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Lombardo F, Bombaci B, Costa S, Valenzise M, Giannitto N, Cardile D, Baldari S, Salzano G, Passanisi S. Gastroparesis in Adolescent Patient with Type 1 Diabetes: Severe Presentation of a Rare Pediatric Complication. J Clin Res Pediatr Endocrinol 2024; 16:111-115. [PMID: 36047486 PMCID: PMC10938516 DOI: 10.4274/jcrpe.galenos.2022.2022-5-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/25/2022] [Indexed: 12/01/2022] Open
Abstract
Gastroparesis is a long-term complication of diabetes related to autonomic neuropathy. It is characterized clinically by delayed gastric emptying and upper gastrointestinal symptoms, including early satiety, postprandial fullness, nausea, vomiting, and abdominal pain. Gastric emptying scintigraphy is the gold standard for diagnosis as it reveals delayed gastric emptying. Therapeutic strategies include dietary modifications, improvement of glycemic control, and prokinetic drugs. Case descriptions of diabetic gastroparesis in pediatric ages are very scarce. We report the case of a 16-year-old adolescent with severe presentation of diabetic gastroparesis. She presented with recurrent episodes of nausea, vomiting and abdominal pain which led progressively to reduced oral intake and weight loss. Her past glycemic control had been quite brittle, as demonstrated by several hospitalizations due to diabetic ketoacidosis and recurrent episodes of severe hypoglycemia. After the exclusion of infectious, mechanical, metabolic, and neurological causes of vomiting, a gastric emptying scintigraphy was performed, leading to the diagnosis of gastroparesis. Treatment with metoclopramide was started with progressive relief of symptoms. To improve glycemic control, insulin therapy with an advanced hybrid, closed loop system was successfully started. Pediatricians should consider diabetic gastroparesis in children and adolescents with long-standing, poorly controlled diabetes and appropriate symptomology.
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Affiliation(s)
- Fortunato Lombardo
- University of Messina, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Messina, Italy
| | - Bruno Bombaci
- University of Messina, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Messina, Italy
| | - Stefano Costa
- University of Messina, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Pediatric Gastroenterology and Cystic Fibrosis Unit, Messina, Italy
| | - Mariella Valenzise
- University of Messina, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Messina, Italy
| | - Nino Giannitto
- University of Messina, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Messina, Italy
| | - Davide Cardile
- University of Messina, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Messina, Italy
| | - Sergio Baldari
- University of Messina, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Messina, Italy
| | - Giuseppina Salzano
- University of Messina, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Messina, Italy
| | - Stefano Passanisi
- University of Messina, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Messina, Italy
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Klouda T, Ryan E M, Leonard JB, Freiberger D, Midyat L, Dahlberg S, Rosen R, Visner G. Gastrointestinal complications in pediatric lung transplant recipients: Incidence, risk factors, and effects on patient outcomes. Pediatr Transplant 2024; 28:e14665. [PMID: 38317336 DOI: 10.1111/petr.14665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/25/2023] [Accepted: 11/21/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Gastrointestinal (GI) complications in lung transplant recipients can occur any time during the post-operative period, leading to prolonged morbidity and mortality. Despite the negative association between GI complications and patient outcomes, little is known about their incidence and risk factors for their development in pediatric lung transplant recipients. METHODS We performed a retrospective chart review at one pediatric tertiary center to describe the frequency of GI complications in lung transplant recipients. We identified potential risk factors for the diagnosis of gastroparesis, gastroesophageal reflux disease (GERD) and aspiration in the post-transplant period. Lastly, we investigated the association of these complications with mortality and graft survival. RESULTS 84.3% of lung transplant recipients experienced at least one GI complication in the post-transplant period. Gastroparesis (52.9%), GERD (41.2%), and oropharyngeal dysphagia/laryngeal penetration (33.3%) were the most common complications diagnosed. Post-operative opioid exposure was a risk factor for gastroparesis, with the odds increasing 3.0% each day a patient was prescribed opioids (p = .021). The risk of death or retransplant in individuals who experienced gastroparesis was 2.7 times higher than those not diagnosed with gastroparesis (p = .027). CONCLUSION Exposure to opioids in the post-operative period is a risk factor for gastroparesis and a prolonged hospitalization placed patients at risk for aspiration. Gastroparesis was associated with increased patient mortality and graft failure, while aspiration and GERD had no effect on long term outcomes. Future prospective studies investigating the relationship between opioid use and the development of a gastroparesis are necessary to improve patient outcomes.
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Affiliation(s)
- Timothy Klouda
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Morgan Ryan E
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jessica Brie Leonard
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Dawn Freiberger
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Levent Midyat
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Suzanne Dahlberg
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rachel Rosen
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Gary Visner
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
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Shyr BS, Shyr YM, Chen SC, Wang SE, Shyr BU. Reappraisal of surgical and survival outcomes of 500 consecutive cases of robotic pancreaticoduodenectomy. J Hepatobiliary Pancreat Sci 2024; 31:99-109. [PMID: 37881144 DOI: 10.1002/jhbp.1383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND The role of the robotic approach for pancreaticoduodenectomy has not been well established with robust data. This study aimed to reappraise feasibility and justification of robotic pancreaticoduodenectomy (RPD) over time. METHODS A total of 500 patients undergoing RPD were enrolled and divided into early (first 250 patients) and late (last 250 patients) groups for a comparative study. RESULTS The conversion rate was 8.8% overall and was significantly lower in the late group (5.6% vs. 12.0%; p = .012). The overall median intraoperative blood loss was 130 mL. Radicality of resection was similar between early and late groups. The overall surgical mortality after RPD was 1.3%. The overall surgical morbidity and major complication was 44.1% and 13.2%, respectively, and similar between early and late groups. Chyle leakage was the most common complication after RPD (25.0%), followed by postoperative pancreatic fistula (POPF). The POPF rate was 8.6% overall, with 5.9% in the early group and 11.0% in the late group, p = .051. The overall delayed gastric emptying rate was 3.5%. The late group had better survival outcomes than those of the early group after RPD for ampullary adenocarcinoma (p = .027) but not for pancreatic head adenocarcinoma. CONCLUSIONS Reappraisal of this study has confirmed that RPD is not only technically feasible without increasing surgical risks but also oncologically justified without compromising survival outcomes for both pancreatic head and other periampullary cancers over time. Moreover, RPD is associated with the benefits of low surgical mortality, blood loss, and delayed gastric emptying.
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Affiliation(s)
- Bor-Shiuan Shyr
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yi-Ming Shyr
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shih-Chin Chen
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shin-E Wang
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Bor-Uei Shyr
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Donnelly L, Turner B, Davies AH. Atypical case of coexistent vascular compression syndromes: median arcuate ligament syndrome and nutcracker syndrome. BMJ Case Rep 2023; 16:e257754. [PMID: 37989330 PMCID: PMC10668132 DOI: 10.1136/bcr-2023-257754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
Vascular compression syndromes, including median arcuate ligament syndrome (MALS) and nutcracker syndrome (NCS), are poorly understood and frequently delayed diagnoses. This case describes a young adult female presenting with chronic vomiting, abdominal pain and weight loss, with dependence on nasogastric feeding. Subsequent to her gastrointestinal symptoms, she developed haematuria and orthostatic intolerance. Investigations confirmed NCS and possible MALS, with superadded gastroparesis and bradygastria. Under the joint care of general and vascular surgeons, she underwent a gastrojejunostomy and panelled renocaval bypass which led to partial resolution of her symptoms. It is hypothesised that gastroparesis may have been caused by MALS via a neurogenic mechanism, or coexistent compression of the duodenum by the superior mesenteric artery. This case highlights the difficulty in diagnosis of vascular compression syndromes, the overlap between the conditions and the potential for multiple coexistent conditions which complicate diagnosis and lead to increased lead-time and morbidity for patients.
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Affiliation(s)
- Liam Donnelly
- London North West University Healthcare NHS Trust, London, UK
| | | | - Alun H Davies
- Academic Section of Vascular Surgery, Imperial College London, London, UK
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Phan F, Halbron M, Jacqueminet S, Popelier M, Soliman H, Coffin B, Hartemann A, Amouyal C. Improved dyspeptic symptoms of type 1 diabetes adults with gastroparesis on hybrid closed loop system: A case series. Diabetes Metab 2023; 49:101471. [PMID: 37657737 DOI: 10.1016/j.diabet.2023.101471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/15/2023] [Accepted: 08/19/2023] [Indexed: 09/03/2023]
Affiliation(s)
- Franck Phan
- Sorbonne Université, Paris, France; Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France; Centre de Recherche des Cordeliers, INSERM, UMR_S 1138, Paris, France; Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Marine Halbron
- Sorbonne Université, Paris, France; Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France; Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Sophie Jacqueminet
- Sorbonne Université, Paris, France; Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France; Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Marc Popelier
- Sorbonne Université, Paris, France; Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France; Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Heithem Soliman
- INSERM, UMR 1149, Université de Paris-Cité, équipe PIMS, Paris, France; Assistance Publique-Hôpitaux de Paris (APHP), DMU Esprit, Gastroenterology Unit, Louis Mourier Hospital, Colombes, France; Université Paris Cité, Paris, France
| | - Benoit Coffin
- INSERM, UMR 1149, Université de Paris-Cité, équipe PIMS, Paris, France; Assistance Publique-Hôpitaux de Paris (APHP), DMU Esprit, Gastroenterology Unit, Louis Mourier Hospital, Colombes, France; Université Paris Cité, Paris, France
| | - Agnès Hartemann
- Sorbonne Université, Paris, France; Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France; Centre de Recherche des Cordeliers, INSERM, UMR_S 1138, Paris, France; Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Chloé Amouyal
- Sorbonne Université, Paris, France; Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France; Institute of Cardiometabolism and Nutrition ICAN, Paris, France; Nutrition and Obesities: Systemic Approaches (NutriOmics) Research Unit, INSERM, UMRS U1269, Paris, France.
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Greene B, Lagrotteria A, Tsang ME, Jayaraman S. Closed incision negative pressure wound therapy following pancreaticoduodenectomy for prevention of surgical site infections in high-risk patients. Can J Surg 2023; 66:E507-E512. [PMID: 37875305 PMCID: PMC10609889 DOI: 10.1503/cjs.000723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Surgical site infection (SSI) is one of the most common sources of morbidity after pancreaticoduodenectomy. Surgical site infections are associated with readmissions, prolonged length of stay, delayed initiation of adjuvant chemotherapy and negative effects on quality of life. Incisional vacuum-assisted closure (iVAC) devices applied on closed incisions may reduce SSI rates. The objective of this retrospective review is to evaluate the impact of iVAC on SSI rate after pancreaticoduodenectomy. METHODS A cohort of patients undergoing pancreaticoduodenectomy at a single institution who had at least 1 risk factor for SSI and who received an iVAC were compared with a historical cohort of high-risk patients who received conventional dressings after pancreaticoduodenectomy. The primary outcome was incidence of SSI within 30 days, abstracted from chart review. Secondary outcomes were 30-day readmission, 90-day mortality, rate of postoperative pancreatic fistula and rate of delayed gastric emptying. RESULTS In total, 175 patients were included, of whom 61 received an iVAC. The incidence of SSI was 13% (8 of 61 patients) and 16% (18 of 114 patients) in the iVAC and conventional dressing groups, respectively (odds ratio 0.81, 95% confidence interval 0.33-1.98). Preoperative biliary drainage was the most frequent SSI risk factor. Binary logistic regression using SSI as the outcome demonstrated no significant association with iVAC use when adjusted for SSI risk factors. There were no differences in rates of postoperative pancreatic fistula, delayed gastric emptying or 90-day mortality. CONCLUSION This report describes the outcomes of the integration of iVAC devices into routine clinical practice at a high-volume institution. Application of this device after pancreaticoduodenectomy for patients at elevated risk of SSI was not associated with a reduction in the rate of SSIs.
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Affiliation(s)
- Brittany Greene
- From the Division of General Surgery, Section of Hepatobiliary-Pancreatic and Gastrointestinal Surgery, Washington University School of Medicine in St. Louis, St. Louis, Mo. (Greene); Temerty Faculty of Medicine (Lagrotteria), and Division of General Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto (Tsang, Jayaraman); Division of General Surgery, St. Joseph's Health Centre (Tsang, Jayaraman), and Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ont. (Jayaraman)
| | - Andrew Lagrotteria
- From the Division of General Surgery, Section of Hepatobiliary-Pancreatic and Gastrointestinal Surgery, Washington University School of Medicine in St. Louis, St. Louis, Mo. (Greene); Temerty Faculty of Medicine (Lagrotteria), and Division of General Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto (Tsang, Jayaraman); Division of General Surgery, St. Joseph's Health Centre (Tsang, Jayaraman), and Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ont. (Jayaraman)
| | - Melanie E Tsang
- From the Division of General Surgery, Section of Hepatobiliary-Pancreatic and Gastrointestinal Surgery, Washington University School of Medicine in St. Louis, St. Louis, Mo. (Greene); Temerty Faculty of Medicine (Lagrotteria), and Division of General Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto (Tsang, Jayaraman); Division of General Surgery, St. Joseph's Health Centre (Tsang, Jayaraman), and Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ont. (Jayaraman)
| | - Shiva Jayaraman
- From the Division of General Surgery, Section of Hepatobiliary-Pancreatic and Gastrointestinal Surgery, Washington University School of Medicine in St. Louis, St. Louis, Mo. (Greene); Temerty Faculty of Medicine (Lagrotteria), and Division of General Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto (Tsang, Jayaraman); Division of General Surgery, St. Joseph's Health Centre (Tsang, Jayaraman), and Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ont. (Jayaraman)
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Varni JW, Chumpitazi BP, Febo-Rodriguez L, Shulman RJ. Gastrointestinal Symptoms Profile in Gastroparesis Compared to Other Functional and Organic Gastrointestinal Diseases. J Pediatr Gastroenterol Nutr 2023; 77:e1-e7. [PMID: 37098108 DOI: 10.1097/mpg.0000000000003806] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
OBJECTIVES The primary objective was to compare the patient-reported gastrointestinal symptoms profiles of pediatric patients with gastroparesis to pediatric patients with 1 of 7 other functional gastrointestinal disorders and organic gastrointestinal diseases using the Pediatric Quality of Life Inventory (PedsQL) Gastrointestinal Symptoms Scales. METHODS The gastrointestinal symptoms profiles of 64 pediatric patients with gastroparesis who manifested abnormal gastric retention based on gastric emptying scintigraphy testing were compared to 582 pediatric patients with 1 of 7 physician-diagnosed gastrointestinal disorders (functional abdominal pain, irritable bowel syndrome, functional dyspepsia, gastroesophageal reflux disease, functional constipation, Crohn disease, ulcerative colitis). The PedsQL Gastrointestinal Symptoms Scales encompass 10 individual multi-item scales which measure stomach pain, stomach discomfort when eating, food and drink limits, trouble swallowing, heartburn and reflux, nausea and vomiting, gas and bloating, constipation, blood in poop, and diarrhea/fecal incontinence, with an overall total gastrointestinal symptoms score. RESULTS The gastrointestinal symptoms profile analysis identified significantly worse overall total gastrointestinal symptoms scores between pediatric patients with gastroparesis compared to all other gastrointestinal groups except for irritable bowel syndrome (most P s < 0.001), with significant differences for stomach discomfort when eating compared to all 7 other gastrointestinal groups (most P s < 0.001). Nausea and vomiting were significantly worse for gastroparesis compared to all other gastrointestinal groups except for functional dyspepsia (all P s < 0.001). CONCLUSIONS Pediatric patients with gastroparesis self-reported significantly worse overall total gastrointestinal symptoms compared to all other gastrointestinal diagnostic groups except for irritable bowel syndrome, with stomach discomfort when eating and nausea and vomiting symptoms exhibiting the greatest differences compared to most gastrointestinal diagnostic groups.
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Affiliation(s)
- James W Varni
- From the Department of Pediatrics, College of Medicine, Texas A&M University, College Station, TX
- the Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, College Station, TX
| | - Bruno P Chumpitazi
- the Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Children's Nutrition Research Center, Agriculture Research Services, United States Department of Agriculture, Houston, TX
| | | | - Robert J Shulman
- the Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Children's Nutrition Research Center, Agriculture Research Services, United States Department of Agriculture, Houston, TX
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Cichosz SL, Hejlesen O. Classification of Gastroparesis from Glycemic Variability in Type 1 Diabetes: A Proof-of-Concept Study. J Diabetes Sci Technol 2022; 16:1190-1195. [PMID: 33993744 PMCID: PMC9445338 DOI: 10.1177/19322968211015206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVE Delayed gastric emptying is a substantial challenge for people with diabetes, affecting quality of life and blood glucose regulation. The complication is underdiagnosed, and current diagnostic tests are expensive or time consuming or have modest accuracy. The assessment of glycemic variations has potential use in gastroparesis screening. The aim of this study was to investigate the differences in glycemic variability between type 1 diabetes patients with gastroparesis and without a diagnosis of gastroparesis and the potential for using a classification model to differentiate between groups. METHODS Continuous glucose monitoring (CGM) from 425 patients with diabetes was included in the analytic cohort, including 16 patients with a diagnosis of gastroparesis and 409 without a known gastroparesis diagnosis. Sixteen features (9 daytime features and 7 nighttime features) describing glucose dynamics were extracted to assess differences between patients with and without a diagnosis of gastroparesis. A logistic regression model was trained using forward selection and cross-validation. RESULTS In total, 3 features were included in the model utilizing forward selection of features and cross-validation: mean absolute glucose (MAG), span, and standard deviation during the night. The Receiver operating characteristic (ROC) AUC for the classification model was 0.76. CONCLUSIONS Gastroparesis seems to have an impact on glucose variability, especially during the night. Moreover, CGM could possibly be used as a part of the screening process for delayed gastric emptying, but more studies are needed to determine a realistic accuracy.
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Affiliation(s)
- Simon Lebech Cichosz
- Department of Health Science and Technology, Aalborg University, Denmark
- Simon Lebech Cichosz, PhD, Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7D2, Aalborg DK-9220, Denmark.
| | - Ole Hejlesen
- Department of Health Science and Technology, Aalborg University, Denmark
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Abstract
PURPOSE OF REVIEW Our purpose was to review the most recent publications on nutritional management in gastroparesis, and their relevance for global management of gastroparesis. RECENT FINDINGS The last months, several reviews on gastroparesis have been published as well as excellent reviews on the nutritional management of patients suffering this condition. In these publications, the relevance of nutrition in management of gastroparesis has been highlighted. However, alarming studies have been published from several authors from Europe and the United States showing that a majority of patients did not follow any dietary advice from a specialist in nutrition, most patients start restrictive diets by their own, and that as much as 60% of patients have a caloric-deficient diet. In addition, recent studies show that some of the recommendations, like a radical exclusion of fibers from the diet, may be reconsidered taking into account the potential beneficial effects of fibers in global health. SUMMARY Nutritional interventions are one of the cornerstones in management of gastroparesis. Consequently, an interdisciplinary approach, with managing teams composed by gastroenterologist and specialist in nutrition should be the correct strategy to achieve the best outcomes in symptom control and prevention of complications related to nutritional deficits. VIDEO ABSTRACT http://links.lww.com/COCN/A17.
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Affiliation(s)
- Ariadna Aguilar
- Digestive System Research Unit, University Hospital Vall d'Hebrón
- Autonomous University of Barcelona
| | - Carolina Malagelada
- Digestive System Research Unit, University Hospital Vall d'Hebrón
- Autonomous University of Barcelona
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Jordi Serra
- Digestive System Research Unit, University Hospital Vall d'Hebrón
- Autonomous University of Barcelona
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
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Febo-Rodriguez L, Chumpitazi BP, Musaad S, Sher AC, Varni JW, Shulman RJ. Gastrointestinal Symptoms Profile in Pediatric Patients With Gastroparesis Compared to Healthy Controls. J Pediatr Gastroenterol Nutr 2022; 75:151-158. [PMID: 35653378 DOI: 10.1097/mpg.0000000000003484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The primary objective was to compare the patient-reported gastrointestinal symptoms profiles of pediatric patients with gastroparesis to matched healthy controls using the Pediatric Quality of Life Inventory™ (PedsQL™) Gastrointestinal Symptoms Scales. The secondary objectives were to compare pediatric patients with gastroparesis to pediatric patients with gastroparesis-like symptoms and normal gastric emptying and to compare pediatric patients with gastroparesis-like symptoms and normal gastric emptying to matched healthy controls. METHODS The PedsQL™ Gastrointestinal Symptoms Scales were completed by 64 pediatric patients with gastroparesis, 59 pediatric patients with gastroparesis-like symptoms and normal gastric emptying, and 200 age, gender, and race/ethnicity matched healthy controls. The PedsQL™ Gastrointestinal Symptoms Scales encompass 10 individual multi-item scales which measure stomach pain, stomach discomfort when eating, food and drink limits, trouble swallowing, heartburn and reflux, nausea and vomiting, gas and bloating, constipation, blood in poop, and diarrhea/fecal incontinence. Based on gastric emptying scintigraphy testing, those with abnormal gastric retention were classified as having gastroparesis. RESULTS The gastrointestinal symptoms profile analysis identified large differences between those with gastroparesis compared to healthy controls (most P <0.001), with the largest effect sizes for upper gastrointestinal symptoms including stomach pain, stomach discomfort when eating, food and drink limits, nausea, and vomiting. Those with gastroparesis self-reported similar gastrointestinal symptoms to those with normal gastric emptying, except for increased constipation. CONCLUSIONS Pediatric patients with gastroparesis self-reported broad multidimensional gastrointestinal symptoms profiles in comparison to healthy controls with large differences, indicating the critical need for more highly efficacious interventions to bring patient functioning within the normal range of healthy functioning.
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Affiliation(s)
| | - Bruno P Chumpitazi
- the Department of Pediatrics, Baylor College of Medicine, Houston, TX
- the Department of Pediatric Radiology, Baylor College of Medicine, Houston, TX
| | - Salma Musaad
- the Department of Pediatrics, Baylor College of Medicine, Houston, TX
- the Department of Pediatric Radiology, Baylor College of Medicine, Houston, TX
| | - Andrew C Sher
- the Children's Nutrition Research Center, Agriculture Research Services, United States Department of Agriculture, Houston, TX
| | - James W Varni
- From the Department of Pediatrics, University of Miami, Miami, FL
| | - Robert J Shulman
- the Department of Pediatrics, Baylor College of Medicine, Houston, TX
- the Department of Pediatric Radiology, Baylor College of Medicine, Houston, TX
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Kondajji A, Klingler M, Tu C, Kelley R, El-Hayek K, Rodriquez J, Cline M, Fathalizadeh A, Allemang M. Gastroparesis with concomitant gastrointestinal dysmotility is not a contraindication for per-oral pyloromyotomy (POP). Surg Endosc 2022; 36:4226-4232. [PMID: 34642799 DOI: 10.1007/s00464-021-08756-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 09/27/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Per-oral pyloromyotomy (POP or G-POEM) provides significant short-term improvements in symptoms and objective emptying for patients with medically refractory gastroparesis, but it is unclear if patients with gastroparesis and co-existing dysmotility (small bowel or colonic delay) also benefit. In this study, we used wireless motility capsule (WMC) data to measure outcomes in patients with isolated gastroparesis (GP) and gastroparesis with co-existing dysmotility (GP + Dys) who underwent POP. METHODS We retrospectively analyzed patients who had POP and completed WMC data during their evaluation of intestinal dysmotility. WMC data were reviewed to identify patients who demonstrated isolated GP or GP + Dys. Each patient's pre-op and post-op Gastroparesis Cardinal Symptom Index (GCSI) and 4-h solid-phase scintigraphy gastric emptying studies (GES) scores were compared to evaluate improvement. RESULTS Of the entire cohort (n = 73), 89% were female with a mean age of 47.0 ± 15.0 years old. Gastroparesis etiologies were divided among idiopathic (54.8%), diabetic (26%), postsurgical (8.2%), autoimmune (5.5%), and multifactorial (5.5%). Forty-one patients (56%) had GP and 32 patients (44%) had GP + Dys. GCSI improved after POP whether the patient had isolated GP (- 12.31, p < 0.001) or GP + Dys (- 9.58, p < 0.001); however, there was no significant difference in total GCSI improvement between the two groups. A subset of patients had postoperative GES available (n = 47). In the isolated GP and GP + Dys cohorts, 15/28 (54%) and 12/19 (63%) patients had normal post-op 4-h GES, respectively, but no statistical difference between the two groups. CONCLUSION Patients with medically refractory gastroparesis with and without concomitant gastrointestinal dysmotility show short-term subjective and objective improvement after POP. Concomitant small bowel or colonic dysmotility should not deter physicians from offering POP in carefully selected patients with gastroparesis.
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Affiliation(s)
- Abhiram Kondajji
- Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, OH, USA.
- General Surgery Resident, Cleveland Clinic-South Pointe Hospital, 20000 Harvard Road, Warrensville Height, OH, 44122, USA.
| | - Michael Klingler
- Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Chao Tu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Rebecca Kelley
- Dermatology and Plastic Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - John Rodriquez
- Digestive Disease and Surgical Institute, Cleveland Clinic, Abu Dhabi, UAE
| | - Michael Cline
- Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alisan Fathalizadeh
- Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Matthew Allemang
- Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, OH, USA
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12
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Tranchina K, Matlock D, Hernandez C, Turgeon J, Bingham JM. Mitigating Benzodiazepine Dependence and the Risk of Drug-Induced QTc Prolongation in the Treatment of Gastroparesis: A Case Report. Medicina (B Aires) 2022; 58:medicina58030409. [PMID: 35334585 PMCID: PMC8951483 DOI: 10.3390/medicina58030409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/24/2022] [Accepted: 03/02/2022] [Indexed: 12/03/2022] Open
Abstract
Patients are often faced with challenges when it comes to safe therapeutic options. An 89-year-old female with a history of arrhythmias and refractory gastroparesis complained of adverse drug events from her benzodiazepine. While performing a comprehensive medication review and a medication safety review using an advanced clinical decision support system, the pharmacist successfully tapered off the benzodiazepine to a safer alternative antidepressant indicated for the treatment of gastroparesis. Special attention was given to selecting drugs with less QT prolongation risk, based on her age, current drug regimen, previous medical history, and presence of polypharmacy.
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Affiliation(s)
- Karley Tranchina
- College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA;
| | - Derek Matlock
- MedWiseRx, 100 N Stone Ave., Tucson, AZ 85701, USA; (D.M.); (C.H.)
| | - Carlos Hernandez
- MedWiseRx, 100 N Stone Ave., Tucson, AZ 85701, USA; (D.M.); (C.H.)
| | - Jacques Turgeon
- Tabula Rasa HealthCare Group, Precision Pharmacotherapy Research and Development Institute, 13485 Veterans Way, Orlando, FL 32827, USA
- Correspondence: ; Tel.: +1-856-938-8793
| | - Jennifer M. Bingham
- Tabula Rasa HealthCare Group, Office of Translational Research and Residency Programs, 228 Strawbridge Dr, Moorestown, NJ 08057, USA;
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13
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Chamely EA, Hoang B, Jafri NS, Felinski MM, Bajwa KS, Walker PA, Barge J, Wilson EB, Cen P, Shah SK. Palliative Endoscopic Salvage of a Functionally Obstructed Gastrojejunostomy - Report of Technique. CRSLS 2022; 9:e2021.00094. [PMID: 36016812 PMCID: PMC9387390 DOI: 10.4293/crsls.2021.00094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Gastric outlet obstruction secondary to foregut gastrointestinal malignancies can be managed with a variety of medical, endoscopic, and surgical options. Laparoscopic gastrojejunostomy is an option for those patients who are able to tolerate an operation as a long-term palliative option. This operation may be associated with some significant postoperative technical and nontechnical complications, including delayed gastric emptying. This paper describes an incision-less, endoscopic option that we propose can be used to salvage a functionally obstructed gastrojejunostomy. CASE DESCRIPTION A 57-year old male patient had a history of pancreatic adenocarcinoma causing gastric outlet obstruction and underwent a previously created surgical gastrojejunostomy at an outside hospital. His procedure was complicated by anastomotic leak and essentially persistent obstructive symptoms secondary to delayed gastric emptying. Though his anastomosis was demonstrably patent, these symptoms were thought to be secondary to a functional obstruction at the gastrojejunostomy. After repeated workups and many failed attempts to treat these symptoms, he ultimately underwent endoscopic placement of an uncovered colonic stent into the efferent limb of his gastrojejunostomy. This allowed for preferential drainage of gastric contents down the efferent limb, and improvement of his delayed gastric emptying. CONCLUSIONS In a select group of patients with advanced foregut malignancy, and with high re-operative risks, salvage endoscopic stenting may be useful in the palliation of symptoms from a functionally obstructed gastrojejunostomy.
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Affiliation(s)
- Elias A Chamely
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX
| | - Bryan Hoang
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX
| | - Nadim S Jafri
- Michael E DeBakey Institute of Comparative Cardiovascular Science and Biomedical Devices, Texas A&M University, College Station, TX
| | - Melissa M Felinski
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX
| | - Kulvinder S Bajwa
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX
| | - Peter A Walker
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX
| | | | - Erik B Wilson
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX
| | - Putao Cen
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX
| | - Shinil K Shah
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX
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14
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Jalleh RJ, Marathe CS, Jones KL, Horowitz M, Rayner CK. Digesting the pathogenesis of diabetic gastroparesis. J Diabetes Complications 2021; 35:107992. [PMID: 34389236 DOI: 10.1016/j.jdiacomp.2021.107992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 02/07/2023]
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15
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Abell TL, Garcia LM, Wiener GJ, Wo JM, Bulat RS, Smith N. Effect of Oral CNSA-001 (sepiapterin, PTC923) on gastric accommodation in women with diabetic gastroparesis: A randomized, placebo-controlled, Phase 2 trial. J Diabetes Complications 2021; 35:107961. [PMID: 34176722 DOI: 10.1016/j.jdiacomp.2021.107961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/12/2021] [Accepted: 05/16/2021] [Indexed: 12/11/2022]
Abstract
AIMS Diabetic gastroparesis may be associated with impaired nitric oxide metabolism and reduced tetrahydrobiopterin (BH4) synthesis. Oral treatment with CNSA-001 (sepiapterin, currently known as PTC923) increased BH4 levels in humans in a previous study. This Phase 2 study evaluated CNSA-001 in women with diabetic gastroparesis. METHODS Non-pregnant diabetic women with moderate/severe symptomatic gastroparesis, delayed gastric emptying, and impaired gastric accommodation (nutrient satiety testing) were randomized to 10mg/kg BID CNSA-001 or matching placebo for 14days. The primary endpoint was change in gastric accommodation (maximal tolerated liquid meal volume) at 14- and 28-days' follow-up. RESULTS Gastric accommodation improved in CNSA-001-treated vs. placebo-treated subjects at 28days (least squares mean [LSM] difference: 98 [95% CI 36 to 161], p=0.0042). Subjects' ratings of bloating, fullness, nausea, and pain were lower vs. baseline in the CNSA-001 group at 14 and 28days, though these improvements were not observed consistently in placebo-treated subjects. There were no significant group differences in upper gastrointestinal symptom scores, and in gastric emptying breath test parameters. CNSA-001 was well tolerated, with no withdrawals for adverse events. CONCLUSIONS CNSA-001 improved gastric accommodation in women with diabetic gastroparesis. Further evaluation of CNSA-001 in gastroparesis is warranted; ClinicalTrials.gov number, NCT03712124.
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Affiliation(s)
| | | | | | - John M Wo
- Indiana University Hospital, Indianapolis, IN, USA
| | - Robert S Bulat
- Johns Hopkins Center for Neurogastroenterology, Baltimore, MD, USA
| | - Neil Smith
- PTC Therapeutics Inc., South Plainfield, NJ, USA.
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16
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Argüero J, Cano-Busnelli V, Cavadas D, Marcolongo M. Rumination syndrome and gastroparesis: Linked entities? Rev Gastroenterol Mex (Engl Ed) 2021; 86:205-207. [PMID: 33261941 DOI: 10.1016/j.rgmx.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 06/12/2023]
Affiliation(s)
- J Argüero
- Departamento de Gastroenterología, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.
| | - V Cano-Busnelli
- División de Esófago y Estómago, Departamento de Cirugía, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - D Cavadas
- División de Esófago y Estómago, Departamento de Cirugía, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - M Marcolongo
- Departamento de Gastroenterología, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
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17
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Huynh DTK, Shamash K, Burch M, Phillips E, Cunneen S, Van Allan RJ, Shouhed D. Median Arcuate Ligament Syndrome and Its Associated Conditions. Am Surg 2019; 85:1162-1165. [PMID: 31657316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The risk factors and associated conditions of median arcuate ligament syndrome (MALS) have not been well characterized in the literature. In this study, we aim to investigate the presentation and outcomes of MALS patients with an emphasis on the prevalence of other uncommon disorders. To this end, data of patients with MALS who underwent surgery between 2013 and 2018 were collected and compiled into a retrospective database and analyzed. Eleven patients were identified. Seven of these eleven patients underwent diagnostics to evaluate gastric emptying. Five of these seven patients (71.4%) had radiographic evidence of delayed gastric emptying. Four of the eleven patients (36.4%) were found to have anatomic abnormalities of their visceral vasculature. Two of the eleven patients (18.2%) were found to have connective tissue disorders, both with Ehlers-Danlos syndrome. Three of the eleven (27.3%) had a diagnosis of postural orthostatic tachycardia syndrome. This is the first case series reporting on an association between MALS and delayed gastric emptying. We also explored the relationship between MALS and visceral vascular abnormalities, Ehlers-Danlos syndrome, and postural orthostatic tachycardia syndrome. It is notable that these conditions are more prevalent in the MALS population than in the general population, suggesting a possible pathophysiologic relationship.
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18
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Abstract
Patients with gastroparesis sometimes suffer from intractable nausea and vomiting, abdominal pain, and bloating, as well as a host of other symptoms that can often be difficult to control. Initially, patients are treated conservatively; some do well with conservative management but unfortunately some do not. Over the years, studies have shown the benefits of gastric electrical stimulation, which often results in symptomatic improvement and improvement in gastric emptying times. This article discusses the history of gastric electrical stimulation and its use in clinical practice to help those suffering from gastroparesis that is refractory to conservative medical management.
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Affiliation(s)
- Hadi Atassi
- Department of Medicine, Division of Internal Medicine, University of Louisville, 550 South Jackson Street, ACB A3K00, Louisville, KY 40202, USA
| | - Thomas L Abell
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, 550 South Jackson Street, ACB A3L15, Louisville, KY 40202, USA.
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19
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Jielani A, Fatima T, Hussain JA, Rasheed R. Gastric Emptying Scintigraphy In Assessment Of Chronic Vomiting. J Ayub Med Coll Abbottabad 2018; 30:295-297. [PMID: 29938440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Gastroparesis being multifocal abnormality is characterized by objective feeling of prolong time of gastric retention without any evidence of anatomical blockage. The key symptoms include early satiety, feeling of fullness after meals, nausea, vomiting, bloating, and upper abdominal pain. Radio isotopic Gastric emptying study using radiolabelled test food is integrated clinically for evaluation of functional gastric motility disorders. We present a young female having abdominal pain and vomiting for two months. She was investigated for anatomical causes and no abnormality was uncovered. Gastric Emptying scintigraphy revealed delayed lag phase and half gastric emptying time consistent with the diagnosis of Gastroparesis.
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Affiliation(s)
- Asif Jielani
- Department of Nuclear Medicine, INOR Cancer Hospital Abbottabad, Pakistan
| | - Tatheer Fatima
- Department of Nuclear Medicine, INOR Cancer Hospital Abbottabad, Pakistan
| | | | - Rashid Rasheed
- Department of Nuclear Medicine, INOR Cancer Hospital Abbottabad, Pakistan
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20
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Aleppo G, Calhoun P, Foster NC, Maahs DM, Shah VN, Miller KM. Reported gastroparesis in adults with type 1 diabetes (T1D) from the T1D Exchange clinic registry. J Diabetes Complications 2017; 31:1669-1673. [PMID: 28989086 PMCID: PMC7172031 DOI: 10.1016/j.jdiacomp.2017.08.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/02/2017] [Accepted: 08/30/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To better understand the prevalence and impact of gastroparesis in the T1D Exchange clinic registry database. METHODS The analysis included 7107 adult participants with T1D across 45 sites (median age 46years. and median duration 24years). Linear and logistic regression models were used to assess the association of gastroparesis vs. no gastroparesis (obtained from medical record) with demographic characteristics, glycemic control and diabetes complications. RESULTS Among 7107 registry participants, 340 (4.8%) had a clinical diagnosis of gastroparesis. Females were more likely to have gastroparesis compared with males (5.8% vs. 3.5%, P<0.001). Participants with gastroparesis compared with those without gastroparesis were older (median age 49.4 vs. 45.3years, P<0.001), had a longer duration of T1D (median duration 32 vs. 23years, P<0.001), higher mean HbA1c (8.1% vs. 7.7% [65 vs. 61mmol/mol], P<0.001), more frequent severe hypoglycemia (25% vs. 11% with ≥1 event in the past 12months, P<0.001), lower socio-economic status, less likely to be using CGM and insulin pump and greater prevalence of microvascular and neuropathic complications than participants without gastroparesis. CONCLUSION Gastroparesis is associated with higher risk of severe hypoglycemia despite higher HbA1c levels than in T1D patients without gastroparesis. The increased presence of multiple long-term complications and overall poor glycemic control in these subjects emphasizes the need to establish diagnostic protocols for earlier diagnosis, achieve tighter glycemic control with more extensive use of insulin pumps and continuous glucose monitoring, and the need for wider availability of medical therapies for treatment of diabetic gastroparesis.
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Affiliation(s)
| | - Peter Calhoun
- Jaeb Center for Health Research, Tampa, FL, United States
| | | | | | - Viral N Shah
- Barbara Davis Center for Childhood Diabetes, Aurora, CO, United States
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21
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Woodhouse S, Hebbard G, Knowles SR. Psychological controversies in gastroparesis: A systematic review. World J Gastroenterol 2017; 23:1298-1309. [PMID: 28275310 PMCID: PMC5323455 DOI: 10.3748/wjg.v23.i7.1298] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/18/2017] [Accepted: 02/08/2017] [Indexed: 02/06/2023] Open
Abstract
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.
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Bapaye A, Mahadik M, Pujari R, Vyas V, Dubale N. Per-oral endoscopic pyloromyotomy and per-oral endoscopic myotomy for coexisting refractory gastroparesis and recurrent achalasia cardia in a single patient. Gastrointest Endosc 2016; 84:734-5. [PMID: 27090287 DOI: 10.1016/j.gie.2016.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 04/07/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Amol Bapaye
- Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Mahesh Mahadik
- Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Rajendra Pujari
- Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Viral Vyas
- Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Nachiket Dubale
- Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
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Cámara-Lemarroy CR, Rodriguez-Gutierrez R, Monreal-Robles R, Marfil-Rivera A. Gastrointestinal disorders associated with migraine: A comprehensive review. World J Gastroenterol 2016; 22:8149-8160. [PMID: 27688656 PMCID: PMC5037083 DOI: 10.3748/wjg.v22.i36.8149] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/03/2016] [Accepted: 08/23/2016] [Indexed: 02/06/2023] Open
Abstract
Migraine is a recurrent and commonly disabling primary headache disorder that affects over 17% of women and 5%-8% of men. Migraine susceptibility is multifactorial with genetic, hormonal and environmental factors all playing an important role. The physiopathology of migraine is complex and still not fully understood. Many different neuropeptides, neurotransmitters and brain pathways have been implicated. In connection with the myriad mechanisms and pathways implicated in migraine, a variety of multisystemic comorbidities (e.g., cardiovascular, psychiatric and other neurological conditions) have been found to be closely associated with migraine. Recent reports demonstrate an increased frequency of gastrointestinal (GI) disorders in patients with migraine compared with the general population. Helicobacter pylori infection, irritable bowel syndrome, gastroparesis, hepatobiliary disorders, celiac disease and alterations in the microbiota have been linked to the occurrence of migraine. Several mechanisms involving the gut-brain axis, such as a chronic inflammatory response with inflammatory and vasoactive mediators passing to the circulatory system, intestinal microbiota modulation of the enteric immunological milieu and dysfunction of the autonomic and enteric nervous system, have been postulated to explain these associations. However, the precise mechanisms and pathways related to the gut-brain axis in migraine need to be fully elucidated. In this review, we survey the available literature linking migraine with GI disorders. We discuss the possible physiopathological mechanisms, and clinical implications as well as several future areas of interest for research.
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Cotter TG, Gurney M, Loftus CG. Gas and Bloating-Controlling Emissions: A Case-Based Review for the Primary Care Provider. Mayo Clin Proc 2016; 91:1105-13. [PMID: 27492915 DOI: 10.1016/j.mayocp.2016.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 04/08/2016] [Accepted: 04/12/2016] [Indexed: 12/19/2022]
Abstract
The evaluation of the patient with gas and bloating can be complex and the treatment extremely challenging. In this article, a simplified approach to the history and relevant physical examination is presented and applied in a case-oriented manner, suitable for application in the primary care setting.
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Affiliation(s)
| | - Mark Gurney
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Conor G Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
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25
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Homko C, Siraj ES, Parkman HP. The impact of gastroparesis on diabetes control: Patient perceptions. J Diabetes Complications 2016; 30:826-9. [PMID: 27166926 DOI: 10.1016/j.jdiacomp.2016.03.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 03/18/2016] [Accepted: 03/19/2016] [Indexed: 12/12/2022]
Abstract
UNLABELLED The impact of gastroparesis on diabetes management and control from the patient perspective has not been well characterized. The aim of this study was to identify patient perceptions regarding the impact of gastroparesis on managing their diabetes. METHODS Patients with diabetes being referred for gastroparesis were enrolled in this prospective study. Gastroparetic symptom severity was assessed with the Patient Assessment of Upper GI Symptoms (PAGI-SYM). A questionnaire examined the impact of gastroparesis on diabetes related symptoms and control. RESULTS 54 diabetic gastroparesis patients (36 T1DM, 18 T2DM) participated. Duration of diabetes averaged 17.4±1.4years and gastroparetic symptoms 5.1±1.1years. Patients rated their most severe symptoms as postprandial fullness, early satiety, and nausea. Two thirds of diabetic subjects identified that since their diagnosis of gastroparesis, their diabetes was more difficult to control (44 of 54 patients) and that extra time and effort were required for care of their diabetes (45 of 54). Patients with T1DM, compared to those with T2DM, more often expressed that since developing gastroparesis, their blood sugars have been higher, they have had more frequent episodes of hypoglycemia, and they found that their gastroparetic symptoms worsened if blood sugars were too high. CONCLUSIONS Gastroparesis has a significant impact on patients' perceived ability to self-manage and control their diabetes. T1DM patients, in particular, associate their gastroparesis with episodes of hyper- and hypo-glycemia, and find their gastroparetic symptoms worsen with poor control. Future research should focus on strategies to support self-management of patients with diabetic gastroparesis.
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MESH Headings
- Adult
- Attitude to Health
- Cohort Studies
- Combined Modality Therapy
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 1/therapy
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/psychology
- Diabetes Mellitus, Type 2/therapy
- Female
- Gastroparesis/complications
- Gastroparesis/epidemiology
- Gastroparesis/physiopathology
- Gastroparesis/psychology
- Hospitals, University
- Humans
- Hyperglycemia/prevention & control
- Hypoglycemia/prevention & control
- Male
- Middle Aged
- Philadelphia/epidemiology
- Prevalence
- Prospective Studies
- Psychiatric Status Rating Scales
- Self Report
- Self-Management/psychology
- Severity of Illness Index
- Stress, Psychological/complications
- Stress, Psychological/psychology
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Affiliation(s)
- Carol Homko
- Sections of Gastroenterology, Department of Medicine, Temple University School of Medicine, Philadelphia, PA; Endocrinology, Diabetes, and Metabolism, Department of Medicine, Temple University School of Medicine, Philadelphia, PA
| | - Elias S Siraj
- Endocrinology, Diabetes, and Metabolism, Department of Medicine, Temple University School of Medicine, Philadelphia, PA
| | - Henry P Parkman
- Sections of Gastroenterology, Department of Medicine, Temple University School of Medicine, Philadelphia, PA.
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Bradshaw LA, Cheng LK, Chung E, Obioha CB, Erickson JC, Gorman BL, Somarajan S, Richards WO. Diabetic gastroparesis alters the biomagnetic signature of the gastric slow wave. Neurogastroenterol Motil 2016; 28:837-48. [PMID: 26839980 PMCID: PMC4877247 DOI: 10.1111/nmo.12780] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 12/25/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Gastroparesis is characterized by delayed gastric emptying without mechanical obstruction, but remains difficult to diagnose and distinguish from other gastrointestinal (GI) disorders. Gastroparesis affects the gastric slow wave, but non-invasive assessment has been limited to the electrogastrogram (EGG), which reliably characterizes temporal dynamics but does not provide spatial information. METHODS We measured gastric slow wave parameters from the EGG and magnetogastrogram (MGG) in patients with gastroparesis and in healthy controls. In addition to dominant frequency (DF) and percentage power distribution (PPD), we measured the propagation velocity from MGG spatiotemporal patterns and the percentage of slow wave coupling (%SWC) from EGG. KEY RESULTS No significant difference in DF was found between patients and controls. Gastroparesis patients had lower percentages of normogastric frequencies (60 ± 6% vs 78 ± 4%, p < 0.05), and higher brady (9 ± 2% vs 2 ± 1%, p < 0.05) and tachygastric (31 ± 2% vs 19 ± 1%, p < 0.05) frequency content postprandial, indicative of uncoupling. Propagation patterns were substantially different in patients and longitudinal propagation velocity was retrograde at 4.3 ± 2.9 mm/s vs anterograde at 7.4 ± 1.0 mm/s for controls (p < 0.01). No difference was found in %SWC from EGG. CONCLUSIONS & INFERENCES Gastric slow wave parameters obtained from MGG recordings distinguish gastroparesis patients from controls. Assessment of slow wave propagation may prove critical to characterization of underlying disease processes. Future studies should determine pathologic indicators from MGG associated with other functional gastric disorders, and whether multichannel EGG with appropriate signal processing also reveals pathology.
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Affiliation(s)
- L A Bradshaw
- Department of Surgery, Vanderbilt University, Nashville, TN, USA
- Department of Physics, Vanderbilt University, Nashville, TN, USA
- Department of Physics, Lipscomb University, Nashville, TN, USA
| | - L K Cheng
- Department of Surgery, Vanderbilt University, Nashville, TN, USA
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - E Chung
- Department of Surgery, Vanderbilt University, Nashville, TN, USA
| | - C B Obioha
- Department of Surgery, Vanderbilt University, Nashville, TN, USA
| | - J C Erickson
- Department of Physics, Vanderbilt University, Nashville, TN, USA
- Department of Physics-Engineering, Washington & Lee University, Lexington, VA, USA
| | - B L Gorman
- Department of Physics, Lipscomb University, Nashville, TN, USA
| | - S Somarajan
- Department of Surgery, Vanderbilt University, Nashville, TN, USA
- Department of Physics, Vanderbilt University, Nashville, TN, USA
| | - W O Richards
- Department of Surgery, University of South Alabama, Mobile, AL, USA
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27
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Abstract
BACKGROUND A difficult management problem for the upper gastrointestinal surgeon exists when a patient presents with symptomatic and refractory severe delayed gastric emptying. Surgical treatment is further complicated by coexisting gastro-oesophageal reflux. No universal surgical strategy exists for this problem. METHODS A novel surgical strategy combines partial sleeve gastrectomy (SG) and hiatus hernia (HH) repair with fundoplication. A review of treating four such patients is described with objective outcome data. RESULTS Overall, solid gastric emptying improved in all, from median 350 (163-488) min pre-operatively to 108 (84-135) at 10 months (3-24) post-operatively, corresponding to 67% improvement. Primary symptoms resolved in all; however, one patient had recurrent symptoms. GERD-HRQL also improved in all, from median 23 (3-25) to 4 (0-8) at 21 months (6-30, 83% improvement). Gas bloat improved in three. All had post-operative gastroscopies showing intact repair and absent oesophagitis, with no patient requiring post-operative PPI. Patient weight reduced by median 11% (7-20) post-operatively. There was no significant peri-operative morbidity. CONCLUSIONS With careful patient selection and work-up, SG and HH repair with fundoplication may improve quality of life by coupling adequate reflux control with improved gastric emptying.
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Affiliation(s)
- Philip A Le Page
- Department of Surgery, Concord and Repatriation Hospitals, Hospital Road, Concord, NSW, 2139, Australia,
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28
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Legaspi R, Narciso P. Euglycemic Diabetic Ketoacidosis Due to Gastroparesis, A Local Experience. J Ark Med Soc 2015; 112:62-63. [PMID: 26390536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Euglycemic Diabetic Ketoacidosis is an uncommon occurrence. It is caused by an interaction of existing and worsening acidosis due to nausea and vomiting by a precipitating illness. In this case, a Type I Diabetic patient initially presented with Diabetic Ketoacidosis (DKA) that eventually evolved into Euglycemic Ketoacidosis brought about by continuous nausea and vomiting. The case presented the complexity involved with Type I Diabetes in regards to glucose and energy metabolism and highlights the need for vigilance in monitoring acid/base balance in all diabetic patients who are ill and present with normal blood glucose level.
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Roman S, Marjoux S, Thivolet C, Mion F. Oesophageal function assessed by high-resolution manometry in patients with diabetes and inadequate glycaemic control. Diabet Med 2014; 31:1452-9. [PMID: 24766201 DOI: 10.1111/dme.12476] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 12/19/2013] [Accepted: 04/22/2014] [Indexed: 12/12/2022]
Abstract
AIMS To describe oesophageal function in people with diabetes and poor glycaemic control using oesophageal high-resolution manometry and to compare the result between control subjects and patients with gastro-oesophageal reflux disease. METHODS The results of oesophageal high-resolution manometry and a gastric emptying test were reviewed in 20 patients with diabetes. The high-resolution manometry protocol consisted of 5-ml swallows of water and multiple swallows of water. Oesophageal motility disorders were classified according to the Chicago classification system. The occurence of multiphasic contractions and intragastric and intrabolus pressures were measured. High-resolution manometry results were compared between 10 control subjects and 20 patients with gastro-oesophageal reflux disease. Data were expressed as medians and compared using Mann-Whitney and chi-squared tests. RESULTS Oesophageal motility disorders were similarly distributed between the groups. Multiphasic contractions occurred more frequently in patients with diabetes than in those with gastro-oesophageal reflux disease (60 vs 20% per patient; P<0.01) and were not observed in control subjects. Gastric emptying was delayed in six patients with diabetes and did not correlate with symptoms or oesophageal motility disorders. Intrabolus pressure was higher in patients with diabetes and gastroparesis than in those without (17 vs 10 mmHg; P=0.02) and correlated with intragastric pressure (r=0.46, P<0.01). During multiple swallows of water, oesophageal contractile activity was incompletely inhibited in 83% of patients with diabetes and gastroparesis vs 9% without (P<0.01). Oesophageal function and gastric emptying were not influenced by fasting glycaemia. CONCLUSIONS Patients with gastroparesis might present with impaired inhibition of contractile activity during multiple swallows of water. Increased intrabolus pressure is suggestive of delayed oesophageal clearance as a consequence of gastroparesis.
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Affiliation(s)
- S Roman
- Digestive Physiology, Hospices Civils de Lyon, Lyon, France; Digestive Physiology, Lyon I University, Lyon, France; Inserm U1032, LabTAU, Lyon, France
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30
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Affiliation(s)
- Terry Ann Simmons
- Terry Ann Simmons is a clinical documentation specialist at the Hospital of Central Connecticut in New Britain
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31
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Kundu S, Rogal S, Alam A, Levinthal DJ. Rapid improvement in post-infectious gastroparesis symptoms with mirtazapine. World J Gastroenterol 2014; 20:6671-6674. [PMID: 24914393 PMCID: PMC4047357 DOI: 10.3748/wjg.v20.i21.6671] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 01/10/2014] [Accepted: 03/05/2014] [Indexed: 02/06/2023] Open
Abstract
We report the case of a 34-year-old woman with severe post-infectious gastroparesis who was transferred from an outside medical facility for a second opinion regarding management. This patient had no prior history of gastrointestinal symptoms. However, in the aftermath of a viral illness, she developed two months of intractable nausea, vomiting, and oral intake intolerance that resulted in numerous hospitalizations for dehydration and electrolyte disturbances. A solid-phase gastric emptying scan had confirmed delayed emptying, confirming gastroparesis. Unfortunately, conventional pro-kinetic agents and numerous anti-emetic drugs provided little or no relief of the patient’s symptoms. At our institution, the patient experienced a cessation of vomiting, reported a significant reduction in nausea, and tolerated oral intake shortly after taking mirtazapine. Based on mirtazapine’s primary action as a serotonin (5-HT) 1a receptor agonist, we infer that this receptor system mediated the clinical improvement through a combination of peripheral and central neural mechanisms. This report highlights the potential utility of 5-HT1a agonists in the management of nausea and vomiting. We conclude that mirtazapine may be effective in treating symptoms associated with non-diabetic gastroparesis that are refractory to conventional therapies.
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Abstract
Management of dyslipidemia in diabetic patients poses a major burden on both patients and healthcare providers. Gastroparesis, a condition in which gastric emptying is delayed, is a common condition in diabetes. Given the fact that normal values of plasma lipids are standardized to be measured after several hours of fasting, delayed transit of food and nutrients into the small bowel (as occurs in gastroparesis) may result in an artificial increase in plasma lipids, causing misdiagnosis of dyslipidemia (pseudodyslipidemia), and lead to overtreatment with lipid-lowering agents.
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Affiliation(s)
- Tomer Adar
- Digestive Diseases Institute, Shaare Zedek Medical Center Affiliated with the Hebrew University, 12 Bayit Street, 91031, Jerusalem, Israel,
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33
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Boltin D, Zvidi I, Steinmetz A, Bernstine H, Groshar D, Nardi Y, Boaz M, Niv Y, Dickman R. Vomiting and dysphagia predict delayed gastric emptying in diabetic and nondiabetic subjects. J Diabetes Res 2014; 2014:294032. [PMID: 24949485 PMCID: PMC4037617 DOI: 10.1155/2014/294032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 04/17/2014] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Gastroparesis is a heterogeneous disorder most often idiopathic, diabetic, or postsurgical in nature. The demographic and clinical predictors of gastroparesis in Israeli patients are poorly defined. METHODS During the study period we identified all adult patients who were referred to gastric emptying scintigraphy (GES) for the evaluation of dyspeptic symptoms. Of those, 193 patients who were referred to GES from our institution were retrospectively identified (76 (39%) males, mean age 60.2 ± 15.6 years). Subjects were grouped according to gastric half-emptying times (gastric T 1/2). Demographic and clinical data were extracted from electronic medical records or by a phone interview. KEY RESULTS Gastric emptying half-times were normal (gastric T 1/2 0-99 min) in 101 patients, abnormal (gastric T 1/2 100-299 min) in 67 patients, and grossly abnormal (gastric T 1/2 ≥ 300 min) in 25 patients. Vomiting and dysphagia, but neither early satiety nor bloating, correlated with delayed gastric emptying. Diabetes was associated with grossly abnormal gastric T 1/2. Idiopathic gastroparesis was associated with a younger age at GES. No correlation was observed between gastric T 1/2 values and gender, smoking, H. pylori infection, HBA1C, or microvascular complication of diabetes. CONCLUSIONS INFERENCES: Vomiting and dysphagia are predictive of delayed gastric emptying in both diabetic and nondiabetic subjects. Diabetes is associated with more severe gastroparesis.
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Affiliation(s)
- Doron Boltin
- Department of Gastroenterology, Rabin Medical Center, Beilinson Hospital, 39 Jabotinski Street 49100, Petach Tikva, Israel
- *Doron Boltin:
| | - Ibrahim Zvidi
- Department of Gastroenterology, Rabin Medical Center, Beilinson Hospital, 39 Jabotinski Street 49100, Petach Tikva, Israel
| | - Adam Steinmetz
- Department of Nuclear Medicine, Rabin Medical Center, Beilinson Hospital, Israel
| | - Hanna Bernstine
- Department of Nuclear Medicine, Rabin Medical Center, Beilinson Hospital, Israel
| | - David Groshar
- Department of Nuclear Medicine, Rabin Medical Center, Beilinson Hospital, Israel
| | - Yuval Nardi
- Department of Biostatistics, Rabin Medical Center, Beilinson Hospital, Israel
| | - Mona Boaz
- Epidemiology Unit, Edith Wolfson Medical Center, Holon and the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Yaron Niv
- Department of Gastroenterology, Rabin Medical Center, Beilinson Hospital, 39 Jabotinski Street 49100, Petach Tikva, Israel
| | - Ram Dickman
- Department of Gastroenterology, Rabin Medical Center, Beilinson Hospital, 39 Jabotinski Street 49100, Petach Tikva, Israel
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Ahmed K, Lal Y. Unusual case of gastroparesis leading to severe gastromegaly with demyelinating disease as a rare cause. S D Med 2013; 66:467-469. [PMID: 24383263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Gastroparesis is an entity of symptomatic abnormal gastric emptying, with diabetes mellitus, postsurgical and idiopathic etiologies accounting for majority of the cases. CASE REPORT We report the case of a young African American female, who presented with abdominal discomfort, inability to tolerate a regular diet and intermittent episodes of numbness, tingling and cramps in her extremities. CT scan of the abdomen and pelvis showed a massively distended stomach, compressing the intestines and liver. A gastric emptying study revealing markedly worsened gastroparesis. Severe gastroparesis causing massive gastromegaly secondary to multiple sclerosis was diagnosed. CONCLUSION This case illustrates severe gastromegaly that is rarely seen to this extent and identifies multiple sclerosis (MS) as a rare cause of gastroparesis. MS should be considered in the differential diagnosis of gastroparesis in appropriate clinical settings.
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Affiliation(s)
- Kabir Ahmed
- Division of Internal Medicine, Sanford School of Medicine, the University of South Dakota, USA
| | - Yasir Lal
- Division of Internal Medicine, Avera McKennan Hospital & University Health Center, USA
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35
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36
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Tavakkoli A, Sayed BA, Talley NJ, Moshiree B. Acid and non-acid reflux in patients refractory to proton pump inhibitor therapy: Is gastroparesis a factor? World J Gastroenterol 2013; 19:6193-6198. [PMID: 24115816 PMCID: PMC3787349 DOI: 10.3748/wjg.v19.i37.6193] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 07/14/2013] [Accepted: 07/19/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine whether an increased number and duration of non-acid reflux events as measured using the multichannel intraluminal impedance pH (MII-pH) is linked to gastroparesis (GP).
METHODS: A case control study was conducted in which 42 patients undergoing clinical evaluation for continued symptoms of gastroesophageal reflux disease (both typical and atypical symptoms) despite acid suppression therapy. MII-pH technology was used over 24 h to detect reflux episodes and record patients’ symptoms. Parameters evaluated in patients with documented GP and controls without GP by scintigraphy included total, upright, and supine number of acid and non-acid reflux episodes (pH < 4 and pH > 4, respectively), the duration of acid and non-acid reflux in a 24-h period, and the number of reflux episodes lasting longer than 5 min.
RESULTS: No statistical difference was seen between the patients with GP and controls with respect to the total number or duration of acid reflux events, total number and duration of non-acid reflux events or the duration of longest reflux episodes. The number of non-acid reflux episodes with a pH > 7 was higher in subjects with GP than in controls. In addition, acid reflux episodes were more prolonged (lasting longer than 5 min) in the GP patients than in controls; however, these values did not reach statistical significance. Thirty-five patients had recorded symptoms during the 24 h study and of the 35 subjects, only 9% (n = 3) had a positive symptom association probability (SAP) for acid/non-acid reflux and 91% had a negative SAP.
CONCLUSION: The evaluation of patients with a documented history of GP did not show an association between GP and more frequent episodes of non-acid reflux based on MII-pH testing.
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37
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Anderson WD, Strayer SM. Evaluation of nausea and vomiting: a case-based approach. Am Fam Physician 2013; 88:371-379. [PMID: 24134044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In the absence of acute abdominal pain, significant headache, or recent initiation of certain medications, acute nausea and vomiting is usually the result of self-limited gastrointestinal infections. Nausea and vomiting is also a common adverse effect of radiation therapy, chemotherapy, and surgical anesthesia. Other potential diagnoses include endocrine conditions (including pregnancy), central nervous system disorders, psychiatric causes, toxin exposure, metabolic abnormalities, and obstructive or functional gastrointestinal causes. The likely cause of acute nausea and vomiting can usually be determined by history and physical examination. Alarm signs such as dehydration, acidosis caused by an underlying metabolic disorder, or an acute abdomen warrant additional evaluation. Based on the suspected diagnosis, basic laboratory testing may include urinalysis, urine pregnancy testing, complete blood count, comprehensive metabolic panel, amylase and lipase levels, thyroid-stimulating hormone level, and stool studies with cultures. Imaging studies include abdominal radiography, ultrasonography, and computed tomography. Computed tomography of the head should be performed if an acute intracranial process is suspected. Chronic nausea and vomiting is defined by symptoms that persist for at least one month. Patients with risk factors for gastric malignancies or alarm symptoms should be evaluated with esophagogastroduodenoscopy. If gastroparesis is suspected, a gastric emptying study is recommended. In addition to functional causes, it is also important to consider psychiatric causes when evaluating patients with chronic nausea and vomiting.
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Lahr CJ, Griffith J, Subramony C, Halley L, Adams K, Paine ER, Schmieg R, Islam S, Salameh J, Spree D, Kothari T, Kedar A, Nikitina Y, Abell T. Gastric electrical stimulation for abdominal pain in patients with symptoms of gastroparesis. Am Surg 2013; 79:457-464. [PMID: 23635579 PMCID: PMC5089064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Abdominal pain physiology may be better understood studying electrophysiology, histology, and symptom scores in patients with the symptoms of gastroparesis (Gp) treated with gastric electrical stimulation (GES). Ninety-five Gp patients' symptoms were recorded at baseline and during temporary and permanent GES. Gastric-emptying times and cutaneous, mucosal, and serosal electrogastrograms were obtained. S100-stained, full-thickness gastric biopsies were compared with autopsy controls. Sixty-eight patients reported severe pain at baseline. Severe pain patients' mean pain scores decreased with temporary GES from 3.62 to 1.29 (P < 0.001) and nonsevere pain from 1.26 to 0.67 (P = 0.01). With permanent GES, severe mean pain scores fell to 2.30 (P < 0.001); nonsevere pain changed to 1.60 (P = 0.221). Mean follow-up was 275 days. Mean cutaneous, mucosal, and serosal frequencies and frequency-to-amplitude ratios were markedly higher than literature controls. For patients with Gp overall and subdivided by etiology and severity of pain, S-100 neuronal fibers were significantly reduced in both muscularis propria layers. GES improved severe pain associated with symptoms of Gp. This severe pain is associated with abnormal electrogastrographic activity and loss of S100 neuronal fibers in the stomach's inner and outer muscularis propria and, therefore, could be the result of gastric neuropathy.
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Affiliation(s)
- Christopher J Lahr
- Department of Surgery, School of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA.
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Del Pozo E, Vaquero L, Pisabarros C, Arias L, Vivas S. [Severe gastroparesis with associated achalasia]. Gastroenterol Hepatol 2012; 35:102-103. [PMID: 22266299 DOI: 10.1016/j.gastrohep.2011.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 10/17/2011] [Accepted: 10/19/2011] [Indexed: 05/31/2023]
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40
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Sharma D, Morrison G, Joseph F, Purewal TS, Weston PJ. The role of continuous subcutaneous insulin infusion therapy in patients with diabetic gastroparesis. Diabetologia 2011; 54:2768-70. [PMID: 21842427 DOI: 10.1007/s00125-011-2282-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 07/14/2011] [Indexed: 12/27/2022]
Abstract
AIMS/OBJECTIVE To describe the effectiveness of continuous subcutaneous insulin infusion (CSII) in patients with symptomatic diabetic gastroparesis and unstable glycaemic control. METHODS Data from 26 patients with symptomatic diabetic gastroparesis and unstable glycaemic control using multiple-dose insulin (MDI) regimens, and subsequently managed with CSII, were analysed. RESULTS Following initiation of CSII, the median length of inpatient bed days associated with hospital admissions related to gastroparesis and glycaemic instability was reduced from 8.5 (range 0-144) days patient( -1) year( -1) prior to CSII to 0 (range 0-15) days patient( -1) year( -1). The median HbA(1c) reduction with CSII was 1.8% (22 mmol/mol; p < 0.05). The median capillary blood glucose (CBG) with CSII was significantly lower than with MDI: 7.7 mmol/l (range 3.8-15.4 mmol/l) vs 9.8 mmol/l (range 2.3-27 mmol/l), respectively, p < 0.001. Glycaemic variability with CSII was significantly reduced compared with MDI: CBG CV 0.37 vs CV 0.53, respectively, p < 0.001. CONCLUSIONS/INTERPRETATION CSII therapy in patients with diabetic gastroparesis results in significant improvement in glycaemic control and reductions in glycaemic variability and number of hospital inpatient bed days.
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Affiliation(s)
- D Sharma
- The Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK.
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41
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Abell TL, Johnson WD, Kedar A, Runnels JM, Thompson J, Weeks ES, Minocha A, Griswold ME. A double-masked, randomized, placebo-controlled trial of temporary endoscopic mucosal gastric electrical stimulation for gastroparesis. Gastrointest Endosc 2011; 74:496-503.e3. [PMID: 21872708 PMCID: PMC5098698 DOI: 10.1016/j.gie.2011.05.022] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 05/17/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND Endoscopically placed, temporary gastric electrical stimulation (tGES) may relieve symptoms of gastroparesis (Gp) and predict permanent gastric electrical stimulation (GES) outcomes. OBJECTIVE To measure effects of 72 hours of temporary GES on Gp symptoms. DESIGN, SETTING, AND PATIENTS From 2005 to 2006, we conducted a hospital-based, randomized, placebo-controlled, crossover trial of two consecutive, 4-day sessions (session 1 and session 2), enrolling 58 patients (11 males, 47 females; mean age 46 years) with GP symptom histories of three etiologies (idiopathic, 38; diabetes mellitus, 13; postsurgical, 7). INTERVENTION 72 continuous hours temporary GES was provided for group A during session 1, and for group B during session 2. MAIN OUTCOME MEASUREMENTS Symptoms measured daily; gastric emptying, electrogastrography, and quality of life measured at baseline and session close. RESULTS In session 1, vomiting decreased in both groups, but was greater with stimulation, resulting in a day 3 difference of -1.02 (95% CI, -1.62 to -0.42; P < .001). Scores did not return to baseline during washout; on day 4, the difference persisted at -1.08 (95% CI, -1.81 to -0.35; P = .005). In session 2, vomiting slightly decreased with stimulation and slightly increased without it; at day 8, the nonactivated group had nonsignificantly greater vomiting, 0.12 (-0.68 to 0.92; P = .762). An overall treatment effect of a slight, nonsignificant daily decrease in average vomiting scores, -0.12 (-0.26 to 0.03; P = .116), was observed by pooling stimulation effects across sessions. LIMITATIONS Missing data; potential physiological imbalances between groups. CONCLUSIONS Although overall treatment effects were not significant, differences in favor of stimulation were suggested. Barriers to observing treatment effects included a decrease in vomiting for both groups during session 1, insufficient washout, and the absence of baseline vomiting for some patients. Future studies should better define inclusion criteria, use longer washout periods, randomize by etiology and baseline physiological findings, and pursue alternative designs. ( CLINICAL TRIAL REGISTRATION NUMBER 00432835.).
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Affiliation(s)
- Thomas L Abell
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA.
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42
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Hasler WL, Wilson LA, Parkman HP, Nguyen L, Abell TL, Koch KL, Pasricha PJ, Snape WJ, Farrugia G, Lee L, Tonascia J, Unalp-Arida A, Hamilton F. Bloating in gastroparesis: severity, impact, and associated factors. Am J Gastroenterol 2011; 106:1492-502. [PMID: 21483459 PMCID: PMC3137717 DOI: 10.1038/ajg.2011.81] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Bloating is commonly reported in gastroparesis, but its prevalence, impact, and associated factors are uninvestigated. We aimed to quantify the prevalence of bloating in gastroparesis and relate its severity to clinical factors and quality of life. METHODS Survey, examination, and scintigraphy data were compared in 335 gastroparesis patients from 6 centers of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Gastroparesis Clinical Research Consortium. Bloating severity was stratified using Gastroparesis Cardinal Symptom Index (GCSI) bloating subscale scores. RESULTS Bloating severity of at least mild (GCSI ≥2) and severe (GCSI ≥4) grades were reported by 76 and 41% of patients, respectively. Bloating severity related to female gender (P<0.0001) and overweight status (P=0.04) on regression analysis and correlated with intensity of nausea, postprandial fullness, visible distention, abdominal pain, and altered bowel function (P<0.05). Disease etiology, smoking status, and gastric emptying did not relate to bloating subset (P>0.05). Disease-specific quality of life and general measures of well-being were progressively impaired with increasing bloating severity (P=0.01). Probiotic use (P=0.03) and use of antidepressants with significant norepinephrine reuptake inhibitor activity (P=0.045) use related to bloating severity; antiemetic use trended higher with worsening bloating (P=0.06). CONCLUSIONS Bloating is prevalent in gastroparesis and is severe in many individuals. Bloating severity relates to female gender, body weight, and intensity of other symptoms. The symptom impairs quality of life but is not influenced by gastric emptying rates. Antiemetics, probiotics, and antidepressants with significant norepinephrine reuptake inhibitor activity may affect reports of bloating. These findings provide insight into this underappreciated symptom of gastroparesis.
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Affiliation(s)
- William L Hasler
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA.
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Affiliation(s)
- Sujith V Cherian
- Department of Internal Medicine, SUNY Upstate Medical University, USA.
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Abstract
Diabetes is the most common cause of gastroparesis and it is now recognized that the relationship between gastric emptying and glycemia is complex and intertwined. Postprandial blood glucose levels influence, and are influenced by, the rate of gastric emptying, highlighting the difficulty in determining which is the cause and which is the effect. Novel diagnostic techniques and therapeutic strategies have been developed for the management of diabetic gastroparesis. This article highlights recent advances in knowledge about diabetic gastroparesis, with an emphasis on the inter-relationships between disordered gastric motor function on glycemia and vice versa, as well as therapeutic strategies for optimizing glycemic control using modulation of gastric emptying.
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Affiliation(s)
- Jessica Chang
- Discipline of Medicine, Royal Adelaide Hospital, University of Adelaide, South Australia 5000, Australia
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Stiefelhagen P. [Prescriptions for gastroparesis]. MMW Fortschr Med 2010; 152:19. [PMID: 20443338 DOI: 10.1007/bf03366304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Gamenthaler A, Moon N, Lucero S, Miroshnikova T, Giron JA. Colitis and gastroparesis associated with syphilis in an HIV-infected person with an undetectable viral load. AIDS Read 2009; 19:230-244. [PMID: 19642241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We present a patient with fully controlled HIV disease and a normal CD4 count whose initial treatment for syphilis failed. Biopsy-proven syphilitic colitis and severe gastroparesis developed, requiring the insertion of a temporary percutaneous gastrostomy tube. The patient responded to a course of high-dose aqueous crystalline penicillin followed by doxycycline, and he completely recovered. The occurrence of failure of conventional syphilis treatment in HIV-infected patients is discussed.
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Affiliation(s)
- Andrew Gamenthaler
- Department of Surgery, Memorial University Medical Center, Savannah, Georgia, USA
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Ciortescu I, Stanciu C. [Gastroparesis--diagnosis and treatment]. Rev Med Chir Soc Med Nat Iasi 2009; 113:330-338. [PMID: 21495337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Gastroparesis is a disorder characterized by a delay in gastric emptying of a meal in the absence of a mechanical gastric outlet obstruction. Diagnosis of gastroparesis is based on the presence of symptoms ( nausea, vomiting, postprandial abdominal fullness), excluded mechanical obstruction (endoscopy) and on objectively determined delay in gastric emptying. Gastric emptying can be assessed by scintigraphy and stable isotope breath tests. The true prevalence of gastroparesis is unknown. The aetiology of gastroparesis is diverse. In approximately one third of cases, gastroparesis is related to the presence of diabetes mellitus; one third of case is of unknown cause (idiopathic). Mild disease will respond to dietary and life style measures and prokinetics (domperidone, metoclopramide, erytromicyne). Severe disease can benefit from intrapyloric botulinum toxin injection, gastric pacing or more radical surgical interventions (partial or total gastrectomy).
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Affiliation(s)
- Irina Ciortescu
- Institutul de Gastroenterologie si Hepatologie Iaşi, Facultatea de Medicină, Universitatea de Medicină si Farmacie Gr.T. Popa Iaşi
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Tonelli AR, Drane WE, Collins DP, Nichols W, Antony VB, Olson EL. Erythromycin improves gastric emptying half-time in adult cystic fibrosis patients with gastroparesis. J Cyst Fibros 2009; 8:193-7. [PMID: 19269261 DOI: 10.1016/j.jcf.2009.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Revised: 02/13/2009] [Accepted: 02/16/2009] [Indexed: 01/13/2023]
Abstract
BACKGROUND Gastrointestinal manifestations are frequently encountered in cystic fibrosis patients. Gastroparesis evidenced by a variety of diagnostic methods has been described in patients with cystic fibrosis, predominantly in children and in individuals with advanced lung disease. The presence of gastroparesis in adult patients with different degrees of lung involvement and its response to the acute and chronic administration of macrolides have not been reported. METHODS Using the University of Florida Cystic Fibrosis database we identified symptomatic patients who had gastroparesis confirmed by a prolonged half-time during gastric emptying scintigraphy. RESULTS Of 86 cystic fibrosis patients, periodically followed in our institution, we found five who had classical symptoms and prolonged gastric emptying half-time. Age 25.2+/-8 years, 80% females, BMI 22+/-9 kg/m(2), HbA1c 5.8+/-0.6 g/dl, FEV1 53.2+/-15% of predicted. Gastric emptying half-time was 191.4+/-91.4 min (range 100-300 min) and decreased to 12.2+/-6 min (range 5-20 min) after IV administration of erythromycin (p=0.043). Patients were followed up for 3+/-2.1 years. All patients but one, who was taking opiods, had good clinical response to PO macrolides. CONCLUSIONS Gastroparesis occurs in patients with cystic fibrosis, even in patients with relatively preserved lung function and in those without cystic-fibrosis related diabetes. Macrolides may be an effective therapy in cystic fibrosis patients with gastroparesis when administered acutely or chronically.
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Affiliation(s)
- Adriano R Tonelli
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, Florida, United States.
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Asai S, Katabami T, Obi N, Matsui T, Kato H, Obi R, Ogawa Y, Kawata T, Takama H, Ohta A, Tanaka Y. No ghrelin response to oral glucose in diabetes mellitus with gastroparesis. Endocr J 2009; 56:79-87. [PMID: 18946177 DOI: 10.1507/endocrj.k08e-169] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
To investigate the role of ghrelin, an endogenous ligand of the growth hormone secretagogue receptor, in diabetic gastroparesis, we evaluated the plasma ghrelin profile during the oral glucose tolerance test in 55 patients with diabetes (men/women: 36/19, mean +/- SE of age: 55.1 +/- 1.7 years) with or without gastroparesis (diagnosed by the (13)C-acetate breath test). We also further examined cardiac autonomic neuropathy by assessing 24-hour variation of the R-R interval in randomly selected 32 patients with diabetes (men/women: 23/9, mean +/- SE of age: 54.2 +/- 2.5 years), and evaluated the influence of autonomic neuropathy on ghrelin. The fasting plasma ghrelin level was significantly lower in diabetes mellitus with gastroparesis than in healthy controls (7.9 +/- 0.7 fmol/ml versus 16.6 +/- 5.3 fmol/ml, p = 0.006). Patients with diabetes with gastroparesis showed no decrease of plasma ghrelin after glucose loading, unlike patients without gastroparesis or healthy controls. Diabetes mellitus with autonomic neuropathy, but not those without it, also showed no decrease of plasma ghrelin after glucose loading. Diabetic gastroparesis may be related to ghrelin-associated neurohormonal abnormalities, but the pathophysiological meaning of this abnormal ghrelin response needs further clarification.
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Affiliation(s)
- Shiko Asai
- Department of Internal Medicine, Division of Metabolism and Endocrinology, St. Marianna University School of Medicine, Kawasaki, Japan
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