal tract in rats awaked. Male albino rats (230 to 280g) were divided into groups false-operated (FO) or designated with fistula (F), moreover, had groups fistula + bleeding (FS), fistula + vagotomy (FV) and fistula + esplancnotomy (FE), all with studied 24 hours after preparation of the fistula with needle (21G). Hemodynamic parameters of mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP) were monitored continuously and cardiac output (CO) determined by term-dilution. After the surgical procedures the rats FO and (F) had the hemodynamic parameters and gastric emptying (GE) studied in the time post-prandial (10, 20 or 30min.). The MAP of rats (F) had lower values (p <0.05) when compared to FO (116.3  3.5 vs. 101.3  3.3 mmHg). Moreover, in rats (F) increased (p <0.05) the values of CVP when compared to rats FO (1.9  0.4 vs 5.8  0.6 cmH2O), HR (365.0  7.0 vs 417.0  7.0 bpm) and the CO (119.9  9.6 vs 172  5.3 ml / min). In relation the rats the FO was a gastric retention increased in (F) in the time post-prandial 10, 20 and 30min (45.6  3.6 vs 57.5  2.1%; 36.4  2.7 vs 50.5  3.3% and 33.3  2.7 vs 44.7  3.0%, respectively). The rats of the group (FS), showed values of (GE) lower than the animals (F) (36.5  3.2 vs 50.5  3.3%, p <0.05) but similar to FO ( 36.4  2.7%). The vagotomy (FV), it reversed the delay in the (GE) induced by fistula (F) (40.4  2.3 vs 50.5  3.3%), in contrast, the rats undergoing esplancnotomy (FE) showed no differences in comparation with the (F) (50.5  3.3 and 50.1  1.4%). Moreover, was not found involvement of acid secretion in the delays of the (GE) after fistula. Therefore, the overload heart arisen from arteriovenous fistula with needles, size (21, 23 or 26G) to promote changes in hemodynamic parameters, leads decreases the (GE) and interfere in the intestinal transit of liquids in rats awaked. This delay in the (GE) was also abolished after bleeding or prior the subdiaphragmatic vagotomy, but no change after esplancnotomy.

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.