What the anaesthetists said, and then said again
This is the single interaction with ordinary medical care that patients most need to disclose, and it is the one most often not asked about.
Delayed gastric emptying
Slowed gastric emptying as a mechanism, an adverse event, and a peri-operative consideration.
Background rates, and why they matter for attribution
Pancreatitis is rare, was adjudicated in the outcome programmes, and did not show the imbalance early case reports suggested.
The tolerability data everybody quotes and nobody reads
Trial adverse-event tables count episodes reported to a study nurse. They are the best data we have and they systematically under-record the mundane.
Antiemetics, laxatives and the thin literature underneath them
We separate what is supported, what is reasonable, and what is folklore, and we do not pretend the boundaries are crisp.
Tolerability is the ceiling, and the ceiling is personal
An effect is dose-limiting when it prevents adequate intake, prevents normal activity, or produces a risk of its own. Discomfort alone is not the test.
Adverse events by dose, adverse events by week
Trial adverse-event tables count episodes reported to a study nurse. They are the best data we have and they systematically under-record the mundane.
The area postrema, and the anatomy of an unwanted effect
What scintigraphy and breath-test studies established about emptying rate, and what they did not.
Adverse events by dose, adverse events by week
Almost every figure in circulation about tolerability comes from six publications. This is what they say.
Dose-limiting: a definition worth being strict about
An effect is dose-limiting when it prevents adequate intake, prevents normal activity, or produces a risk of its own. Discomfort alone is not the test.
What the trials counted as intolerance
The ceiling varies severalfold between people, and nothing measurable at baseline predicts where it sits.
Holding the dose before surgery: for whom, for how long
This is the single interaction with ordinary medical care that patients most need to disclose, and it is the one most often not asked about.
Tolerability is the ceiling, and the ceiling is personal
An effect is dose-limiting when it prevents adequate intake, prevents normal activity, or produces a risk of its own. Discomfort alone is not the test.
Forty-four per cent: reading the nausea figure properly
Severity in these tables is graded by interference with activity, not by how unpleasant the experience was. Those are different measurements.
Antiemetics, laxatives and the thin literature underneath them
Dietary measures are widely recommended, plausible on mechanism, and supported mainly by observational data and clinical experience.
The mechanism behind the mechanism
Delayed gastric emptying is a mechanism that becomes an adverse effect above a threshold. It is not a complication in the ordinary sense.
The interventions with trial support, and the much longer list without
Almost nothing in the standard management repertoire has been tested in a randomised trial in this specific population. We say what is extrapolated and from where.
What actually helps, ranked by evidence
Dietary measures are widely recommended, plausible on mechanism, and supported mainly by observational data and clinical experience.
Dose-limiting: a definition worth being strict about
Trial discontinuation figures are a floor, not an estimate: trial populations are supported in ways ordinary patients are not.
What the trials adjudicated, and how
We give background rates alongside trial rates, because an event occurring during treatment is not thereby caused by it.
Dose-limiting: a definition worth being strict about
An effect is dose-limiting when it prevents adequate intake, prevents normal activity, or produces a risk of its own. Discomfort alone is not the test.