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Am J Physiol Gastrointest Liver Physiol (January 4, 2007). doi:10.1152/ajpgi.00519.2006
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Submitted on November 6, 2006
Accepted on January 1, 2007

Concurrent duodenal manometric and impedance recording to evaluate the effects of hyoscine on motility and flow events, glucose absorption, and incretin release

Reawika Chaikomin1, Keng Liang Wu1, Selena Doran1, Karen L. Jones1, Andre Smout2, Willem Renooij3, Richard Holloway4, James Meyer1, Michael Horowitz1, and Christopher K Rayner1*

1 Discipline of Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
2 Gastroenterology, University Medical Center Utrecht, Utrecht, Netherlands
3 Surgery, University Medical Center Utrecht, Utrecht, Utrecht, Netherlands
4 Department of GI Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia

* To whom correspondence should be addressed. E-mail: chris.rayner{at}adelaide.edu.au.

Upper gastrointestinal motor function and incretin hormone secretion are major determinants of postprandial glycemia and insulinemia. However, the impact of small intestinal flow events on glucose absorption and incretin release is poorly defined. Intraluminal impedance monitoring is a novel technique that allows flow events to be quantified. Eight healthy volunteers were studied twice, in random order. A catheter incorporating 6 pairs of electrodes at 3 cm intervals, and 6 corresponding manometry sideholes, was positioned in the duodenum. Hyoscine butylbromide 20 mg, or saline, was given as an intravenous bolus, followed by a continuous intravenous infusion of either hyoscine (20 mg/h) or saline, over 60 minutes. Concurrently, glucose and 3-O-methylglucose (3-OMG) were infused into the proximal duodenum (3 kcal/min), with frequent blood sampling to measure glucose, 3-OMG, insulin, glucagon-like peptide-1 (GLP-1) and glucose-dependant insulinotropic polypeptide (GIP). The frequency of duodenal pressure waves and propagated pressure wave sequences was reduced by hyoscine in the first 10 minutes (P<0.01 for both), but not after that time. In contrast, there were markedly fewer duodenal flow events throughout 60 minutes with hyoscine (P<0.005). Overall, blood glucose (P<0.01) and plasma 3-OMG concentrations (P<0.05) were lower during hyoscine than saline, while plasma insulin, GLP-1, and GIP concentrations were initially (t=20 min) lower during hyoscine (P<0.05). In conclusion, intraluminal impedance measurement may be more sensitive than manometry in demonstrating alterations in duodenal motor function. A reduction in the frequency of duodenal flow events is associated with a decreased rate of glucose absorption and incretin release in healthy subjects.







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