1
|
Eiswerth M, Mathur P, Rashed H, Greenway F, Ravussin E, Johnson W, Jirapinyo P, Thompson CC, Kehdy F, Sarker S, Naing LY, Daniels MW, Abell T. Autonomic and Enteric Profiling May Help Predict Response to Diverse Obesity Therapies. Obes Surg 2024; 34:3147-3160. [PMID: 39046627 DOI: 10.1007/s11695-024-07360-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 06/07/2024] [Accepted: 06/07/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE Changes in autonomic (ANS) and enteric nervous systems (ENS) may be involved in pathogenesis of obesity. We hypothesized that baseline autonomic and enteric parameters may predict outcomes of diverse obesity therapies. MATERIAL AND METHODS We studied ANS and ENS physiology in 37 patients (8 male, 29 female, age 45 years, weight 129.7 kg) at 4 centers in patients undergoing medical (9: low-calorie diet) versus invasive (22: 16 sleeve, 6 bypass) and semi-invasive (6: 2 band, 2 high energy stimulation, 2 aspiration) weight loss therapies. Weight loss was reported as percent weight loss from baseline to latest values at 1 year and in some up to 5 years; classified as < or > /= 20% for each group. ANS testing included sympathetic adrenergic function by measuring reflex vasoconstriction and postural adjustment ratio. ENS was measured non-invasively using cutaneous low-resolution electrogastrogram. RESULTS Percent weight loss was greater with the invasive (28.5%) than semi-invasive (9.1%) or non-invasive low-calorie diet (4.4%) (p < .001). Percent weight loss at 1 year (and up to 5 years) corresponded to the adrenergic measure of postural adjustment ratio (r = .42, p = .012), total pulse amplitude at rest (r = .56, p < .001), and electrogastrogram standing-to-rest difference (r = .33, p = .056). CONCLUSION Baseline autonomic and enteric function measures correspond to percentage with loss in this pilot study using diverse weight loss methods. Autonomic and enteric profiling has potential clinical use for evaluation and treatment of obesity but needed larger controlled trials.
Collapse
Affiliation(s)
- Michael Eiswerth
- Division of Gastroenterology, Hepatology, and Nutrition, GI Motility Research, University of Louisville, 8 Frazier, 220 Abraham Flexner Dr, Louisville, KY, 40202, USA
| | - Prateek Mathur
- Division of Gastroenterology, Hepatology, and Nutrition, GI Motility Research, University of Louisville, 8 Frazier, 220 Abraham Flexner Dr, Louisville, KY, 40202, USA
| | - Hani Rashed
- Vanderbilt University Medical Center, Nashville, TN, 37235, USA
| | - Frank Greenway
- Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA
| | - Eric Ravussin
- Vanderbilt University Medical Center, Nashville, TN, 37235, USA
| | - William Johnson
- Vanderbilt University Medical Center, Nashville, TN, 37235, USA
| | | | | | - Farid Kehdy
- Division of Gastroenterology, Hepatology, and Nutrition, GI Motility Research, University of Louisville, 8 Frazier, 220 Abraham Flexner Dr, Louisville, KY, 40202, USA
| | - Shabnam Sarker
- Vanderbilt University Medical Center, Nashville, TN, 37235, USA
| | - Le Yu Naing
- Division of Gastroenterology, Hepatology, and Nutrition, GI Motility Research, University of Louisville, 8 Frazier, 220 Abraham Flexner Dr, Louisville, KY, 40202, USA
| | - Michael W Daniels
- Division of Gastroenterology, Hepatology, and Nutrition, GI Motility Research, University of Louisville, 8 Frazier, 220 Abraham Flexner Dr, Louisville, KY, 40202, USA
| | - Thomas Abell
- Division of Gastroenterology, Hepatology, and Nutrition, GI Motility Research, University of Louisville, 8 Frazier, 220 Abraham Flexner Dr, Louisville, KY, 40202, USA.
| |
Collapse
|
2
|
Naing LY, Mathur P, Chhabra G, Stocker A, Abell TL. Gastroparesis and Gastroparesis Syndromes as Neuromuscular Disorders. Semin Neurol 2023; 43:540-552. [PMID: 37562455 DOI: 10.1055/s-0043-1771469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Gastroparesis syndromes (GpS) are a spectrum of disorders presenting with characteristic symptoms increasingly recognized as being gastrointestinal (GI) neuromuscular disorders (NMDs). This review focuses on GpS as a manifestation of neurologic disorders of GI NMD. GpS can be associated with systemic abnormalities, including inflammatory, metabolic, and serologic disorders, as well as autoimmune antibodies via nerve and muscle targets in the GI tract, which can be treated with immunotherapy, such as intravenous immunoglobulin. GpS are associated with autonomic (ANS) and enteric (ENS) dysfunction. Disorders of ANS may interact with the ENS and are the subject of continued investigation. ENS disorders have been recognized for a century but have only recently begun to be fully quantified. Anatomic structural changes in the GI tract are increasingly recognized in GpS. Detailed descriptions of anatomic changes in GpS, and their correlation with physiologic findings, have opened a new era of investigation. The management of GpS, when viewed as GI NMD, has shifted the paradigms of both diagnosis and treatment. This article concludes with current approaches to GpS directed at underlying neuromuscular pathology.
Collapse
Affiliation(s)
- Le Yu Naing
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Prateek Mathur
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Garvit Chhabra
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Abigail Stocker
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Thomas L Abell
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Louisville, Louisville, Kentucky
| |
Collapse
|
4
|
Bhatti S, Rashed H, Abell T. Autonomic Nervous System Profiling In Response to Liver Transplantation: Prognostic Evaluation and Preliminary Study. Transplant Proc 2021; 53:1711-1718. [PMID: 33994186 DOI: 10.1016/j.transproceed.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 03/12/2021] [Accepted: 04/05/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Liver cirrhosis leads to autonomic dysfunction (AD). We present a pilot study and review of published literature to investigate the long-term changes in the Autonomic Nervous System (ANS) of patients who underwent liver transplant. We propose Autonomic Function Tests (AFT) can be used as a predictor of liver transplant outcome. METHODS Twenty-eight patients (19 men and 9 women; mean age 45 years) with cirrhosis due to different etiologies underwent a noninvasive ANS evaluation test, pre- and post-liver transplant at 3 to 6 months, 8 to 12 months, and 14 to 24 months. Data were compared with 45 age-matched controls (14 men and 31 women). We investigated changes in the following 3 adrenergic measures: percentage of cutaneous vasoconstriction in the hand and foot in response to cold stress test and cutaneous blood flow adjustment ratio; and 3 cardiovagal measures: change in heart rate in relation to deep respiration, forced respiration represented as Valsalva Ratio, and head-up tilting (30/15 ratio). RESULTS A total of 23 of 28 patients (82%) had impairment in AFT before transplant, 16 of 28 (57%) in the sympathetic adrenergic measures, and 15 of 28 (54%) in the parasympathetic cardiovagal measures. There was a gradual improvement in ANS function posttransplant, with a significant improvement in the cardiovagal measure of Valsalva Ratio (P < .05 from baseline). These data suggest some temporary decline in ANS functions within the first 6 months posttransplant. CONCLUSIONS To optimize outcomes in liver transplant patients with autonomic dysfunction, autonomic testing perhaps combined with frailty testing can be used as objective measures of mortality in the pre-liver transplant stage.
Collapse
Affiliation(s)
- Sundus Bhatti
- Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas
| | - Hani Rashed
- University of Louisville, Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Louisville, Kentucky
| | - Thomas Abell
- University of Louisville, Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Louisville, Kentucky.
| |
Collapse
|