Nutritional problems in end-stage liver disease - Contribution of impaired gastric emptying and ascites

Goals: To evaluate gastric emptying before and after paracentesis in patients with cirrhosis. Background: Patients with ascites often report early satiety. The effect of paracentesis on gastric emptying has not been studied previously. Study: Twelve patients who required therapeutic paracentesis were studied (mean age, 57 years; range, 47-69 years). Gastric emptying was performed with radionuclide scintigraphy. Satiety was evaluated with a visual analogue scale. Wilcoxon signed-rank tests were used for comparison between pre- and poststudies. Results: The causes of cirrhosis included alcohol (seven patients), a combination of alcohol and hepatitis C (two), chronic hepatitis C only (one), primary biliary cirrhosis (one), and cryptogenic (one). The median volume of ascetic fluid removed at paracentesis was 5,450 mL (range, 2,500-7,200 mL). Median 2-hour gastric emptying was 65.5% before paracentesis and 61.5% after (p > 0.05), Median 4-hour gastric emptying was 92.5% before paracentesis and 96.5% after (p > 0.05). Both satiety score and caloric intake were significantly improved after paracentesis (p < 0.05). Conclusions: Although satiety and calorie intake improve after large-volume paracentesis in patients with cirrhosis, these changes do not seem to correspond with improved gastric emptying. Therefore, other mechanisms most likely contribute to satiety.