Objective: Contradictory reports have been published on gastric emptying in patients with liver cirrhosis. The differences have been attributed to differences in the innervation of the stomach or in the behaviour of the gastric wall. The type of test meal used may, however, have its importance. We looked for the role of the test meal in the assessment of gastric emptying in cirrhosis.
Design: In a prospective study, we included 15 patients with liver cirrhosis who had no symptoms of autonomic neuropathy, portal hypertensive gastropathy or antral vascular ectasia and 15 controls. In these subjects we estimated the gastric emptying and varied the type of test meals.
Methods: An ultrasonographic method was used for the estimation of gastric emptying. Antral area was monitored in the aorto-mesenteric plane in the fasting condition and at 0, 15, 30, 45, 60 min after a test meal. Each patient was tested twice on 2 consecutive days in randomized order with a liquid meal (220 kJ) and a semisolid meal (1472 kJ).
Results: Fasting antral areas (mean +/- SD) had similar size in both groups with both meals. Gastric emptying (expressed by the area under the curve and half-time (T1/2)) of the semisolid meal was not different in cirrhosis (2347 +/- 1648) compared to controls (2840 +/- 1983). Postprandial antral distension was also similar in both groups (312.2 +/- 133.6% in cirrhosis vs. 397.9 +/- 155.6% in controls). But emptying of the liquid meal was accelerated in the cirrhotic patients with respect to the area under the curve (AUC: 882 +/- 548) and half-time (12 +/- 2 min) vs. controls (AUC: 1863 +/- 1088, P<0.01; T1/2: 18 +/- 7 min, P<0.05). Postprandial antral distension with the liquid meal was decreased (299.4 +/- 76.5% vs. 431.5 +/-154.0%, P<0.01, in controls).
Conclusion: These data suggest that in patients with liver cirrhosis free of autonomic neuropathy and without portal hypertensive gastropathy or vascular antral ectasia, gastric emptying of liquid low calorie meals is accelerated. The gastric emptying of a semisolid meal richer in calories is normal. Thus, the physical and chemical properties of a meal are major determinants of gastric emptying and may account for the large divergence of results hitherto published on this topic.