The effect of gastric secretion on gastric physiology and emptying in the fasted and fed state assessed by magnetic resonance imaging

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Abstract
Conventional measurement of gastric secretion is invasive and cannot assess the intra‐gastric distribution of gastric contents or the effects of secretion on gastric function. This study assessed the effect of gastric secretion on gastric volume responses and emptying (GE) using a validated fast T1 mapping magnetic resonance imaging (MRI) technique. Twelve healthy participants were studied in the fasted state and after 200 kcal Gadolinium‐DOTA labelled glucose meal during intravenous infusion of pentagastrin or placebo in double‐blind, randomized order. Total gastric volume (TGV) and gastric content volume (GCV) was assessed by MRI volume scans and secretion by fast T1 mapping. Data was described by the κ‐coefficient (volume change after meal ingestion), by GE half time (T50) and maximal GE rate (GERmax) derived all from a GE model. Pentagastrin increased GCV and TGV compared to placebo [κ(GCV):1.6 ± 0.1 vs 0.6 ± 0.1; κ(TGV): 1.6 ± 0.1 vs 0.7 ± 0.1; P < 0.001]. T1 maps revealed a secretion layer above the meal, the volume of which was associated with κ (R2 = 83%, P < 0.001). TGV and GCV change were similar in both conditions (κ; P = ns). T50 was higher for pentagastrin than for placebo (84 ± 7 vs 56 ± 4min, P < 0.001); however, GERmax was similar (5.9 ± 0.6 vs 4.9 ± 0.4 mL min−1, P = ns). This study shows volume and distribution of gastric secretion can be quantified in‐vivo by non‐invasive MRI T1 mapping. Increased GCV drove TGV accommodation without evidence of a direct effect of pentagastrin or excess acid on gastric function. Secretion increases GCV thus prolongs GE as assessed by T50; however, GE rate is unchanged.

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