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Bharadwaj S, Meka K, Tandon P, Rathur A, Rivas JM, Vallabh H, Jevenn A, Guirguis J, Sunesara I, Nischnick A, Ukleja A. Management of gastroparesis-associated malnutrition. J Dig Dis 2016; 17:285-94. [PMID: 27111029 DOI: 10.1111/1751-2980.12344] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/07/2016] [Accepted: 03/24/2016] [Indexed: 12/11/2022]
Abstract
Gastroparesis (GP) is a chronic debilitating dysmotility characterized by unrelenting nausea, vomiting, bloating, early satiety, postprandial fullness and abdominal pain. Patients with GP experience other associated conditions, including gastroesophageal reflux disease, gastric bezoars and small bowel bacterial overgrowth. Furthermore, GP is associated with poor quality of life, increased emergency room visits, hospitalizations and subsequent increased healthcare costs. Currently, the managements of GP consist of glycemic control, antiemetics, prokinetics and the use of gastric electrical stimulation. However, most GP patients are at risk for significant nutritional abnormalities. As such, it is essential to screen and diagnose malnutrition in these patients. Poor oral intake in such patients could be supplemented by enteral tube feeding. Parenteral nutrition, although a last resort, is associated with a number of complications and should be used only for the short term. In summary, a systematic approach including initial nutritional screening, diet recommendations, medical therapy, nutritional re-evaluation and enteral and parental nutrition should be considered in complex GP patients.
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Affiliation(s)
- Shishira Bharadwaj
- Department of Gastroenterology/Hepatology, Center for Human Nutrition, Cleveland Clinic Foundation, College of Osteopathic Medicine Cleveland, Ohio, USA
| | - Krishna Meka
- Department of Gastroenterology/Hepatology, Michigan State University, East Lansing, MI, USA
| | - Parul Tandon
- Department of Gastroenterology/Hepatology, Michigan State University, East Lansing, MI, USA
| | - Abdullah Rathur
- Department of Gastroenterology/Hepatology, Michigan State University, East Lansing, MI, USA
| | - John M Rivas
- Department of Gastroenterology/Hepatology, Cleveland Clinic, West Palm Beach, Florida, USA
| | - Hiren Vallabh
- Department of Gastroenterology/Hepatology, Center for Human Nutrition, Cleveland Clinic Foundation, College of Osteopathic Medicine Cleveland, Ohio, USA
| | - Andrea Jevenn
- Department of Gastroenterology/Hepatology, Center for Human Nutrition, Cleveland Clinic Foundation, College of Osteopathic Medicine Cleveland, Ohio, USA
| | - John Guirguis
- Department of Gastroenterology/Hepatology, Center for Human Nutrition, Cleveland Clinic Foundation, College of Osteopathic Medicine Cleveland, Ohio, USA
| | - Imran Sunesara
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Amy Nischnick
- Department of Gastroenterology/Hepatology, Center for Human Nutrition, Cleveland Clinic Foundation, College of Osteopathic Medicine Cleveland, Ohio, USA
| | - Andrew Ukleja
- Department of Gastroenterology/Hepatology, Cleveland Clinic, West Palm Beach, Florida, USA
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Yasuda H, Fujiwara N, Ishizaki Y, Komatsu N. Anemia attributed to vitamin B6 deficiency in post-pancreaticoduodenectomy patients. Pancreatology 2014; 15:81-3. [PMID: 25543166 DOI: 10.1016/j.pan.2014.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 11/08/2014] [Accepted: 12/08/2014] [Indexed: 12/11/2022]
Abstract
Micronutrient deficiencies such as vitamin A, iron, zinc, and selenium have been known to occur as a consequence of pancreaticoduodenectomy (PD), but vitamin B6 deficiency has not been previously reported. We report two post-PD patients who developed anemias attributed to vitamin B6 deficiency. Oral supplementations of vitamin B6 significantly improved anemias in both cases. Micronutrients including vitamin B6 should be monitored in post-PD patients, and supplementations should be carried out when necessary.
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Affiliation(s)
- Hajime Yasuda
- Division of Hematology, Department of Medicine, Juntendo University School of Medicine, Tokyo, Japan.
| | - Noriko Fujiwara
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoichi Ishizaki
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Norio Komatsu
- Division of Hematology, Department of Medicine, Juntendo University School of Medicine, Tokyo, Japan
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Abstract
Gastric resection, whether partial or total gastrectomy, often results in nutrition-related complications including weight loss, diet intolerances, and micronutrient deficiencies. The physiology of normal and postgastrectomy digestion is the basis for most of the current diet recommendations after gastric surgery. A careful review reveals that there is not sufficient literature to support a standard postgastrectomy diet. Rather, individualized diet manipulation for symptom relief is recommended. This review highlights the physiology behind common postgastrectomy complications, provides guidelines for the medical and nutrition management of these complications, and presents a basic approach to postgastrectomy gastrointestinal symptoms.
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Affiliation(s)
- Christie Rogers
- Nutrition Support Services, University of Virginia Health System, Charlottesville, VA 22908, USA.
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Abstract
Gastroparesis is a debilitating disease that is the consequence of a variety of conditions resulting in a significant loss of quality of life. Although many cases are mild, some patients have protracted nausea and vomiting, making it difficult, if not impossible, to maintain their hydration and nutritional status. Furthermore, therapeutic levels of medications, such as prokinetic and antiemetic agents, can be difficult to achieve. The intent of this article is to provide the clinician with suggestions to improve the nutritional status of patients with gastroparesis and offer strategies to deal with the nutritional insults that arise in these unfortunate patients.
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Affiliation(s)
- Carol Rees Parrish
- Digestive Health Center of Excellence, Division of Gastroenterology and Hepatology, University of Virginia Health System, PO Box 800708, Charlottesville, VA 22908-0708, USA.
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Abstract
Celiac disease is a common systemic disorder that can have multiple hematologic manifestations. Patients with celiac disease may present to hematologists for evaluation of various hematologic problems prior to receiving a diagnosis of celiac disease. Anemia secondary to malabsorption of iron, folic acid, and/or vitamin B12 is a common complication of celiac disease and many patients have anemia at the time of diagnosis. Celiac disease may also be associated with thrombocytosis, thrombocytopenia, leukopenia, venous thromboembolism, hyposplenism, and IgA deficiency. Patients with celiac disease are at increased risk of being diagnosed with lymphoma, especially of the T-cell type. The risk is highest for enteropathy-type T-cell lymphoma (ETL) and B-cell lymphoma of the gut, but extraintestinal lymphomas can also be seen. ETL is an aggressive disease with poor prognosis, but strict adherence to a gluten-free diet may prevent its occurrence.
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Affiliation(s)
- Thorvardur R. Halfdanarson
- Division of Hematology and
- Correspondence: Joseph A. Murray,
Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St, SW, Rochester MN 55905; e-mail:
; or Thorvardur R. Halfdanarson,
Mayo Clinic College of Medicine, Division of Hematology, 200 First St SW, Rochester, MN 55905; e-mail:
| | | | - Joseph A. Murray
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN
- Correspondence: Joseph A. Murray,
Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St, SW, Rochester MN 55905; e-mail:
; or Thorvardur R. Halfdanarson,
Mayo Clinic College of Medicine, Division of Hematology, 200 First St SW, Rochester, MN 55905; e-mail:
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Nahon S, Lahmek P, Lesgourgues B, Nahon-Uzan K, Tuszynski T, Traissac L, Delas N. Predictive factors of GI lesions in 241 women with iron deficiency anemia. Am J Gastroenterol 2002; 97:590-3. [PMID: 11922551 DOI: 10.1111/j.1572-0241.2002.05534.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES GI blood loss is the most common cause of iron deficiency anemia (IDA) in postmenopausal women and menstrual blood loss in premenopausal women. We aimed to evaluate the diagnostic yield of endoscopy in women with IDA and to define predictive factors of a GI lesion. METHOD Clinical, biological, endoscopic, and histological data from patients with IDA were systematically collected on a computer. Multivariate analysis (logistic regression) was performed to determine whether these data were associated with a GI lesion. RESULTS Between January, 1989 and June, 1999, 241 consecutive women had endoscopies for IDA (mean age = 52.3 +/- 21.8 yr). A substantial GI lesion was detected in 119 patients (49.4%). Ten patients (4%) had both upper and lower GI lesions. A source of IDA was revealed by upper endoscopy in 86 cases (35.6%) and by colonoscopy in 33 (13.7%). The most common upper lesions were peptic ulceration (42/241 [17.4%]), esophagitis (15/241 [6.2%]), and cancer (9/241 [3.7%]). Colonic cancer (15/241 [6.2%]) and polyps (10/241 [4.1%]) were the most frequent lesions detected by colonoscopy. Predictive factors (odds ratio, 95% CI) of GI lesions diagnosed by endoscopy were abdominal symptoms (8.3, 3.9-17.2), age > 50 yr (4.4, 2.1-9.2), and Hb < 9 g/dl (3, 1.5-6.1). Thirty-one women (13%) had none of these predictive factors; in this group only two lesions were identified (one esophagitis and one duodenal ulcer). The positive predictive value of these three independent predictors was 87%, and the negative predictive value was 93.5%. CONCLUSION Endoscopy revealed a source of IDA in 49.4% of cases. Three predictive factors of GI lesion were identified. Endoscopic investigation should be avoided in women without these three predictive factors. Conversely, these factors are strongly associated with a GI lesion.
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Affiliation(s)
- Stéphane Nahon
- Service d'Hépato-Gastroentérologie, Centre Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France
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