1
|
Ghusn W, Cifuentes L, Campos A, Sacoto D, De La Rosa A, Feris F, Calderon G, Gonzalez-Izundegui D, Stutzman J, Hurtado MD, Camilleri M, Acosta A. Association Between Food Intake and Gastrointestinal Symptoms in Patients With Obesity. GASTRO HEP ADVANCES 2022; 2:121-128. [PMID: 36741967 PMCID: PMC9894313 DOI: 10.1016/j.gastha.2022.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND AIMS Hunger, satiation, postprandial satiety, and hedonic eating constitute key food intake parameters. We aim to study whether these symptoms are associated with gastrointestinal symptoms (GIS) in patients with obesity. METHODS This is a cross-sectional study of patients with obesity. Patients completed the following validated biomarkers and questionnaires: hunger was measured via visual analog scale (100 mm) following a standard meal, satiation was measured via ad libitum meal (calories to fullness; kcal), postprandial satiety was measured via gastric emptying scintigraphy (T1/2; mins), and hedonic eating was measured via the Hospital Anxiety and Depression Scale questionnaire. Participants completed the abridged Bowel Disease Questionnaire to evaluate their GIS. We calculated the odds ratios (ORs) adjusted for sex, weight, and age between food intake parameters <25th or >75th percentile observed in a prior cohort of 450 participants with obesity and GIS. RESULTS A total of 274 participants (41 ± 10 [SD] years, 75% females, body mass index 39 ± 8 kg/m2) were included in the analysis. Increased hunger was associated with a lower prevalence of lumpy stools (OR = 0.18, P = .02). Satiation was associated with abdominal pain/discomfort (relieved by defecation [OR = 2.4, P = .02] or associated with change in stool consistency [OR = 2.92, P < .01]), loose/watery stools (OR = 2.09, P = .02), and bloating (OR = 2.49, P < .01). Abnormal postprandial satiety was associated with bloating (OR = 2.26, P < .01) and loose/watery stools (OR = 1.84, P = .04). Hedonic eating was associated with abdominal pain/discomfort with stool frequency change (OR = 2.4, P = .02), >3 bowel movements per day (OR = 1.93, P = .048), bloating (OR = 2.49, P = .01), abdominal pain after meals >1 per month (OR = 4.24, P < .01), and nausea >1 per week (OR = 4.51, P < .01). CONCLUSION Alterations in hunger, satiation, postprandial satiety, and hedonic eating are associated with GIS in patients with obesity.
Collapse
Affiliation(s)
- Wissam Ghusn
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Lizeth Cifuentes
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Alejandro Campos
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Daniel Sacoto
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Alan De La Rosa
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Fauzi Feris
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Gerardo Calderon
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Daniel Gonzalez-Izundegui
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jessica Stutzman
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Maria Daniela Hurtado
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Michael Camilleri
- Clinical Enteric Neuroscience Translational and Epidemiology Research (C.E.N.T.E.R.), Mayo Clinic, Rochester, Minnesota
| | - Andres Acosta
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
2
|
Piper NBC, Whitfield EA, Stewart GD, Xu X, Furness SGB. Targeting appetite and satiety in diabetes and obesity, via G protein-coupled receptors. Biochem Pharmacol 2022; 202:115115. [PMID: 35671790 DOI: 10.1016/j.bcp.2022.115115] [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: 02/28/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 11/17/2022]
Abstract
Type 2 diabetes and obesity have reached pandemic proportions throughout the world, so much so that the World Health Organisation coined the term "Globesity" to help encapsulate the magnitude of the problem. G protein-coupled receptors (GPCRs) are highly tractable drug targets due to their wide involvement in all aspects of physiology and pathophysiology, indeed, GPCRs are the targets of approximately 30% of the currently approved drugs. GPCRs are also broadly involved in key physiologies that underlie type 2 diabetes and obesity including feeding reward, appetite and satiety, regulation of blood glucose levels, energy homeostasis and adipose function. Despite this, only two GPCRs are the target of approved pharmaceuticals for treatment of type 2 diabetes and obesity. In this review we discuss the role of these, and select other candidate GPCRs, involved in various facets of type 2 diabetic or obese pathophysiology, how they might be targeted and the potential reasons why pharmaceuticals against these targets have not progressed to clinical use. Finally, we provide a perspective on the current development pipeline of anti-obesity drugs that target GPCRs.
Collapse
Affiliation(s)
- Noah B C Piper
- Receptor Transducer Coupling Laboratory, School of Biomedical Sciences, Faculty of Medicine, University of Queensland, St. Lucia, QLD 4072, Australia
| | - Emily A Whitfield
- Receptor Transducer Coupling Laboratory, School of Biomedical Sciences, Faculty of Medicine, University of Queensland, St. Lucia, QLD 4072, Australia
| | - Gregory D Stewart
- Drug Discovery Biology Laboratory, Monash Institute of Pharmaceutical Sciences & Department of Pharmacology Monash University, Parkville, VIC 3052, Australia
| | - Xiaomeng Xu
- Drug Discovery Biology Laboratory, Monash Institute of Pharmaceutical Sciences & Department of Pharmacology Monash University, Parkville, VIC 3052, Australia
| | - Sebastian G B Furness
- Receptor Transducer Coupling Laboratory, School of Biomedical Sciences, Faculty of Medicine, University of Queensland, St. Lucia, QLD 4072, Australia; Drug Discovery Biology Laboratory, Monash Institute of Pharmaceutical Sciences & Department of Pharmacology Monash University, Parkville, VIC 3052, Australia.
| |
Collapse
|
3
|
van Dyck Z, Schulz A, Blechert J, Herbert BM, Lutz APC, Vögele C. Gastric interoception and gastric myoelectrical activity in bulimia nervosa and binge-eating disorder. Int J Eat Disord 2021; 54:1106-1115. [PMID: 32400920 PMCID: PMC8359291 DOI: 10.1002/eat.23291] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/29/2020] [Accepted: 04/29/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Identifying factors that control food intake is crucial to the understanding and treatment of eating disorders characterized by binge eating. In healthy individuals, stomach distension plays an important role in the development of satiation, but gastric sensations might be overridden in binge eating. The present study investigated the perception of gastric signals (i.e., gastric interoception) and gastric motility in patients experiencing binge-eating episodes, that is, bulimia nervosa (BN) and binge-eating disorder (BED). METHOD Twenty-nine patients with BN or BED (ED group) and 32 age-, sex-, and BMI-matched healthy controls (HC group) participated in the study. The onset of satiation and stomach fullness were assessed using a novel 2-step water load test (WLT-II). Gastric myoelectrical activity (GMA) was measured by electrogastrography (EGG) before and after ingestion of noncaloric water. RESULTS Individuals in the ED group drank significantly more water until reporting satiation during the WLT-II. The percentage of normal gastric myoelectrical power was significantly smaller in the ED group compared to HC, and negatively related to the number of objective binge-eating episodes per week in patients with BN or BED. Power in the bradygastria range was greater in ED than in HC participants. DISCUSSION Patients with EDs have a delayed response to satiation compared to HC participants, together with abnormal GMA. Repeated binge-eating episodes may induce disturbances to gastric motor function.
Collapse
Affiliation(s)
- Zoé van Dyck
- Institute for Health and Behaviour, Department of Behavioural and Cognitive SciencesUniversity of LuxembourgEsch‐sur‐AlzetteLuxembourg
| | - André Schulz
- Institute for Health and Behaviour, Department of Behavioural and Cognitive SciencesUniversity of LuxembourgEsch‐sur‐AlzetteLuxembourg
| | - Jens Blechert
- Centre for Cognitive Neuroscience and Department of PsychologyUniversity of SalzburgSalzburgAustria
| | - Beate M. Herbert
- Department of Clinical Psychology and PsychotherapyEberhard‐Karls‐University of TübingenTübingenGermany
| | - Annika P. C. Lutz
- Institute for Health and Behaviour, Department of Behavioural and Cognitive SciencesUniversity of LuxembourgEsch‐sur‐AlzetteLuxembourg
| | - Claus Vögele
- Institute for Health and Behaviour, Department of Behavioural and Cognitive SciencesUniversity of LuxembourgEsch‐sur‐AlzetteLuxembourg
| |
Collapse
|
4
|
Nord CL, Dalmaijer ES, Armstrong T, Baker K, Dalgleish T. A Causal Role for Gastric Rhythm in Human Disgust Avoidance. Curr Biol 2021; 31:629-634.e3. [PMID: 33238154 PMCID: PMC7883304 DOI: 10.1016/j.cub.2020.10.087] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/06/2020] [Accepted: 10/28/2020] [Indexed: 01/16/2023]
Abstract
Rotten food, maggots, bodily waste-all elicit disgust in humans. Disgust promotes survival by encouraging avoidance of disease vectors1 but is also implicated in prejudice toward minority groups; avoidance of environmentally beneficial foods, such as insect protein; and maladaptive avoidance behavior in neuropsychiatric conditions.2-5 Unlike fear, pathological disgust is not improved substantially by exposure therapy clinically,6 nor in experimental work does behavioral avoidance of disgusting images habituate following prolonged exposure.7,8 Under normal physiological conditions, perception of disgusting stimuli disrupts myoelectrical rhythms in the stomach,9-13 inducing gastric dysrhythmias that correlate with neural signatures of disgust.11 However, the causal role of gastric rhythm in disgust avoidance is unknown. We manipulated gastric rhythm using domperidone, a peripheral dopamine D2/D3 antagonist and common anti-emetic, at a dose (10 mg) that acts to convert gastric dysrhythmias to normal rhythms.9 In a preregistered, randomized, double-blind, placebo-controlled crossover design in 25 healthy volunteers (aged 18-25), we measured the effects of domperidone on core disgust avoidance, using eye tracking to measure implicit (oculomotor) avoidance of disgusting images (feces) before and after an "exposure" intervention (monetary reinforcement for looking at disgusting images).7,8 We find that domperidone significantly reduces oculomotor disgust avoidance following incentivized exposure. This suggests that domperidone may weaken the "immunity" of disgust to habituation, putatively by reducing gastric dysrhythmias during incentivized engagement with disgusting stimuli. This indicates a causal role for disgust-related visceral changes in disgust avoidance, supporting the hypothesis that physiological homeostasis contributes to emotional experience.
Collapse
Affiliation(s)
- Camilla L Nord
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, UK.
| | - Edwin S Dalmaijer
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, UK.
| | - Thomas Armstrong
- Department of Psychology, Whitman College, 345 Boyer Avenue, Walla Walla, WA 99362, USA
| | - Kate Baker
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, UK
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, UK; Cambridgeshire and Peterborough NHS Foundation Trust
| |
Collapse
|
5
|
Brown H, Proulx MJ, Stanton Fraser D. Hunger Bias or Gut Instinct? Responses to Judgments of Harm Depending on Visceral State Versus Intuitive Decision-Making. Front Psychol 2020; 11:2261. [PMID: 33041900 PMCID: PMC7530233 DOI: 10.3389/fpsyg.2020.02261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/11/2020] [Indexed: 12/12/2022] Open
Abstract
Empirical investigation into the emotional and physiological processes that shape moral decision-making is vast and growing. Yet, relatively less attention has been paid to measures of interoception in morality research despite its centrality in both emotional and physiological processes. Hunger and thirst represent two everyday interoceptive states, and hunger, in particular, has been shown to be influential for moral decision-making in numerous studies. It is possible that a tendency to focus on internal sensations interoceptive sensibility (IS), as well as the emotional and physiological states associated with visceral states, could be important in the relationships between hunger, thirst, and moral judgments. This cross-sectional online research (n = 154) explored whether IS, hunger, thirst, and emotional state influenced appropriateness and acceptability judgments of harm. The moral dilemma stimuli used allowed the independent calculation of (1) people's tendency to avoid harmful action at all costs and (2) people's tendency to maximize outcomes that benefit the greater good. The Cognitive Reflection Task (CRT) was implemented to determine whether an ability to override intuitive responses to counterintuitive problems predicted harm-based moral judgments, as found previously. Hunger bias, independent of IS and emotional state, was influential for non-profitable acceptability judgments of harmful actions. Contrary to dual-process perspectives, a novel finding was that more intuitive responses on the CRT predicted a reduced aversion to harmful actions that was indirectly associated with IS. We suggest that IS may indicate people's vulnerability to cognitive miserliness on the CRT task and reduced deliberation of moral dilemma stimuli. The framing of moral dilemmatic questions to encourage allocentric (acceptability questions) versus egocentric perspectives (appropriateness questions) could explain the divergence between hunger bias and intuitive decision-making for predicting these judgments, respectively. The findings are discussed in relation to dual-process accounts of harm-based moral judgments and evidence linking visceral experiences to harm aversion and moral decision-making.
Collapse
Affiliation(s)
- Helen Brown
- Crossmodal Cognition Lab, Department of Psychology, University of Bath, Bath, United Kingdom
| | | | - Danaë Stanton Fraser
- Crossmodal Cognition Lab, Department of Psychology, University of Bath, Bath, United Kingdom.,CREATE Lab, University of Bath, Bath, United Kingdom
| |
Collapse
|
6
|
Vicario CM, Kuran KA, Rogers R, Rafal RD. The effect of hunger and satiety in the judgment of ethical violations. Brain Cogn 2018; 125:32-36. [PMID: 29852339 DOI: 10.1016/j.bandc.2018.05.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 05/03/2018] [Accepted: 05/08/2018] [Indexed: 12/22/2022]
Abstract
Human history is studded with instances where instinctive motivations take precedence over ethical choices. Nevertheless, the evidence of any linking between motivational states and morality has never been systematically explored. Here we addressed this topic by testing a possible linking between appetite and moral judgment. We compared moral disapproval ratings (MDR) for stories of ethical violations in participants under fasting and after having eaten a snack. Our results show that subjective hunger, measured via self-reported rating, reduces MDR for ethical violations. Moreover, the higher the disgust sensitivity the higher the MDR for ethical violations. This study adds new insights to research on physiological processes influencing morality by showing that appetite affects moral disapproval of ethical violations.
Collapse
Affiliation(s)
- Carmelo M Vicario
- School of Psychology, University of Tasmania, Hobart, Tasmania, Australia; School of Psychology, Brigantia Building, Bangor University, Bangor, Gwynedd, Wales LL57 2AS, UK; Department of Scienze Cognitive, Psycologiche, Pedagogiche e degli Studi Culturali, University of Messina, Messina, Italy; Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.
| | - Karolina A Kuran
- School of Psychology, Brigantia Building, Bangor University, Bangor, Gwynedd, Wales LL57 2AS, UK
| | - Robert Rogers
- School of Psychology, Brigantia Building, Bangor University, Bangor, Gwynedd, Wales LL57 2AS, UK
| | - Robert D Rafal
- School of Psychology, Brigantia Building, Bangor University, Bangor, Gwynedd, Wales LL57 2AS, UK
| |
Collapse
|
7
|
Levine ME, Stern RM, Koch KL. Enhanced perceptions of control and predictability reduce motion-induced nausea and gastric dysrhythmia. Exp Brain Res 2014; 232:2675-84. [PMID: 24748483 DOI: 10.1007/s00221-014-3950-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 04/03/2014] [Indexed: 12/01/2022]
Abstract
Nausea is a debilitating condition that is typically accompanied by gastric dysrhythmia. The enhancement of perceived control and predictability has generally been found to attenuate the physiological stress response. The aim of the present study was to test the effect of these psychosocial variables in the context of nausea, motion sickness, and gastric dysrhythmia. A 2x2, independent-groups, factorial design was employed in which perceived control and predictability were each provided at high or low levels to 80 participants before exposure to a rotating optokinetic drum. Ratings of nausea were obtained throughout a 6-min baseline period and a 16-min drum rotation period. Noninvasive recordings of the electrical activity of the stomach called electrogastrograms were also obtained throughout the study. Nausea scores were significantly lower among participants with high control than among those with low control, and were significantly lower among participants with high predictability than among those with low predictability. Estimates of gastric dysrhythmia obtained from the EGG during drum rotation were significantly lower among participants with high predictability than among those with low predictability. A significant interaction effect of control and predictability on gastric dysrhythmia was also observed, such that high control was only effective for arresting the development of gastric dysrhythmia when high predictability was also available. Stronger perceptions of control and predictability may temper the development of nausea and gastric dysrhythmia during exposure to provocative motion. Psychosocial interventions in a variety of nausea contexts may represent an alternative means of symptom control.
Collapse
Affiliation(s)
- Max E Levine
- Department of Psychology, Siena College, Loudonville, NY, 12211, USA,
| | | | | |
Collapse
|
8
|
Jain S. Multi-organ autonomic dysfunction in Parkinson disease. Parkinsonism Relat Disord 2011; 17:77-83. [PMID: 20851033 PMCID: PMC3021587 DOI: 10.1016/j.parkreldis.2010.08.022] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 08/27/2010] [Accepted: 08/30/2010] [Indexed: 12/18/2022]
Abstract
Both pathologic and clinical studies of autonomic pathways have expanded the concept of Parkinson disease (PD) from a movement disorder to a multi-level widespread neurodegenerative process with non-motor features spanning several organ systems. This review integrates neuropathologic findings and autonomic physiology in PD as it relates to end organ autonomic function. Symptoms, pathology and physiology of the cardiovascular, skin/sweat gland, urinary, gastrointestinal, pupillary and neuroendocrine systems can be probed by autopsy, biopsy and non-invasive electrophysiological techniques in vivo which assess autonomic anatomy and function. There is mounting evidence that PD affects a chain of neurons in autonomic pathways. Consequently, autonomic physiology may serve as a window into non-motor PD progression and allow the development of mechanistically based treatment strategies for several non-motor features of PD. End-organ physiologic markers may be used to inform a model of PD pathophysiology and non-motor progression.
Collapse
Affiliation(s)
- Samay Jain
- Clinical Director, Movement Disorders Division, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213-3232, USA.
| |
Collapse
|
9
|
Levine ME, Stern RM, Koch KL. The effects of manipulating expectations through placebo and nocebo administration on gastric tachyarrhythmia and motion-induced nausea. Psychosom Med 2006; 68:478-86. [PMID: 16738082 DOI: 10.1097/01.psy.0000221377.52036.50] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Interest in the role of expectation in the development of nausea and other adverse conditions has existed for decades. The purpose of this study was to examine the effects of manipulating expectations through the administration of placebos and nocebos on nausea and gastric tachyarrhythmia provoked by a rotating optokinetic drum. METHOD Seventy-five participants were assigned to one of three groups. Positive-expectancy group participants were given placebo pills that would allegedly protect them against the development of nausea and motion sickness. Negative-expectancy group participants were given the same pills as nocebos; they were led to believe there was a tendency for them to make nausea somewhat worse. Placebo-control group participants were told the pills were indeed placebos that would have no effect whatsoever. RESULTS Subjective symptoms of motion sickness were significantly lower among negative-expectancy group participants than positive-expectancy and placebo-control group participants (p<0.05). Gastric tachyarrhythmia, the abnormal stomach activity that frequently accompanies nausea, was also significantly lower among negative-expectancy group participants than positive-expectancy and Placebo-Control Group participants during drum rotation (p<.05) [corrected] CONCLUSIONS Inducing negative expectations through nocebo administration reduced nausea and gastric dysrhythmia during exposure to provocative motion, whereas positive placebos were ineffective for preventing symptom development. That manipulation of expectation affected gastric physiological responses as well as reports of symptoms, suggests an unspecified psychophysiological mechanism was responsible for the observed group differences. These results also suggest that patients preparing for difficult medical procedures may benefit most from being provided with detailed information about how unpleasant their condition may become.
Collapse
Affiliation(s)
- Max E Levine
- Wake Forest University School of Medicine, Department of Internal Medicine, Section of Gastroenterology, Medical Center Boulevard, Winston-Salem, North Carolina 27157, USA.
| | | | | |
Collapse
|
10
|
Bellini M, Biagi S, Stasi C, Costa F, Mumolo MG, Ricchiuti A, Marchi S. Gastrointestinal manifestations in myotonic muscular dystrophy. World J Gastroenterol 2006; 12:1821-8. [PMID: 16609987 PMCID: PMC4087506 DOI: 10.3748/wjg.v12.i12.1821] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Revised: 09/02/2005] [Accepted: 09/12/2005] [Indexed: 02/06/2023] Open
Abstract
Myotonic dystrophy (MD) is characterized by myotonic phenomena and progressive muscular weakness. Involvement of the gastrointestinal tract is frequent and may occur at any level. The clinical manifestations have previously been attributed to motility disorders caused by smooth muscle damage, but histologic evidence of alterations has been scarce and conflicting. A neural factor has also been hypothesized. In the upper digestive tract, dysphagia, heartburn, regurgitation and dyspepsia are the most common complaints, while in the lower tract, abdominal pain, bloating and changes in bowel habits are often reported. Digestive symptoms may be the first sign of dystrophic disease and may precede the musculo-skeletal features. The impairment of gastrointestinal function may be sometimes so gradual that the patients adapt to it with little awareness of symptoms. In such cases routine endoscopic and ultrasonographic evaluations are not sufficient and targeted techniques (electrogastrography, manometry, electromyography, functional ultrasonography, scintigraphy, etc.) are needed. There is a low correlation between the degree of skeletal muscle involvement and the presence and severity of gastrointestinal disturbances whereas a positive correlation with the duration of the skeletal muscle disease has been reported. The drugs recommended for treating the gastrointestinal complaints such as prokinetic, anti-dyspeptic drugs and laxatives, are mainly aimed at correcting the motility disorders. Gastrointestinal involvement in MD remains a complex and intriguing condition since many important problems are still unsolved. Further studies concentrating on genetic aspects, early diagnostic techniques and the development of new therapeutic strategies are needed to improve our management of the gastrointestinal manifestations of MD.
Collapse
Affiliation(s)
- Massimo Bellini
- Gastroenterology Unit, Department of Internal Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy.
| | | | | | | | | | | | | |
Collapse
|