The effects of comprehensive mental intervention on the recovery time of patients with postsurgical gastroparesis syndrome

Pathogenesis and management of diabetic gastroparesis: An updated clinically oriented review

BACKGROUND AND AIMS

Diabetic gastroparesis (DGp) is a common and preventable complication of uncontrolled diabetes mellitus (D.M.) and significantly affects the Quality of Life of patients. Diagnosis and management present as a clinical challenge due to the disease's complexity and limited effective therapeutic options. This review aims to comprehensively outline the pathogenesis, diagnosis, and management of diabetic gastroparesis, evaluating evolving approaches to guide clinicians and provide future recommendations.

METHODS

A literature review was conducted on scholarly databases of PubMed, Google Scholar, Scopus and Web of Science encompassing published articles, gray literature and relevant clinical guidelines. Data were synthesized and analyzed to provide a comprehensive overview of diabetic gastroparesis, focusing on pathogenesis, diagnosis, and management.

RESULTS

The review intricately explores the pathogenesis contributing to diabetic gastroparesis, emphasizing autonomic neuropathy, oxidative stress, inflammation, hormonal dysregulation, microbiota alterations, and gastrointestinal neuropathy. Primary management strategies are underscored, including lifestyle modifications, symptom relief, and glycemic control. The discussion encompasses pharmacological and surgical options, highlighting the importance of a multidisciplinary approach involving various healthcare professionals for comprehensive patient care.

CONCLUSION

This review offers a thorough understanding of pathogenesis, diagnosis, and management of diabetic gastroparesis, underlining evolving approaches for clinicians. A multidisciplinary approach is crucial to address both the physical and mental health aspects of diabetes and its complications.

Diabetic Gastroparesis and its Emerging Therapeutic Options: A Narrative Review of the Literature

Diabetic gastroparesis (DG) is one of the many complications of diabetes mellitus (DM). Even though this condition surfaces years after uncontrolled disease, it affects the quality of life in several ways and causes significant morbidity. Common symptoms experienced by the patients include postprandial nausea, vomiting, abdominal fullness, and pain. Strict glycemic control is essential to evade the effects of DG. The purpose of this review article is to briefly study the pathophysiology, clinical features, diagnostic modalities, and the effects of DG on different aspects of life. Furthermore, it also focuses on the emerging treatment modalities for DG. Tradipitant and relamorelin are two such treatment options that are gaining noteworthy recognition and are discussed in detail in this review article. As observed through various clinical trials, these drugs help alleviate symptoms like nausea, vomiting, abdominal pain, and bloating in patients suffering from DG, thereby targeting the most common and bothersome symptoms of the disease. This leads to an improvement in the quality of life, making it a reliable treatment option for this disease. But while pharmacological intervention is vital, psychological support and lifestyle changes are equally important and are the reason why a multidisciplinary approach is required for the treatment of DG.

Acupuncture for postoperative gastroparesis syndrome: A protocol for systematic review and meta-analysis

BACKGROUND

Postsurgical gastroparesis syndrome (PGS) is an early common complication after upper abdominal surgery, especially which occurs mainly after gastroduodenal operation. Acupuncture, a complementary and alternative therapy, has been widely used in China because of its significant effect and few side effects. We conduct a protocol for systematic review and meta-analysis to assess the efficacy and safety of acupuncture for the treatment of PGS.

METHODS

This systematic review was registered in the PROSPERO network (registration number: CRD42022369167). We will follow the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocol to accomplish the study. Following databases will be searched: PubMed, MEDLINE, EMBASE, Cochrane Library, China National Knowledge Infrastructure, Wanfang data, Chinese Scientific Journals Database, and China biomedical literature database. All randomized controlled trials (RCTs) on the application of acupuncture in the treatment of patients with PGS will be included. The risk of bias of the included studies will be assessed using the Cochrane tool of risk of bias. All statistical analyses will be conducted using the STATA13.0 software.

RESULTS

This study is ongoing and the results will be submitted to a peer-reviewed journal for publication.

CONCLUSION

The conclusion of this review will provide evidence to judge whether acupuncture is an effective intervention for patient with PGS.

Impact of Mental Health on General Surgery Patients and Strategies to Improve Outcomes

Mental Health Disorders (MHD) are a growing concern nationwide. The significant impact MHD have on surgical outcomes has only recently started to be understood. This literature review investigated how mental health impacts the outcomes of general surgery patients and what can be done to make improvements. Patients with schizophrenia had the poorest surgical outcomes. Mental health disorders increased post-surgical pain, hospital length of stay, complications, readmissions, and mortality. Mental health disorders decreased wound healing and quality of care. Optimizing outcomes will be best accomplished through integrating more effective perioperative screening tools and interventions. Screenings tools can incorporate artificial intelligence, MHD data, resilience and its biomarkers, and patient mental health questionnaires. Interventions include cognitive behavioral therapy, virtual reality, spirituality, pharmacology, and resilience training.

Gastroparesis: A Multidisciplinary Approach to Management

Gastroparesis is a neuromuscular disorder whose hallmark is delayed gastric emptying. It is a global challenge to the healthcare system because of poor treatment satisfaction for both the patients and clinicians, eventually leading to a reduction in the quality of life, with antecedent anxiety and depression. Although it is multifactorial in origin, diabetic, idiopathic, and drug-induced gastroparesis are the major risk factors. Disrupted interstitial cells of Cajal (ICC) and gastric dysrhythmia are pivotal to the pathogenesis, with most of the investigations targeted toward assessing gastric emptying and accommodation usually affected by distorted ICC and other neural networks. The treatment challenges can be overcome by a multidisciplinary approach involving gastroenterologists, gastrointestinal surgeons, biomedical engineers, nutritionists, psychologists, nurses, radionuclide radiologists, pharmacists, and family physicians. The exploration of the fundamental physiological processes underlying gastroparesis with the use of biomechanical materials should be given more attention by biomedical engineers to integrate innovative engineering with medicine for solving complex medical issues.

Pathophysiology, Aetiology and Treatment of Gastroparesis

Gastroparesis is characterized by delayed gastric emptying, with symptoms such as nausea, vomiting and abdominal pain, in the absence of mechanical obstruction. In most cases, it is idiopathic although diabetes mellitus is another leading cause. The physiology of gastric emptying is a complex process which is influenced by various inputs including the central nervous system, enteric nervous system and gut hormones. Developments in our understanding of gastroparesis have now demonstrated dysfunction in these systems, thus disrupting normal gastric emptying. Once mechanical obstruction is excluded, gastric scintigraphy remains the gold standard for diagnosis although wireless motility capsule and breath testing are alternative methods for diagnosis. Treatment for gastroparesis is challenging, and widely available therapies are often limited either by their poor evidence for efficacy or concerns over their long-term safety profile. Novel prokinetic agents have shown initial promise in clinical trials, and new endoscopic techniques such as gastric per-oral endoscopic myotomy are emerging. These new treatment modalities may provide an option in refractory gastroparesis with the adage of reduced morbidity compared to surgical treatments.

Gastroparesis Following Resection of a Fourth-Ventricle Ependymoma in a Child

BACKGROUND

Gastroparesis following resection of a fourth ventricle tumor has never been reported in the literature. We report a unique case of gastroparesis following resection of a fourth-ventricle ependymoma in a child.

CASE DESCRIPTION

A 14-year-old boy had a 12-day history of headache, nausea, and vomiting. Magnetic resonance imaging revealed a tumor in the fourth ventricle. He underwent a posterior median craniotomy, and total removal was achieved. Histologic analysis revealed an anaplastic ependymoma (World Health Organization grade III). Three days after surgery, the patient complained of upper abdominal pain, nausea, and vomiting. Computed tomography of the abdomen showed dilatation of the stomach. Gastroscopy revealed moderate gastritis without gastric outlet obstruction. Nine days after surgery, a jejunal feeding tube (J-tube) was placed for nutritional support. Once the patient improved his oral intake and demonstrated that he could keep up with his nutritional requirements, the J-tube was discontinued 19 days after surgery. The patient had no neurologic or gastrointestinal complaints at the 2-month follow up.

CONCLUSIONS

We report, to our knowledge, the first case of gastroparesis following resection of a fourth-ventricle ependymoma in a child. Gastroparesis can recover spontaneously, which we suspect may be due to reversible injury of the dorsal motor nucleus of the vagus.

Da-Cheng-Qi Decoction Combined with Conventional Treatment for Treating Postsurgical Gastrointestinal Dysfunction

Aim

To assess the current clinical evidence of the effectiveness of Da-Cheng-Qi Decoction (DCQD) for the treatment of Postoperative gastrointestinal dysfunction (PGD).

Methods

Randomized controlled trails (RCTs) of Da-Cheng-Qi Decoction (DCQD) to PGD were searched from available major electronic databases to September 2016. The intervention must be a modified DCQD or DCQD integrated to Western Medicine (WM) compared with WM or placebo or blank. The main outcome index was clinical effectiveness and improvement of major symptoms. Data extraction, data analysis, and methodological quality assessment are conducted according to the Cochrane Handbook for Systematic Review of Interventions, version 5.0.2. RevMan 5.3 software was applied to our data analyses.

Results

Seven RCTs involving 494 participants were recruited and identified. The methodological quality of all trials were assessed and generally of low-level. Those studies were published between 2004 and 2013. All 7 studies which used herbals (modified DCQD) integrate WM in test group compared with WM as the intervention and only one study (Sunyouxu 2013) integrates placebo to Western Medicine as the control group intervention. The treatment course was 1 week to 2 weeks. Evaluation of intervention effectiveness consists of the clinical effective rate indicator and the PGD symptoms indicator including time of borborygmus, time of gastrointestinal exhaust, and time of defecate. The clinical effectiveness results are beneficial to the test group.

Conclusion

DCQD could improve PGD symptoms and promotion clinical effectiveness.

Psychological controversies in gastroparesis: A systematic review

AIM

To systematically review literature addressing three key psychologically-oriented controversies associated with gastroparesis.

METHODS

A comprehensive search of PubMed, CINAHL, and PsycINFO databases was performed to identify literature addressing the relationship between gastroparesis and psychological factors. Two researchers independently screened all references. Inclusion criteria were: an adult sample of gastroparesis patients, a quantitative methodology, and at least one of the following: (1) evaluation of the prevalence of psychopathology; (2) an outcome measure of anxiety, depression, or quality of life; and (3) evidence of a psychological intervention. Case studies, review articles, and publications in languages other than English were excluded from the current review.

RESULTS

Prevalence of psychopathology was evaluated by three studies (n = 378), which found that combined anxiety/depression was present in 24% of the gastroparesis cohort, severe anxiety in 12.4%, depression in 21.8%-23%, and somatization in 50%. Level of anxiety and depression was included as an outcome measure in six studies (n = 1408), and while limited research made it difficult to determine the level of anxiety and depression in the cohort, a clear positive relationship with gastroparesis symptom severity was evident. Quality of life was included as an outcome measure in 11 studies (n = 2076), with gastroparesis patients reporting lower quality of life than population norms, and a negative relationship between quality of life and symptom severity. One study assessed the use of a psychological intervention for gastroparesis patients (n = 120) and found that depression and gastric function were improved in patients who received psychological intervention, however the study had considerable methodological limitations.

CONCLUSION

Gastroparesis is associated with significant psychological distress and poor quality of life. Recommendations for future studies and the development of psychological interventions are provided.