Antroduodenal motility and small bowel transit during continuous intraduodenal or intragastric administration of enteral nutrition

Background Gastrointestinal intolerance is observed more frequently during intraduodenal (ID) tube feeding than during intragastric (IG) feeding, poss ibly because it evokes a stronger gastrointestinal response and accelerates small bowel transit. We have investigated whether the accelerated small bo wel transit during ID feeding results from alterations in antroduodenal mot ility pattern. Design The effect of IG and ID infusion of a polymeric diet (Nutrison, 125 kcal h(-1)) on antroduodenal motility, small bowel transit time (SBTT) and gastrointestinal hormone release was studied in nine healthy subjects. Thes e subjects were studied on three occasions for 6h during fasting, continuou s IG or ID feeding. Results Phase III recurrence time was significantly prolonged during IG fee ding compared with fasting (240 +/- 51 vs. 136 +/- 24 min; P < 0.05). None of the subjects had recurrence of phase III during ID feeding; the fed moto r pattern remained present. Parameters of fed motility (mean amplitude and motility index) were not significantly different between IG and ID feeding, although the frequency of antral and duodenal contractions was lower durin g ID than during IG feeding. SBTT was significantly accelerated during ID c ompared with IG feeding and with fasting (58 +/- 8 vs, 73 +/- 9 and 83 +/- 10 min respectively; P < 0.05). Plasma cholecystokinin (CCK) and pancreatic polypeptide (PP) levels were significantly higher during ID than during IG feeding. Peptide YY (PYY) levels were significantly higher during ID than during fasting, but not during IG feeding Conclusions During intraduodenal feeding, a fed motility pattern is preserv ed, whereas during intragastric feeding transition from a fed to a fasting motor pattern is observed in over 50% of the subjects. These differences ma y be related to augmented hormone release during intraduodenal feeding.