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Abstract The geometry and motility of the stomach play a critical role in the digestion of ingested liquid meals. Sleeve gastrectomy, a common type of bariatric surgery used to reduce the size of the stomach, significantly alters the stomach's anatomy and motility, which impacts gastric emptying and digestion. In this study, we use an imaging data-based computational model, StomachSim, to investigate the consequences of sleeve gastrectomy. The pre-operative stomach anatomy was derived from imaging data, and the postsleeve gastrectomy shapes were generated for different resection volumes. We investigate the effect of sleeve sizes and motility patterns on gastric mixing and emptying. Simulations were conducted using an immersed-boundary flow solver, modeling a liquid meal to analyze changes in gastric mixing and emptying rates. The results reveal that different degrees of volume reduction and impaired gastric motility have complex effects on stomach's mixing and emptying functions, which are important factors in gastric health of the patient. Specifically, the total gastric liquid emptying rates increased by 21% with a 30% volume reduction and by 51% with reductions exceeding 50%, due to altered intragastric pressure. Additionally, impaired motility functions resulted in slower mixing, leading to delayed food emptying. These findings provide insights into the biomechanical effects of sleeve gastrectomy on gastric digestion and emptying functions, highlighting the potential of computational models to inform surgical planning and postoperative management. 

An in silico model of the stomach is presented to study the phenomenon of duodenogastric reflux. We use the model to investigate the role of pyloric incompetence, food properties, and gastroparesis on reflux. This first-ever in silico study of duodenogastric reflux provides new insights into the mechanisms and factors implicated in this reflux and the sequelae of conditions that result from the exposure of the stomach lumen to bile. 

Pyloric interventions are surgical procedures employed to increase the gastric emptying rate in gastroparesis patients. In this study, we use anin silicomodel to investigate the consequences of pyloric intervention on gastric flow and emptying for two phenotypes of gastroparesis: antral hypomotility and decreased gastric tone. The transpyloric pressure gradient predicted by thein silicomodel, based on viscous fluid flow equations, is compared againstin vivomeasurements. Both phenotypes exhibit a similar pre-procedural emptying rate reduction, but after pyloric surgery, antral hypomotility case with preserved gastric tone shows significant improvements in emptying rates, up to 131%, accompanied by bile reflux from the duodenum into the stomach. Conversely, severely reduced gastric tone cases exhibited a post-procedural reduction in the net emptying rate due to the relatively larger bile reflux. In cases with a combination of antral hypomotility and reduced gastric tone, post-procedural improvements were observed only when both conditions were mild. Our findings highlight the pivotal role of the relative increase in pyloric orifice diameter in determining post-operative emptying rates. The study suggests a possible explanation for the selective response of patients toward these procedures and underscores the potential ofin silicomodelling to generate valuable insights to inform gastric surgery. 

The peristaltic motion of stomach walls combines with the secretion of digestive enzymes to initiate the process that breaks down food. In this study, the mixing, breakdown, and emptying of a liquid meal containing protein is simulated in a model of a human stomach. In this model, pepsin, the gastric enzyme responsible for protein hydrolysis, is secreted from the proximal region of the stomach walls and allowed to react with the contents of the stomach. The velocities of the retropulsive jet induced by the peristaltic motion, the emptying rate, and the extent of hydrolysis are quantified for a control case as well as for three other cases with reduced motility of the stomach, which may result from conditions such as diabetes mellitus. This study quantifies the effect of stomach motility on the rate of food breakdown and its emptying into the duodenum and we correlate these observations with the mixing in the stomach induced by the wall motion.