Duodenal nutrient exposure contributes to enhancing gastric accommodation

Background The gastric accommodation reflex consists of a relaxation which creates a reservoir for the ingested food before emptying to the duodenum occurs. The mechanisms that control gastric accommodation are not fully understood. This study aims to use intragastric pressure (IGP) measurement and pyloric balloon obstruction to determine the contribution of duodenal nutrient exposure to gastric accommodation and meal-induced satiation. Methods Two conditions were tested in 11 healthy subjects (28.3 +/- 3.2 years; 23.6 +/- 0.7 kg/m(2); four females). IGP was measured during an intragastric nutrient drink (ND) infusion at a constant rate (60 mL/min) in the presence of a deflated (control) or inflated (pyloric obstruction) balloon placed into the pylorus. During the study, subjects filled out Likert scales for satiation scores and visual analogue scale for 9 epigastric symptoms (hunger, expected amount to eat, satiation, bloating, fullness, nausea, belching, gastric cramps, and pain) before and during ND infusion until maximal satiation. Key Results During pyloric obstruction, the IGP drop and the area above the IGP curve (AAC) were significantly smaller compared with the control condition (6.7 +/- 1.0 mm Hg vs3.6 +/- 0.8 mm Hg, P = .03 and 69.7 +/- 13.5 mm Hg x min vs 20.1 +/- 9.0 mm Hg x min, P = .001, respectively). Pyloric obstruction decreased nutrient tolerance compared with the control condition (787.9 +/- 73.1 mL vs 970.9 +/- 79.2 mL, respectively, P < .05). Pyloric obstruction increased symptoms of bloating (1.3 +/- 0.4 vs 2.6 +/- 0.6; P = .04), fullness (2.3 +/- 0.5 vs 3.6 +/- 0.3; P = .03), and nausea (0.4 +/- 0.2 vs 1.3 +/- 0.4; P = .04) compared to control. Conclusion & Inferences Duodenal nutrient exposure contributes to enhancing gastric accommodation. Preventing the passage of nutrients from the stomach to the duodenum inhibits gastric accommodation and increases meal-induced satiation, bloating, nausea, and fullness.