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| 1 | Mechanisms underlying feed intolerance in the critically ill: Implications for treatment显示文摘Malnutrition is associated with poor outcomes in critically ill patients. Although nutritional support is yet to be proven to improve mortality in non-malnourished critically ill patients, early enteral feeding is considered best practice. However, enteral feeding is often limited by delayed gastric emptying. The best method to clinically identify delayed gastric emptying and feed intolerance is unclear. Gastric residual volume (GRV) measured at the bedside is widely used as a surrogate marker for gastric emptying, but the value of GRV measurement has recently been disputed. While the mechanisms underlying delayed gastric emptying require further investigation, recent research has given a better appreciation of the pathophysiology. A number of pharmacological strategies are available to improve the success of feeding. Recent data suggest a combination of intravenous metoclopramide and erythromycin to be the most successful treatment, but novel drug therapies should be explored. Simpler methods to access the duodenum and more distal small bowel for feed delivery are also under investigation. This review summarises current understanding of the factors responsible for, and mechanisms underlying feed intolerance in critical illness, together with the evidence for current practices. Areas requiring further research are also highlighted. | Adam Deane Marianne J Chapman Robert J Fraser Laura K Bryant Carly Burgstad Nam Q Nguyen | 2007 | World Journal of Gastroenterology2007，13，29： | 18 |
| 2 | Outcomes of Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding显示文摘AIM:To evaluate weight loss and surgical outcomes of Roux-en-Y gastric bypass(RYGB)and laparoscopic adjustable gastric band(LAGB).METHODS:Data relating to changes in body mass index(BMI)and procedural complications after RYGB(1995-2009;n=609;116M:493F;42.4±0.4 years)or LAGB(2004-2009;n=686;131M:555F;37.2±0.4years)were extracted from prospective databases.RESULTS:Pre-operative BMI was higher in RYGB than LAGB patients(46.8±7.1 kg/m2vs 40.4±4.2 kg/m2,P<001);more patients with BMI<35 kg/m2underwent LAGB than RYGB(17.1%vs 4.1%,P<0.0001).BMI decrease was greater after RYGB.There were direct relationships between weight loss and pre-operative BMI(P<0.001).Although there was no difference in weight loss between genders during the first 3-year post-surgery,male LAGB patients had greater BMI reduction than females(-8.2±4.3 kg/m2vs-3.9±1.9kg/m2,P=0.02).Peri-operative complications occurred more frequently following RYGB than LAGB(8.0%vs0.5%,P<0.001);majority related to wound infection.LAGB had more long-term complications requiring corrective procedures than RYGB(8.9%vs 2.1%,P<0.001).Conversion to RYGB resulted in greater BMI reduction(-9.5±3.8 kg/m2)compared to removal and replacement of the band(-6.0±3.0 kg/m2).Twelve months post-surgery,fasting glucose,total cholesterol and low density lipoprotein levels were significantly lower with the magnitude of reduction greater in RYGB patients.CONCLUSION:RYGB produces substantially greater weight loss than LAGB.Whilst peri-operative complications are greater after RYGB,long-term complication rate is higher following LAGB. | Nam Q Nguyen Philip Game Justin Bessell Tamara L Debreceni Melissa Neo Carly M Burgstad Pennie Taylor Gary A Wittert | 2013 | World Journal of Gastroenterology2013，19，36： | 3 |
| 3 | Endogenous Glucagon-Like Peptide-1 Slows Gastric Emptying in Healthy Subjects, Attenuating Postprandial Glycemia显示文摘 | Adam M. Deane Nam Q. Nguyen Julie E. Stevens Robert J. L. Fraser Richard H. Holloway Laura K. Besanko Carly Burgstad Karen L. Jones Marianne J. Chapman Chris K. Rayner Michael Horowitz | 2010 | The Journal of Clinical Endocrinology & Metabolism2010，，1： | 1 |
| 4 | Delayed enteral feeding impairs intestinal carbohydrate absorption in critically ill patients 显示文摘 | Nguyen N Q Besanko L K Burgstad C | 2012 | Crit Care Med2012，40，1： | 1 |
| 5 | Prokinetic therapy for feed intolerance in critical illness: One drug or two?显示文摘 | Nam Q. Nguyen Marianne Chapman Robert J. Fraser Laura K. Bryant Carly Burgstad Richard H. Holloway | 2007 | Critical Care Medicine2007，，11： | 1 |
| 6 | Gas- tric emptying of a liquid nutrient meal in the critically ill: relationship between scintigraphic and carbon breath test measurement显示文摘 | Chapman M J Besanko L K Burgstad C M | 2011 | Gut2011，60，10： | 1 |
| 7 | Delayed enteral feeding impairs intestinal carbohydrate absorption in critically ill patients显示文摘 | Nguyen NQ Besanko LK Burgstad C | | 0，，01： | 1 |
| 8 | Gastric emptying of a liquid nutrient meal in the critically ill: relationship between scintigraphic and carbon breath test measurement 显示文摘 | Chapman MJ Besanko LK Burgstad CM | 2011 | Gut2011，60，： | 1 |
| 9 | Gastric emptying of a liquid nutrient meal in the critically ill:Relationship between scintigraphic and carbon breath test measurement显示文摘 | Chapman MJ Besanko LK Burgstad CM | 2011 | Gut2011，60，10： | 1 |
| 10 | Impact of bolus volume on small intestinal intra-luminal impedance in healthy subjects显示文摘AIM: To assess the impact of bolus volume on the characteristics of small intestinal (SI) impedance signals.METHODS: Concurrent SI manometry-impedance measurements were performed on 12 healthy volunteers to assess the pattern of proximal jejunal fluid bolus movement over a 14 cm-segment.Each subject was given 34 boluses of normal saline (volume from 1 to 30 mL) via the feeding tube placed immediately above the proximal margin of the studied segment.A bolus-induced impedance event occurred if there was > 12% impedance drop from baseline,over ≥ 3 consecutive segments within 10 s of bolus injection.A minor or major imped-ance event was defined as a duration of impedance drop < 60 s or ≥ 60 s,respectively.RESULTS: The minimum volume required for a detectable SI impedance event was 2 mL.A direct linear relationship between the SI bolus volume and the occurrence of impedance events was noted until SI bolus volume reached 10 mL,a volume which always produced an impedance flow event.There was a moderate correlation between the bolus volume and the duration of impedance drop (r = 0.63,P < 0.0001) and the number of propagated channels (r = 0.50,P < 0.0001).High volume boluses were associated with more major impedance events (≥ 10 mL boluses = 63%,3 mL boluses = 17%,and < 3 mL boluses = 0%,P = 0.02).CONCLUSION: Bolus volume had an impact on the type and length of propagation of SI impedance events and a threshold of 2 mL is required to produce an event. | Nam Q Nguyen Laura K Bryant Carly M Burgstad Robert J Fraser Daniel Sifrim Richard H Holloway | 2010 | World Journal of Gastroenterology2010，16，17： | 0 |
| 11 | Modulation of individual components of gastric motor response to duodenal glucose显示文摘AIM:To evaluate individual components of the antro-pyloro-duodenal(APD)motor response to graded small intestinal glucose infusions in healthy humans.METHODS:APD manometry was performed in 15healthy subjects(12 male;40±5 years,body mass index 26.5±1.6 kg/m2)during four 20-min intraduodenal infusions of glucose at 0,0.5,1.0 and 1.5 kcal/min,in a randomised double-blinded fashion.Glucose solutions were infused at a rate of 1 mL/min and separated by 40-min'wash-out'period.Data are mean±SE.Inferential analyses are repeated measure analysis of variance with Bonferroni post-hoc testing.RESULTS:At 0 kcal/min frequency of pressure waves were:antrum(7.5±1.8 waves/20 min)and isolated pyloric pressure waves(IPPWs)(8.0±2.3 waves/20min)with pyloric tone(0.0±0.9 mmHg).Intraduodenal glucose infusion acutely increased IPPW frequency(P<0.001)and pyloric tone(P=0.015),and decreased antral wave frequency(P=0.007)in a dosedependent fashion.A threshold for stimulation was observed at 1.0 kcal/min for pyloric phasic pressure waves(P=0.002)and 1.5 kcal/min for pyloric tone and antral contractility.CONCLUSION:There is hierarchy for the activation of gastrointestinal motor responses to duodenal glucose infusion.An increase in IPPWs is the first response observed. | Adam M Deane Laura K Besanko Carly M Burgstad Marianne J Chapman Michael Horowitz Robert JL Fraser | 2013 | World Journal of Gastroenterology2013，19，35： | 0 |
| 12 | Lower esophageal sphincter relaxation is impaired in older patients with dysphagia显示文摘AIM: To characterize the effects of age on the mechanisms underlying the common condition of esophageal dysphagia in older patients, using detailed manometric analysis. METHODS: A retrospective case-control audit was performed on 19 patients aged ≥ 80 years (mean age 85 ± 0.7 year) who underwent a manometric study for dysphagia (2004-2009). Data were compared with 19 younger dysphagic patients (32 ± 1.7 years). Detailed manometric analysis performed prospectively included basal lower esophageal sphincter pressure (BLESP), pre-swallow and nadir LESP, esophageal body pressures and peristaltic duration, during water swallows (5 mL) in right lateral (RL) and upright (UR) postures and with solids. Data are mean ± SE; a P-value < 0.05 was considered significant. RESULTS: Elderly dysphagic patients had higher BLESP than younger patients (23.4 ± 3.8 vs 14.9 ± 1.2 mmHg; P < 0.05). Pre-swallow LESP was elevated in the elderly in both postures (RL: 1 and 4 s P = 0.019 and P = 0.05; UR: P < 0.05 and P = 0.05) and solids (P < 0.01). In older patients, LES nadir pressure was higher with liquids (RL: 2.3 ± 0.6 mmHg vs 0.7 ± 0.6 mmHg, P < 0.05; UR: 3.5 ± 0.9 mmHg vs 1.6 ± 0.5 mmHg, P = 0.01) with shorter relaxation after solids (7.9 ± 1.5 s vs 9.7 ± 0.4 s, P = 0.05). No age-related differences were seen in esophageal body pressures or peristalsis duration. CONCLUSION: Basal LES pressure is elevated and swallow-induced relaxation impaired in elderly dysphagic patients. Its contribution to dysphagia and the effects of healthy ageing require further investigation. | Laura K Besanko Carly M Burgstad Reme Mountifi eld Jane M Andrews Richard Heddle Helen Checklin Robert JL Fraser | 2011 | World Journal of Gastroenterology2011，17，10： | 0 |
| 13 | Age-related impairment of esophagogastric junction relaxation and bolus flow time显示文摘AIM To investigate the functional effects of abnormal esophagogastric(EGJ) measurements in asymptomatic healthy volunteers over eighty years of age. METHODS Data from 30 young controls(11 M, mean age 37 ± 11 years) and 15 aged subjects(9 M, 85 ± 4 years) were compared for novel metrics of EGJ-function: EGJcontractile integral(EGJ-CI), 'total' EGJ-CI and bolus flow time(BFT). Data were acquired using a 3.2 mm, 25 pressure(1 cm spacing) and 12 impedance segment(2 cm) solid-state catheter(Unisensor and MMS SolarGI system) across the EGJ. Five swallows each of 5 m L liquid(L) and viscous(V) bolus were analyzed. Mean values were compared using Student's t test for normally distributed data or Mann Whitney U-test when non-normally distributed. A P value < 0.05 was considered significant.RESULTS EGJ-CI at rest was similar for older subjects compared to controls. 'Total' EGJ-CI, measured during liquid swallowing, was increased in older individuals when compared to young controls(O 39 ± 7 mm Hg.cm vs C 18 ± 3 mm Hg.cm; P = 0.006). For both liquid and viscous bolus consistencies, IRP4 was increased(L: 11.9 ± 2.3 mm Hg vs 5.9 ± 1.0 mm Hg, P = 0.019 and V: 14.3 ± 2.4 mm Hg vs 7.3 ± 0.8 mm Hg; P = 0.02) and BFT was reduced(L: 1.7 ± 0.3 s vs 3.8 ± 0.2 s and V: 1.9 ± 0.3 s vs 3.8 ± 0.2 s; P < 0.001 for both) in older subjects, when compared to young. A matrix of bolus flow and presence above the EGJ indicated reductions in bolus flow at the EGJ occurred due to both impaired bolus transport through the esophageal body(i.e., the bolus never reached the EGJ) and increased flow resistance at the EGJ(i.e., the bolus retained just above the EGJ).CONCLUSION Bolus flow through the EGJ is reduced in asymptomatic older individuals. Both ineffective esophageal bolus transport and increased EGJ resistance contribute to impaired bolus flow. | Charles Cock Laura K Besanko Carly M Burgstad Alison Thompson Stamatiki Kritas Richard Heddle Robert JL Fraser Taher I Omari | 2017 | World Journal of Gastroenterology2017，23，15： | 0 |
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