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Silveira SQ, da Silva LM, de Campos Vieira Abib A, de Moura DTH, de Moura EGH, Santos LB, Ho AMH, Nersessian RSF, Lima FLM, Silva MV, Mizubuti GB. Relationship between perioperative semaglutide use and residual gastric content: A retrospective analysis of patients undergoing elective upper endoscopy. J Clin Anesth 2023; 87:111091. [PMID: 36870274 DOI: 10.1016/j.jclinane.2023.111091] [Citation(s) in RCA: 52] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/12/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023]
Abstract
STUDY OBJECTIVE Semaglutide is a long-acting glucagon-like peptide-1 receptor agonist used for management of type 2 diabetes and/or obesity. To test the hypothesis that perioperative semaglutide use is associated with delayed gastric emptying and increased residual gastric content (RGC) despite adequate preoperative fasting, we compared the RGC of patients who had and had not taken semaglutide prior to elective esophagogastroduodenoscopy. The primary outcome was the presence of increased RGC. DESIGN Single-center retrospective electronic chart review. SETTING Tertiary hospital. PATIENTS Patients undergoing esophagogastroduodenoscopy under deep sedation/general anesthesia between July/2021-March/2022. INTERVENTIONS Patients were divided into two (SG = semaglutide, NSG = non-semaglutide) groups, according to whether they had received semaglutide within 30 days prior to the esophagogastroduodenoscopy. MEASUREMENTS Increased RGC was defined as any amount of solid content, or > 0.8 mL/Kg (measured from the aspiration/suction canister) of fluid content. MAIN RESULTS Of the 886 esophagogastroduodenoscopies performed, 404 (33 in the SG and 371 in the NSG) were included in the final analysis. Increased RGC was observed in 27 (6.7%) patients, being 8 (24.2%) in the SG and 19 (5.1%) in the NSG (p < 0.001). Semaglutide use [5.15 (95%CI 1.92-12.92)] and the presence of preoperative digestive symptoms (nausea/vomiting, dyspepsia, abdominal distension) [3.56 (95%CI 2.2-5.78)] were associated with increased RGC in the propensity weighted analysis. Conversely, a protective [0.25 (95%CI 0.16-0.39)] effect against increased RGC was observed in patients undergoing esophagogastroduodenoscopy combined with colonoscopy. In the SG, the mean time of preoperative semaglutide interruption in patients with and without increased RGC was 10.5 ± 5.5 and 10.2 ± 5.6 days, respectively (p = 0.54). There was no relationship between semaglutide use and the amount/volume of RGC found on esophagogastroduodenoscopy (p = 0.99). Only one case (in the SG) of pulmonary aspiration was reported. CONCLUSIONS Semaglutide was associated with increased RGC in patients undergoing elective esophagogastroduodenoscopy. Digestive symptoms prior to esophagogastroduodenoscopy were also predictive of increased RGC.
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Affiliation(s)
- Saullo Queiroz Silveira
- Department of Anesthesiology, Vila Nova Star Hospital / Rede D'Or - CMA Anesthesia group, São Paulo, SP, Brazil
| | - Leopoldo Muniz da Silva
- Department of Anesthesiology, São Luiz Hospital - ITAIM / Rede D'Or - CMA Anesthesia group, São Paulo, SP, Brazil
| | | | | | | | | | - Anthony M-H Ho
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada
| | - Rafael Souza Fava Nersessian
- Department of Anesthesiology, São Luiz Hospital - ITAIM / Rede D'Or - CMA Anesthesia group, São Paulo, SP, Brazil
| | - Filipe Lugon Moulin Lima
- Department of Anesthesiology, Vila Nova Star Hospital / Rede D'Or - CMA Anesthesia group, São Paulo, SP, Brazil
| | - Marcela Viana Silva
- Department of Endoscopy, Vila Nova Star Hospital / Rede D'Or - CMA Anesthesia group, São Paulo, SP, Brazil
| | - Glenio B Mizubuti
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada.
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Masuy I, Van Oudenhove L, Tack J. Review article: treatment options for functional dyspepsia. Aliment Pharmacol Ther 2019; 49:1134-1172. [PMID: 30924176 DOI: 10.1111/apt.15191] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/03/2018] [Accepted: 01/23/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Functional dyspepsia, consisting of epigastric pain syndrome and postprandial distress syndrome, is a prevalent functional gastrointestinal disorder. To date, only limited treatment options are available and conflicting results in terms of efficacy have been reported. Consequently, nonpharmacological treatment options are increasingly being explored for functional dyspepsia. AIM To provide an overview of current pharmacological and nonpharmacological treatment options for functional dyspepsia. METHODS A literature search was conducted on Pubmed and other sources to identify relevant studies. RESULTS Acid suppressive therapy reduced symptoms in 30%-70% of the patients, with higher benefit in epigastric pain syndrome and superior effectiveness for proton pump inhibitors compared to H2 -antagonists. Prokinetic agents, primarily used to treat postprandial distress syndrome, showed variable efficiency: 59%-81% responder rate for dopamine receptor antagonists, 32%-91% for serotonin-4-receptor agonists and 31%-80% for muscarinic receptor antagonists. H Pylori eradication, recommended in infected patients, was effective in 24%-82%. Refractory symptoms are addressed with neuromodulators. However, their efficacy in functional dyspepsia remains incompletely elucidated, available data showing symptom reduction in 27%-71% of the patients. Regarding herbal agents, peppermint oil reduced symptoms in 66%-91%, rikkunshito in 29%-34% and iberogast in 20%-95%. Lastly, acupuncture, cognitive behavioural therapy and hypnotherapy may help to provide symptom control, but research on their efficacy remains sparse. CONCLUSIONS None of the available therapies is effective in the majority of patients without being associated with major side effects. Developing new treatment options is challenging due to the heterogeneity of functional dyspepsia, the lack of readily identified target mechanisms and the poor association between pathophysiological disturbances and symptoms.
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Affiliation(s)
- Imke Masuy
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - Lukas Van Oudenhove
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - Jan Tack
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
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Motion Tracking System for Robust Non-Contact Blood Perfusion Sensor. SENSORS 2018; 18:s18010277. [PMID: 29346298 PMCID: PMC5795823 DOI: 10.3390/s18010277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/07/2018] [Accepted: 01/15/2018] [Indexed: 11/17/2022]
Abstract
We propose a motion-robust laser Doppler flowmetry (LDF) system that can be used as a non-contact blood perfusion sensor for medical diagnosis. Endoscopic LDF systems are typically limited in their usefulness in clinical contexts by the need for the natural organs to be immobilized, as serious motion artifacts due to the axial surface displacement can interfere with blood perfusion measurements. In our system, the focusing lens moves to track the motion of the target using a low-frequency reference signal in the optical data, enabling the suppression of these motion artifacts in the axial direction. This paper reports feasibility tests on a prototype of this system using a microfluidic phantom as a measurement target moving in the direction of the optical axis. The frequency spectra detected and the perfusion values calculated from those spectra show that the motion tracking system is capable of suppressing motion artifacts in perfusion readings. We compared the prototype LDF system’s measurements with and without motion feedback, and found that motion tracking improves the fidelity of the perfusion signal by as much as 87%.
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Chong A, Ha JM, Kim S. Gastric emptying scan after distal subtotal gastrectomy: Differences between Billroth I and II and predicting the presence of food residue at endoscopy. Int J Clin Exp Med 2015; 8:20769-20777. [PMID: 26885000 PMCID: PMC4723845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/25/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE We investigated whether gastric emptying scans (GESs) showed different emptying patterns between patients after different types of laparoscopic distal subtotal gastrectomies. We also investigated whether the presence of food residue via endoscopy can be predicted by GESs. MATERIALS AND METHODS We retrospectively enrolled patients who had GESs within postoperative week 1 after a Billroth I or Billroth II operation. Diabetic patients were excluded. GESs were done with a solid test meal. Percent emptying at each scan time was analyzed. The presence of food residue in the stomach and gastrointestinal symptoms at the outpatient clinic were also analyzed. RESULTS In total, 46 patients were enrolled (Billroth I: Billroth II = 21:25). Sixteen patients underwent a second GES (postoperative 3-6 months). Both groups showed delayed gastric emptying at the postoperative 1 week scan, but group I showed much slower emptying. However, this difference disappeared by the second scan. Based on endoscopies conducted 6 months after the operation, 73.2% of patients had significant amounts of food residue, which hindered an accurate evaluation. The proportion of patients with food residues did not differ between the groups. Receiver Operating Characteristic (ROC) curve analysis revealed that a cut-off value of ≤ 30% emptying at 100 min and 120 min in postoperative 3-6 month scans was both highly sensitive and specific for predicting the presence of food residue (90.91% and 75% for 100 min and 91.67% and 75% for 120 min, respectively). CONCLUSIONS GESs within a week after distal subtotal gastrectomy show slower emptying of Billroth I than II. At a ≤ 30% emptying threshold, a GES can predict subtotal gastrectomy patients who might have a significant amount of food residue in their stomach even after following typical fasting instructions to prepare endoscopy.
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Affiliation(s)
- Ari Chong
- Department of Nuclear Medicine, Chosun University Hospital, School of Medicine, Chosun UniversityGwangju, Korea
| | - Jung-Min Ha
- Department of Nuclear Medicine, Chosun University Hospital, School of Medicine, Chosun UniversityGwangju, Korea
| | - Sungsoo Kim
- Department of Surgery, Chosun University Hospital, School of Medicine, Chosun UniversityGwangju, Korea
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Lim HC, Kim JH, Youn YH, Lee EH, Lee BK, Park H. Effects of the Addition of Mosapride to Gastroesophageal Reflux Disease Patients on Proton Pump Inhibitor: A Prospective Randomized, Double-blind Study. J Neurogastroenterol Motil 2013; 19:495-502. [PMID: 24199010 PMCID: PMC3816184 DOI: 10.5056/jnm.2013.19.4.495] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 06/24/2013] [Accepted: 06/25/2013] [Indexed: 12/19/2022] Open
Abstract
Background/Aims Proton pump inhibitors (PPIs) which are the most effective agents for the treatment of gastroesophageal reflux disease (GERD), have been known to delay gastric emptying. Mosapride has been used as prokinetics by accelerating gastric emptying. We evaluated the efficacy of mosapride to prevent PPI-induced delayed gastric emptying in a prospective randomized, double-blind and placebo-controlled trial. Methods Thirty patients who were diagnosed as GERD and had normal gastric emptying were included in this study. PPI monotherapy group was treated with placebo drug in addition to pantoprazole and PPI plus mosapride group was treated with mosapride in addition to pantoprazole for 8 weeks. Gastric emptying scan and questionnaires about GERD and dyspeptic symptoms were assessed by scoring before and after treatment. To evaluate the changes of gastrointestinal endocrine hormones by PPI which are associated gastric acid secretion and gastric motility, fasting plasma gastrin and cholecystokinin were taken at weeks 0 and 8. Results Half gastric emptying time was increased (P = 0.023) in PPI monotherapy group, and there were no significant changes in PPI plus mosapride group. Plasma gastrin level increased in PPI monotherpay group (P = 0.028) and there were no significant changes in PPI plus mosapride group. Plasma cholecystokinin level was not changed after treatment in both groups. GERD symptoms were improved after treatment in both groups, and postprandial bloating and nausea were improved in PPI plus mosapride group. Conclusions Mosapride showed to be effective in preventing delayed gastric emptying and the increase in plasma gastrin level induced by PPI treatment, but did not show prominent clinical symptom improvements.
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Affiliation(s)
- Hyun Chul Lim
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Lim HC, Lee SI, Chen JDZ, Park H. Electrogastrography associated with symptomatic changes after prokinetic drug treatment for functional dyspepsia. World J Gastroenterol 2012; 18:5948-56. [PMID: 23139612 PMCID: PMC3491603 DOI: 10.3748/wjg.v18.i41.5948] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 06/07/2012] [Accepted: 06/28/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the effect of prokinetic drugs on electrogastrography (EGG) parameters according to symptomatic changes in patients with functional dyspepsia (FD).
METHODS: Seventy-four patients with FD were prospectively enrolled in this study between December 2006 and December 2010. We surveyed the patients using a questionnaire on dyspeptic symptoms before and after an 8-wk course of prokinetic drug treatment. We also measured cutaneous pre-prandial and post-prandial EGG recordings including percentage of gastric waves (normogastria, bradygastria, tachygastria), dominant frequency (DF), dominant power (DP), dominant frequency instability coefficient (DFIC), dominant power instability coefficient (DPIC), and the ratio of post-prandial to fasting in DP before and after the 8-wk course of prokinetic drug treatment.
RESULTS: Fifty-two patients (70%) achieved symptomatic improvement after prokinetic drug treatment. Patients who had normal gastric slow waves showed symptom improvement group after treatment. Post-prandial DF showed a downward trend in the symptom improvement group, especially in the itopride group. Post-prandial DP was increased regardless of symptom improvement, especially in the itopride group and mosapride group. Post-prandial DFIC and DPIC in the symptom improvement group were significantly increased after the treatment. The EGG power ratio was increased after treatment in the symptom improvement group (0.50 ± 0.70 vs 0.93 ± 1.77, P = 0.002), especially in the itopride and levosulpiride groups.
CONCLUSION: Prokinetics could improve the symptoms of FD by regulating gastric myoelectrical activity, and EGG could be a useful tool in evaluating the effects of various prokinetics.
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Huerta-Franco MR, Vargas-Luna M, Montes-Frausto JB, Flores-Hernández C, Morales-Mata I. Electrical bioimpedance and other techniques for gastric emptying and motility evaluation. World J Gastrointest Pathophysiol 2012; 3:10-8. [PMID: 22368782 PMCID: PMC3284521 DOI: 10.4291/wjgp.v3.i1.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Revised: 12/06/2011] [Accepted: 02/08/2012] [Indexed: 02/06/2023] Open
Abstract
The aim of this article is to identify non-invasive, inexpensive, highly sensitive and accurate techniques for evaluating and diagnosing gastric diseases. In the case of the stomach, there are highly sensitive and specific methods for assessing gastric motility and emptying (GME). However, these methods are invasive, expensive and/or not technically feasible for all clinicians and patients. We present a summary of the most relevant international information on non-invasive methods and techniques for clinically evaluating GME. We particularly emphasize the potential of gastric electrical bioimpedance (EBI). EBI was initially used mainly in gastric emptying studies and was essentially abandoned in favor of techniques such as electrogastrography and the gold standard, scintigraphy. The current research evaluating the utility of gastric EBI either combines this technique with other frequently used techniques or uses new methods for gastric EBI signal analysis. In this context, we discuss our results and those of other researchers who have worked with gastric EBI. In this review article, we present the following topics: (1) a description of the oldest methods and procedures for evaluating GME; (2) an explanation of the methods currently used to evaluate gastric activity; and (3) a perspective on the newest trends and techniques in clinical and research GME methods. We conclude that gastric EBI is a highly effective non-invasive, easy to use and inexpensive technique for assessing GME.
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Maneerattanaporn M, Chang L, Chey WD. Emerging pharmacological therapies for the irritable bowel syndrome. Gastroenterol Clin North Am 2011; 40:223-43. [PMID: 21333909 DOI: 10.1016/j.gtc.2010.12.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The irritable bowel syndrome (IBS) is a symptom-based disorder defined by the presence of abdominal pain and altered bowel habits. Clinical presentations of IBS are diverse, with some patients reporting diarrhea, some constipation, and others a mixture of both. Like the varied clinical phenotypes, the pathogenesis of IBS is also diverse. IBS is not a single disease entity, but rather likely consists of several different disease states. This fact has important implications for the choices and efficacy of IBS treatment. This article reviews the IBS drugs that have reached phase II or III clinical trials.
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Affiliation(s)
- Monthira Maneerattanaporn
- Division of Gastroenterology, University of Michigan Health System, 3912 Taubman Center, Ann Arbor, MI 48109-0362, USA
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Shi G, Wu SD, Liu B, Sun W, Zhang XB, Kong J. Effects of gastrokinetic agents on human sphincter of Oddi motility. Shijie Huaren Xiaohua Zazhi 2010; 18:2150-2154. [DOI: 10.11569/wcjd.v18.i20.2150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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 observe the effects of domperidone, mosapride and tegaserod on the motility of human sphincter of Oddi (SO) and to analyze potential mechanisms involved.
METHODS: Thirty-two patients with T-tube drainage after choledochotomy were randomly divided into three groups: domperidone group, mosapride group and tegaserod group. The pressure of the SO was measured with a choledochofiberscope via T-tube fistula. Agents were given sublingually. Basic pressure of the SO (SOBP), amplitude of the SO (SOCA), duration of phasic contractions (SOD), duodenal pressure (DP), and common bile duct pressure (CBDP) were recorded and analyzed.
RESULTS: SOBP and SOCA decreased markedly not only in the domperidone group (10.30 ± 4.99 vs 6.40 ± 3.66; 110.52 ± 37.80 vs 68.67 ± 41.02; both P < 0.05) but also in the mosapride group (2.56 ± 13.02 vs 6.00 ± 5.74; 83.44 ± 46.16 vs 52.48 ± 44.19; both P < 0.05). SOBP and SOCA did not change after tegaserod intake. No significant changes in SOF, SOD and CBDP were noted in all the groups.
CONCLUSION: Both domperidone and mosapride at clinical doses decrease SOBP and SOCA and inhibit SO motility, while tegaserod at clinical dose does not affect SO motility.
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