Gastroparesis Research Papers - Academia.edu (original) (raw)

Background: Jejunal feeding is an attractive means for delivering nutrients to critically ill patients. Nasojejunal tubes may have different advantages and disadvantages that may have important clinical implications. Methods: To compare the suitability of 2 different nasojejunal feeding tubes (Tube A, Dobbhoff; Tube B, Freka-Trelumina) for use by endoscopists and nursing staff, a randomized, controlled, prospective trial was performed in 60 patients. The primary end point was time required for tube placement. Secondary end points were successful placement and nursing problems encountered during clinical use. Results of upper endoscopy were also recorded. Results: Placement took significantly longer with Tube A than Tube B (95% CI for median [11.5, 20.0] minutes vs. [5.5, 7.5] minutes; p < 0.001), and was less successful (73.3% vs. 90%; p = 0.18). Nursing problems occurred significantly more often with Tube A compared with Tube B (11 vs. 1; p < 0.001). Tube B stayed in place significantly longer than Tube A (37 days vs. 21 days; p = 0.034). In 45% of the cases, upper endoscopy provided a diagnosis of potential therapeutic relevance. Conclusions: Selection of a nasojejunal tube for endoscopic placement has significant implications with respect to time required for placement, duration of tube usage and the practicability for nursing staff. Diagnostic upper endoscopy performed concomitantly often reveals findings of clinical importance. (Gastrointest Endosc 2002;56:858-63.) Endoscopic placement of nasojejunal tubes: comparison of 2 different tubes

- by
- •
- Comparative Study, Instrumentation, Prospective studies, Clinical Sciences

Tabla 2 Causas principales de gastroparesia Diabetes mellitus Idiopática Posquirúrgica: J Resección gástrica parcial/vagotomía J Int. Nissen Patología neurológica: J Tumor cerebral J Enf. de Parkinson Enfermedades del colágeno: J Esclerodermia J LES Trastornos endocrino-metabólicos: J Insuficiencia renal J Patología tiroidea Paraneoplásico Fármacos: opioides, tricíclicos, octreótido J. Serra

- by Jordi Serra
- •
- Dyspepsia, Gastric Emptying, Molecular Structure, Sulpiride

Background A gastrostomy placement is frequently performed in pediatric patients who require long-term enteral tube feeding. Unfortunately, postoperative complications such as leakage, feeding intolerance, and gastroesophageal reflux frequently occur. These complications may be due to postoperative gastric dysmotility. Our aim was to evaluate the effect of gastrostomy placement on gastric emptying in children. Methods A prospective study was performed including 50 children undergoing laparoscopic gastrostomy. Before and 3 months after gastrostomy, assessment was performed using the 13 C-octanoic acid breath test, 24-h pH monitoring, and reflux symptom questionnaires. Results Gastric half-emptying time significantly increased from the 57th to the 79th percentile (p < 0.001) after gastrostomy (p < 0.001). Fifty percent of patients with normal preoperative gastric emptying develop delayed gastric emptying (DGE, P > 95) after gastrostomy (p = 0.01). Most patients (≥75%) with leakage and/or feeding intolerance after gastrostomy had DGE after operation. A decrease in gastric emptying was associated with an increase in esophageal acid exposure time (r = 0.375, p < 0.001). Conclusion Gastrostomy placement in children causes a significant delay in gastric emptying. Postoperative DGE was associated with gastroesophageal reflux and was found in most patients with postoperative leakage and feeding intolerance. These negative physiologic effects should be taken into account when considering gastrostomy placement in children.

- by David Van Der Zee
- •
- Prospective studies, Child, Infant, Clinical Sciences

Background-Symptoms of gastroparesis based on patient recall correlate poorly with gastric emptying. Aim-To determine if symptoms recorded during gastric emptying scintigraphy (GES) correlate with gastric emptying and with symptoms based on patient recall. Methods-Patients undergoing GES completed the Patient Assessment of GI Symptoms (PAGI-SYM) assessing symptoms over the prior 2 weeks and a questionnaire for which patients graded six symptoms during GES. A Symptom Severity Index (SSI) represented the mean of six symptoms at each time point. Key Results-560 patients underwent GES for clinical evaluation of symptoms. Of 388 patients included in the study: 232 patients had normal GES (NGES), 156 delayed GES (DGES), and 11 rapid GES (RGES). SSI increased pre-to postprandial for each group: NGES: 0.51±0.07 to 0.92±0.03, DGES: 0.60±0.09 to 1.13±0.05, and RGES: 0.56±0.12 to 0.79±0.13. DGES patients had a higher postprandial SSI than NGES patients (1.13±0.05 vs 0.92±0.03, p<0.05). Postprandial symptoms of stomach fullness (1.9±0.12 vs 1.5±0.09; p=0.011), bloating (1.4±0.11 vs 1.1±0.09; p =0.033), and abdominal pain (1.1±0.08 vs 0.7±0.12; p=0.012) were higher in DGES than NGES. Symptom severity based on PAGI-SYM for 2 weeks prior to GES correlated with symptoms during the test for nausea (NGES r=0.61, DGES r=0.70), stomach fullness (NGES r=0.47, DGES r=0.60), and bloating (NGES r=0.62, DGES r=0.66). Conclusions & Inferences-Stomach fullness, bloating, and abdominal pain recorded during GES were higher in patients with delayed gastric emptying than in patients with normal gastric emptying. Symptoms recorded during GES correlated with those during daily life by patient recall.

- by Umar Khayyam
- •
- Nausea, Clinical Sciences, Questionnaires, Abdominal Pain

To develop a clinically relevant and easy to use pain assessment tool for individuals with advanced dementia that has adequate psychometric properties. Design: Instrument development study using expert clinicians and behavioral observation methods. Measurement of sensitivity of the instrument to detect the effects of analgesic medications in a quality improvement activity. Setting: Inpatient dementia special care units in a Veterans Administration Medical Center. Participants: Nineteen residents with advanced dementia who were aphasic or lacked the ability to report their degree of pain and six professional staff members. Additionally, data from medical records of 25 residents who were receiving pain medications as required (PRN) were collected. Measurements: Based on the literature review, related assessment tools and consultation with expert clinicians, a five-item observational tool with a range of 0 to 10 was developed. The tool, Pain Assessment in Advanced Dementia (PAINAD), was compared with the Discomfort Scale and two visual analog scales (discom-fort and pain) by trained raters/expert clinicians in the development study, and used for detection of analgesic efficacy in a quality improvement activity. Results: Adequate levels of interrater reliability were achieved between dyads of the principal investigator with each clinical research rater and between two raters. PAINAD had satisfactory reliability by internal consistency with a one factor solution. PAINAD and the Discomfort Scale-Dementia of Alzheimer Type (DS-DAT) were significantly correlated, providing evidence of construct validity. PAINAD detected statistically significant difference between scores obtained before and after receiving a pain medication. Conclusions: The PAINAD is a simple, valid, and reliable instrument for measurement of pain in noncommunicative patients. Since the patient population used for its development and testing was limited to a relatively small number of males, further research is needed before it can be universally recommended.

- by Christine de la Loge
- •
- Assessment, Adolescent, Europe, Construct Validity

Gastroesophageal reflux disease is thought to predispose to adverse lung allograft outcomes. However, little is known about the burden of gastroesophageal reflux (GER) and gastroparesis in pediatric patients. In this study we describe the burden of reflux and gastroparesis in children undergoing lung transplant, and evaluates their impact on allograft survival and rejection incidence. This study is a retrospective analysis of pediatric lung transplant recipients who had combined pH and multichannel intraluminal impedance testing (pH-MII) and gastric-emptying scans (GES). Hazard ratios with 95% confidence intervals (CIs) estimated from Cox proportional hazard models were used to examine the associations between reflux parameters and adverse allograft outcomes. Covariates considered in the multivariate analysis included abnormal pH-MII testing, abnormal GES and Nissen fundoplication status. Kaplan-Meier curves were created, with log-rank testing employed to assess differences between ...

- by Daisy Liu
- •
- Adolescent, Medicine, Child, Infant

Patient safety is one of the key components of nursing care for cancer cases. Valid and reliable context-based instruments are necessary for accurate evaluation of patient safety in oncology units. The aim of the present study was to develop and evaluate the psychometric properties of the Patient Safety Violation Scale in medical oncology units in Iran. In this methodological study, a pool of 58 items was generated through reviewing the existing literature. The validity of the 58-item scale was assessed through calculating impact score, content validity ratio, and content validity index for its items as well as conducting exploratory factor analysis. The reliability of the scale was evaluated by assessing its internal consistency and test- retest stability. Study sample consisted of 300 oncology nurses who were recruited from thirteen teaching hospitals affiliated to Tehran University of Medical Sciences, Tehran, Iran. Sixteen items were excluded from the scale due to having low imp...

- by Christine de la Loge
- •
- Assessment, Adolescent, Europe, Construct Validity
- by Allison Thorn
- •
- Nursing, Gastroenterology, Differential Diagnosis, Nausea

Gastroparesis (Gp) is a poorly understood chronic gastrointestinal medical condition for which patient reported outcomes (PRO) are lacking. Previously developed symptoms scoring has been used for several decades. Using symptoms scores as a basis for documentation, 12 years of support/focus group patient feedback from the nearly 1000 attendees were integrated with medical care and recommendations for treatment were developed. Early attenders of the support group were compared with non-attendees for illness acuity, disability, and duration and number of office phone calls. Patients cared for in an academic medical practice were assessed for patient-derived PRO symptoms, coupled with standardized Health Related Quality of Life (HRQOL) measures. Based on factors identified by the patients via support/focus groups, a diagnostic and prognostic tool was developed. The new tool utilized PRO symptoms and included provider assessments of medical illnesses as well as resource utilization. This...

(J.M.C.); a.masclee@mumc.nl (A.A.M.M.) * Correspondence: fabienne.smeets@maastrichtuniversity.nl; Tel.: +314-3387-5021 † These authors contributed equally to this work. Abstract: Beneficial effects of pyloric botulinum toxin injection have been described in a subgroup of gastroparesis patients. Our aim is to evaluate whether clinical, manometric and/or scintigraphic parameters are able to predict treatment outcome. Forty patients (67% female, age 49 (36-56) years) with decompensated gastroparesis treated with botulinum toxin were included in this retrospective analysis. Objective parameters were high-resolution antroduodenal manometry, gastric emptying rate (scintigraphy), and weight change. Subjective treatment outcome was assessed with a Global Physician Assessment Scale. Binary logistic regression analysis was performed to identify predictors for treatment outcome. Fourteen patients (35%) were symptom-responders, and 65% of patients were short-term weight-responders. For both subjective and objective treatment outcome, no differences were found in manometric and scintigraphic variables between responders and non-responders. Neither clinical nor manometric or scintigraphic variables could predict subjective and objective treatment outcome. In conclusion, symptom improvement is achieved in a subgroup of gastroparesis patients treated with endoscopic pyloric botulinum toxin. Although the majority of patients were able to maintain their baseline weight at short-term follow-up, a substantial group of patients needed nutritional interventions on long-term follow-up. However, none of the demographic, clinical, scintigraphic, or antroduodenal manometry variables were able to predict either subjective or objective treatment outcome.

- by Richard McCallum
- •
- Medicine, Esophageal pH monitoring, Clinical Sciences, Aged

Gastric myoelectrical activity can be measured by a noninvasive technique called electrogastrography where surface electrodes are placed on the epigastric area of the abdomen. The electrogastrogram (EGG) signal is by nature a nonstationary signal in terms of its frequency, amplitude and wave shape. Unlike the other methods discrete wavelet analysis (DWT) was designed for nonstationary signals. For automatic assessment of EGG, we used artificial neural networks (ANNs) that have been widely employed in pattern recognition due to their great potential of high performance, flexibility, robust fault tolerance, cost-effective functionality and capability for real-time applications. So we developed a new method for classification of EGG based on DWT and ANN.

- by Sadık Kara
- •
- Biomedical Engineering, Pattern Recognition, Adolescent, Electrocardiography

Pancreaticoduodenectomy (PD) is considered the gold standard treatment for periampullory carcinomas. This procedure presents 30%-40% of morbidity. Patients who have undergone pancreaticoduodenectomy often present perioperative malnutrition that is worse in the early postoperative days, affects the process of healing, the intestinal barrier function and the number of postoperative complications. Few studies focus on the relation between enteral nutrition (EN) and postoperative complications. Our aim was to perform a review, including only randomized controlled trial meta-analyses or well-designed studies, of evidence regarding the correlation between EN and main complications and outcomes after pancreaticoduodenectomy, as delayed gastric emptying (DGE), postoperative pancreatic fistula (POPF), postpancreatectomy hemorrhage (PPH), length of stay and infectious OPEN ACCESS Nutrients 2015, 7 3155 complications. Several studies, especially randomized controlled trial have shown that EN does not increase the rate of DGE. EN appeared safe and tolerated for patients after PD, even if it did not reveal any advantages in terms of POPF, PPH, length of stay and infectious complications.

- by Giulia Monte
- •
- Nutrition and Dietetics, Treatment Outcome, Nutrients, Risk factors

I often receive referrals for patients presenting with persistent vomiting and a background history of long-standing diabetes mellitus from my colleague endocrinologists and physicians. Once the common causes are ruled outsuch as drugs (metformin), hyper-or hypoglycaemia, diabetic ketoacidosis, infections and pancreatitismy mind inevitably turns to gastroparesis.

- by Dr Chieng Jin Yu
- •
- Gastroparesis

IMPORTANCE Gastroparesis remains a challenging syndrome to manage, with few effective treatments and a lack of rigorously controlled trials. Tricyclic antidepressants are often used to treat refractory symptoms of nausea, vomiting, and abdominal pain. Evidence from well-designed studies for this use is lacking. OBJECTIVE To determine whether treatment with nortriptyline results in symptomatic improvement in patients with idiopathic gastroparesis. DESIGN, SETTING, AND PARTICIPANTS The NORIG (Nortriptyline for Idiopathic Gastroparesis) trial, a 15-week multicenter, parallel-group, placebo-controlled, double-masked, randomized clinical trial from the National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Clinical Research Consortium (GpCRC), comparing nortriptyline with placebo for symptomatic relief in idiopathic gastroparesis. One hundred thirty patients with idiopathic gastroparesis were enrolled between March 2009 and June 2012 at 7 US academic medical centers. Patient follow-up was completed in October 2012. Inclusion criteria included delayed gastric emptying and moderate to severe symptom scores using the Gastroparesis Cardinal Symptom Index (GCSI). INTERVENTIONS Nortriptyline vs placebo. Study drug dose was increased at 3-week intervals (10, 25, 50, 75 mg) up to 75 mg at 12 weeks. MAIN OUTCOMES AND MEASURES The primary outcome measure of symptomatic improvement was a decrease from the patient's baseline GCSI score of at least 50% on 2 consecutive 3-week GCSI assessments during 15 weeks of treatment. RESULTS The primary symptomatic improvement outcome did not differ between 65 patients randomized to nortriptyline vs 65 patients randomized to placebo: 15 (23% [95% CI, 14%-35%]) in the nortriptyline group vs 14 (21% [95% CI, 12%-34%]) in the placebo group (P = .86). Treatment was stopped more often in the nortriptyline group (19 [29% {95% CI, 19%-42%}]) than in the placebo group (6 [9%] {95% CI, 3%-19%}]) (P = .007), but numbers of adverse events were not different (27 [95% CI, 18-39] vs 28 [95% CI, 19-40]) (P = .89). CONCLUSIONS AND RELEVANCE Among patients with idiopathic gastroparesis, the use of nortriptyline compared with placebo for 15 weeks did not result in improvement in overall symptoms. These findings do not support the use of nortriptyline for idiopathic gastroparesis.

- by Frank Hamilton
- •
- Treatment Outcome, JAMA, Gastroparesis, Medical and Health Sciences

The objective of this study was to assess the feasibility and safety of inserting a double-lumen gastrojejunostomy tube (GJT) after pancreaticoduodenectomy (PD) and to evaluate associated outcomes. Background: Gastroparesis is a frequent postoperative event following PD. This often necessitates prolonged gastric decompression and nutritional support. A double-lumen GJT may be particularly useful in this situation: gastric decompression may be achieved through the gastric port without a nasogastric tube; enteral feeding may be administered through the jejunal port. Methods: Thirty-six patients with periampullary tumors were randomized at the time of PD to insertion of GJT or to the routine care of the operating surgeon. Outcomes, including length of stay, complications, and costs, were followed prospectively. Results: The 2 groups had similar characteristics. Prolonged gastroparesis occurred in 4 controls (25%) and in none of the patients who had a GJT (P ϭ 0.03). Complication rates were similar in each group. Mean postoperative length of stay was significantly longer in controls compared with patients who had a GJT (15.8 Ϯ 7.8 days versus 11.5 Ϯ 2.9 days, respectively; P ϭ 0.01). Hospital charges were 82,151Ϯ56,632incontrolsand82,151 Ϯ 56,632 in controls and 82,151Ϯ56,632incontrolsand52,589 Ϯ 15,964 in the GJT group (P ϭ 0.036). Conclusions: In patients undergoing PD, insertion of a GJT is safe. Moreover, insertion of a GJT improves average length of stay. At the time of resection of periampullary tumors, GJT insertion should be considered, especially given this is a patient population in which weight loss and cachexia are frequent.

- by Alan Livingstone
- •
- Surgery, Treatment, Evolution, Medicine

The mean age of 243 IG patients studied was 41 years; 88% were female, 46% were overweight, 50% had acute onset of symptoms, and 19% reported an initial infectious prodrome. Severe delay in gastric emptying (>35% retention at 4 hours)... more

- by Richard McCallum
- •
- Depression, Gastroenterology, Communicable Diseases, Anxiety

Background Delayed gastric emptying (DGE) is a common complication following pancreaticoduodenectomy (PD). Our retrospective study aimed to evaluate the influence of enteral nutrition (EN) on DGE incidence after standard PD with antrectomy and Child reconstruction. Methods We retrospectively analyzed 275 consecutive patients who underwent standard PD between January 2000 and September 2009. Patients operated on after January 2005 received EN (EN group, n0152) until total oral alimentation. Patients operated on prior to 2005 did not receive EN (control group, n0123) and were orally fed after removing the nasogastric tube. Primary endpoint was the incidence of DGE according to the International Study Group of Pancreatic Surgery criteria. Secondary endpoints were the incidence of any other complications. Results The incidence of DGE was 26% vs. 38% (p00.04) in the EN and control groups, respectively, with 17% vs. 19% for grade B DGE (NS) and 9% vs. 19% for grade C DGE (p00.02). The differences in DGE did not significantly decrease the duration of stay (18±11 vs. 19±13 days; NS). Postpancreatectomy hemorrhage was significantly reduced in the EN group (8% vs. 20%, p00.008), with the incidence of postoperative pancreatic fistula being similar in both groups (15% vs. 12%; NS). Using multivariate analysis, EN (p00.047, OR00.559 [0.315; 0.994]), operative time (p<0.001, OR01.007 [1.003; 1.010]), and patient age (p00.014, OR01.031 [1.006; 1.057]) were independent factors affecting the incidence of DGE. Conclusions EN reduces DGE and postpancreatectomy hemorrhage after PD.

- by Laurent Sulpice
- •
- Medicine, Multivariate Analysis, Clinical Sciences, Aged

Abnormal gastric motility function could be related to gastric electrical uncoupling, the lack of electrical, and respectively mechanical, synchronization in different regions of the stomach. Therefore, non-invasive detection of the onset of gastric electrical uncoupling can be important for diagnosing associated gastric motility disorders. The aim of this study is to provide a wavelet-based analysis of electrogastrograms (EGG, the cutaneous recordings of gastric electric activity), to detect gastric electric uncoupling. Eight-channel EGG recordings were acquired from sixteen dogs in basal state and after each of two circular gastric myotomies. These myotomies simulated mild and severe gastric electrical uncoupling, while keeping the separated gastric sections electrophysiologically active by preserving their blood supply. After visual inspection, manually selected 10-minute EGG segments were submitted to wavelet analysis. Quantitative methodology to choose an optimal wavelet was derived. This "matching" wavelet was determined using the Pollen parameterization for 6-tap wavelet filters and error minimization criteria. After a wavelet-based compression, the distortion of the approximated EGG signals was computed. Statistical analysis on the distortion values allowed to significantly (p < 0.05) distinguish basal state from mild and severe gastric electrical uncoupling groups in particular EGG channels.

- by Martin Mintchev
- •
- Mathematics, Algorithms, Chemistry, Biomedical Engineering
- by Raja Kandaswamy
- •
- Clinical, Clinical Sciences, Diabetes complications, Carbonated Beverages

See related article, Camilleri M et al, on page 5 in CGH. BACKGROUND & AIMS: Idiopathic gastroparesis (IG) is a common but poorly understood condition with significant morbidity. We studied characteristics of patients with IG enrolled in the National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Clinical Research Consortium Registry. METHODS: Data from medical histories, symptom questionnaires, and 4-hour gastric emptying scintigraphy studies were obtained from patients with IG. RESULTS: The mean age of 243 patients with IG studied was 41 years; 88% were female, 46% were overweight, 50% had acute onset of symptoms, and 19% reported an initial infectious prodrome. Severe delay in gastric emptying (Ͼ35% retention at 4 hours) was present in 28% of patients. Predominant presenting symptoms were nausea (34%), vomiting (19%), an abdominal pain (23%). Women had more severe nausea, satiety, constipation, and overall gastroparesis symptoms. Patients who experienced acute-onset IG had worse nausea than those with insidious onset. Overweight patients had more bloating and gastric retention at 2 hours but less severe loss of appetite. Patients with severely delayed gastric emptying had worse vomiting and more severe loss of appetite and overall gastroparesis symptoms. Severe anxiety and depression were present in 36% and 18%, respectively. A total of 86% met criteria for functional dyspepsia, primarily postprandial distress syndrome. CONCLUSIONS: IG is a disorder that primarily affects young women, beginning acutely in 50% of cases; unexpectedly, many patients are overweight. Severe delay in gastric emptying was associated with more severe symptoms of vomiting and loss of appetite. IG is a diverse syndrome that varies by sex, body mass, symptom onset, and delay in gastric emptying.

- by Frank Hamilton
- •
- Depression, Gastroenterology, Communicable Diseases, Anxiety

Gastroparesis patients may have associated psychological distress. This study aimed to measure depression and anxiety in gastroparesis in relation to disease severity, etiology, and gastric retention. Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) scores for state (Y1) and trait (Y2) anxiety were obtained from 299 gastroparesis patients from 6 centers of the National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Clinical Research Consortium. Severity was investigator graded as grades 1, 2, or 3 and patient reported by Gastroparesis Cardinal Symptom Index (GCSI) scores. Antiemetic/prokinetic medication use, anxiolytic and antidepressant medication use, supplemental feedings, and hospitalizations were recorded. BDI, Y1, and Y2 scores were compared in diabetic vs. idiopathic etiologies and mild (≤20%) vs. moderate (>20-35%) vs. severe (>35-50%) vs. very severe (>50%) gastric retention at 4 h. BDI, Y1, and Y2 scores were greater...

- by Frank Hamilton
- •
- Depression, Gastroenterology, Anxiety, Clinical research

- by Giuseppe Damiano
- •
- Nutrition and Dietetics, Treatment Outcome, Medicine, Nutrients

Aims The impact of gastroparesis on patients from the patient's viewpoint is needed to better address treatment priorities. The aims of this study were to: (1) Delineate burdens and concerns of patients with gastroparesis; (2) investigate specific symptoms contributing to impaired quality of life (QOL) in gastroparesis. Methods The International Foundation for Functional GI Disorders gastroparesis survey questionnaire was developed to describe patients' viewpoint about their experience with gastroparesis and included Patient Assessment of Upper GI Symptoms (PAGI-SYM) and SF-36 QOL survey. Results A total of 1423 adult patients with gastroparesis completed the survey. Average duration of gastroparesis symptoms was 9.3 years with time from onset to diagnosis 5.0 years. Patients felt that they receive good information regarding treatment options from physicians, the Internet, and Facebook. Patients rated their satisfaction with available treatment for their gastroparesis as dissatisfied (33%), somewhat dissatisfied (27%), neutral (14%), somewhat satisfied (15%), and satisfied (4%). Patients felt that gastroparesis symptoms that are most important to improve with treatment are nausea, stomach pain, and vomiting. Overall, there was a decreased quality of life by SF-36. Physical health QOL score was negatively correlated with symptoms including nausea (r =-0.37), upper abdominal pain (r =-0.37), and early satiety (r =-0.37). Conclusions This large series of patients with gastroparesis describes their burdens, concerns, and QOL. Nausea, vomiting, early satiety, and abdominal pain are important symptoms for treatment. Many patients are not satisfied with current treatments, wanting specific treatments for their disorder. Interestingly, a large number of patients find out about treatments, not only from their physician, but also using the Internet including social media.

- by Tegan Gaetano
- •
- Quality of life, Adolescent, Young Adult, Clinical Sciences

Purpose: We assessed the effects of transcutaneous electrical nerve stimulation (TENS) on neurogastric functioning in scleroderma patients. Methods: Seventeen SSc patients underwent 30 min TENS treatment >10Hz at GI acupuncture points PC6 and ST36, once (acute TENS) and then after two weeks of TENS sessions for 30 min twice daily (prolonged TENS). Data collected at Visits 1 and 2 included gastric myoelectrical activity (GMA) by surface electrogastrography (EGG), heart rate variability (HRV) by surface electrocardiography (EKG), GI specific symptoms and health related SF-36 questionnaires. Plasma VIP, motilin and IL-6 levels were determined. Statistical analyses were performed by Student's t-test, Spearman Rank and p-values <0.05 were considered significant. Results: 1. Only after prolonged TENS, the percentages of normal slow waves and average slow wave coupling (especially channels 1, 2 reflecting gastric pacemaker and corpus regions) were significantly increased; 2. the percentage of normal slow waves was significantly correlated to sympathovagal balance; 3. Mean plasma VIP and motilin levels were significantly decreased after acute TENS, (vs. baseline), generally maintained in the prolonged TENS intervals. Compared to baseline, mean plasma IL-6 levels were significantly increased after acute TENS, but significantly decreased after prolonged TENS. 4. After prolonged TENS, the frequency of awakening due to abdominal pain and abdominal bloating were significantly and modestly decreased, respectively. Conclusions: In SSc patients, two weeks of daily TENS improved patient GMA scores, lowered plasma VIP, motilin and IL-6 levels and improved association between GMA and sympathovagal balance. This supports the therapeutic potential of prolonged TENS to enhance gastric myoelectrical functioning in SSc.

- by Hanaa Sallam
- •
- Treatment Outcome, Medicine, Electrocardiography, Heart rate

The aim of this study was to determine the effects and mechanism of synchronized gastric electrical stimulation (SGES) on gastric contractions and gastric emptying. The first experiment was designed to study the effects of SGES on antral contractions in four randomized sessions. Sessions 1 (control) and 2 (atropine) were performed in the fasting state, composed of three 30-min periods (baseline, stimulation, and recovery). Sessions 3 (control) and 4 (SGES performed during 2nd 20-min period) were performed in the fed state, consisting of two 20-min periods; glucagon was injected after the first 20-min recording. The second experiment was designed to study the effect of SGES on gastric emptying and consisted of two sessions (control and SGES). SGES was delivered with train duration of 0.5–0.8s, pulse frequency of 40 Hz, width of 2 ms, and amplitude of 4 mA. We found that 1) SGES induced gastric antral contractions in the fasting state. The motility index was 1.3 ± 0.5 at baseline and ...

- by Hanaa Sallam
- •
- Medicine, Biological Sciences, Dogs, Motility

We assessed the effects of transcutaneous electrical nerve stimulation (TENS) on neurogastric functioning in scleroderma patients. Seventeen SSc patients underwent 30 min TENS treatment >10Hz at GI acupuncture points PC6 and ST36, once (acute TENS) and then after two weeks of TENS sessions for 30 min twice daily (prolonged TENS). Data collected at Visits 1 and 2 included gastric myoelectrical activity (GMA) by surface electrogastrography (EGG), heart rate variability (HRV) by surface electrocardiography (EKG), GI specific symptoms and health related SF-36 questionnaires. Plasma VIP, motilin and IL-6 levels were determined. Statistical analyses were performed by Student's t-test, Spearman Rank and p-values <0.05 were considered significant. 1. Only after prolonged TENS, the percentages of normal slow waves and average slow wave coupling (especially channels 1, 2 reflecting gastric pacemaker and corpus regions) were significantly increased; 2. the percentage of normal slow w...

- by Hanaa Sallam
- •
- Treatment Outcome, Medicine, Electrocardiography, Heart rate

Gastroparesis is a serious complication of lung transplantation that can lead to weight loss, gastroesophageal reflux disease, and recurrent aspiration pneumonia. We present 2 lung allograft recipients in whom gastroparesis resolved with the use of transcutaneous electrical nerve stimulation (TENS). In both patients, severe symptoms of gastroparesis refractory to medical therapy were completely ablated after 20 and 30 days of therapy. Both patients are currently asymptomatic with a normal diet, without the use of promotility agents. Lung transplant recipients with severe gastroparesis can derive significant benefit from TENS.

Background: Ghrelin, the endogenous ligand of the growth hormone secretagogue receptor, is released from the stomach. Animal studies suggest that ghrelin stimulates gastrointestinal motor activity. Aim: To investigate the influence of ghrelin on gastric emptying rate and meal-related symptoms in idiopathic gastroparesis. Methods: In six patients with idiopathic gastroparesis, a breath test was used to measure gastric emptying rates (t 1/2) for solids and liquids after administration of saline or ghrelin 40 lg/30 min in a double-blind, randomized fashion. At each breath sampling, the patient was asked to grade the intensity of six different symptoms (epigastric pain, bloating, post-prandial fullness, nausea, belching and epigastric burning) and these were added to obtain meal-related symptom severity score. Results: Ghrelin significantly enhanced liquid emptying (t 1/2 : 86 ± 7 vs. 53 ± 6 min, P ¼ 0.02) and tended to enhance solid emptying (144 ± 45 vs. 98 ± 15 min, P ¼ 0.06). Ghrelin pre-treatment significantly decreased cumulative meal-related symptom score (196 ± 30 vs. 136 ± 23, P ¼ 0.04) and individual scores for fullness (55 ± 8 vs. 39 ± 8, P ¼ 0.02), and for pain (40 ± 8 vs. 16 ± 5, P < 0.05). Conclusions: In idiopathic gastroparesis, administration of ghrelin enhances gastric emptying and improves meal-related symptoms. These observations suggest a potential for ghrelin receptor agonists in the treatment of gastroparesis.

- by Kristin Verbeke
- •
- Treatment Outcome, Ghrelin, Human Growth Hormone, Dyspepsia

The objective of the present study was to measure gastric emptying time of solids and semisolids in dyspeptic individuals with cholecystolithiasis before and 6 months after cholecystectomy in order to determine whether cholecystectomy interferes with gastric emptying. A prospective, self-pairing study was conducted on 29 patients selected according to appropriate inclusion and exclusion criteria. Gastric emptying time of solids and semisolids was determined before and six months after laparoscopic cholecystectomy by the 13C-octanoic acid and 13C-acetate breath tests, respectively. The samples were analyzed by infrared spectrometry. The gastric retention time (lag phase) and gastric emptying half-time of solid and semisolid were determined and the results obtained before and after surgery were compared in the same patient. In addition, the effects of surgery on dyspeptic symptoms were assessed. No significant differences (p>0.05) in gastric retention time and gastric emptying half...

- by Magno Barbosa
- •
- Surgery, Gastroenterology, Treatment, Adolescent

UK PubMed Central (UKPMC) is an archive of life sciences journal literature.

- by Waldemar Uhl
- •
- Somatostatin, Survival Rate, Drainage, Postoperative Hemorrhage

Gastric electrical stimulation has been proven effective for drug-refractory gastroparesis. Placement of stimulator leads and device usually requires a laparotomy, although laparoscopic placement has also been used. To compare laparotomy with laparoscopy, we examined 36 patients, 18 undergoing laparoscopy and 18 undergoing laparotomy, matched for primary diagnosis and health resource usage. We compared baseline symptoms, length of surgery, length of postoperative hospital stay, gastric emptying, and health resources in each of the 2 groups over time, to see what variables, if any, differed. Baseline symptoms, gastric emptying, and health resource usage were similar. Operative times were also similar, but length of stay declined from a mean of 6.4 days for laparotomy to 1.1 days for laparoscopy. Long-term outcome, via symptoms, gastric emptying, and health resource utilization were comparable between the 2 groups. Laparoscopic placement of gastric electrical stimulator leads and devi...

- by Hosein Shokouh-amiri
- •
- Medicine, Follow-up studies, Length of Stay, Clinical Sciences

Background: The treatment of gastroparesis remains unsatisfactory despite prokinetic and anti-emetic drugs. Gastric electrical stimulation has been proposed as a therapeutic option. We have assessed the effect of gastric electrical stimulation on symptoms, medical treatment, body weight and gastric emptying in patients with intractable symptomatic gastroparesis in a non-placebocontrolled study. Methods: In this multicenter study, 38 highly symptomatic patients with drug-refractory gastroparesis were enrolled. Patients first received temporary electrical stimulation using percutaneous electrodes. The 33 responders to temporary stimulation then underwent surgical implantation of a permanent stimulator. Severity of vomiting and nausea was assessed before and after stimulation. Patients were reassessed 3, 6, and 12 months after permanent implantation. Results: With stimulation, 35/38 patients (97%) experienced 1 80% reduction in vomiting and nausea. This effect persisted throughout the observation period (2.9-15.6 months, 341 patient-months). Gastric emptying did not initially change, but improved in most patients at 12 months. At 1 year, the average weight gain was 5.5% and 9/14 patients initially receiving enteral or parenteral nutrition were able to discontinue it. Conclusion: Electrical stimulation of the stomach has an immediate and potent antiemetic effect. It offers a safe and effective alternative for patients with intractable symptomatic gastroparesis.

- by Gervais Tougas
- •
- Adolescent, Diabetes mellitus, Feasibility Studies, Digestion
- by Kjersti Kirkeby
- •
- Quality of life, Treatment Outcome, Adolescent, Multidisciplinary

Gastroparesis is common in surgical patients and frequently leads to the need for enteral tube feeding. Nasoenteral feeding tubes are usually placed endoscopically by gastroenterologists, but this procedure is relatively cumbersome for patients and labor-intensive for hospital staff. Electromagnetic (EM) guided bedside placement of nasoenteral feeding tubes by nurses may reduce patient discomfort, workload and costs, but randomized studies are lacking, especially in surgical patients. We hypothesize that EM guided bedside placement of nasoenteral feeding tubes is at least as effective as endoscopic placement in surgical patients, at lower costs. The CORE trial is an investigator-initiated, parallel-group, pragmatic, multicenter randomized controlled non-inferiority trial. A total of 154 patients admitted to gastrointestinal surgical wards in five hospitals, requiring nasoenteral feeding, will be randomly allocated to undergo EM guided or endoscopic nasoenteral feeding tube placement...

- by Elisabeth Mathus-vliegen
- •
- Research Design, Endoscopy, Electromagnetic Fields, Clinical Sciences

Erratic blood glucose levels can be a cause and consequence of delayed gastric emptying in patients with diabetes. It is unknown if better glycemic control increases risks of hypoglycemia or improves hemoglobin A1c levels and gastrointestinal symptoms in diabetic gastroparesis. This study investigated the safety and potential efficacy of continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) in poorly controlled diabetes with gastroparesis. Forty-five type 1 or 2 patients with diabetes and gastroparesis and hemoglobin A1c >8% from the NIDDK Gastroparesis Consortium enrolled in a 24 week open-label pilot prospective study of CSII plus CGM. The primary safety outcome was combined numbers of mild, moderate, and severe hypoglycemic events at screening and 24 weeks treatment. Secondary outcomes included glycemic excursions on CGM, hemoglobin A1c, gastroparesis symptoms, quality-of-life, and liquid meal tolerance. Combined mild, moderate, and severe hyp...

- by Frank Hamilton
- •
- Quality of life, Treatment Outcome, Adolescent, Multidisciplinary

Background Despite the relatively high prevelance of gastroparesis and functional dyspepsia, the aetiology and pathophysiology of these disorders remain incompletely understood. Similarly, the diagnostic and treatment options for these two disorders are relatively limited despite recent advances in our understanding of both disorders. Purpose This manuscript reviews the advances in the understanding of the epidemiology, pathophysiology, diagnosis, and treatment of gastroparesis and functional dyspepsia as discussed at a recent conference sponsored by the American Gastroenterological Association (AGA) and the American Neurogastroenterology and Motility Society (ANMS). Particular focus is placed on discussing unmet needs and areas for future research.

- by Frank Hamilton
- •
- Dyspepsia, Differential Diagnosis, Clinical Sciences, Gastrointestinal motility

To investigate the prevalence of impaired gastric emptying (IGE) and its relation to autonomic nervous dysfunction (AD), functional bowel syndrome, and inflammatory and serological variables in patients with primary Sjögren's syndrome (pSS). Methods. Twenty-eight patients with pSS according to the American-European Consensus Criteria were included in the study. Gastric emptying was evaluated by the octanoate breath test from which half-time (t half) and lag-time (t lag) were determined and compared with the results from 50 healthy controls. Autonomic nervous function was evaluated by 5 objective autonomic reflex tests (ART) and by the Autonomic Symptom Profile (ASP) questionnaire evaluating AD symptoms. These results were compared with previously investigated healthy ART controls and population-based ASP controls. Patients were also assessed regarding symptoms of functional bowel syndrome. Results. The t half and the t lag were significantly prolonged in patients compared to controls. Forty-three percent of patients with pSS presented signs of IGE and 29% fulfilled the criteria for gastroparesis. Significant correlations were found between t lag and increased levels of IgG (p = 0.02) and erythrocyte sedimentation rate (ESR; p = 0.01). In addition, rheumatoid factor (RF) seropositives showed objective signs of IGE to a greater extent than RF seronegatives. No associations between IGE, ART variables, ASP variables, or gastrointestinal symptoms were found. Conclusion. IGE was common in pSS. Associations with inflammatory and serological features of pSS could imply immunological mechanisms behind the IGE. Objective signs of IGE were not associated with objective signs or subjective symptoms of AD or functional bowel syndrome.

- by Per Wollmer
- •
- Rheumatology, Immunology, Autonomic Nervous System, Prospective studies

Background: Standardization of the 13 C-octanoic acid breath test is still lacking. Aim: To evaluate the accuracy of the 13 C-octanoic acid breath test using a new standardized ready-to-eat, gluten-, glucose-, and lactose-free muffin. Methods: Healthy subjects were recruited and sorted by sex and age. Patients with diabetic gastroparesis and untreated celiac disease with known gastric motility disorders were also tested with the new labelled muffin. Expired breath 13 CO 2 was analysed and t 1/2 was calculated. Results: Overall, 131 healthy subjects were enrolled. The reference range of t 1/2 was 88 ± 29 min with the value of 146 min as the upper limit of normal range. No significant difference in t 1/2 was found among subjects sorted by sex or age. The within-subject variability of t 1/2 was 17%. Mean (±standard deviation) t 1/2 values were 179 ± 50 min in patients with diabetic gastroparesis (n = 8) and 151 ± 20 min in those with untreated celiac disease (n = 11) (p ≤ 0.001 vs controls). Conclusions: A new standardized test meal simplifies the execution of the 13 C-octanoic acid breath test, is not influenced by sex or age, has low intra-individual variability, is palatable, does not cause side effects, and is able to evaluate gastric emptying in both patients and healthy controls. Moreover, it can be used in subjects with lactose intolerance, diabetes, and celiac disease.

- by Paolo Usai Satta
- •
- Food, Celiac Disease, Carbon Isotopes, Stable Isotope

Electrogastrography (EGG) is a noninvasive way to record gastric electrical activity of stomach muscle by placing electrodes on the abdominal skin. Our goal was to investigate the frequency of abnormalities of the EGG in real clinical diabetic gastroparesis patients using WT method and to compare performance of STFT and WT methods in the case of time-frequency resolution. The results showed that WT sonograms can be used to classify patients successfully as healthy or sick. And also, due to the fact that the WT method does not suffer from some intrinsic problems that affect the STFT method, one can see that the WT method can help improve the quality of the sonogram of the EGG signals.

- by Sadık Kara
- •
- Biomedical Engineering, Electrophysiology, Adolescent, Time-Frequency Analysis

- by Laura Miriel
- •
- Quality of life, Treatment Outcome, Adolescent, Multidisciplinary

Autonomous neuropathy in patients with diabetes is associated with dysmotility and abdominal discomfort. The disturbances resemble to some extent those seen in patients with functional dyspepsia. To gain further insight into the disorders, we compared patients with long-standing diabetes, patients with functional dyspepsia, and healthy individuals with respect to abdominal symptoms, width of gastric antral area, and autonomic nerve function. We investigated 42 type I diabetic outpatients by structured interview for abdominal discomfort, ultrasonography of the gastric antrum, assessment of w~gal and sympathetic nerve function by respiratory sinus arrhythmia and skin conductance, and measurement of blood sugar and HbAlc. Immediately after a standard meal of soup with meat, 21 (50%) of the 42 patients with diabetes complained of abdominal discomfort (pain, bloating, fullness), which was significantly less frequent (95c~ CI of difference 0.03-0.5) than previously seen in patients with functional dyspepsia (76%), and significantly more frequent (95% CI of difference 0.3-0.6) than that seen in healthy individuals (4%). Bloating was the most marked postprandial complain!. Mean fasting antral area was significantly wider in patients with diabetes (mean 4.9 cm-, SD 1.7) compared to healthy individuals (mean 3.5 cm-, SD 1.2), 95q: CI of difference 0.6-2.2 cm 2. Mean postprandial antral area was 14.8 cm~ (SD 4.6) in the patients with diabetes, which is insignificantly wider than in patients with functional dyspepsia (mean 13.0 cm 2, SD 4.0) but significantly wider (95% CI of difference 1.9-6.5 cm 2) than that seen in healthy individuals (mean 10.6 cruZ, SD 3.8). The mean respiratory sinus arrhythmia was 0.7 beats/rain (SD 0.7) in the patients with diabetes, which was insignificantly lower than that seen in patients with functional dyspepsia (2.1 beats/rain, SD 4.5), and significantly lower (99% CI of difference 3.8-7.1 beats/rain) compared to healthy individuals (6.2 beats/rain, SD 3.8). It is concluded that patients with diabetes have a wider gastric antrum and more discomfort after a meal than healthy individuals. Compared to patients with functional dyspepsia, patients with diabetes have a wider postprandial antrum but fewer symptoms. The very low vagal tone seen in patients with diabetes may play an important role in the pathogenesis of their gastric filotility disturbance and postprandial abdominal discomfort.

- by S. Svebak
- •
- Adolescent, Blood Glucose, Skin conductance, Heart rate

Background. Gastroparesis is a recognized complication following organ transplantation with incidences reported between 24 and 83%. Gastroparesis can complicate medical management in these patients leading to the inability to take medications and possibly chronic transplant rejection. Gastric electrical stimulation (GES) has been shown in both controlled and uncontrolled studies to reduce the frequency of nausea and vomiting and lead to weight gain in patients with gastroparesis refractory to standard medical treatment; however, there is little evidence to support the use of GES in transplant recipients. The goal was to evaluate the response of transplant patients with gastroparesis to GES and compare to nontransplant recipients.

- by Juan Cendan
- •
- Treatment Outcome, Transplantation, Clinical Sciences, Questionnaires