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Objective: Regulation of postprandial (pp) plasma glucose excursions is complex. Insulin and glucagon are thought to play the predominant role. Nevertheless, only 50% of the variation in pp plasma glucose excursions is explained by variations by the latter. Theoretically, gastric emptying (GE) should be another important factor. However, its impact on pp glucose homeostasis is unknown. Research Design and Methods: We examined the consequences of pramlintide-induced delay in GE on pp glycemia and glucose fluxes, determined isotopically. GE was recorded by scintigraphy. Fourteen healthy subjects (8 men, 6 women; age 40 [+ or -] 3 yr, body mass index 27.8 [+ or -] 1.1 kg/[m.sup.2]) ate a mixed meal, and 30 [micro]g of pramlintide (PRAM) or placebo (PBO) were injected subcutaneously. Results: At 60 min, greater proportions of the initial gastric contents remained in the stomach (PBO vs. PRAM). Thereafter, GE slopes paralleled until 240 min. Fifty percent retention times were lower when PBO was given (P < 0.001). GE was greater from 240 min to the end of the PRAM experiments, so that only slightly greater proportions of the meal remained in the stomach at 330 min. Reductions of GE lowered pp glucose (7.5 [+ or -] 0.3 vs. 6.0 [+ or -] 0.2 mmol/1, P < 0.001), even though plasma insulin was lower with PRAM (164 [+ or -] 13 vs. 138 [+ or -] 13 pmol/ml, both P < 0.01). Reduction in total glucose appearance (P < 0.001) was due to reduced meal-derived glucose appearance (10.2 [+ or -] 0.5 vs. 7.0 [+ or -] 0.4 [micro]mol x [kg.sup.-1] x [min.sup.-1], P < 0.001). Endogenous glucose appearance was greater with PRAM (P < 0.001). Splanchnic glucose uptake was greater with PRAM (26.5 [+ or -] 1.6 vs. 32.5 [+ or -] 2.1%, P = 0.014). Conclusions: These data support the concept that GE is an important physiological regulator of pp glucose homeostasis in humans.

Background: Glucagon-like peptide-1 (7-36)amide (GLP-1) retards gastric emptying, reduces food intake, and inhibits antroduodenal and stimulates pyloric motility. Aims: To assess the effects of synthetic GLP-1 on fundus tone and [...]

Acute pancreatitis is the second most common cause of hospital admission of all gastrointestinal disorders and is associated with an overall mortality rate of 0.5 per cent[1]. Nevertheless, the individual trials, and even the pooled data in meta-analyses, did not include enough patients with "predicted severe biliary pancreatitis without cholangitis" to study hard clinical endpoints such as mortality (possible type II statistical error). Therefore, the Dutch Pancreatitis Study Group[10] initiated the APEC trial to clarify the role of early ERCP in patients with predicted severe biliary pancreatitis in the absence of cholangitis. [Extracted from the article]