Does Adding Milk to Tea Delay Gastric Emptying? (GETEAM)

Gastric Emptying of Tea With Milk, Compared With Tea Without Milk. Does Milk Delay Gastric Emptying?

Most pre-operative fasting regimes dictate that if there is any milk added to tea or coffee, the preoperative fasting time should be extended from 2 to 6 hours. The purpose of this study is to demonstrate whether there is really a delay in gastric emptying time associated with the inclusion of milk in a cup of tea.

Study Overview

• Status: Completed
• Conditions: Gastric Emptying
• Intervention / Treatment: Other: Black tea; Other: Tea with milk

Detailed Description

This was a randomised controlled crossover study conducted in ten healthy volunteers. The paracetamol absorption technique and real-time ultrasound measurement of the cross-sectional area (CSA) of the gastric antrum were used to assess gastric emptying following ingestion of 300ml of black tea or 300ml of tea with milk (250ml black tea plus 50ml of full fat milk)

Each participant took part in both arms of the trial, drinking black tea and tea with milk, the order of which was determined by a computerised random number generator and concealed from the investigators by opaque brown paper envelopes.

In each arm of the study the procedure was as follows. The subject sat in a semi-reclined position at a 45 angle, a 16g intravenous cannula was sited in an upper limb and baseline blood samples taken. The initial cross-sectional area of the gastric antrum was then measured by ultrasound.

The investigating anaesthetist then left the room, the subject opened their randomisation envelope and drank, as directed, either 300ml of black tea or 300ml of tea with milk (250ml black tea plus 50ml of full fat milk) over 3 minutes, followed by 1.5 g of dispersible paracetamol dissolved in 30ml of water.

Blood samples were taken every 10 minutes for the first hour, then every 30 minutes until 150 minutes had elapsed. Paracetamol concentrations in each sample were measured using an enzymatic assay. Time to peak concentration (tmax) was thus determined.

The CSA of the gastric antrum was measured by ultrasound in real-time (RUS) at baseline, every ten minutes for 60 minutes and then at 30-minute intervals for 150 minutes. Antral CSA was plotted against time and gastric emptying expressed as half-time to gastric emptying (T½). This was defined as the time from baseline to the time the gastric antrum returns to half the maximal value.

The primary outcome was tmax. Previous studies have shown mean or median tmax values for paracetamol to vary from 25 to 60 minutes following ingestion of clear fluids, with standard deviation up to 38 minutes. In this study we considered that a delay of gastric emptying of under 60 minutes would not be clinically important; and that we would be able to declare that the two regimes were equivalent if the (two sided) 95% confidence interval for the mean difference in tmax, between black tea and tea with milk included only times less than 60 minutes. Using these assumptions and taking (pessimistically) a correlation between repeated measurements of 0.0, power analysis determined nine participants would be required (with 90% power) to show equivalence.

A 95% confidence interval for the mean difference in tmax that lay entirely within 60 minutes of no effect would confirm the hypothesis that tea with milk was clinically equivalent to black tea.

• Study Type: Interventional
• Enrollment (Actual): 10
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United Kingdom
  • London, United Kingdom, SE1 7EH
    • St Thomas' Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 40 years (Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Healthy non-pregnant volunteers

Exclusion Criteria:

• medical conditions with a predisposition to delayed gastric emptying (e.g. diabetes or gastric disease)
• ingestion of paracetamol within the previous 24 hours
• ingestion of solids or non-clear liquids in the previous six hours
• ingestion of clear liquids in the previous two hours.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Basic Science
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Black Tea	Other: Black tea; 300ml of tea without milk
Active Comparator: Tea with Milk	Other: Tea with milk; 250ml of black tea with 50ml of full fat milk

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Tmax	tmax = the time taken to reach peak paracetamol concentration. The blood samples were analysed for the level of paracetamol, from which the time taken to reach peak paracetamol concentration was subsequently calculated. Blood samples were taken at the same time points as the ultrasound measurements.	Blood samples taken every 10 minutes for 1 hour and then 30 minute intervals until 150 minutes had elapsed. Each participant spent approximately 3 hours for each arm of the trial separated by no less than 24 hours

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
T½	T½ = time from baseline to the time the cross-sectional surface area (CSA) of the gastric antrum, measured using realtime ultrasound, returned to half the maximal value (CSA½max ). CSA ½ max calculated as below: CSA½max = CSAmax - [(CSAmax - CSAbaseline)/2]	Measurments taken every 10 minutes for 1 hour and then 30 minute intervals until 150 minutes had elapsed. Each participant spent approximately 3 hours for each arm of the trial separated by no less than 24 hours.

Collaborators and Investigators

• Sponsor: Guy's and St Thomas' NHS Foundation Trust
• Investigators: Principal Investigator: Geraldine O'Sullivan, St Thomas' Hospital, Guy's & St Thomas' NHS Foundation Trust

Publications and helpful links

General Publications

• Smith I, Kranke P, Murat I, Smith A, O'Sullivan G, Soreide E, Spies C, in't Veld B; European Society of Anaesthesiology. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2011 Aug;28(8):556-69. doi: 10.1097/EJA.0b013e3283495ba1.
• Wong CA, Loffredi M, Ganchiff JN, Zhao J, Wang Z, Avram MJ. Gastric emptying of water in term pregnancy. Anesthesiology. 2002 Jun;96(6):1395-400. doi: 10.1097/00000542-200206000-00019.
• Darwiche G, Almer LO, Bjorgell O, Cederholm C, Nilsson P. Measurement of gastric emptying by standardized real-time ultrasonography in healthy subjects and diabetic patients. J Ultrasound Med. 1999 Oct;18(10):673-82. doi: 10.7863/jum.1999.18.10.673.

Study record dates

Study Major Dates

• Study Start: November 1, 2011
• Primary Completion (Actual): January 1, 2012
• Study Completion (Actual): March 1, 2012

Study Registration Dates

• First Submitted: March 7, 2013
• First Submitted That Met QC Criteria: March 11, 2013
• First Posted (Estimate): March 13, 2013

Study Record Updates

• Last Update Posted (Estimate): December 18, 2013
• Last Update Submitted That Met QC Criteria: November 24, 2013
• Last Verified: November 1, 2013

More Information

Terms related to this study

• Keywords: Ultrasound; Gastrointestinal tract emptying; Pre-operative fasting; Paracetamol Absorption
• Other Study ID Numbers: STH01