1
|
Gonzalez JM, Mion F, Pioche M, Garbay V, Baumstarck K, Boucekine M, Debourdeau A, Rivory J, Barthet M, Vitton V. Gastric peroral endoscopic myotomy versus botulinum toxin injection for the treatment of refractory gastroparesis: results of a double-blind randomized controlled study. Endoscopy 2024; 56:345-352. [PMID: 38141620 DOI: 10.1055/a-2235-3286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2023]
Abstract
INTRODUCTION Gastric peroral endoscopic myotomy (G-POEM) is a promising technique for treating refractory gastroparesis. We present the first double-blind randomized study comparing the clinical efficacy of G-POEM versus pyloric botulinum toxin injection (BTI). METHODS This randomized study, conducted in two expert centers, enrolled patients with refractory gastroparesis, medically managed for >6 months and confirmed by gastric emptying scintigraphy (GES), into two groups, G-POEM versus BTI, with follow-up of 1 year. The primary end point was the 3-month clinical efficacy, defined as a >1-point decrease in the mean Gastroparesis Cardinal Symptom Index (GCSI) score. Secondary end points were: 1-year efficacy, GES evolution, adverse events, and quality of life. RESULTS 40 patients (22 women; mean age 48.1 [SD 17.4]), with mean symptom duration of 5.8 (SD 5.7) years, were randomized. Etiologies included idiopathic (n=18), diabetes (n=11), postoperative (n=6), and mixed (n=4). G-POEM showed a higher 3-month clinical success than BTI (65% vs. 40%, respectively; P=0.10), along with non-significantly higher 1-year clinical success (60% vs. 40%, respectively) on intention-to-treat analysis. The GCSI decreased in both groups at 3 months and 1 year. Only three minor adverse events occurred in the G-POEM group. The GES improvement rate was 72% in the G-POEM group versus 50% in the BTI group (non-significant). CONCLUSION G-POEM seems to have a higher clinically relevant success rate than BTI, but this was not statistically demonstrated. This study confirms the interest in treatments targeting the pylorus, either mechanically or chemically, for managing refractory gastroparesis.
Collapse
Affiliation(s)
| | | | - Mathieu Pioche
- Endoscopy Unit, Digestive Disease Department, Hôpital Edouard Herriot, Lyon, France
| | - Victor Garbay
- Hôpital Nord, Gastroenterology, AP-HM, Marseille, France
| | - Karine Baumstarck
- Public Health, Aix-Marseille Université Faculté de Medecine, Marseille, France
| | - Mohamed Boucekine
- Public Health, Aix-Marseille Université Faculté de Medecine, Marseille, France
| | | | - Jérôme Rivory
- Endoscopy Unit, Digestive Disease Department, Hôpital Edouard Herriot, Lyon, France
| | - Marc Barthet
- Hôpital Nord, Gastroenterology, AP-HM, Marseille, France
| | | |
Collapse
|
2
|
Drury AM, Albunni H, Al-Haddad M, Powelson JA, Lutz A, Fridell JA. Role of gastric peroral endoscopic myotomy (GPOEM) in chronic gastroparesis management after pancreas transplantation. Clin Transplant 2024; 38:e15176. [PMID: 37922244 DOI: 10.1111/ctr.15176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/11/2023] [Accepted: 10/20/2023] [Indexed: 11/05/2023]
Abstract
Gastroparesis is a common complaint among patients with diabetes. Symptoms tend to improve following successful pancreas transplantation (PTx), but persist despite euglycemia in a subset of patients. We aimed to assess the benefit of gastric peroral endoscopic myotomy (G-POEM) in persistent gastroparesis following PTx. This was a single center retrospective review of all patients who underwent G-POEM for persistent gastroparesis following PTx. Patient demographics, pre and post procedure perception of symptom severity according to the patient assessment of upper gastrointestinal symptoms severity index (PAGI-SYM), gastroparesis cardinal symptom index (GCSI) score, and 36-item short form survey (SF36) score along with gastric emptying scintigraphy (GES) were analyzed. Seven PTx recipients underwent G-POEM for persistent gastroparesis symptoms. The majority were female. All reported nausea/vomiting, abdominal pain, bloating, and post prandial fullness prior to G-POEM. The post procedure survey scores improved in all patients although this was not significant. The improvement in gastric emptying on GES was statistically significant. G-POEM is a relatively new treatment option for gastroparesis. While it requires specialized proceduralist and training, we have documented improvement in the management of symptoms. With increasing experience, we anticipate more significant benefit in post PTx patients with persistent symptoms of gastroparesis undergoing G-POEM.
Collapse
Affiliation(s)
- Allison M Drury
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Hashem Albunni
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Mohammad Al-Haddad
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - John A Powelson
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrew Lutz
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jonathan A Fridell
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| |
Collapse
|
3
|
Karcioglu O, Akman C, Atnis I. Efficacy and Safety Analysis of Botox Application and Iatrogenic Botulism: Panacea or Peril? Curr Pharm Des 2024; 30:578-588. [PMID: 38409723 DOI: 10.2174/0113816128284720240212111926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/24/2023] [Accepted: 01/29/2024] [Indexed: 02/28/2024]
Abstract
Clostridium botulinum toxin-A (BoNT-A) creates temporary paralysis in the muscles by acting on the muscle-nerve junction. It is injected into the mimic muscles when a decrease in the movements of the mimic muscles is desired. Despite many favorable applications, the use of BoNT-A is not without drawbacks. Although there is no expected serious side effect on health in BoNT-A treatments, various problems can be encountered in patients treated for aesthetic purposes. Botulism is a rare but potentially life-threatening syndrome, which is caused by the toxin produced by the bacterium Clostridium botulinum, which acts on the nervous system, vegetative forms of C. botulinum can only survive in anaerobic conditions, while spore forms are common in nature and can withstand harsh conditions. Botulism can stem from bacterial spores which release toxin in the body; in the form of enteric botulism, and wound botulism. The cases that develop 'iatrogenic botulism' after such procedures are usually those receiving high-dose toxin for therapeutic purposes. The treatment of botulism mainly consists of anti-toxin therapy and, if necessary, intensive care to prevent organ failures, including respiratory support. This article aims to cover all these issues related to botulism and other adverse outcomes related to BoNT-A injection in light of the most recent literature.
Collapse
Affiliation(s)
- Ozgur Karcioglu
- Department of Emergency Medicine, Taksim Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Canan Akman
- Department of Emergency Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Ilknur Atnis
- Department of Emergency Medicine, Niğde Omer Halisdemir Education and Research Hospital, University of Health Sciences, Nigde, Turkey
| |
Collapse
|
4
|
Wadhwa V, Gonzalez A, Azar F, Singh H, Gupta K, Liang H, Schneider A, Ponsky J, Erim T, Rodriguez J, Castro FJ. Response to botulinum toxin may predict response to peroral pyloromyotomy in patients with gastroparesis. Endoscopy 2023; 55:508-514. [PMID: 36417930 DOI: 10.1055/a-1986-4292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND : Patients with gastroparesis who have undergone prior intrapyloric botulinum toxin injection (BTI) may seek an opinion regarding peroral pyloromyotomy (POP). There are only two small reports assessing the role of BTI as a predictor for successful treatment with POP. METHODS We performed a retrospective cohort study to assess whether symptomatic improvement after BTI predicts a response to POP. We included 119 patients who had undergone both BTI and POP at Cleveland Clinic Ohio or Cleveland Clinic Florida from January 2016 to September 2019. RESULTS 65.5 % of patients had symptomatic improvement after BTI. Gastroparesis Cardinal Symptom Index (GCSI) scores were available for 74 patients, with 64 % achieving a response to POP, defined as a decrease in mean GCSI ≥ 1. In multivariable analysis, response to BTI (odds ratio [OR] 7.7 [95 %CI 2.2-26.1]) and higher pre-POP GCSI score (OR 2.3 [95 %CI 1.2-4.6]) were independent predictors of response to POP. CONCLUSIONS Clinical improvement after BTI is a predictor of response to POP in patients with gastroparesis. This information may aid in improving patient selection for POP.
Collapse
Affiliation(s)
- Vaibhav Wadhwa
- Center for Interventional Gastroenterology, University of Texas Health Science, Houston, Texas, United States
| | - Adalberto Gonzalez
- Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, Florida, United States
| | - Francisco Azar
- Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, Florida, United States
| | - Harjinder Singh
- Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, Florida, United States
| | - Kapil Gupta
- Department of Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Hong Liang
- Department of Clinical Research, Cleveland Clinic Florida, Weston, Florida, United States
| | - Alison Schneider
- Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, Florida, United States
| | - Jeffery Ponsky
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Tolga Erim
- Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, Florida, United States
| | - John Rodriguez
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Fernando J Castro
- Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, Florida, United States
| |
Collapse
|
5
|
Ferhatoglu MF, Kartal A, Filiz AI, Kebudi A. Outcome of Gastric Fundus and Pylorus Botulinum Toxin A Injection in Obese Patients Class I–II with Normal Pyloric Orifice Structure: A Retrospective Analysis. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Murat Ferhat Ferhatoglu
- Department of General Surgery, Faculty of Medicine, Istanbul Okan University, Istanbul, Turkey
| | | | - Ali Ilker Filiz
- Department of General Surgery, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Abut Kebudi
- Department of General Surgery, Faculty of Medicine, Istanbul Okan University, Istanbul, Turkey
| |
Collapse
|
6
|
Vitton V, Benoît D'Journo X, Reynaud-Gaubert M, Barthet M, Gonzalez JM. Gastric peroral endoscopic myotomy (GPOEM) for severe gastroparesis after lung transplantation: A promising minimally invasive option. Clin Transplant 2021; 35:e14434. [PMID: 34291504 DOI: 10.1111/ctr.14434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/17/2021] [Accepted: 05/26/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND After lung transplantation (LT), gastroparesis is frequent, occurring in 25-63% of cases and leading to pulmonary infections. In refractory disease, classical management has demonstrated limited efficacy. Gastric peroral endoscopic myotomy (G-POEM) is a recently developed safe and effective procedure that has been performed here on five patients with severe post-LT gastroparesis. METHODS In all patients, the diagnosis was confirmed by disturbed gastric emptying scintigraphy and GCSI calculation showing severe disease. Upper gastrointestinal endoscopies confirmed the absence of organic lesions. All patients were informed about the procedure and signed informed consent forms. The procedure consisted of performing an endoscopic pyloromyotomy under general anesthesia. RESULTS The patients were between 35 and 64 years of age. Four had chronic disease, starting approximately 1 year following LT, and one had acute, severe gastroparesis requiring intubation in the intensive care unit. All patients underwent G-POEM after failure of medical treatment, without any complications. Three of the patients with chronic disease improved; they resumed a normal diet and gained weight. The patient with acute disease was discharged within a few days following the procedure and resumed oral intake. CONCLUSION G-POEM is promising for managing post-LT refractory gastroparesis and should be further evaluated.
Collapse
Affiliation(s)
- Véronique Vitton
- Department of Gastroenterology, Aix-Marseille Université, APHM, Hôpital Nord, Marseille, France
| | - Xavier Benoît D'Journo
- Department of Thoracic Surgery, Aix-Marseille Université, APHM, Hôpital Nord, Marseille, France
| | | | - Marc Barthet
- Department of Gastroenterology, Aix-Marseille Université, APHM, Hôpital Nord, Marseille, France
| | - Jean-Michel Gonzalez
- Department of Gastroenterology, Aix-Marseille Université, APHM, Hôpital Nord, Marseille, France
| |
Collapse
|
7
|
Ye Y, Jiang B, Manne S, Moses PL, Almansa C, Bennett D, Dolin P, Ford AC. Epidemiology and outcomes of gastroparesis, as documented in general practice records, in the United Kingdom. Gut 2021; 70:644-653. [PMID: 32493829 PMCID: PMC7948194 DOI: 10.1136/gutjnl-2020-321277] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To generate real-world evidence for the epidemiology of gastroparesis in the UK, we evaluated the prevalence, incidence, patient characteristics and outcomes of gastroparesis in the Clinical Practice Research Datalink (CPRD) database. DESIGN This was a retrospective, cross-sectional study. Prevalence and incidence of gastroparesis were evaluated in the CPRD database, with linkage to Hospital Episodes Statistics Admitted Patient Care and Office for National Statistics mortality data. Prevalence and incidence were age and sex standardised to mid-2017 UK population estimates. Descriptive analyses of demographics, aetiologies, pharmacological therapies and mortality were conducted. RESULTS Standardised prevalence of gastroparesis, as documented in general practice records, was 13.8 (95% CI 12.6 to 15.1) per 100 000 persons in 2016, and standardised incidence of gastroparesis rose from 1.5 (95% CI 1.1 to 1.8) per 100 000 person-years in 2004 to 1.9 (95% CI 1.4 to 2.3) per 100 000 person-years in 2016. The most common disease aetiologies were idiopathic (39.4%) and diabetic gastroparesis (37.5%), with a similar distribution of type 1 and type 2 diabetes among the 90% who had type of diabetes documented. Patients with diabetic gastroparesis had a significantly higher risk of mortality than those with idiopathic gastroparesis after diagnosis (adjusted HR 1.9, 95% CI 1.2 to 3.0). Of those with gastroparesis, 31.6% were not offered any recognised pharmacological therapy after diagnosis. CONCLUSION This is, to our knowledge, the first population-based study providing data on epidemiology and outcomes of gastroparesis in Europe. Further research is required to fully understand the factors influencing outcomes and survival of patients with gastroparesis.
Collapse
Affiliation(s)
- Yizhou Ye
- Global Evidence and Outcomes, Takeda Pharmaceutical Company Ltd, Cambridge, Massachusetts, USA
| | - Baoguo Jiang
- Safety and Observational Statistics, Takeda Pharmaceutical Company Ltd, Cambridge, Massachusetts, USA
| | - Sudhakar Manne
- Safety and Observational Statistics, Takeda Pharmaceutical Company Ltd, Cambridge, Massachusetts, USA
| | - Peter L Moses
- Clinical Science, Takeda Pharmaceutical Company Ltd, Cambridge, Massachusetts, USA
| | - Cristina Almansa
- Clinical Science, Takeda Pharmaceutical Company Ltd, Cambridge, Massachusetts, USA
| | - Dimitri Bennett
- Global Evidence and Outcomes, Takeda Pharmaceutical Company Ltd, Cambridge, Massachusetts, USA,Perelman School of Medicine, Adjunct, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paul Dolin
- Global Evidence and Outcomes, Takeda Development Centre Europe, London, UK
| | - Alexander C Ford
- Leeds Institute of Medical Research at St. James’s, University of Leeds, Leeds, UK,Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| |
Collapse
|
8
|
Lenz J, Rault B, Roman S, Pioche M, Mion F. A case of acute pancreatitis after intrapyloric botulinum toxin injection to treat gastroparesis. Clin Res Hepatol Gastroenterol 2021; 45:101628. [PMID: 33579661 DOI: 10.1016/j.clinre.2021.101628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/13/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Jamila Lenz
- Hospices Civils de Lyon, Hôpital E. Herriot, Digestive Physiology Department, Lyon, France
| | - Berenice Rault
- Hospices Civils de Lyon, Hôpital E. Herriot, Gastroenterology and Hepatology Department, Lyon, France
| | - Sabine Roman
- Hospices Civils de Lyon, Hôpital E. Herriot, Digestive Physiology Department, Lyon, France; Université de Lyon, Digestive Physiology, Lyon, France; Lab Tau, INSERM 1032, Lyon, France
| | - Mathieu Pioche
- Hospices Civils de Lyon, Hôpital E. Herriot, Gastroenterology and Hepatology Department, Lyon, France
| | - François Mion
- Hospices Civils de Lyon, Hôpital E. Herriot, Digestive Physiology Department, Lyon, France; Université de Lyon, Digestive Physiology, Lyon, France; Lab Tau, INSERM 1032, Lyon, France.
| |
Collapse
|
9
|
Rangan V, Ukleja A. Gastroparesis in the Hospital Setting. Nutr Clin Pract 2020; 36:50-66. [PMID: 33336872 DOI: 10.1002/ncp.10611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 11/04/2020] [Indexed: 12/15/2022] Open
Abstract
Gastroparesis (GP) is commonly seen in hospitalized patients. Refractory vomiting and related dehydration, electrolyte abnormalities, and malnutrition are indications for hospital admission. In addition, tube feeding intolerance is a common sign of gastric dysmotility in critically ill patients. The diagnosis and management of GP in the hospital setting can be quite challenging. Diagnostic tests are often deferred because of patient intolerance of the oral meal for standard scintigraphy or severity of the primary disease. The diagnosis of GP is often established on the basis of clinical scenario and risk factors for gastric motor dysfunction. Medical therapy in GP is directed toward controlling nausea and vomiting by prokinetic and antinausea medications and correcting nutrition risks or treating malnutrition with nutrition therapy. Enteral nutrition is the preferred nutrition intervention for patients with GP. Delayed gastric emptying in critically ill patients has a negative impact on the timely delivery of enteral feeding and meeting the energy and protein goals. Measures to improve gastric tolerance or provide feeding beyond the stomach are often needed, since early enteral nutrition has been an important target of therapy for critically ill patients. This review will address the current understanding of the mechanisms of GP and feeding intolerance in critical illness, diagnostic workup, drug therapies, and interventions to improve the provision of enteral nutrition in hospital settings when gastric dysmotility is present or suspected.
Collapse
Affiliation(s)
- Vikram Rangan
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew Ukleja
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
10
|
Parsi MA, Jirapinyo P, Abu Dayyeh BK, Bhutani MS, Chandrasekhara V, Krishnan K, Kumta NA, Melson J, Pannala R, Trikudanathan G, Trindade AJ, Sethi A, Watson RR, Maple JT, Lichtenstein DR. Techniques and devices for the endoscopic treatment of gastroparesis (with video). Gastrointest Endosc 2020; 92:483-491. [PMID: 32684298 DOI: 10.1016/j.gie.2020.03.3857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 03/30/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Gastroparesis is a symptomatic chronic disorder of the stomach characterized by delayed gastric emptying in the absence of mechanical obstruction. Several endoscopic treatment modalities have been described that aim to improve gastric emptying and/or symptoms associated with gastroparesis refractory to dietary and pharmacologic management. METHODS In this report we review devices and techniques for endoscopic treatment of gastroparesis, the evidence regarding their efficacy and safety, and the financial considerations for their use. RESULTS Endoscopic modalities for treatment of gastroparesis can be broadly categorized into pyloric, nonpyloric, and nutritional therapies. Pyloric therapies such as botulinum toxin injection, stent placement, pyloroplasty, and pyloromyotomy specifically focus on pylorospasm as a therapeutic target. These interventions aim to reduce the pressure gradient across the pyloric sphincter, with a resultant improvement in gastric emptying. Nonpyloric therapies, such as venting gastrostomy and gastric electrical stimulation, are intended to improve symptoms. Nutritional therapies, such as feeding tube placement, aim to provide nutritional support. CONCLUSIONS Several endoscopic interventions have shown utility in improving the quality of life and symptoms of select patients with refractory gastroparesis. Methods to identify which patients are best suited for a specific treatment are not well established. Endoscopic pyloromyotomy is a relatively recent development that may prove to be the preferred pyloric-directed intervention, although additional and longer-term outcomes are needed.
Collapse
Affiliation(s)
- Mansour A Parsi
- Section for Gastroenterology and Hepatology, Tulane University Health Sciences Center, New Orleans, Louisiana, USA
| | - Pichamol Jirapinyo
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Barham K Abu Dayyeh
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Manoop S Bhutani
- Department of Gastroenterology Hepatology and Nutrition, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vinay Chandrasekhara
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kumar Krishnan
- Division of Gastroenterology, Department of Internal Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nikhil A Kumta
- Division of Gastroenterology, Mount Sinai Hospital, New York, New York, USA
| | - Joshua Melson
- Division of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Rahul Pannala
- Division of Digestive Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Guru Trikudanathan
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Arvind J Trindade
- Department of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA
| | - Amrita Sethi
- Department of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - Rabindra R Watson
- New York-Presbyterian Medical Center/Columbia University Medical Center, New York, New York, USA
| | - John T Maple
- Department of Gastroenterology, Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
| | - David R Lichtenstein
- Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | | |
Collapse
|
11
|
Chang PC, Jhou HJ, Chen PH, Huang CK, Chiang HH, Chen KH, Chang TW. Intragastric Botulinum Toxin A Injection Is an Effective Obesity Therapy for Patients with BMI > 40 kg/m 2: a Systematic Review and Meta-analysis. Obes Surg 2020; 30:4081-4090. [PMID: 32734569 DOI: 10.1007/s11695-020-04842-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 12/24/2022]
Abstract
We conducted a systematic review and meta-analysis to assess the efficacy of intragastric BTA injection in patients with obesity and morbid obesity. Five RCTs were identified. Intragastric BTA injection was no superior to saline in absolute weight loss or BMI change, but significantly lengthened the gastric emptying time (MD, 15.57; 95% CI, 8.75 to 22.38). In meta-regression analysis, the absolute weight loss was lower in the patients with high baseline BMI. In subgroup analysis, the use of BTA in absolute weight loss was significantly lower among the patients with baseline BMI more than 40 kg/m2 (MD, - 5.31; 95% CI, - 6.17 to - 4.45). The benefit of intragastric BTA injection in reduction of absolute weight was observed in patients with baseline BMI more than 40 kg/m2.
Collapse
Affiliation(s)
- Po-Chih Chang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan.,Weight Management Center, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan.,Ph. D. Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.,Department of Sports Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Hong-Jie Jhou
- Department of Neurology, Changhua Christian Hospital, Changhua City, Taiwan
| | - Po-Huang Chen
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Chih-Kun Huang
- Body Science and Metabolic Disorders International Medical Center, China Medical University Hospital, Taichung City, Taiwan
| | - Hung-Hsing Chiang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Kai-Hua Chen
- Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung City, 80756, Taiwan
| | - Ting-Wei Chang
- Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung City, 80756, Taiwan.
| |
Collapse
|
12
|
Jagtap N, Kalapala R, Reddy DN. Assessment of Pyloric Sphincter Physiology Using Functional Luminal Imaging Probe in Healthy Volunteers. J Neurogastroenterol Motil 2020; 26:391-396. [PMID: 32606259 PMCID: PMC7329157 DOI: 10.5056/jnm19200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/06/2020] [Accepted: 03/22/2020] [Indexed: 01/17/2023] Open
Abstract
Background/Aims The functional luminal imaging probe (FLIP) can measure tissue distensibility and geometric changes through volumetric distention. The esophagogastric junction has been well studied using EndoFLIP, studies on pylorus are lacking. We aim to study biomechanical properties of pylorus using EndoFLIP to create normative data. Methods We performed a prospective study of 20 healthy volunteers (ages, 18-54 years; 10 men) who underwent pylorus evaluation using 12- cm FLIP placed across the pyloric sphincter. FLIP data were analyzed using FLIP planimetry plots at baseline and after administration of hyoscine butyl bromide injection. Results The median pylorus distensibility index (P-DI) was 8.37 mm2/mmHg (interquartile range, 4.22-13.04 mm2/mmHg) at 40 mL balloon volume. The 90th percentile at 40 mL balloon for P-DI was 14.89 mm2/mmHg, for cross-sectional area was 244.20 mm2/mmHg, and diameter and pressure were 17.58 mm and 48.84 mmHg, respectively. There was significant increase in P-DI after administration of hyoscine butyl bromide injection (P < 0.05). Conclusion The normative values can be used as reference values for pyloric distensibility. This reference can be used in studies of related to pyloric diseases such as gastroparesis.
Collapse
Affiliation(s)
- Nitin Jagtap
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Rakesh Kalapala
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - D Nageshwar Reddy
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| |
Collapse
|
13
|
Bensen GP, Rutherford CC, Gardner TB. Systemic Botulism Toxicity Caused by Pyloric Botox Injection to Treat Gastroparesis. Case Rep Gastroenterol 2020; 14:373-376. [PMID: 32884513 PMCID: PMC7443624 DOI: 10.1159/000508854] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/19/2020] [Indexed: 11/19/2022] Open
Abstract
Systemic botulism resulting from therapeutic Botox (OnabotulinumtoxinA) injection has been rarely reported, and never in the context of pylorus injection to treat gastroparesis. We report the case of a 27-year-old female with Emery-Dreifuss muscular dystrophy who developed severe systemic botulism toxicity following the intrapyloric injection of 100 units of Botox to treat gastroparesis. The patient eventually made a full recovery.
Collapse
Affiliation(s)
- Gordon P Bensen
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Cristina C Rutherford
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Timothy B Gardner
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| |
Collapse
|
14
|
Reichenbach ZW, Stanek S, Patel S, Ward SJ, Malik Z, Parkman HP, Schey R. Botulinum Toxin A Improves Symptoms of Gastroparesis. Dig Dis Sci 2020; 65:1396-1404. [PMID: 31617132 DOI: 10.1007/s10620-019-05885-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 10/09/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND AIMS Pyloric injections of botulinum toxin A (BoNT/A) have shown benefit in open-label studies for patients with gastroparesis but not in randomized trials. We sought to examine the effectiveness of BoNT/A injections in a prospective open-label trial of patients with gastroparesis to assess specific symptom improvements over the course of 6 months. We also wanted to determine if specific biochemical measures including creatinine kinase, lactate dehydrogenase, aldolase, and C-reactive protein suggesting muscular injection could be used to predict successful response to pyloric injections of BoNT/A. METHODS Patients with gastroparesis undergoing pyloric BoNT/A injections for the treatment of symptomatic gastroparesis were enrolled. The patients completed the Gastroparesis Cardinal Symptom Index (GCSI) at the initial encounter and at 1, 3, and 6 months. Blood samples were collected before and 1 h after BoNT/A therapy. RESULTS We enrolled 34 patients for serum analysis of which 25 patients were available for symptom follow-up. Sixty-four percent of patients had an improvement in symptoms at 1 month. Patients with improved GCSI total score at 1 month had an improvement in most individual symptoms evaluated. For patients that improved at 1 month, this improvement often extended up to 6 months (p = 0.04). Serum measures studied did not correlate with clinical outcomes. CONCLUSIONS BoNT/A therapy to the pylorus provided symptomatic improvement at 1 month in 64% of patients. For those patients initially responding, the improvement can last out to 6 months. The biochemical markers did not serve to predict the outcome of injections.
Collapse
Affiliation(s)
- Zachary Wilmer Reichenbach
- Department of Gastroenterology, Temple University Hospital, 3401 N. Broad Street, Ambulatory Care Center, 3rd Floor, Philadelphia, PA, 19140, USA. .,Center for Substance Abuse Research (CSAR), Lewis Katz School of Medicine, Temple University, 3500 N. Broad Street, Medical Education and Research Bldg., 8th Floor, Philadelphia, PA, 19140, USA.
| | - Steven Stanek
- Department of Gastroenterology, Temple University Hospital, 3401 N. Broad Street, Ambulatory Care Center, 3rd Floor, Philadelphia, PA, 19140, USA
| | - Shyam Patel
- Department of Gastroenterology, Temple University Hospital, 3401 N. Broad Street, Ambulatory Care Center, 3rd Floor, Philadelphia, PA, 19140, USA
| | - Sara Jane Ward
- Center for Substance Abuse Research (CSAR), Lewis Katz School of Medicine, Temple University, 3500 N. Broad Street, Medical Education and Research Bldg., 8th Floor, Philadelphia, PA, 19140, USA
| | - Zubair Malik
- Department of Gastroenterology, Temple University Hospital, 3401 N. Broad Street, Ambulatory Care Center, 3rd Floor, Philadelphia, PA, 19140, USA
| | - Henry P Parkman
- Department of Gastroenterology, Temple University Hospital, 3401 N. Broad Street, Ambulatory Care Center, 3rd Floor, Philadelphia, PA, 19140, USA
| | - Ron Schey
- Department of Gastroenterology, Temple University Hospital, 3401 N. Broad Street, Ambulatory Care Center, 3rd Floor, Philadelphia, PA, 19140, USA
| |
Collapse
|
15
|
Abstract
This article reviews the most common gastrointestinal (GI) problems that occur in patients with Parkinson disease, including weight loss, drooling, dysphagia, delayed gastric emptying, constipation, and defecatory dysfunction. Appropriate workup and treatment options are reviewed in detail in order to provide clinicians with a comprehensive and practical guide to managing these problems in Parkinson disease patients. GI adverse effects of commonly used Parkinson disease motor medications are also reviewed.
Collapse
Affiliation(s)
- John Legge
- Department of Neurology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA; VCU NOW Center, 11958 West Broad Street, 4th Floor, Box 980220, Henrico, VA 23298-0220, USA
| | - Nicholas Fleming
- Department of Neurology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA; VCU NOW Center, 11958 West Broad Street, 4th Floor, Box 980220, Henrico, VA 23298-0220, USA
| | - Leslie Jameleh Cloud
- VCU NOW Center, 11958 West Broad Street, 4th Floor, Box 980220, Henrico, VA 23298-0220, USA; Parkinson's and Movement Disorders Center, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
| |
Collapse
|
16
|
Farmer AD, Bruckner-Holt C, Schwartz S, Sadler E, Kadirkamanthan S. Diabetic Gastroparesis: Perspectives From a Patient and Health Care Providers. J Patient Cent Res Rev 2019; 6:148-157. [PMID: 31414026 DOI: 10.17294/2330-0698.1689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Gastroparesis is defined as a delay in gastric emptying in the absence of mechanical obstruction in the stomach. Gastroparesis has a number of causes, including postsurgical, secondary to medications, postinfectious, idiopathic, and as a complication of diabetes mellitus, where it is underrecognized. The cardinal symptoms of diabetic gastroparesis are nausea, early satiety, bloating, and vomiting. Diabetic gastroparesis is more common in females and has a cumulative incidence of 5% in type 1 diabetes and 1% in type 2 diabetes. It is associated with a reduction in quality of life and exerts a significant burden on health care resources. The pathophysiology of this disorder is incompletely understood. Diagnosis is made based on typical symptoms associated with the demonstration of delayed gastric emptying in the absence of gastric outlet obstruction. Gastric emptying scintigraphy is the gold standard for demonstrating delayed gastric emptying, but other methods exist including breath testing and the wireless motility capsule. Diabetic gastroparesis should be managed within a specialist multidisciplinary team, and general aspects involve dietary manipulations/nutritional support, pharmacological therapy, and surgical/endoscopic interventions. Specific pharmacological therapies include prokinetics and antiemetics, with several new medications in the drug development pipeline. Surgical/endoscopic interventions include botulinum toxin injection into the pylorus, gastric peroral endoscopic myotomy and gastric electrical stimulation. This article provides a detailed review and summary of the epidemiology, pathophysiology, investigation, and management of diabetic gastroparesis, and also gives an individual patient's perspective of living with this disabling disorder.
Collapse
Affiliation(s)
- Adam D Farmer
- Institute of Applied Clinical Science, University of Keele, Keele, United Kingdom.,Department of Gastroenterology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
| | - Caroline Bruckner-Holt
- Department of Palliative Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
| | - Susanne Schwartz
- Gastroparesis & Intestinal Failure Trust, Stafford, United Kingdom
| | - Emma Sadler
- Department of Research and Development, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
| | - Sri Kadirkamanthan
- Department of Surgery, Broomfield Hospital NHS Trust, Chelmsford, United Kingdom
| |
Collapse
|
17
|
Strijbos D, Keszthelyi D, Smeets FGM, Kruimel J, Gilissen LPL, de Ridder R, Conchillo JM, Masclee AAM. Therapeutic strategies in gastroparesis: Results of stepwise approach with diet and prokinetics, Gastric Rest, and PEG-J: A retrospective analysis. Neurogastroenterol Motil 2019; 31:e13588. [PMID: 30947400 PMCID: PMC6850664 DOI: 10.1111/nmo.13588] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/14/2019] [Accepted: 03/11/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Gastroparesis is characterized by abnormal gastric motor function with delayed gastric emptying in the absence of mechanical obstruction. In our tertiary referral center, patients are treated with a stepwise approach, starting with dietary advice and prokinetics, followed by three months of nasoduodenal tube feeding with "gastric rest." When not successful, a percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) for long-term enteral feeding is placed. AIM To evaluate the effect of this stepwise approach on weight and symptoms. METHODS Analyses of data of all referred gastroparesis patients between 2008 and 2016. KEY RESULTS A total of 86 patients (71% female, 20-87 years [mean 55.8 years]) were analyzed of whom 50 (58%) had adequate symptom responses to diet and prokinetics. The remaining 36 (decompensated gastroparesis) were treated with three months gastric rest. Symptom response rate was 47% (17/36). Significant weight gain was seen in all patients, independent of symptom response. In the remaining 19 symptom non-responders, the enteral feeding was continued through PEG-J. Treatment was effective (symptoms) in 37%, with significant weight gain in all. In 84% of patients, the PEG-J is still in use (mean duration 962 days). CONCLUSIONS AND INFERENCES Following a stepwise treatment approach in gastroparesis, adequate symptom response was reached in 86% of all patients. Weight gain was achieved in all patients, independent of symptom response. Diet and prokinetics were effective with regard to symptoms in 58%, temporary gastric rest in 47%, and PEG-J as third step in 37% of patients.
Collapse
Affiliation(s)
- Denise Strijbos
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht University Medical CentreMaastrichtThe Netherlands,Department of Gastroenterology and HepatologyCatharina Hospital EindhovenEindhovenThe Netherlands
| | - Daniel Keszthelyi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Fabiënne G. M. Smeets
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Joanna Kruimel
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Lennard P. L. Gilissen
- Department of Gastroenterology and HepatologyCatharina Hospital EindhovenEindhovenThe Netherlands
| | - Rogier de Ridder
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht University Medical CentreMaastrichtThe Netherlands
| | - José M. Conchillo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Ad A. M. Masclee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht University Medical CentreMaastrichtThe Netherlands
| |
Collapse
|
18
|
Pasricha TS, Pasricha PJ. Botulinum Toxin Injection for Treatment of Gastroparesis. Gastrointest Endosc Clin N Am 2019; 29:97-106. [PMID: 30396531 PMCID: PMC6223662 DOI: 10.1016/j.giec.2018.08.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Refractory gastroparesis is among the most difficult therapeutic challenges in gastroenterology. Pyloric dysfunction has been described in a subset of patients with gastroparesis, prompting experimentation with botulinum toxin injections into the pylorus, which is relatively safe and has been successfully used in other gastrointestinal disorders. However, causality between pyloric dysfunction and symptoms of gastroparesis has never been demonstrated. Although several open-label studies showed initial promise, 2 randomized clinical trials failed to elicit a difference in clinical outcomes in botulinum toxin versus placebo. Based on current evidence, further use of botulinum toxin for gastroparesis is discouraged outside of a research trial.
Collapse
Affiliation(s)
- Trisha S. Pasricha
- Department of Medicine Baltimore, Junior Assistant Resident, Osler Medical Training Program Johns Hopkins Hospital, MD, USA
| | - Pankaj J. Pasricha
- Department of Gastroenterology, Professor of Medicine and Neurosciences, Johns Hopkins Hospital, Baltimore, MD, USA
| |
Collapse
|
19
|
Botulinum Toxin as a Treatment for Refractory Gastroparesis: a Literature Review. ACTA ACUST UNITED AC 2018; 16:479-488. [DOI: 10.1007/s11938-018-0187-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
20
|
Avalos DJ, Sarosiek I, Loganathan P, McCallum RW. Diabetic gastroparesis: current challenges and future prospects. Clin Exp Gastroenterol 2018; 11:347-363. [PMID: 30310300 PMCID: PMC6165730 DOI: 10.2147/ceg.s131650] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Diabetic gastroparesis (DMGP) is a condition of delayed gastric emptying after gastric outlet obstruction has been excluded. Symptoms of nausea, vomiting, early satiety, bloating, and abdominal pain are associated with DMGP. Uncontrolled symptoms can lead to overall poor quality of life and financial burdens on the healthcare system. A combination of antiemetics and prokinetics is used in symptom control; metoclopramide is the main prokinetic available for clinical use and is the only U.S. Food and Drug Administration-approved agent in the United States. However, a black box warning in 2009 reporting its association with tardive dyskinesia and recommending caution in chronically using this agent beyond 3 months has decreased its role in clinical practice. There is an unmet need for new prokinetics with good efficacy and safety profiles. Currently, there are several new drugs with different mechanisms of action in the pipeline that are under investigation and show promising preliminary results. Surgically combining gastric electrical stimulation with pyloroplasty is considered "gold" standard. Advances in therapeutic endoscopic intervention with gastric per-oral endoscopic pyloromyotomy have also been shown to improve gastric emptying and gastroparesis (GP) symptoms. In this review, we will comment on the challenges encountered when managing patients with DMGP and provide an update on advances in drug development and endoscopic and surgical interventions.
Collapse
Affiliation(s)
- Danny J Avalos
- Division of Gastroenterology, Center for Neurogastroenterology and GI Motility, Texas Tech University Health Sciences Center, El Paso, TX, USA,
| | - Irene Sarosiek
- Division of Gastroenterology, Center for Neurogastroenterology and GI Motility, Texas Tech University Health Sciences Center, El Paso, TX, USA,
| | - Priyadarshini Loganathan
- Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Richard W McCallum
- Division of Gastroenterology, Center for Neurogastroenterology and GI Motility, Texas Tech University Health Sciences Center, El Paso, TX, USA,
| |
Collapse
|
21
|
Tack J, Camilleri M. New developments in the treatment of gastroparesis and functional dyspepsia. Curr Opin Pharmacol 2018; 43:111-117. [PMID: 30245474 DOI: 10.1016/j.coph.2018.08.015] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/26/2018] [Accepted: 08/28/2018] [Indexed: 12/12/2022]
Abstract
Functional dyspepsia (FD) and gastroparesis are frequent causes of upper gastrointestinal symptoms such as postprandial fullness, early satiation, epigastric pain or burning, upper abdominal bloating, bothersome belching, nausea and vomiting. The underlying pathophysiological mechanisms are heterogeneous and involved mechanisms such as abnormal gastric motility (accommodation, emptying), visceral hypersensitivity, low grade mucosal inflammation and cellular changes in enteric nerves, muscle or interstitial cells of Cajal. Patient-reported outcomes for evaluating treatment efficacy in these conditions were recently developed and validated. Prokinetic agents, which enhance gastric motility, are used for treating both gastroparesis and FD. In FD, besides acid suppressive therapy and Helicobacter pylori eradication, neuromodulators and drugs that enhance gastric accommodation can be applied. In gastroparesis, anti-emetics may also provide symptom relief. Novel approaches under evaluation in these conditions are the fundus relaxing agents acotiamide and buspirone and the antidepressant mirtazapine in FD. For gastroparesis, recently studied agents include the prokinetic ghrelin agonist relamorelin, the prokinetic serotonergic agents velusetrag and prucalopride, the anti-emetic aprepitant and per-endoscopic pyloric myotomy procedures.
Collapse
Affiliation(s)
- Jan Tack
- TARGID, University Hospital, Leuven, Belgium.
| | | |
Collapse
|
22
|
Landreneau JP, Strong AT, El-Hayek K, Tu C, Villamere J, Ponsky JL, Kroh MD, Rodriguez JH. Laparoscopic pyloroplasty versus endoscopic per-oral pyloromyotomy for the treatment of gastroparesis. Surg Endosc 2018; 33:773-781. [DOI: 10.1007/s00464-018-6342-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 07/06/2018] [Indexed: 12/11/2022]
|
23
|
Gonzalez JM, Benezech A, Vitton V, Barthet M. G-POEM with antro-pyloromyotomy for the treatment of refractory gastroparesis: mid-term follow-up and factors predicting outcome. Aliment Pharmacol Ther 2017; 46:364-370. [PMID: 28504312 DOI: 10.1111/apt.14132] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 02/21/2017] [Accepted: 04/13/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Gastric peroral endoscopic pyloromyotomy (G-POEM) was introduced for treating refractory gastroparesis. AIM To present a series of patients focussed on clinical mid-term efficacy and predictive outcomes factors. METHODS This was a single centre study of 29 patients operated on between January 2014 and April 2016, with disturbed gastric emptying scintigraphy (GES) and/or elevated Gastroparesis Cardinal Symptoms Index (GCSI). The procedures were performed as previously described. The primary endpoint was the efficacy at 3 and 6 months, based on GCSI and symptoms. The secondary endpoints were GES evolution, procedure reproducibility and safety, and identification of predictive factors for success. RESULTS There were 10 men, 19 women (mean age 52.8±18). The technical success rate was 100% (average 47 minutes). There were two complications managed conservatively: one bleeding and one abscess. The median follow-up was 10±6.4 months. The clinical success rate was 79% at 3 months, 69% at 6 months, with a significant decrease in the mean GCSI compared to pre-operatively (3.3±0.9 vs 1±1.2 and 1.1±0.9 respectively). The GES (n=23) normalised in 70% of cases, with a significant improvement of the mean half emptying time and retention at 2 hours, and a discordance in 21% of the cases. In univariate analysis, diabetes and female gender were significantly associated with risk of failure, but not confirmed in multivariate analysis. CONCLUSIONS The mid-term efficacy of G-POEM reaches 70% at 6 months. The procedure remains reproducible and safe. Diabetes and female gender were predictive of failure.
Collapse
Affiliation(s)
- J M Gonzalez
- Service de Gastro-entérologie, Hôpital Nord, APHM, Aix Marseille Université, Marseille, France
| | - A Benezech
- Service de Gastro-entérologie, Hôpital Nord, APHM, Aix Marseille Université, Marseille, France
| | - V Vitton
- Service de Gastro-entérologie, Hôpital Nord, APHM, Aix Marseille Université, Marseille, France
| | - M Barthet
- Service de Gastro-entérologie, Hôpital Nord, APHM, Aix Marseille Université, Marseille, France
| |
Collapse
|
24
|
Giordano CN, Matarasso SL, Ozog DM. Injectable and topical neurotoxins in dermatology: Indications, adverse events, and controversies. J Am Acad Dermatol 2017; 76:1027-1042. [PMID: 28522039 DOI: 10.1016/j.jaad.2016.11.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 11/03/2016] [Accepted: 11/06/2016] [Indexed: 12/27/2022]
Abstract
The use of neuromodulators for therapeutic and cosmetic indications has proven to be remarkably safe. While aesthetic and functional adverse events are uncommon, each anatomic region has its own set of risks of which the physician and patient must be aware before treatment. The therapeutic usages of botulinum toxins now include multiple specialties and multiple indications. New aesthetic indications have also developed, and there has been an increased utilization of combination therapies to combat the effects of global aging. In the second article in this continuing medical education series, we review the prevention and treatment of adverse events, therapeutic and novel aesthetic indications, controversies, and a brief overview of combination therapies.
Collapse
Affiliation(s)
| | - Seth L Matarasso
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California
| | - David M Ozog
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan.
| |
Collapse
|
25
|
Sobrino-Cossío S, Soto-Pérez J, Coss-Adame E, Mateos-Pérez G, Teramoto Matsubara O, Tawil J, Vallejo-Soto M, Sáez-Ríos A, Vargas-Romero J, Zárate-Guzmán A, Galvis-García E, Morales-Arámbula M, Quiroz-Castro O, Carrasco-Rojas A, Remes-Troche J. Post-fundoplication symptoms and complications: Diagnostic approach and treatment. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2017. [DOI: 10.1016/j.rgmxen.2017.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
|
26
|
Sobrino-Cossío S, Soto-Pérez JC, Coss-Adame E, Mateos-Pérez G, Teramoto Matsubara O, Tawil J, Vallejo-Soto M, Sáez-Ríos A, Vargas-Romero JA, Zárate-Guzmán AM, Galvis-García ES, Morales-Arámbula M, Quiroz-Castro O, Carrasco-Rojas A, Remes-Troche JM. Post-fundoplication symptoms and complications: Diagnostic approach and treatment. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2017; 82:234-247. [PMID: 28065591 DOI: 10.1016/j.rgmx.2016.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/13/2016] [Accepted: 08/16/2016] [Indexed: 12/12/2022]
Abstract
Laparoscopic Nissen fundoplication is currently considered the surgical treatment of choice for gastroesophageal reflux disease (GERD) and its long-term effectiveness is above 90%. Adequate patient selection and the experience of the surgeon are among the predictive factors of good clinical response. However, there can be new, persistent, and recurrent symptoms after the antireflux procedure in up to 30% of the cases. There are numerous causes, but in general, they are due to one or more anatomic abnormalities and esophageal and gastric function alterations. When there are persistent symptoms after the surgical procedure, the surgery should be described as "failed". In the case of a patient that initially manifests symptom control, but the symptoms then reappear, the term "dysfunction" could be used. When symptoms worsen, or when symptoms or clinical situations appear that did not exist before the surgery, this should be considered a "complication". Postoperative dysphagia and dyspeptic symptoms are very frequent and require an integrated approach to determine the best possible treatment. This review details the pathophysiologic aspects, diagnostic approach, and treatment of the symptoms and complications after fundoplication for the management of GERD.
Collapse
Affiliation(s)
- S Sobrino-Cossío
- Servicio de Endoscopia, Hospital Ángeles del Pedregal, Ciudad de México, México.
| | - J C Soto-Pérez
- Clínica de Fisiología Digestiva (Motilab), Clínica Medivalle, Ciudad de México, México; Clínica de Fisiología Digestiva, Hospital Ángeles Metropolitano, Ciudad de México, México; Servicio de Endoscopia, Hospital Central Sur de Alta Especialidad PEMEX, Ciudad de México, México
| | - E Coss-Adame
- Laboratorio de Motilidad y Fisiología Digestiva, Instituto Nacional de Ciencias Médicas y de la Nutrición «Dr. Salvador Zubirán», Ciudad de México, México
| | - G Mateos-Pérez
- Servicio de Endoscopia, Hospital Ángeles del Pedregal, Ciudad de México, México
| | | | - J Tawil
- Departamento de Trastornos Funcionales Digestivos, Gedyt-Gastroenterología Diagnóstica y Terapéutica, Buenos Aires, Argentina
| | - M Vallejo-Soto
- Servicio de Cirugía General, Hospital Ángeles de Querétaro, Querétaro, México
| | - A Sáez-Ríos
- Servicio de Cirugía General, Hospital Central Militar, Ciudad de México, México
| | | | - A M Zárate-Guzmán
- Unidad de Endoscopia, Hospital General de México «Dr. Eduardo Liceaga», Ciudad de México, México
| | - E S Galvis-García
- Unidad de Gastroenterología, Hospital Privado, Guadalajara, Jalisco, México
| | - M Morales-Arámbula
- Unidad de Radiología, Hospital Ángeles del Pedregal, Ciudad de México, México
| | - O Quiroz-Castro
- Servicio de Cirugía General, Hospital Ángeles del Pedregal, Ciudad de México, México
| | - A Carrasco-Rojas
- Laboratorio de Motilidad y Fisiología Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, México
| | - J M Remes-Troche
- Laboratorio de Motilidad y Fisiología Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, México
| |
Collapse
|
27
|
Yin G, Tan W, Hu D. Endoscopic ultrasonography-guided intrapyloric injection of botulinum toxin to treat diabetic gastroparesis. Dig Endosc 2016; 28:759. [PMID: 27556873 DOI: 10.1111/den.12711] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 08/12/2016] [Indexed: 02/08/2023]
Affiliation(s)
- Guojian Yin
- Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Wen Tan
- Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Duanmin Hu
- Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| |
Collapse
|
28
|
Thompson JS, Langenfeld SJ, Hewlett A, Chiruvella A, Crawford C, Armijo P, Oleynikov D. Surgical treatment of gastrointestinal motility disorders. Curr Probl Surg 2016; 53:503-549. [PMID: 27765162 DOI: 10.1067/j.cpsurg.2016.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 08/22/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Jon S Thompson
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE.
| | - Sean J Langenfeld
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Alexander Hewlett
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | | | | | | | - Dmitry Oleynikov
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE
| |
Collapse
|
29
|
Abstract
Gastroparesis is a syndrome of delayed gastric emptying in the absence of mechanical obstruction. Symptoms can be debilitating, affect nutritional states, and significantly impact patients' quality of life. The management of these patients can prove quite difficult to many providers. This article will review the current management recommendations of gastroparesis, discuss investigational medications and interventions, and summarize future directions of therapies targeting the underlying disease process. Current therapies are subdivided into those improving gastric motility and those directly targeting symptoms. Non-pharmacologic interventions, including gastric stimulator implantation and intra-pyloric botulinum toxic injection are reviewed. A discussion of expert opinion in the field, a look into the future of gastroparesis management, and a key point summary conclude the article.
Collapse
Affiliation(s)
- James Langworthy
- a Temple University Hospital , Department of Internal Medicine , Philadelphia , PA , USA
| | - Henry P Parkman
- b Temple University Hospital , Section of Gastroenterology , Philadelphia , PA , USA
| | - Ron Schey
- b Temple University Hospital , Section of Gastroenterology , Philadelphia , PA , USA
| |
Collapse
|