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Chen C, Beloqui A, Xu Y. Oral nanomedicine biointeractions in the gastrointestinal tract in health and disease. Adv Drug Deliv Rev 2023; 203:115117. [PMID: 37898337 DOI: 10.1016/j.addr.2023.115117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/03/2023] [Accepted: 10/21/2023] [Indexed: 10/30/2023]
Abstract
Oral administration is the preferred route of administration based on the convenience for and compliance of the patient. Oral nanomedicines have been developed to overcome the limitations of free drugs and overcome gastrointestinal (GI) barriers, which are heterogeneous across healthy and diseased populations. This review aims to provide a comprehensive overview and comparison of the oral nanomedicine biointeractions in the gastrointestinal tract (GIT) in health and disease (GI and extra-GI diseases) and highlight emerging strategies that exploit these differences for oral nanomedicine-based treatment. We introduce the key GI barriers related to oral delivery and summarize their pathological changes in various diseases. We discuss nanomedicine biointeractions in the GIT in health by describing the general biointeractions based on the type of oral nanomedicine and advanced biointeractions facilitated by advanced strategies applied in this field. We then discuss nanomedicine biointeractions in different diseases and explore how pathological characteristics have been harnessed to advance the development of oral nanomedicine.
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Affiliation(s)
- Cheng Chen
- UCLouvain, Université catholique de Louvain, Louvain Drug Research Institute, Advanced Drug Delivery and Biomaterials, 1200 Brussels, Belgium
| | - Ana Beloqui
- UCLouvain, Université catholique de Louvain, Louvain Drug Research Institute, Advanced Drug Delivery and Biomaterials, 1200 Brussels, Belgium; WEL Research Institute, avenue Pasteur, 6, 1300 Wavre, Belgium.
| | - Yining Xu
- Department of Pharmacy, Institute of Metabolic Diseases and Pharmacotherapy, West China Hospital, Sichuan University, Chengdu 610041, China; Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry, Department of Clinical Pharmacy and Pharmacy Administration, West China School of Pharmacy, Sichuan University, Chengdu 610041, China.
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Asif MS, Khan MKG, Nabeel MA, Ashfaq T, Nasir A, Abdullah RM, Kareem MAF. Frequency of Gastroparesis Symptoms in Patients With Type-2 Diabetes Mellitus at a Tertiary Care Hospital in Pakistan. Cureus 2023; 15:e44236. [PMID: 37772239 PMCID: PMC10523834 DOI: 10.7759/cureus.44236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 09/30/2023] Open
Abstract
Background Gastroparesis symptoms seem to affect many diabetes mellitus patients. Pakistan has a high prevalence of diabetes, with an estimated 33 million people living with the condition. This study aimed to investigate the frequency of gastroparesis symptoms in patients with type-2 diabetes mellitus (T2DM). Methods This cross-sectional study was conducted from April to May 2022 in the outpatient Department of Medicine at the University College of Medicine and Dentistry, Lahore, Pakistan. Patients of both genders aged between 18 and 75 years and having T2DM were analysed. Data regarding demographic information, medical history, BMI assessment, and symptoms related to gastroparesis, as measured by the Gastroparesis Cardinal Symptoms Index (GCSI) were collected at the time of enrolment. For gastroparesis, a diagnostic cutoff of ≥1.90 was considered as per GCSI. Results Of a total of 148 T2DM patients, 85 (57.4%) were females. The mean age was calculated to be 54.0±11.3 years, ranging between 23 and 75 years. There were 134 (90.5%) patients who were using metformin. The most common symptom was fullness, reported by 66 (44.6%), while nausea, bloating, early satiety, retching, and vomiting were noted in 61 (41.2%), 59 (39.9%), 55 (37.2%), 39 (26.4%), and 22 (14.9%) patients, respectively. The frequency of gastroparesis was found in 17 (11.5%) T2DM patients. Stratification of gastroparesis revealed a significant association with female gender (82.4% vs. 54.2%, p=0.0272). Conclusion The study found a high frequency of gastroparesis symptoms in patients with T2DM. Nausea and bloating were the most commonly reported symptoms, while vomiting was the least common. The prevalence of gastroparesis was significantly higher in the female gender.
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Affiliation(s)
| | | | | | - Tabin Ashfaq
- Medicine, University College of Medicine and Dentistry, Lahore, PAK
| | - Areeqa Nasir
- Medicine, University College of Medicine and Dentistry, Lahore, PAK
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Ahmed SS, El-Hafez HAA, Mohsen M, El-Baiomy AA, Elkhamisy ET, El-Eshmawy MM. Is vitamin B12 deficiency a risk factor for gastroparesis in patients with type 2 diabetes? Diabetol Metab Syndr 2023; 15:33. [PMID: 36855172 PMCID: PMC9976380 DOI: 10.1186/s13098-023-01005-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 02/19/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Diabetic gastroparesis is a severe diabetic complication refers to delayed gastric emptying in the absence of mechanical obstruction of the stomach. Vitamin B12 affects the dynamics of autonomic nervous system and its deficits has been linked to cardiovascular autonomic neuropathy therefore, vitamin B12 deficiency was hypothesized to be implicated in the development of diabetic gastroparesis. This study was conducted to explore the possible association between vitamin B12 deficiency and gastroparesis in patients with type 2 diabetes (T2D). METHODS A total of 100 T2D patients with diabetes duration > 10 years and 50 healthy controls matched for age and sex were recruited for this study. T2D patients were divided into 2 groups: patients with gastroparesis and patients without gastroparesis. The diagnosis of gastroparesis was based on Gastroparesis Cardinal Symptom Index (GCSI) Score ≥ 1.9 and ultrasonographic findings including gastric emptying ˂ 35.67% and motility index ˂ 5.1. Anthropometric measurements, plasma glucose, glycosylated hemoglobin (HbA1c), lipids profile, vitamin B12 and transabdominal ultrasonography were assessed. RESULTS The frequency of vitamin B12 deficiency in total patients with T2D was 35% (54.5% in patients with gastroparesis vs. 11.1% in patients without gastroparesis, P < 0. 001). Vitamin B12 level was negatively correlated with GCSI Score whereas, it was positively correlated with gastric emptying and motility index. Vitamin B12 deficiency was an independent predictor for gastroparesis in patients with T2D; it predicts gastroparesis at a cut off value of 189.5 pmol/L with 69.1% sensitivity and 64.4% specificity, P = 0.002. CONCLUSIONS Beside the known risk factors of diabetic gastroparesis, vitamin B12 deficiency is an independent predictor of diabetic gastroparesis in patients with T2D.
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Affiliation(s)
- Sally S. Ahmed
- Internal Medicine Department, Faculty of Medicine, Mansoura Specialized Medical Hospital, Mansoura University, Box: 35516, Mansoura, Egypt
| | - Hala A. Abd El-Hafez
- Internal Medicine Department, Faculty of Medicine, Mansoura Specialized Medical Hospital, Mansoura University, Box: 35516, Mansoura, Egypt
| | - Mohamed Mohsen
- Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Azza A. El-Baiomy
- Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Enas T. Elkhamisy
- Internal Medicine Department, Faculty of Medicine, Mansoura Specialized Medical Hospital, Mansoura University, Box: 35516, Mansoura, Egypt
| | - Mervat M. El-Eshmawy
- Internal Medicine Department, Faculty of Medicine, Mansoura Specialized Medical Hospital, Mansoura University, Box: 35516, Mansoura, Egypt
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Gastrointestinal and Liver Complications in Patients with Diabetes Mellitus-A Review of the Literature. J Clin Med 2022; 11:jcm11175223. [PMID: 36079153 PMCID: PMC9456591 DOI: 10.3390/jcm11175223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/25/2022] [Accepted: 09/01/2022] [Indexed: 11/29/2022] Open
Abstract
The number of diabetes mellitus patients has increased over the last few years in developing countries, along with obesity and sedentary lifestyle. Besides macroangiopathy and microangiopathy, damage to the nerve fibers of the peripheral nervous system is the most common chronic complication of diabetes. Digestive complications in diabetic patients represent a consequence of diabetic autonomic neuropathy involving the gastrointestinal tract, but unfortunately not always evaluated by diabetologists. Aside from the complications encountered in the digestive tract, patients with diabetes mellitus are prone to developing liver diseases. This review will describe the prevalence of these complications, the modality of diagnosis, and therapeutical solutions in order to reduce the risk of progression of these complications in diabetic subjects.
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Symptoms Suggestive of Gastroparesis in a Community-Based Cohort of European Americans and African Americans with Type 2 Diabetes Mellitus. Dig Dis Sci 2020; 65:2321-2330. [PMID: 31820181 PMCID: PMC9135394 DOI: 10.1007/s10620-019-05974-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 11/22/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although gastroparesis is seen in patients with type 2 diabetes mellitus (T2DM), the prevalence of symptoms suggestive of gastroparesis in patients with T2DM is unknown, particularly among African Americans. AIMS To determine the prevalence of symptoms associated with gastroparesis in a large community-based population of European Americans and African Americans with T2DM. METHODS Individuals with T2DM in the Diabetes Heart Study were asked to complete the gastroparesis cardinal symptom index (GCSI) and other GI-related questionnaires. GCSI total score ≥ 18 represented moderate or worse symptoms suggestive of gastroparesis. RESULTS A total of 1253 participants (700 female, 553 male) completed the GCSI: 750 were European American and 503 African American. GCSI scores ≥ 18 were recorded in 72 participants: 38 (5%) of European Americans and 34 (7%) of African Americans. The average GCSI was 24.1 in European Americans and 24.6 in African Americans, indicating moderate to severe symptoms. Compared to European Americans with GCSI scores ≥ 18, African Americans were younger (59.4 vs. 53.3 years, p = 0.004), had earlier onset of T2DM (46.3 vs. 40.1 years, p = 0.01), higher HbA1c (7.6 vs. 9.1, p = 0.0009), underwent fewer upper endoscopies (55.3% vs. 26.5%, p = 0.02), and had more anxiety and depression (p < 0.001). CONCLUSIONS Moderate or greater symptoms suggestive of gastroparesis are present in 5-7% of European and African American patients with T2DM in community-based populations. Symptoms suggestive of gastroparesis may be underappreciated in patients with T2DM and account for upper gastrointestinal symptoms, unexplained glycemic control issues, and decreased quality of life.
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Garg H, Podder S, Bala I, Gulati A. Comparison of fasting gastric volume using ultrasound in diabetic and non-diabetic patients in elective surgery: An observational study. Indian J Anaesth 2020; 64:391-396. [PMID: 32724247 PMCID: PMC7286410 DOI: 10.4103/ija.ija_796_19] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/16/2020] [Accepted: 04/08/2020] [Indexed: 01/23/2023] Open
Abstract
Background and Aims: Gastroparesis despite standard fasting in diabetic patients may increase the aspiration risk. This study aimed to compare fasting gastric volume (GV) of diabetic with non-diabetic patients scheduled for elective surgery using USG. Methods: This prospective observational study included 53 diabetic and 50 non-diabetic patients aged >18 years, American Society of Anesthesiologists' physical status I-III having similar fasting intervals. Before induction, using standard gastric scanning protocol, qualitative and quantitative assessments of gastric antrum in supine and right lateral decubitus (RLD) positions were performed with a curved array probe. USG grade, cross-sectional area (CSA) of the antrum and GV were calculated. The gastric antrum was classified as Grade 0, 1 or 2, signifying empty antrum, fluid in RLD position only and antral fluid in both supine and RLD positions, respectively. Results: In supine position, CC and AP diameters were 1.96 ± 0.41 cm and 0.9 ± 0.57 cm in control group and 2.28 ± 0.50 cm and 1.39 ± 0.44 cm in diabetic group, respectively. In RLD, CC was 2.28 ± 0.57 cm and AP was 1.24 ± 0.42 cm in control group as compared to CC 2.54 ± 0.56 cm and AP 1.82 ± 0.56 cm in diabetic group. The CSA of 2.57 ± 1.19 cm2 and 3.73 ± 1.61 cm2 in diabetic were significantly higher (P = 0.001) than 1.41 ± 0.55 cm2 and 2.30 ± 1.18 cm2 of control, in supine and RLD positions, respectively. GV was 4.20 ± 22.26 ml in control group and 9.15 ± 25.70 ml in diabetic group. Conclusion: Diabetic patients have higher gastric antral cross-sectional area and gastric volumes as observed by gastric ultrasound than the non-diabetic patients.
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Affiliation(s)
- Heena Garg
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Subrata Podder
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Indu Bala
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Gulati
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Wei M, Gu E, Luo J, Zhang Z, Xu D, Tao X, Shah NP, Wei H. Enterococcus hirae WEHI01 isolated from a healthy Chinese infant ameliorates the symptoms of type 2 diabetes by elevating the abundance of Lactobacillales in rats. J Dairy Sci 2020; 103:2969-2981. [PMID: 32059859 DOI: 10.3168/jds.2019-17185] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 11/28/2019] [Indexed: 12/26/2022]
Abstract
Enterococcus hirae WEHI01 is a potential probiotic strain isolated from a healthy Chinese infant. This strain has previously been characterized as having cholesterol-lowering potential and good dairy fermentation performance. In this study, we used rat models with obesity and type 2 diabetes mellitus (T2DM) induced by a high fat and sucrose diet and low-dose streptozotocin, respectively, and we evaluated the effect of E. hirae WEHI01 on glycolipid metabolism, glycolipid-related gene expression, organ histopathology, and intestinal flora changes in the 2 models. Our results showed that administration of 5.0 × 109 cfu of E. hirae WEHI01 for 4 wk decreased serum lipid levels and regulated glycolipid metabolism in the liver of obese rats. Following continuous administration of the same concentration of E. hirae WEHI01 to a T2DM rat model for another 5 wk, E. hirae WEHI01 improved glucose tolerance, recovered body weight loss, and led to significant decreases in tumor necrosis factor-α, IL-6, IL-10, and total bile acid in serum. We also found that E. hirae WEHI01 restored the morphology of the pancreas, kidney, and liver, and changed the composition of the gut microbiota (i.e., decreased the Shannon index, increased the Simpson index, and substantially increased the abundance of Lactobacillales). Combining the results for the obese model and the T2DM model, we speculated that beneficial effects of E. hirae WEHI01 on T2DM could be due to (1) a significant increase in PPARA expression and a tendency for increased CYP7A1 expression in the liver of obese rats, promoting the conversion of cholesterol into bile acid and reducing serum total bile acid levels in T2DM model rats; or (2) a change in gut microbial diversity, especially elevated Lactobacillales abundance, which reduced the total bile acid in T2DM model rats. These results demonstrated that E. hirae WEHI01 has the potential to ameliorate type 2 diabetes in rats and provide a promising rationale for further research into the prevention and treatment of T2DM.
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Affiliation(s)
- Min Wei
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang 330047, China
| | - Enyu Gu
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang 330047, China
| | - Jie Luo
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang 330047, China
| | - Zhihong Zhang
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang 330047, China
| | - Di Xu
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang 330047, China
| | - Xueying Tao
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang 330047, China
| | - Nagendra P Shah
- Food and Nutritional Science, School of Biological Science, University of Hong Kong, Pokfulam Road, Hong Kong, China
| | - Hua Wei
- State Key Laboratory of Food Science and Technology, Nanchang University, Nanchang 330047, China.
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Ryan JG. Emerging Diabetes Research From Early Investigators. Clin Ther 2018; 40:820-822. [PMID: 29861190 DOI: 10.1016/j.clinthera.2018.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 05/14/2018] [Indexed: 10/14/2022]
Affiliation(s)
- John G Ryan
- Miller School of Medicine, University of Miami, Miami, Florida
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Use of Postmortem Computed Tomography to Detect Bowel Obstruction and its Relationship to the Cause of Death. Am J Forensic Med Pathol 2017; 39:30-37. [PMID: 29140803 DOI: 10.1097/paf.0000000000000365] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Bowel distension frequently indicates bowel obstruction, which is a common diagnosis in clinical radiology. Typically, symptoms and complaints lead to radiological examinations and the detection of the etiology. Untreated intestinal obstructions can lead to a fatal outcome through cardiac failure due to septic shock. Certain of these cases undergo medicolegal investigations depending on the case history, the condition of the decedent, the location of the finding, or recent visits to medical professionals. Computed tomography (CT) is a recommended method in clinical radiology for the detection of bowel obstruction, which is indicated by bowel distension and further radiological signs (eg, the whirl sign, which indicates a volvulus). Postmortem CT (PMCT) has increased worldwide, but PMCT differs from clinical CT; thus, the question of whether PMCT is also reliable for the detection of bowel obstruction in decedents or is negatively affected by postmortem modifications should be discussed. This study consists of 10 cases displaying radiological signs of bowel obstruction. Apart from bowel distension, the most common radiological signs (whirl sign, coffee bean sign, bird beak sign, and u-shape sign) are described and depicted. All decedents underwent autopsy and had a postmortem interval of less than 72 hours. Based on these cases, we assess the reliability of PMCT for detecting bowel obstruction and determining its relationship to the cause of death.
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Abstract
Gastrin 17 (G17) is a polypeptide hormone secreted by gastrointestinal G cells, and it binds to cholecystokinin receptor (CCKR) to exert its biological function through signal transduction, stimulating the secretion of gastric acid and the growth of gastrointestinal mucosa. In recent years some studies suggest that G17 promotes cell proliferation and inhibits apoptosis. Since serum G17 can provide some clues to the function of gastric mucosa and the presence of gastric cancer and precancerous disease, it is of great significance in the diagnosis of gastrointestinal diseases. However, serum G17 is affected not only by gastric factors such as the lesion, the degree of atrophy, and Helicobacter pylori (H. pylori) infection, but also by extragastric and drug factors. In this article, we discuss the biological characteristics of G17, factors influencing serum G17 and the relationship between serum G17 and gastrointestinal diseases.
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Homko C, Siraj ES, Parkman HP. The impact of gastroparesis on diabetes control: Patient perceptions. J Diabetes Complications 2016; 30:826-9. [PMID: 27166926 DOI: 10.1016/j.jdiacomp.2016.03.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 03/18/2016] [Accepted: 03/19/2016] [Indexed: 12/12/2022]
Abstract
UNLABELLED The impact of gastroparesis on diabetes management and control from the patient perspective has not been well characterized. The aim of this study was to identify patient perceptions regarding the impact of gastroparesis on managing their diabetes. METHODS Patients with diabetes being referred for gastroparesis were enrolled in this prospective study. Gastroparetic symptom severity was assessed with the Patient Assessment of Upper GI Symptoms (PAGI-SYM). A questionnaire examined the impact of gastroparesis on diabetes related symptoms and control. RESULTS 54 diabetic gastroparesis patients (36 T1DM, 18 T2DM) participated. Duration of diabetes averaged 17.4±1.4years and gastroparetic symptoms 5.1±1.1years. Patients rated their most severe symptoms as postprandial fullness, early satiety, and nausea. Two thirds of diabetic subjects identified that since their diagnosis of gastroparesis, their diabetes was more difficult to control (44 of 54 patients) and that extra time and effort were required for care of their diabetes (45 of 54). Patients with T1DM, compared to those with T2DM, more often expressed that since developing gastroparesis, their blood sugars have been higher, they have had more frequent episodes of hypoglycemia, and they found that their gastroparetic symptoms worsened if blood sugars were too high. CONCLUSIONS Gastroparesis has a significant impact on patients' perceived ability to self-manage and control their diabetes. T1DM patients, in particular, associate their gastroparesis with episodes of hyper- and hypo-glycemia, and find their gastroparetic symptoms worsen with poor control. Future research should focus on strategies to support self-management of patients with diabetic gastroparesis.
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MESH Headings
- Adult
- Attitude to Health
- Cohort Studies
- Combined Modality Therapy
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 1/therapy
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/psychology
- Diabetes Mellitus, Type 2/therapy
- Female
- Gastroparesis/complications
- Gastroparesis/epidemiology
- Gastroparesis/physiopathology
- Gastroparesis/psychology
- Hospitals, University
- Humans
- Hyperglycemia/prevention & control
- Hypoglycemia/prevention & control
- Male
- Middle Aged
- Philadelphia/epidemiology
- Prevalence
- Prospective Studies
- Psychiatric Status Rating Scales
- Self Report
- Self-Management/psychology
- Severity of Illness Index
- Stress, Psychological/complications
- Stress, Psychological/psychology
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Affiliation(s)
- Carol Homko
- Sections of Gastroenterology, Department of Medicine, Temple University School of Medicine, Philadelphia, PA; Endocrinology, Diabetes, and Metabolism, Department of Medicine, Temple University School of Medicine, Philadelphia, PA
| | - Elias S Siraj
- Endocrinology, Diabetes, and Metabolism, Department of Medicine, Temple University School of Medicine, Philadelphia, PA
| | - Henry P Parkman
- Sections of Gastroenterology, Department of Medicine, Temple University School of Medicine, Philadelphia, PA.
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Ge JY, Jiang YW, Wang DY, Liu HF, Song FJ, Lin SZ. Efficacy observation on acupuncture for diabetic gastroparesis. JOURNAL OF ACUPUNCTURE AND TUINA SCIENCE 2016. [DOI: 10.1007/s11726-016-0923-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kempler P, Várkonyi T, Körei AE, Horváth VJ. Gastrointestinal autonomic neuropathy in diabetes: the unattended borderline between diabetology and gastroenterology. Diabetologia 2016; 59:401-3. [PMID: 26638001 DOI: 10.1007/s00125-015-3826-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/05/2015] [Indexed: 12/27/2022]
Affiliation(s)
- Péter Kempler
- 1st Department of Medicine, Semmelweis University, Korányi S. utca 2/A, 1083, Budapest, Hungary.
| | - Tamás Várkonyi
- 1st Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anna E Körei
- 1st Department of Medicine, Semmelweis University, Korányi S. utca 2/A, 1083, Budapest, Hungary
| | - Viktor J Horváth
- 1st Department of Medicine, Semmelweis University, Korányi S. utca 2/A, 1083, Budapest, Hungary
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Rieg JAD, Chirasani VR, Koepsell H, Senapati S, Mahata SK, Rieg T. Regulation of intestinal SGLT1 by catestatin in hyperleptinemic type 2 diabetic mice. J Transl Med 2016; 96:98-111. [PMID: 26552046 PMCID: PMC4695279 DOI: 10.1038/labinvest.2015.129] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 09/10/2015] [Accepted: 09/24/2015] [Indexed: 01/23/2023] Open
Abstract
The small intestine is the major site for nutrient absorption that is critical in maintenance of euglycemia. Leptin, a key hormone involved in energy homeostasis, directly affects nutrient transport across the intestinal epithelium. Catestatin (CST), a 21-amino acid peptide derived from proprotein chromogranin A, has been shown to modulate leptin signaling. Therefore, we reasoned that leptin and CST could modulate intestinal Na(+)-glucose transporter 1 (SGLT1) expression in the context of obesity and diabetes. We found that hyperleptinemic db/db mice exhibit increased mucosal mass, associated with an enhanced proliferative response and decreased apoptosis in intestinal crypts, a finding absent in leptin-deficient ob/ob mice. Intestinal SGLT1 abundance was significantly decreased in hyperleptinemic but not leptin-deficient mice, indicating leptin regulation of SGLT1 expression. Phlorizin, a SGLT1/2 inhibitor, was without effect in an oral glucose tolerance test in db/db mice. The alterations in architecture and SGLT1 abundance were not accompanied by changes in the localization of intestinal alkaline phosphatase, indicating intact differentiation. Treatment of db/db mice with CST restored intestinal SGLT1 abundance and intestinal turnover, suggesting a cross-talk between leptin and CST, without affecting plasma leptin levels. Consistent with this hypothesis, we identified structural homology between CST and the AB-loop of leptin and protein-protein docking revealed binding of CST and leptin with the Ig-like binding site-III of the leptin receptor. In summary, downregulation of SGLT1 in an obese type 2 diabetic mouse model with hyperleptinemia is presumably mediated via the short form of the leptin receptor and reduces overt hyperglycemia.
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Affiliation(s)
- Jessica A. Dominguez Rieg
- Department of Basic Sciences, Bastyr University California, San Diego, CA, USA,VA San Diego Healthcare System, San Diego, California; CA, USA
| | | | - Hermann Koepsell
- Department of Molecular Plant Physiology and Biophysics, Julius-von-Sachs-Institute, University of Würzburg, Würzburg, Germany
| | - Sanjib Senapati
- Department of Biotechnology, Institute of Technology Madras, Chennai, India
| | - Sushil K. Mahata
- VA San Diego Healthcare System, San Diego, California; CA, USA,Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Timo Rieg
- VA San Diego Healthcare System, San Diego, California; CA, USA,Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, La Jolla, CA, USA
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Neiberg RH, Rejeski JJ, Applegate WB, Clark JM, Knowler WC, Bray GA, Espeland MA, Cheskin LJ. Self-Reported Gastrointestinal Symptoms in Type 2 Diabetes Improve With an Intensive Lifestyle Intervention: Results From the Action for Health in Diabetes (Look AHEAD) Clinical Trial. Clin Diabetes 2015; 33:181-8. [PMID: 26487792 PMCID: PMC4608270 DOI: 10.2337/diaclin.33.4.181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In Brief This article reports on an investigation of whether an intensive lifestyle intervention (ILI) would reduce gastrointestinal symptoms over 4 years of follow-up for participants in the Action for Health in Diabetes (Look AHEAD) trial compared to a diabetes support and education (DSE) group. Look AHEAD is a randomized, multicenter trial comparing overweight and obese adults with type 2 diabetes treated with ILI versus DSE. ILI, and weight loss in general, had beneficial effects on gastrointestinal (GI) symptoms, with some variability in the strength of the effect depending on the specific symptom and time course. Potential modifiers were analyzed, yet ILI retained an association with improvement in GI symptoms.
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Affiliation(s)
- Rebecca H. Neiberg
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jared J. Rejeski
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - William B. Applegate
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jeanne M. Clark
- Departments of Medicine and Epidemiology, Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD
| | - William C. Knowler
- Diabetes Epidemiology and Clinical Research Section, National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - George A. Bray
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | - Mark A. Espeland
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Lawrence J. Cheskin
- Departments of Medicine and Epidemiology, Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD
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16
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Lederhuber H, Axer S, Ihle C. Case report: rare case of mechanical bowel obstruction due to strangulation by gastric stimulator electrodes. BMC Surg 2015; 15:35. [PMID: 25881095 PMCID: PMC4381395 DOI: 10.1186/s12893-015-0022-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 03/18/2015] [Indexed: 12/12/2022] Open
Abstract
Background Implantation of a gastric stimulator is a feasible surgical therapy for patients with therapy refractory gastroparesis. In addition it seems to be a promising alternative for treating morbid obesity. We present for the first time the surgical emergency of small bowel obstruction due to strangulation by gastric stimulator electrodes. Case presentation A 59-year-old Caucasian female had undergone implantation of a gastric stimulator to cope with the symptoms of a partial gastroparesis. Eight years after the operation, the patient began to present repeatedly to different hospitals because of abdominal pain and nausea. Symptoms and imaging indicated ileus, which could always be treated conservatively. The underlying pathology could not ultimately be determined and the symptoms were eventually considered gastroparesis-related. After two years the patient was finally referred in circulatory shock due to peritonitis with underlying small bowel obstruction. Emergency laparotomy revealed small bowel strangulation by the gastric stimulator electrodes. Conclusion Repeated presentation of a patient with an unfamiliar treatment modality must raise suspicion of unusual complications. Specialist surgeons treating with innovative methods should provide proper information that is accessible to everyone who might have to treat possible complications.
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Affiliation(s)
- Hans Lederhuber
- Department of General Surgery, Torsby Hospital, Värmland County Council, Lasarättsvägen 8, 68529, Torsby, Sweden.
| | - Stephan Axer
- Department of General Surgery, Torsby Hospital, Värmland County Council, Lasarättsvägen 8, 68529, Torsby, Sweden
| | - Christof Ihle
- Department of General Surgery, Torsby Hospital, Värmland County Council, Lasarättsvägen 8, 68529, Torsby, Sweden
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Abstract
Gastroparesis is a complication of long-standing type 1 and type 2 diabetes mellitus. Symptoms associated with gastroparesis include early satiety, prolonged postprandial fullness, bloating, nausea and vomiting, and abdominal pain. Mortality is increased in patients with diabetic gastroparesis. A subset of patients with diabetic gastroparesis have pylorospasm that results in obstructive gastroparesis. Current treatment approaches include improving glucose control with insulin and prescribing antinauseant drugs, prokinetic agents, and gastric electric stimulation. Future directions include improved diet counseling based on gastric emptying rate, continuous insulin delivery systems with glucose sensor-augmented monitoring, and drugs for correcting gastric neural and electric abnormalities.
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Affiliation(s)
- Kenneth L Koch
- Section on Gastroenterology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Jorge Calles-Escandón
- Section on Endocrinology, MetroHealth Regional, Case Western Reserve University School of Medicine, 2500 Metrohealth Drive, Cleveland, OH 44109, USA
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18
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Yarandi SS, Srinivasan S. Diabetic gastrointestinal motility disorders and the role of enteric nervous system: current status and future directions. Neurogastroenterol Motil 2014; 26:611-24. [PMID: 24661628 PMCID: PMC4104990 DOI: 10.1111/nmo.12330] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 02/18/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Gastrointestinal manifestations of diabetes are common and a source of significant discomfort and disability. Diabetes affects almost every part of gastrointestinal tract from the esophagus to the rectum and causes a variety of symptoms including heartburn, nausea, vomiting, abdominal pain, diarrhea and constipation. Understanding the underlying mechanisms of diabetic gastroenteropathy is important to guide development of therapies for this common problem. Over recent years, the data regarding the pathophysiology of diabetic gastroenteropathy is expanding. In addition to autonomic neuropathy causing gastrointestinal disturbances the role of enteric nervous system is becoming more evident. PURPOSE In this review, we summarize the reported alterations in enteric nervous system including enteric neurons, interstitial cells of Cajal and neurotransmission in diabetic animal models and patients. We also review the possible underlying mechanisms of these alterations, with focus on oxidative stress, growth factors and diabetes induced changes in gastrointestinal smooth muscle. Finally, we will discuss recent advances and potential areas for future research related to diabetes and the ENS such as gut microbiota, micro-RNAs and changes in the microvasculature and endothelial dysfunction.
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Affiliation(s)
- S. S. Yarandi
- Division of Digestive Diseases; Emory University; Atlanta GA
- Atlanta VA Medical Center; Decatur Georgia USA
| | - S. Srinivasan
- Division of Digestive Diseases; Emory University; Atlanta GA
- Atlanta VA Medical Center; Decatur Georgia USA
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19
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Horváth VJ, Izbéki F, Lengyel C, Kempler P, Várkonyi T. Diabetic gastroparesis: functional/morphologic background, diagnosis, and treatment options. Curr Diab Rep 2014; 14:527. [PMID: 25005121 DOI: 10.1007/s11892-014-0527-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The regulation of gastrointestinal motility mainly involves the smooth muscle, neural (extrinsic and intrinsic), and hormonal elements, the glial cells, and the interstitial cells of Cajal. An orchestrated function of all these components is required for the appropriate propulsive movement of the food in the gastrointestinal tract. Gastroparesis, a pathological slowing-down of gastric emptying, is a result of the damage to the tissue elements involved in the regulation of motility. Gastroparesis is one of the well-known complications of long-standing diabetes mellitus. Although it is rarely a life-threatening complication, it has a deteriorating effect on the quality of life, leads to unpredictable oscillation of the blood glucose level, and increases the time required for the absorption of food and medicines. This review describes the clinical characteristics of diabetic gastroparesis and summarizes the organic and functional motility abnormalities caused by this complication. Finally, the currently available and potential future therapeutic approaches are summarized.
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Affiliation(s)
- Viktor J Horváth
- 1st Department of Medicine, Semmelweis University, Koranyi Sandor utca 2/a, 1081, Budapest, Hungary,
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20
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Abstract
Severe gastroparesis is a kind of gastroparesis that is refractory to conventional drug therapy and requires nutritional support and frequently emergency hospitalization. The selection of treatment for severe gastroparesis has always been a dilemma for clinicians. Currently, there have been limited reports on the treatment of severe gastroparesis. This article sums up the primary treatments, drug treatments and other kinds of treatments for severe gastroparesis and discusses the prospects for the treatment of this refractory disease.
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21
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Bhetwal BP, An C, Baker SA, Lyon KL, Perrino BA. Impaired contractile responses and altered expression and phosphorylation of Ca(2+) sensitization proteins in gastric antrum smooth muscles from ob/ob mice. J Muscle Res Cell Motil 2013; 34:137-49. [PMID: 23576331 DOI: 10.1007/s10974-013-9341-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 03/27/2013] [Indexed: 12/21/2022]
Abstract
Diabetic gastroparesis is a common complication of diabetes, adversely affecting quality of life with symptoms of abdominal discomfort, nausea, and vomiting. The pathogenesis of this complex disorder is not well understood, involving abnormalities in the extrinsic and enteric nervous systems, interstitial cells of Cajal (ICCs), smooth muscles and immune cells. The ob/ob mouse model of obesity and diabetes develops delayed gastric emptying, providing an animal model for investigating how gastric smooth muscle dysfunction contributes to the pathophysiology of diabetic gastroparesis. Although ROCK2, MYPT1, and CPI-17 activities are reduced in intestinal motility disorders, their functioning has not been investigated in diabetic gastroparesis. We hypothesized that reduced expression and phosphorylation of the myosin light chain phosphatase (MLCP) inhibitory proteins MYPT1 and CPI-17 in ob/ob gastric antrum smooth muscles could contribute to the impaired antrum smooth muscle function of diabetic gastroparesis. Spontaneous and carbachol- and high K(+)-evoked contractions of gastric antrum smooth muscles from 7 to 12 week old male ob/ob mice were reduced compared to age- and strain-matched controls. There were no differences in spontaneous and agonist-evoked intracellular Ca(2+) transients and myosin light chain kinase expression. The F-actin:G-actin ratios were similar. Rho kinase 2 (ROCK2) expression was decreased at both ages. Basal and agonist-evoked MYPT1 and myosin light chain 20 phosphorylation, but not CPI-17 phosphorylation, was reduced compared to age-matched controls. These findings suggest that reduced MLCP inhibition due to decreased ROCK2 phosphorylation of MYPT1 in gastric antrum smooth muscles contributes to the antral dysmotility of diabetic gastroparesis.
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Affiliation(s)
- Bhupal P Bhetwal
- Department of Physiology & Cell Biology, Center of Biomedical Research Excellence, University of Nevada School of Medicine, CMM 203E-MS 0575, 1664 N Virginia St, Reno, NV 89557, USA
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22
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Schønecker B, Freimanis T, Sørensen IV. Diabetes in Danish bank voles (M. glareolus): survivorship, influence on weight, and evaluation of polydipsia as a screening tool for hyperglycaemia. PLoS One 2011; 6:e22893. [PMID: 21829666 PMCID: PMC3150384 DOI: 10.1371/journal.pone.0022893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 07/08/2011] [Indexed: 12/30/2022] Open
Abstract
Background Previous studies have concluded that the development of polydipsia (PD, a daily water intake ≥21 ml) among captive Danish bank voles, is associated with the development of a type 1 diabetes (T1D), based on findings of hyperglycaemia, glucosuria, ketonuria/-emia, lipemia, destroyed beta cells, and presence of autoantibodies against GAD65, IA-2, and insulin. Aim and Methods We retrospectively analysed data from two separate colonies of Danish bank voles in order to 1) estimate survivorship after onset of PD, 2) evaluate whether the weight of PD voles differed from non-PD voles, and, 3), evaluate a state of PD as a practical and non-invasive tool to screen for voles with a high probability of hypeglycaemia. In addition, we discuss regional differences related to the development of diabetes in Scandinavian bank voles and the relevance of the Ljungan virus as proposed etiological agent. Results We found that median survival after onset of PD is at least 91 days (lower/upper quartiles = 57/134 days) with a maximum recording of at least 404 days survivorship. The development of PD did not influence the weight of Danish bank voles. The measures of accuracy when using PD as predictor of hyperglycaemia, i.e. sensitivity, specificity, positive predictive value, and negative predictive value, equalled 69%, 97%, 89%, and 89%, respectively. Conclusion The relatively long survival of Danish PD bank voles suggests potentials for this model in future studies of the long-term complications of diabetes, of which some observations are mentioned. Data also indicates that diabetes in Danish bank is not associated with a higher body weight. Finally, the method of using measurements of daily water intake to screen for voles with a high probability of hyperglycaemia constitutes a considerable refinement when compared to the usual, invasive, methods.
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Affiliation(s)
- Bryan Schønecker
- Department of Biology, University of Copenhagen, Copenhagen, Denmark.
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23
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Bolin P, Gohh R, Kandaswamy R, Shihab FS, Wiland A, Akhlaghi F, Melancon K. Mycophenolic acid in kidney transplant patients with diabetes mellitus: does the formulation matter? Transplant Rev (Orlando) 2011; 25:117-23. [DOI: 10.1016/j.trre.2010.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 11/18/2010] [Accepted: 12/21/2010] [Indexed: 10/18/2022]
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24
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Bowden DW, Cox AJ, Freedman BI, Hugenschimdt CE, Wagenknecht LE, Herrington D, Agarwal S, Register TC, Maldjian JA, Ng MCY, Hsu FC, Langefeld CD, Williamson JD, Carr JJ. Review of the Diabetes Heart Study (DHS) family of studies: a comprehensively examined sample for genetic and epidemiological studies of type 2 diabetes and its complications. Rev Diabet Stud 2010; 7:188-201. [PMID: 21409311 DOI: 10.1900/rds.2010.7.188] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The Diabetes Heart Study (DHS) is a genetic and epidemiological study of 1,443 European American and African American participants from 564 families with multiple cases of type 2 diabetes. Initially, participants were comprehensively examined for measures of subclinical cardiovascular disease (CVD) including computed tomography measurement of vascular calcified plaque, ultrasound imaging of carotid artery wall thickness, and electrocardiographic intervals. Subsequent studies have investigated the relationship between bone mineral density and vascular calcification, measures of adiposity, and biomarkers. Ongoing studies are carrying out an extensive evaluation of cerebrovascular disease using magnetic resonance imaging and cognitive assessment. A second, parallel study, the African American DHS, has expanded the sample of African Americans to investigate marked racial differences in subclinical CVD between European Americans and African Americans. Studies in development will evaluate the impact of social stress during the lifecourse on CVD risk, and the prevalence of gastroparesis in this diabetes enriched sample. In addition, the ongoing high mortality rate in DHS participants provides novel insights into the increased risks for type 2 diabetes affected individuals. A comprehensive genetic analysis of the sample is underway using the genome-wide association study (GWAS) approach. Data from this GWAS survey will complement prior family-based linkage data in the analysis of genetic contributors to the wide range of traits in the sample. To our knowledge the DHS family of studies has created the most comprehensively examined sample of individuals with type 2 diabetes yet available, and represents a unique resource for the study people with type 2 diabetes. The aim of this review is to provide a collective overview of the major results from the DHS family of studies, and relate them to the larger body of biomedical investigations of diabetes and its complications.
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Affiliation(s)
- Donald W Bowden
- Center for Diabetes Research, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, North Carolina, USA.
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25
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Abstract
Gastroparesis is a condition characterized by delayed gastric emptying and the most common known underlying cause is diabetes mellitus. Symptoms include nausea, vomiting, abdominal fullness, and early satiety, which impact to varying degrees on the patient's quality of life. Symptoms and deficits do not necessarily relate to each other, hence despite significant abnormalities in gastric emptying, some individuals have only minimal symptoms and, conversely, severe symptoms do not always relate to measures of gastric emptying. Prokinetic agents such as metoclopramide, domperidone, and erythromycin enhance gastric motility and have remained the mainstay of treatment for several decades, despite unwanted side effects and numerous drug interactions. Mechanical therapies such as endoscopic pyloric botulinum toxin injection, gastric electrical stimulation, and gastrostomy or jejunostomy are used in intractable diabetic gastroparesis (DG), refractory to prokinetic therapies. Mitemcinal and TZP-101 are novel investigational motilin receptor and ghrelin agonists, respectively, and show promise in the treatment of DG. The aim of this review is to provide an update on prokinetic and mechanical therapies in the treatment of DG.
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Affiliation(s)
- Uazman Alam
- Department of Cardiovascular Sciences, University of Manchester, Core Technology Facility (3rd Floor), Grafton Street, Manchester, M13 9NT UK
| | - Omar Asghar
- Department of Cardiovascular Sciences, University of Manchester, Core Technology Facility (3rd Floor), Grafton Street, Manchester, M13 9NT UK
| | - Rayaz Ahmed Malik
- Department of Cardiovascular Sciences, University of Manchester, Core Technology Facility (3rd Floor), Grafton Street, Manchester, M13 9NT UK
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Wu B, Zheng CQ. Relationship among Helicobacter pylori infection, gut hormones and diabetic gastroparesis. Shijie Huaren Xiaohua Zazhi 2010; 18:1616-1619. [DOI: 10.11569/wcjd.v18.i15.1616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the relationship among serum gastrin (GAS) and somatostatin (SS) and Helicobacter pylori (H.pylori) in patients with diabetic gastroparesis (DGP).
METHODS: Fifty-six patients with type 2 diabetes mellitus were divided into simple diabetes mellitus group and DGP group. Forty-seven non-diabetes mellitus patients were divided into control group and simple gastroparesis group. H.pylori infection in the mucosa of sinus ventriculi was evaluated by rapid urease test and Giemsa staining. The contents of serum GAS and SS were measured by radioimmunoassay.
RESULTS: There was no significant difference between the rapid urease test and Giemsa staining in detecting H.pylori. The detection rate of H.pylori was comparable between the simple diabetes mellitus group and the control group. The detection rate of H.pylori was higher in the simple gastroparesis group than in the control group (rapid urease test: 73.3% vs 47.1%, P < 0.05), and in the DGP group than in the control group (rapid urease test: 87.8% vs 47.1%, P < 0.01; Giemsa staining: 81.9% vs 41.2%, P < 0.01), the simple diabetes mellitus group (rapid urease test: 87.8% vs 47.8%, P < 0.01; Giemsa staining: 81.9 % vs 43.5%, P < 0.05) and the simple gastroparesis group (rapid urease test: 87.8% vs 73.3%, P < 0.01; Giemsa staining: 81.9% vs 66.7%, P < 0.01). In H.pylori-positive patients, the level of serum GAS in the DGP group was higher than that in the control group (147.58 ± 16.68 vs 80.91 ± 15.23, P < 0.01), and the level of serum SS in the DGP group was lower than that in the control group (16.29 ± 4.27 vs 47.81 ± 16.88, P < 0.01). In H.pylori-negative patients, there was no significant differences in serum GAS and SS levels between different groups.
CONCLUSION: H.pylori infection can increase serum GAS level but decrease serum SS level. The pathological alterations in the gastric mucosa induced by H.pylori infection are closely related with the development of DGP.
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