Effects of intramural administration of Botulinum Toxin A on gastric emptying and eating capacity in obese patients.
ABSTRACT Intraparietal gastric administration of Botulinum Toxin A has been studied in open trials to induce satiety and increase weight loss of obese patients with contradictory results. In previous studies only the antrum was the target for Botulinum Toxin A, whereas the fundus, which exerts important activity on gastric accommodation, was excluded. In this study we report the effects of injection into both gastric regions on solid gastric capacity and emptying of the stomach.
In this study we extended our previous investigations to include 30 obese patients who received Botulinum Toxin A (120 U into the antrum and 80 U into the fundus) or saline by intraparietal endoscopic injection. The two groups were homogeneous for age, gender, body weight and body mass index. Body weight and body mass index, solid gastric emptying (T(1/2) and T(lag) at the octanoic acid breath test) and maximal gastric capacity for solids (kcal) were determined before injection and 2 months later. The results were expressed as mean values (S.E.M.). t-Test or Wilcoxon test was used for statistical analysis, p<0.05 being considered significant.
Both treatments induced a significant reduction of body weight and body mass index but Botulinum Toxin A exerted a significantly greater effect (body weight -11.8+/-0.9 kg vs. -5.5+/-1.1 kg, p<0.0002; body mass index -4.1+/-0.2 vs. -2.2+/-0.4, p<0.001). The maximal gastric capacity for solids was also reduced by both Botulinum Toxin A and placebo, the former being significantly more effective (679+/-114 kcal vs. 237+/-94 kcal, p<0.008). Botulinum Toxin A also significantly increased T(1/2) from 83.4+/-3.9 to 101.6+/-9.9 min, p<0.03) but T(lag) was unchanged. Placebo had no effect on either of these parameters.
Our results demonstrated that Botulinum Toxin A makes weight loss easier in obese patients. It acts by increasing the solid gastric emptying time and reducing the solid eating capacity of the stomach.
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ABSTRACT: To investigate gastric emptying of a mixed solid and liquid meal in normal weight and obese children. 114 volunteer children of school age (range 6-11 y) entered the study. Children were considered as being underweight, normal weight, obese, severely obese according to their body mass index (BMI), and were examined using a non-invasive ultrasound method in the morning after an overnight fast period. The examination was always performed in an upright position by the same operator. The half-emptying time and fasting antral area were assessed, and antral area measurements were performed every 30 min for 240 min after meal administration. Five children (4.4%) were underweight, 53 (46.5%) were normal weight, 19 (16.6%) were obese, and 37 (32.5%) were severely obese. The underweight group was not considered for the analysis. No significant difference in t 1/2 was found among the three groups. A positive statistically significant correlation was found between fasting antral area and BMI (r = 0.44; P<0.0001) in all children. The fasting antral area value was 3.5 cm2 (range 1.6-8.1) in normal weight children, 3.6 cm2 (range 1.9-7.7) in obese children, and 3.9 cm2 (range 1.5-10.8) in severely obese children. There was a significant difference between severely obese and normal weight children (P<.05). No significant difference was found in the gastric emptying between severely obese and obese children, and between severely obese and normal weight ones. The difference in fasting antral area in these groups may be considered as an early disturbance. In fact the increased gastric volume could cause a change in the sense of satiety with a consequent increase in the intake of these subjects.International Journal of Obesity 01/2000; 23(12):1303-6. · 5.22 Impact Factor
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ABSTRACT: An enhanced gastric emptying rate might reduce the satiating effect of food and thereby promote obesity. Gastric emptying rate has previously been compared between obese and lean subjects with conflicting outcome. Comparison of gastric emptying rate in lean and obese subjects before and after a major weight reduction. The study was designed as a case-control study comparing obese and lean subjects and a subsequent comparison of obese subjects before and after a dietary induced major weight reduction. Gastric emptying rate following a solid test meal was estimated scintigraphically for 3 h using the left anterior oblique projection. Nineteen non-diabetic obese (mean BMI=38.7 kg/m2) and 12 lean (mean BMI=23.1 kg/m2) males matched for age and height. All obese subjects were re-examined after a mean weight loss of 18.8 kg (95% CI, 14.4-23.2) achieved by 16 weeks of dietary intervention followed by 8 weeks of weight stability. When comparing obese and lean subjects no differences were seen in overall 3 h emptying rate (30.3% per hour vs 30.5% per hour). However, a trend towards a higher percentage gastric emptying during the initial 30 min was seen in the obese when compared to lean subjects (24.0% vs 17.8% of the test meal; P=0.08). Weight loss was associated with a reduction in percentage gastric emptying during the initial 30 min (from 24.0% to 18.3% of the test-meal; P<0. 02), whereas the overall 3 h emptying rate was unaffected (30.3% vs 30.9% per hour). Neither initial or overall emptying rate differed between reduced-obese and lean subjects. Overall 3 h gastric emptying rate was similar in obese and normal weight males, and unaffected by a major weight loss. However, percentage gastric emptying during the initial 30 min for a solid meal appeared to be increased in obese males and was normalized after a major weight reduction.International Journal of Obesity 08/2000; 24(7):899-905. · 5.22 Impact Factor
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ABSTRACT: The role of the stomach in regulating appetite in bulimia nervosa was examined. Subjects were nine normal and nine bulimic women of similar age, height, and weight. Gastric capacity was estimated by filling a balloon in the stomach. The mean stomach capacity of bulimic subjects was significantly larger than that of normal subjects, as revealed by the larger balloon volume tolerated (P less than 0.01) and by the larger volume needed to produce a 5 cm H2O increase in intragastric pressure (P = 0.07). The intake of a liquid meal was also significantly larger for the bulimic subjects. Gastric-emptying rate of a liquid meal was significantly delayed in the bulimic subjects during the initial 5-15 min. In all subjects, test-meal intake correlated significantly with gastric capacity (r = 0.53). In the bulimic subjects, self-reported binge intake (J) also correlated significantly with gastric capacity (r = 0.75). Binge eating in bulimic subjects may enlarge gastric capacity, which could then promote even larger binges through positive feedback.American Journal of Clinical Nutrition 11/1992; 56(4):656-61. · 6.50 Impact Factor