1
|
Taghadosi H, Ghomsheh FT, Dabanloo NJ, Farajidavar A. Electrophysiological modeling of the effect of potassium channel blockers on the distribution of stimulation wave in the human gastric wall cells. J Biomech 2021; 127:110662. [PMID: 34391129 DOI: 10.1016/j.jbiomech.2021.110662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/25/2021] [Accepted: 07/28/2021] [Indexed: 11/19/2022]
Abstract
The purpose of this study is to model the electrophysiological behavior of excitable membrane and wavefront propagation in the Stomach Wall in physiological and pharmacological states. The propagation of this wave is based on cellular electrophysiological activity and ionic channel properties. In this study, we arranged the stomach wall cells together using the Gap Junctions approach. Slow wave is generated by gastric pacemaker cells. This wave propagates via the interaction of cells with each other throughout the stomach wall. Potassium currents are one of the main factors in regulating the pattern of wavefront propagation. To investigate the effect of limiting the exchange of potassium currents from cell membranes, 10%, 50%, 90%, and complete blockade were applied on both non-inactivating potassium current (IKni) and fast-inactivating potassium current (IKfi). The results show that IKniion channel blockage has a considerable effect on the plateau phase in the propagation of the excitation wave. The maximum value of the action potential in the plateau phase in the excitation wave with complete obstruction from -40.92 mV in the physiological state reached -18.97 mV, which is about 54% higher than the physiological state. Also, compared to the physiological state, complete blockage of the I_Kfi causes a 15% increase in the slow-wave spike phase (from -36.72 mV to -31.36 mV). Using this model, the effect of ions in different phases of slow-wave can be investigated. In addition, by blocking ion channels, functional disorders and smooth muscle contraction can be improved.
Collapse
Affiliation(s)
- Hossein Taghadosi
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran.
| | - Farhad Tabatabai Ghomsheh
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Nader Jafarnia Dabanloo
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran.
| | - Aydin Farajidavar
- New York Institute of Technology, Department of Electrical and Computer Engineering, Old Westbury, NY, USA.
| |
Collapse
|
2
|
Abell TL, Kedar A, Stocker A, Beatty K, McElmurray L, Hughes M, Rashed H, Kennedy W, Wendelschafer-Crabb G, Yang X, Fraig M, Gobejishvili L, Omer E, Miller E, Griswold M, Pinkston C. Pathophysiology of Gastroparesis Syndromes Includes Anatomic and Physiologic Abnormalities. Dig Dis Sci 2021; 66:1127-1141. [PMID: 32328893 DOI: 10.1007/s10620-020-06259-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 04/08/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Factors underlying gastroparesis are not well defined. AIMS We hypothesized that multiple systems may be involved in patients with gastroparesis symptoms and performed a comparative physiologic study. METHODS We studied 43 consecutive eligible patients with gastroparetic symptoms categorized by GI symptoms, metabolic status, illness quantification, and gastric physiology. Patients were evaluated by two methods in each of five core areas: inflammatory, autonomic, enteric, electrophysiologic, and hormonal with abnormalities examined by correlations. RESULTS Patients had similar GI symptoms regardless of baseline gastric emptying or diabetic/idiopathic status, and all patients demonstrated abnormalities in each of the 5 areas studied. Nearly all patients presented with elevated markers of serum TNFα (88%) and serum IL-6 (91%); elevated cutaneous electrogastrogram frequency (95%); and interstitial cells of Cajal count abnormalities (inner: 97%, outer: 100%). Measures of inflammation correlated with a number of autonomic, enteric anatomy, electrophysiologic and hormonal abnormalities. CONCLUSIONS We conclude that patients with the symptoms of gastroparesis have multiple abnormalities, when studied by traditional, as well as newer, diagnostic assessments. Inflammation appears to be a fundamental abnormality that affects other organ systems in symptomatic patients. Future work on gastroparetic syndromes and their treatment may benefit from a focus on the diffuse nature of their illness, diverse pathophysiologic mechanisms involved, especially the possible causes of underlying inflammation and disordered hormonal status. TRAIL REGISTRY This study is registered with Clinicaltrials.gov under study # NCT03178370 https://clinicaltrials.gov/ct2/show/NCT03178370 .
Collapse
Affiliation(s)
- Thomas L Abell
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, 550 S. Jackson, ACB A3L15, Louisville, KY, 40202, USA.
| | - Archana Kedar
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, 550 S. Jackson, ACB A3L15, Louisville, KY, 40202, USA
| | - Abigail Stocker
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, 550 S. Jackson, ACB A3L15, Louisville, KY, 40202, USA
| | - Karen Beatty
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, 550 S. Jackson, ACB A3L15, Louisville, KY, 40202, USA
| | | | - Michael Hughes
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, 550 S. Jackson, ACB A3L15, Louisville, KY, 40202, USA
| | | | | | | | - Xiu Yang
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, 550 S. Jackson, ACB A3L15, Louisville, KY, 40202, USA
| | - Mostafa Fraig
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, 550 S. Jackson, ACB A3L15, Louisville, KY, 40202, USA
| | - Leila Gobejishvili
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, 550 S. Jackson, ACB A3L15, Louisville, KY, 40202, USA
| | - Endashaw Omer
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, 550 S. Jackson, ACB A3L15, Louisville, KY, 40202, USA
| | - Ed Miller
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, 550 S. Jackson, ACB A3L15, Louisville, KY, 40202, USA
| | | | - Christina Pinkston
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, 550 S. Jackson, ACB A3L15, Louisville, KY, 40202, USA
| |
Collapse
|
3
|
Abstract
GOAL A comprehensive review of treatments for nausea and vomiting (N/V). BACKGROUND N/V are common symptoms encountered in medicine. While most cases of acute N/V related to a specific cause can be straightforward to manage, other cases of acute N/V such as chemotherapy-induced N/V and especially chronic unexplained N/V can be difficult to control, leading to a significant decline in the patient's quality of life and increased cost of medical care from repeated hospitalizations. STUDY Traditional management has relied on pharmacotherapy which may be inadequate in a certain proportion of these patients. Many of the medications used in the management of N/V have significant side effect profiles making the need for new and improved interventions of great importance. RESULTS This review covers a broad review of the pathophysiology of N/V, pharmacotherapy, including safety concerns and controversies with established pharmaceuticals, newer immunotherapies, bioelectrical neuromodulation (including gastric electrical stimulation), behavioral and surgical therapies, and complementary medicine. CONCLUSION On the basis of emerging understandings of the pathophysiology of N/V, improved therapies are becoming available.
Collapse
Affiliation(s)
| | - Robert T Luckett
- Department of Medicine, Division of Gastroenterology, Hepatology & Nutrition, University of Louisville
| | - Chris Moser
- Department of Medicine, University of Louisville
| | - Dipendra Parajuli
- Department of Medicine, Division of Gastroenterology, Hepatology & Nutrition, University of Louisville
- Robley Rex Va Medical Center, Louisville, KY
| | - Thomas L Abell
- Department of Medicine, Division of Gastroenterology, Hepatology & Nutrition, University of Louisville
| |
Collapse
|
4
|
Carson DA, O'Grady G, Du P, Gharibans AA, Andrews CN. Body surface mapping of the stomach: New directions for clinically evaluating gastric electrical activity. Neurogastroenterol Motil 2021; 33:e14048. [PMID: 33274564 DOI: 10.1111/nmo.14048] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/11/2020] [Accepted: 11/03/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gastric motility disorders, which include both functional and organic etiologies, are highly prevalent. However, there remains a critical lack of objective biomarkers to guide efficient diagnostics and personalized therapies. Bioelectrical activity plays a fundamental role in coordinating gastric function and has been investigated as a contributing mechanism to gastric dysmotility and sensory dysfunction for a century. However, conventional electrogastrography (EGG) has not achieved common clinical adoption due to its perceived limited diagnostic capability and inability to impact clinical care. The last decade has seen the emergence of novel high-resolution methods for invasively mapping human gastric electrical activity in health and disease, providing important new insights into gastric physiology. The limitations of EGG have also now become clearer, including the finding that slow-wave frequency alone is not a reliable discriminator of gastric dysrhythmia, shifting focus instead toward altered spatial patterns. Recently, advances in bioinstrumentation, signal processing, and computational modeling have aligned to allow non-invasive body surface mapping of the stomach to detect spatiotemporal gastric dysrhythmias. The clinical relevance of this emerging strategy to improve diagnostics now awaits determination. PURPOSE This review evaluates these recent advances in clinical gastric electrophysiology, together with promising emerging data suggesting that novel gastric electrical signatures recorded at the body surface (termed "body surface mapping") may correlate with symptoms. Further technological progress and validation data are now awaited to determine whether these advances will deliver on the promise of clinical gastric electrophysiology diagnostics.
Collapse
Affiliation(s)
- Daniel A Carson
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Greg O'Grady
- Department of Surgery, University of Auckland, Auckland, New Zealand.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Peng Du
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.,Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | - Armen A Gharibans
- Department of Surgery, University of Auckland, Auckland, New Zealand.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | | |
Collapse
|
5
|
Liu Y, Ye F, Zhang S, Li S, Chen J. Characteristics of myoelectrical activities along the small intestine and their responses to test meals of different glycemic index in rats. Am J Physiol Regul Integr Comp Physiol 2020; 318:R997-R1003. [PMID: 32320266 DOI: 10.1152/ajpregu.00282.2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The purpose of this study was to characterize intestinal myoelectrical activity along the small intestine and investigate its responses to test meals with different glycemic index at different locations. Sixteen rats were implanted with electrodes in the serosal surface of the duodenum, jejunum, and ileum. Intestinal myoelectrical activities were recorded from these electrodes for 30 min in the fasting state and 3 h after four kinds of meals with different glycemic index, together with the assessment of blood glucose. The results were as follows: 1) in the fasting state, the percentage of normal intestinal slow waves (%NISW) showed no difference; however, the dominant frequency (DF), power (DP), and percentage of spike activity superimposed on the intestinal slow wave (NS/M) were progressively decreased along the entire small intestine; 2) regular solid meal and Ensure solicited no changes in any parameters of intestinal myoelectrical activity; whereas glucose and glucose + glucagon significantly altered the %NISW, DF, DP, and NS/M, and the effects on the proximal intestine were opposite to those in the distal intestine; and 3) postprandial blood glucose level was significantly correlated with %NISW along the entire small intestine. We found that that, in addition to the well-known frequency gradient, there is also a gradual decrease in the DP and spikes along the small intestine in the fasting state. Glucose and hyperglycemic meals inhibit myoelectrical activities in the proximal small intestine but result in enhanced but more dysrhythmic intestinal myoelectrical activities. There is a significant negative correlation between the normality of intestinal slow waves and blood glucose.
Collapse
Affiliation(s)
- Yi Liu
- Veterans Research and Education Foundation, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma.,The 1st Affiliated Hospital of Xi'an Jiaotong University, Shannxi, China.,Department of Physiology, University of Oklahoma, Oklahoma City, Oklahoma.,Division of Gastroenterology and Hepatology, Johns Hopkins Center for Neurogastroenterology, Baltimore, Maryland
| | - Feng Ye
- Veterans Research and Education Foundation, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma.,The 1st Affiliated Hospital of Xi'an Jiaotong University, Shannxi, China.,Department of Physiology, University of Oklahoma, Oklahoma City, Oklahoma.,Division of Gastroenterology and Hepatology, Johns Hopkins Center for Neurogastroenterology, Baltimore, Maryland
| | - Sujuan Zhang
- Veterans Research and Education Foundation, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma.,Department of Physiology, University of Oklahoma, Oklahoma City, Oklahoma.,Division of Gastroenterology and Hepatology, Johns Hopkins Center for Neurogastroenterology, Baltimore, Maryland.,Department of Gastroenterology, Tianjin No. 254 Hospital, Tianjin, China
| | - Shiying Li
- Veterans Research and Education Foundation, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma.,Division of Gastroenterology and Hepatology, Johns Hopkins Center for Neurogastroenterology, Baltimore, Maryland
| | - Jiande Chen
- Veterans Research and Education Foundation, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma.,Division of Gastroenterology and Hepatology, Johns Hopkins Center for Neurogastroenterology, Baltimore, Maryland
| |
Collapse
|
6
|
Hasanin M, Amin O, Hassan H, Kedar A, Griswold M, Abell TL. Temporary Gastric Stimulation in Patients With Gastroparesis Symptoms: Low-Resolution Mapping Multiple Versus Single Mucosal Lead Electrograms. Gastroenterology Res 2019; 12:60-66. [PMID: 31019614 PMCID: PMC6469903 DOI: 10.14740/gr1127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/27/2019] [Indexed: 01/17/2023] Open
Abstract
Background Cajal cells have a fundamental role in generating slow waves that regulate gastric motility. Gastric electrical stimulation (GES) is Food and Drug Administration (FDA)-approved for symptomatic treatment of drug refractory gastroparesis. We hypothesized that using two leads will vary from a single lead by providing greater insight of gastric electrical wave propagation, through differences in measured frequency, amplitude, and frequency over amplitude ratio. We also hypothesized that a significant reduction in symptomatic vomiting score is highly predictive in a single lead temporary gastric electrical stimulation. Methods A total of 111 patients with drug-refractory gastroparesis were enrolled. Forty-two patients had single lead, while 69 patients had two leads. All recordings measured mean frequency and amplitude in each lead. Patients documented symptoms using standardized symptom scores at baseline and day 5 post-procedure. Results Single lead patients with initial low mucosal frequency showed an increase from 3.10 to 4.93 (P = 0.0155), while the high frequency group decreased from 5.89 to 5.12 (P = 0.135). Vomiting score decreased significantly among both groups with GES (P = 0.0001). For two leads, the mucosal frequency decreased at the proximal electrode (P = 0.402), and increased at the distal electrode (P = 0.514), neither statistically significant (P = 0.143). Mucosal electrogram amplitude values changed for both proximal, mean decrease of 0.34 mV (P = 0.241), and distal, mean increase of 0.05 mV (P = 0.65) with a mean difference 0.34 mV (P = 0.238). However, mucosal electrogram frequency and amplitudes on day 5 were highly dependent on the baseline values (P < 0.001). Conclusions Compared to the use of single point electrodes, the use of two low-resolution electrodes allows recording gastric electrical wave propagation with greater detail. Low resolution recording appears to be superior to single point recordings, while awaiting practical high-resolution recordings.
Collapse
Affiliation(s)
- Mohsen Hasanin
- Digestive Disease Division, University of Louisville, Louisville, KY, USA
| | - Om Amin
- Digestive Disease Division, University of West Virginia, Morgantown, WV, USA
| | - Hamza Hassan
- Digestive Disease Division, University of Louisville, Louisville, KY, USA
| | - Archana Kedar
- Digestive Disease Division, University of Louisville, Louisville, KY, USA
| | - Michael Griswold
- Division of Biostatistics and Bioinformatics, University of Mississippi, Jackson, MS, USA
| | - Thomas L Abell
- Digestive Disease Division, University of Louisville, Louisville, KY, USA
| |
Collapse
|
7
|
Ashat M, Lewis A, Liaquat H, Stocker A, McElmurray L, Vedanarayanan V, Soota K, Howell T, Kedar A, Obert J, Abell TL. Intravenous immunoglobulin in drug and device refractory patients with the symptoms of gastroparesis-an open-label study. Neurogastroenterol Motil 2018; 30. [PMID: 29205691 DOI: 10.1111/nmo.13256] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 10/29/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Gastroparesis is a complex clinical entity; many aspects of which remain unknown. Although most patients have idiopathic, diabetic, or postsurgical gastroparesis, many are thought to have measurable neuromuscular abnormalities. Immunotherapy has recently been utilized to treat suspected autoimmune gastrointestinal dysmotility. METHODS Fourteen patients with symptoms of gastroparesis (Gp) who were refractory to drug/device were selected from 443 Gp patients from 2013 to 2015 who were treated at the University of Louisville motility center. All patients underwent a structural and psychiatric evaluation along with detailed psychological and behavioral examination to rule out eating disorders. We performed detailed neuromuscular evaluation and all 14 patients received at least 12 weeks of intravenous immunoglobulin (400 mg/kg infusion weekly). Response was defined subjectively (symptomatic improvement) using standardized IDIOM score system. KEY RESULTS All 14 patients had serological evidence and/or tissue evidence of immunological abnormality. Post-IVIG therapy, there was a significant improvement in symptoms scores for nausea, vomiting, early satiety, and abdominal pain. CONCLUSIONS AND INFERENCES Although limited by the absence of placebo group, the data illustrate the role of autoimmunity and neuromuscular evaluation in patients with gastroparesis and support the utility of a diagnostic trial of immunotherapy in an effort to improve therapeutic outcomes for such patients.
Collapse
Affiliation(s)
- M Ashat
- Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, University of Iowa, Iowa City, IA, USA
| | - A Lewis
- Department of Internal Medicine, University of Louisville, Louisville, KY, USA
| | - H Liaquat
- Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, University of Louisville, Louisville, KY, USA
| | - A Stocker
- Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, University of Louisville, Louisville, KY, USA
| | - L McElmurray
- Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, University of Louisville, Louisville, KY, USA
| | - V Vedanarayanan
- Division of Neuromuscular Medicine, University of Mississippi, Oxford, MS, USA
| | - K Soota
- Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, University of Iowa, Iowa City, IA, USA
| | - T Howell
- GI Motility Clinic, Jewish Hospital, Louisville, KY, USA
| | - A Kedar
- Division of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - J Obert
- Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, University of Louisville, Louisville, KY, USA
| | - T L Abell
- Division of Gastroenterology, Hepatology & Nutrition, Department of Medicine, Jewish Hospital GI Motility Clinic, University of Louisville, Louisville, KY, USA
| |
Collapse
|
8
|
|
9
|
Tse G, Lai ETH, Lee APW, Yan BP, Wong SH. Electrophysiological Mechanisms of Gastrointestinal Arrhythmogenesis: Lessons from the Heart. Front Physiol 2016; 7:230. [PMID: 27378939 PMCID: PMC4906021 DOI: 10.3389/fphys.2016.00230] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/30/2016] [Indexed: 01/09/2023] Open
Abstract
Disruptions in the orderly activation and recovery of electrical excitation traveling through the heart and the gastrointestinal (GI) tract can lead to arrhythmogenesis. For example, cardiac arrhythmias predispose to thromboembolic events resulting in cerebrovascular accidents and myocardial infarction, and to sudden cardiac death. By contrast, arrhythmias in the GI tract are usually not life-threatening and much less well characterized. However, they have been implicated in the pathogenesis of a number of GI motility disorders, including gastroparesis, dyspepsia, irritable bowel syndrome, mesenteric ischaemia, Hirschsprung disease, slow transit constipation, all of which are associated with significant morbidity. Both cardiac and gastrointestinal arrhythmias can broadly be divided into non-reentrant and reentrant activity. The aim of this paper is to compare and contrast the mechanisms underlying arrhythmogenesis in both systems to provide insight into the pathogenesis of GI motility disorders and potential molecular targets for future therapy.
Collapse
Affiliation(s)
- Gary Tse
- Li Ka Shing Faculty of Medicine, School of Biomedical Sciences, The University of Hong KongHong Kong, China
- Department of Medicine and Therapeutics, The Chinese University of Hong KongHong Kong, China
| | - Eric T. H. Lai
- Li Ka Shing Faculty of Medicine, School of Biomedical Sciences, The University of Hong KongHong Kong, China
| | - Alex P. W. Lee
- Department of Medicine and Therapeutics, The Chinese University of Hong KongHong Kong, China
| | - Bryan P. Yan
- Department of Medicine and Therapeutics, The Chinese University of Hong KongHong Kong, China
| | - Sunny H. Wong
- Department of Medicine and Therapeutics, Institute of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong KongHong Kong, China
| |
Collapse
|
10
|
Tse G, Lai ETH, Yeo JM, Tse V, Wong SH. Mechanisms of Electrical Activation and Conduction in the Gastrointestinal System: Lessons from Cardiac Electrophysiology. Front Physiol 2016; 7:182. [PMID: 27303305 PMCID: PMC4885840 DOI: 10.3389/fphys.2016.00182] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/06/2016] [Indexed: 12/12/2022] Open
Abstract
The gastrointestinal (GI) tract is an electrically excitable organ system containing multiple cell types, which coordinate electrical activity propagating through this tract. Disruption in its normal electrophysiology is observed in a number of GI motility disorders. However, this is not well characterized and the field of GI electrophysiology is much less developed compared to the cardiac field. The aim of this article is to use the established knowledge of cardiac electrophysiology to shed light on the mechanisms of electrical activation and propagation along the GI tract, and how abnormalities in these processes lead to motility disorders and suggest better treatment options based on this improved understanding. In the first part of the article, the ionic contributions to the generation of GI slow wave and the cardiac action potential (AP) are reviewed. Propagation of these electrical signals can be described by the core conductor theory in both systems. However, specifically for the GI tract, the following unique properties are observed: changes in slow wave frequency along its length, periods of quiescence, synchronization in short distances and desynchronization over long distances. These are best described by a coupled oscillator theory. Other differences include the diminished role of gap junctions in mediating this conduction in the GI tract compared to the heart. The electrophysiology of conditions such as gastroesophageal reflux disease and gastroparesis, and functional problems such as irritable bowel syndrome are discussed in detail, with reference to ion channel abnormalities and potential therapeutic targets. A deeper understanding of the molecular basis and physiological mechanisms underlying GI motility disorders will enable the development of better diagnostic and therapeutic tools and the advancement of this field.
Collapse
Affiliation(s)
- Gary Tse
- Li Ka Shing Faculty of Medicine, School of Biomedical Sciences, University of Hong KongHong Kong, China
| | - Eric Tsz Him Lai
- Li Ka Shing Faculty of Medicine, School of Biomedical Sciences, University of Hong KongHong Kong, China
| | - Jie Ming Yeo
- School of Medicine, Imperial College LondonLondon, UK
| | - Vivian Tse
- Department of Physiology, McGill UniversityMontreal, QC, Canada
| | - Sunny Hei Wong
- Department of Medicine and Therapeutics, Institute of Digestive Disease, LKS Institute of Health Sciences, Chinese University of Hong KongHong Kong, China
| |
Collapse
|
11
|
Smith A, Cacchione R, Miller ED, Mcelmurray L, Allen R, Stocker A, Abell TL, Hughes MG. Mini-laparotomy with Adjunctive Care versus Laparoscopy for Placement of Gastric Electrical Stimulation. Am Surg 2016. [DOI: 10.1177/000313481608200419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We compared outcomes for two gastric electrical stimulation placement strategies, mini-laparotomy with adjunctive care (MLAC) versus laparoscopy without adjunctive care (LAPA). For electrode placement, the peritoneal cavity was accessed with either a single 2.5 to 3.0 cm midline incision (MLAC) or three trocar incisions (LAPA). For both groups, generator was placed subcutaneously over the anterior rectus sheath. For MLAC, adjunctive pain control measures were used for placement of both electrode and generator (transversus abdominus plane block). For LAPA, those that could not be completed by laparoscopy were converted to traditional open approach and kept in the analysis. MLAC (n = 128) resulted in shorter operative times than LAPA (n = 37) (median operative time: 87.5 vs 137.0 minutes, P ≤ 0.01). Hospital length of stay was also shorter for MLAC than for LAPA (median: 2.0 vs 3.0 days, P ≤ 0.01) without any increase in readmission rates to the hospital within 30 days of discharge (11.0 vs 16.2%, P = 0.39). After equalizing learning curves, these differences were even greater (median operative time: 84.5 vs 137.0 minutes, P < 0.01; median length of stay: 1.0 vs 3.0 days; P < 0.01) without increasing 30-day read-mission rates (9.1 vs 16.2%, P = 0.25). For implantation of gastric electrical stimulators, mini-laparotomy can result in improved outcomes when coupled with adjunctive pain control measures.
Collapse
Affiliation(s)
- Alison Smith
- Department of Medicine, School of Medicine, University of Louisville, Louisville, Kentucky
| | - Robert Cacchione
- Department of Surgery, University of Louisville, Louisville, Kentucky
| | - ED Miller
- Department of Medicine, School of Medicine, University of Louisville, Louisville, Kentucky
| | - Lindsay Mcelmurray
- Department of Medicine, School of Medicine, University of Louisville, Louisville, Kentucky
| | - Robert Allen
- Anesthesiology, KentuckyOne Health, Louisville, Kentucky
| | - Abigail Stocker
- Department of Medicine, School of Medicine, University of Louisville, Louisville, Kentucky
| | - Thomas L. Abell
- Department of Medicine, School of Medicine, University of Louisville, Louisville, Kentucky
| | - Michael G. Hughes
- Department of Surgery, University of Louisville, Louisville, Kentucky
| |
Collapse
|
12
|
O'Grady G, Wang THH, Du P, Angeli T, Lammers WJEP, Cheng LK. Recent progress in gastric arrhythmia: pathophysiology, clinical significance and future horizons. Clin Exp Pharmacol Physiol 2015; 41:854-62. [PMID: 25115692 DOI: 10.1111/1440-1681.12288] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 07/11/2014] [Accepted: 07/14/2014] [Indexed: 01/27/2023]
Abstract
Gastric arrhythmia continues to be of uncertain diagnostic and therapeutic significance. However, recent progress has been substantial, with technical advances, theoretical insights and experimental discoveries offering new translational opportunities. The discoveries that interstitial cells of Cajal (ICC) generate slow waves and that ICC defects are associated with dysmotility have reinvigorated gastric arrhythmia research. Increasing evidence now suggests that ICC depletion and damage, network disruption and channelopathies may lead to aberrant slow wave initiation and conduction. Histological and high-resolution (HR) electrical mapping studies have now redefined the human 'gastric conduction system', providing an improved baseline for arrhythmia research. The application of HR mapping to arrhythmia has also generated important new insights into the spatiotemporal dynamics of arrhythmia onset and maintenance, resulting in the emergence of new provisional classification schemes. Meanwhile, the strong associations between gastric functional disorders and electrogastrography (EGG) abnormalities (e.g. in gastroparesis, unexplained nausea and vomiting and functional dyspepsia) continue to motivate deeper inquiries into the nature and causes of gastrointestinal arrhythmias. In future, technical progress in EGG methods, new HR mapping devices and software, wireless slow wave acquisition systems and improved gastric pacing devices may achieve validated applications in clinical practice. Neurohormonal factors in arrhythmogenesis also continue to be elucidated and a deepening understanding of these mechanisms may open opportunities for drug design for treating arrhythmias. However, for all translational goals, it remains to be seen whether arrhythmia can be corrected in a way that meaningfully improves organ function and symptoms in patients.
Collapse
Affiliation(s)
- Gregory O'Grady
- Department of Surgery, The University of Auckland, Auckland, New Zealand; Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | | | | | | | | | | |
Collapse
|
13
|
Angeli TR, Cheng LK, Du P, Wang THH, Bernard CE, Vannucchi MG, Faussone-Pellegrini MS, Lahr C, Vather R, Windsor JA, Farrugia G, Abell TL, O'Grady G. Loss of Interstitial Cells of Cajal and Patterns of Gastric Dysrhythmia in Patients With Chronic Unexplained Nausea and Vomiting. Gastroenterology 2015; 149:56-66.e5. [PMID: 25863217 PMCID: PMC4617790 DOI: 10.1053/j.gastro.2015.04.003] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 03/24/2015] [Accepted: 04/01/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND & AIMS Chronic unexplained nausea and vomiting (CUNV) is a debilitating disease of unknown cause. Symptoms of CUNV substantially overlap with those of gastroparesis, therefore the diseases may share pathophysiologic features. We investigated this hypothesis by quantifying densities of interstitial cells of Cajal (ICCs) and mapping slow-wave abnormalities in patients with CUNV vs controls. METHODS Clinical data and gastric biopsy specimens were collected from 9 consecutive patients with at least 6 months of continuous symptoms of CUNV but normal gastric emptying who were treated at the University of Mississippi Medical Center, and from 9 controls (individuals free of gastrointestinal disease or diabetes). ICCs were counted and ultrastructural analyses were performed on tissue samples. Slow-wave propagation profiles were defined by high-resolution electrical mapping (256 electrodes; 36 cm(2)). Results from patients with CUNV were compared with those of controls as well as patients with gastroparesis who were studied previously by identical methods. RESULTS Patients with CUNV had fewer ICCs than controls (mean, 3.5 vs 5.6 bodies/field, respectively; P < .05), with mild ultrastructural abnormalities in the remaining ICCs. Slow-wave dysrhythmias were identified in all 9 subjects with CUNV vs only 1 of 9 controls. Dysrhythmias included abnormalities of initiation (stable ectopic pacemakers, unstable focal activities) and conduction (retrograde propagation, wavefront collisions, conduction blocks, and re-entry), operating across bradygastric, normal (range, 2.4-3.7 cycles/min), and tachygastric frequencies; dysrhythmias showed velocity anisotropy (mean, 3.3 mm/s longitudinal vs 7.6 mm/s circumferential; P < .01). ICCs were less depleted in patients with CUNV than in those with gastroparesis (mean, 3.5 vs 2.3 bodies/field, respectively; P < .05), but slow-wave dysrhythmias were similar between groups. CONCLUSIONS This study defined cellular and bioelectrical abnormalities in patients with CUNV, including the identification of slow-wave re-entry. Pathophysiologic features of CUNV were observed to be similar to those of gastroparesis, indicating that they could be spectra of the same disorder. These findings offer new insights into the pathogenesis of CUNV and may help to inform future treatments.
Collapse
Affiliation(s)
- Timothy R Angeli
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Leo K Cheng
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand; Department of Surgery, Vanderbilt University, Nashville, Tennessee
| | - Peng Du
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Tim Hsu-Han Wang
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Cheryl E Bernard
- Division of Gastroenterology and Hepatology, Enteric Neurosciences Program, Mayo Clinic, Rochester, Minnesota
| | - Maria-Giuliana Vannucchi
- Histology and Embryology Research Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Christopher Lahr
- Department of Surgery, Mississippi Medical Center, Jackson, Mississippi
| | - Ryash Vather
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - John A Windsor
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Gianrico Farrugia
- Division of Gastroenterology and Hepatology, Enteric Neurosciences Program, Mayo Clinic, Rochester, Minnesota
| | - Thomas L Abell
- Department of Gastroenterology, University of Louisville, Louisville, Kentucky
| | - Gregory O'Grady
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand; Department of Surgery, University of Auckland, Auckland, New Zealand.
| |
Collapse
|
14
|
Affiliation(s)
- Pankaj Jay Pasricha
- Johns Hopkins Center for Neurogastroenterology, Baltimore, Maryland; Food Body and Mind Center at Johns Hopkins, Baltimore, Maryland; Department of Medicine and Neurosciences, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Innovation Management, Johns Hopkins Carey School of Business, Baltimore, Maryland.
| |
Collapse
|
15
|
Gastric Electrical Stimulation Optimized to Inhibit Gastric Motility Reduces Food Intake in Dogs. Obes Surg 2014; 25:1047-55. [DOI: 10.1007/s11695-014-1491-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
16
|
Changing interdigestive migrating motor complex in rats under acute liver injury. BIOMED RESEARCH INTERNATIONAL 2014; 2014:634281. [PMID: 25544942 PMCID: PMC4228720 DOI: 10.1155/2014/634281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 08/30/2014] [Accepted: 08/31/2014] [Indexed: 11/22/2022]
Abstract
Gastrointestinal motility disorder is a major clinical manifestation of acute liver injury, and interdigestive migrating motor complex (MMC) is an important indicator. We investigated the changes and characteristics of MMC in rats with acute liver injury. Acute liver injury was created by d-galactosamine, and we recorded the interdigestive MMC using a multichannel physiological recorder and compared the indexes of interdigestive MMC. Compared with normal controls, antral MMC Phase I duration was significantly prolonged and MMC Phase III duration was significantly shortened in the rats with acute liver injury. The duodenal MMC cycle and MMC Phases I and IV duration were significantly prolonged and MMC Phase III duration was significantly shortened in the rats with acute liver injury. The jejunal MMC cycle and MMC Phases I and IV duration were significantly prolonged and MMC Phase III duration was significantly shortened in the rats with acute liver injury compared with normal controls. Compared with the normal controls, rats with acute liver injury had a significantly prolonged interdigestive MMC cycle, related mainly to longer MMC Phases I and IV, shortened MMC Phase III, and MMC Phase II characterized by increased migrating clustered contractions, which were probably major contributors to the gastrointestinal motility disorders.
Collapse
|
17
|
Hasler WL, Wilson LA, Parkman HP, Koch KL, Abell TL, Nguyen L, Pasricha PJ, Snape WJ, McCallum RW, Sarosiek I, Farrugia G, Calles J, Lee L, Tonascia J, Unalp-Arida A, Hamilton F. Factors related to abdominal pain in gastroparesis: contrast to patients with predominant nausea and vomiting. Neurogastroenterol Motil 2013; 25:427-38, e300-1. [PMID: 23414452 PMCID: PMC3907086 DOI: 10.1111/nmo.12091] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 12/24/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Factors associated with abdominal pain in gastroparesis are incompletely evaluated and comparisons of pain vs other symptoms are limited. This study related pain to clinical factors in gastroparesis and contrasted pain/discomfort- with nausea/vomiting-predominant disease. METHODS Clinical and scintigraphy data were compared in 393 patients from seven centers of the NIDDK Gastroparesis Clinical Research Consortium with moderate-severe (Patient Assessment of Upper Gastrointestinal Disorders Symptoms [PAGI-SYM] score ≥ 3) vs none-mild (PAGI-SYM < 3) upper abdominal pain and predominant pain/discomfort vs nausea/vomiting. KEY RESULTS Upper abdominal pain was moderate-severe in 261 (66%). Pain/discomfort was predominant in 81 (21%); nausea/vomiting was predominant in 172 (44%). Moderate-severe pain was more prevalent with idiopathic gastroparesis and with lack of infectious prodrome (P ≤ 0.05) and correlated with scores for nausea/vomiting, bloating, lower abdominal pain/discomfort, bowel disturbances, and opiate and antiemetic use (P < 0.05), but not gastric emptying or diabetic neuropathy or control. Gastroparesis severity, quality of life, and depression and anxiety were worse with moderate-severe pain (P ≤ 0.008). Factors associated with moderate-severe pain were similar in diabetic and idiopathic gastroparesis. Compared to predominant nausea/vomiting, predominant pain/discomfort was associated with impaired quality of life, greater opiate, and less antiemetic use (P < 0.01), but similar severity and gastric retention. CONCLUSIONS & INFERENCES Moderate-severe abdominal pain is prevalent in gastroparesis, impairs quality of life, and is associated with idiopathic etiology, lack of infectious prodrome, and opiate use. Pain is predominant in one fifth of gastroparetics. Predominant pain has at least as great an impact on disease severity and quality of life as predominant nausea/vomiting.
Collapse
Affiliation(s)
- W. L. Hasler
- University of Michigan; Ann Arbor; Michigan; USA
| | - L. A. Wilson
- Johns Hopkins University; Baltimore; Maryland; USA
| | | | - K. L. Koch
- Wake Forest University; Winston-Salem; North Carolina; USA
| | - T. L. Abell
- University of Mississippi; Jackson; Mississippi; USA
| | - L. Nguyen
- Stanford University; Palo Alto; California; USA
| | | | - W. J. Snape
- California Pacific Medical Center; San Francisco; California; USA
| | - R. W. McCallum
- Texas Tech University Health Sciences Center; El Paso; Texas; USA
| | - I. Sarosiek
- Texas Tech University Health Sciences Center; El Paso; Texas; USA
| | | | - J. Calles
- Wake Forest University; Winston-Salem; North Carolina; USA
| | - L. Lee
- Johns Hopkins University; Baltimore; Maryland; USA
| | - J. Tonascia
- Johns Hopkins University; Baltimore; Maryland; USA
| | | | - F. Hamilton
- National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda; Maryland; USA
| |
Collapse
|
18
|
Camilleri M, Parkman HP, Shafi MA, Abell TL, Gerson L. Clinical guideline: management of gastroparesis. Am J Gastroenterol 2013; 108:18-37; quiz 38. [PMID: 23147521 PMCID: PMC3722580 DOI: 10.1038/ajg.2012.373] [Citation(s) in RCA: 688] [Impact Index Per Article: 62.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This guideline presents recommendations for the evaluation and management of patients with gastroparesis. Gastroparesis is identified in clinical practice through the recognition of the clinical symptoms and documentation of delayed gastric emptying. Symptoms from gastroparesis include nausea, vomiting, early satiety, postprandial fullness, bloating, and upper abdominal pain. Management of gastroparesis should include assessment and correction of nutritional state, relief of symptoms, improvement of gastric emptying and, in diabetics, glycemic control. Patient nutritional state should be managed by oral dietary modifications. If oral intake is not adequate, then enteral nutrition via jejunostomy tube needs to be considered. Parenteral nutrition is rarely required when hydration and nutritional state cannot be maintained. Medical treatment entails use of prokinetic and antiemetic therapies. Current approved treatment options, including metoclopramide and gastric electrical stimulation (GES, approved on a humanitarian device exemption), do not adequately address clinical need. Antiemetics have not been specifically tested in gastroparesis, but they may relieve nausea and vomiting. Other medications aimed at symptom relief include unapproved medications or off-label indications, and include domperidone, erythromycin (primarily over a short term), and centrally acting antidepressants used as symptom modulators. GES may relieve symptoms, including weekly vomiting frequency, and the need for nutritional supplementation, based on open-label studies. Second-line approaches include venting gastrostomy or feeding jejunostomy; intrapyloric botulinum toxin injection was not effective in randomized controlled trials. Most of these treatments are based on open-label treatment trials and small numbers. Partial gastrectomy and pyloroplasty should be used rarely, only in carefully selected patients. Attention should be given to the development of new effective therapies for symptomatic control.
Collapse
Affiliation(s)
- Michael Camilleri
- Department of Gastroenterology, Mayo Clinic, Rochester, MN 55905, USA.
| | | | | | | | | |
Collapse
|
19
|
Abstract
Gastroparesis is often divided into subsets based on etiology and pathophysiology; however, the utility of these subsets in the diagnosis and treatment of gastro-paresis is not well defined. The objectives are to consider the subsets of gastroparesis from the perspectives of etiology and pathogenesis, pathophysiology, histopathology, and clinical associations, with particular focus on similarities and differences between diabetic and idiopathic gastroparesis and consideration of the potential subset of painful gastroparesis. We conclude that idiopathic and diabetic gastroparesis has similar initial presentations and manifestations, except that idiopathic gastroparesis tends to be associated more frequently with pain. Myopathic disorders are uncommon. Extrinsic denervation was considered the most common etiology; however, with the decline in surgery for peptic ulceration and in-depth study of full-thickness gastric biopsies, the most common intrinsic defects are being recognized in the interstitial cells of Cajal (ICC-opathy) and with immune infiltration and neuronal changes (intrinsic neuropathic gastroparesis). Histomorphological differences at the microscopic level between diabetic and idiopathic gastroparesis are still of unclear significance. Two gastroparesis subsets worthy of special mention, because they are potentially reversible with identification of the cause, are postviral gastroparesis, which has a generally good prognosis, and iatrogenic gastroparesis, especially in patients with non-surgical gastroparesis, such as diabetics exposed to incretins such as pramlintide and exenatide.
Collapse
Affiliation(s)
- M Camilleri
- Clinical Enteric Neuroscience Translational and Epidemiological Research, Mayo Clinic, Rochester, MN 55905, USA.
| | | | | |
Collapse
|
20
|
Abell TL, Johnson WD, Kedar A, Runnels JM, Thompson J, Weeks ES, Minocha A, Griswold ME. A double-masked, randomized, placebo-controlled trial of temporary endoscopic mucosal gastric electrical stimulation for gastroparesis. Gastrointest Endosc 2011; 74:496-503.e3. [PMID: 21872708 PMCID: PMC5098698 DOI: 10.1016/j.gie.2011.05.022] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 05/17/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND Endoscopically placed, temporary gastric electrical stimulation (tGES) may relieve symptoms of gastroparesis (Gp) and predict permanent gastric electrical stimulation (GES) outcomes. OBJECTIVE To measure effects of 72 hours of temporary GES on Gp symptoms. DESIGN, SETTING, AND PATIENTS From 2005 to 2006, we conducted a hospital-based, randomized, placebo-controlled, crossover trial of two consecutive, 4-day sessions (session 1 and session 2), enrolling 58 patients (11 males, 47 females; mean age 46 years) with GP symptom histories of three etiologies (idiopathic, 38; diabetes mellitus, 13; postsurgical, 7). INTERVENTION 72 continuous hours temporary GES was provided for group A during session 1, and for group B during session 2. MAIN OUTCOME MEASUREMENTS Symptoms measured daily; gastric emptying, electrogastrography, and quality of life measured at baseline and session close. RESULTS In session 1, vomiting decreased in both groups, but was greater with stimulation, resulting in a day 3 difference of -1.02 (95% CI, -1.62 to -0.42; P < .001). Scores did not return to baseline during washout; on day 4, the difference persisted at -1.08 (95% CI, -1.81 to -0.35; P = .005). In session 2, vomiting slightly decreased with stimulation and slightly increased without it; at day 8, the nonactivated group had nonsignificantly greater vomiting, 0.12 (-0.68 to 0.92; P = .762). An overall treatment effect of a slight, nonsignificant daily decrease in average vomiting scores, -0.12 (-0.26 to 0.03; P = .116), was observed by pooling stimulation effects across sessions. LIMITATIONS Missing data; potential physiological imbalances between groups. CONCLUSIONS Although overall treatment effects were not significant, differences in favor of stimulation were suggested. Barriers to observing treatment effects included a decrease in vomiting for both groups during session 1, insufficient washout, and the absence of baseline vomiting for some patients. Future studies should better define inclusion criteria, use longer washout periods, randomize by etiology and baseline physiological findings, and pursue alternative designs. ( CLINICAL TRIAL REGISTRATION NUMBER 00432835.).
Collapse
Affiliation(s)
- Thomas L Abell
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA.
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Winstead NS. The challenges of chronic nausea and vomiting and normal gastric emptying. Clin Gastroenterol Hepatol 2011; 9:534-5. [PMID: 21440667 DOI: 10.1016/j.cgh.2011.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 03/13/2011] [Indexed: 02/07/2023]
|
22
|
Zhao Y, Ke M, Wang Z, Wei J, Zhu L, Sun X, Zhang J. Pathophysiological and psychosocial study in patients with functional vomiting. J Neurogastroenterol Motil 2010; 16:274-80. [PMID: 20680166 PMCID: PMC2912120 DOI: 10.5056/jnm.2010.16.3.274] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 07/10/2010] [Accepted: 07/11/2010] [Indexed: 12/16/2022] Open
Abstract
Background/Aims To explore clinical patterns, predisposing factors, psychosocial aspects and the possible pathogenesis in Functional Vomiting (FV) patients. Methods Ten healthy subjects and 19 FV patients participated in this study. Gastrointestinal symptoms and psychological state were evaluated by questionnaires, including Zung self-rating anxiety and depression scale and Eysenck personality questionnaire. Cutaneous electrogastrography, perfusion nutrition load test and intragastric pressure were performed in patients. Perfusion nutrition load test and intragastric pressure were also performed in healthy subjects. Results FV involved young female predominantly (4 male, 15 female; age 25.8 ± 8.4 years). Postprandial vomiting soon after meal without self-induced maneuver was the most common pattern of FV. Prevalence for overlaps between FV and functional dyspepsia was high (84.2%). Emotional changes and stress contributed to the development of FV. Prevalence of abnormal psychological status and personality in patients with FV was high (83.3% and 47.1%). Patients with FV had significant postprandial gastric dysrhythmia, impaired gastric accommodation and enhanced gastric sensitivity. There were significant correlations between clinical presentations, gastric function and psychological states. Conclusions Patients with FV had abnormal psychological status, gastric dysmotility and hypersensitivity, which indicated that both of peripheral and central abnormalities could contribute to the pathogenesis of FV.
Collapse
Affiliation(s)
- Yiming Zhao
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | | | | | | | | | | | | |
Collapse
|