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10 pages, 1271 KiB

Open AccessArticle

Comparison of the Status of Interstitial Cells of Cajal in the Smooth Muscle of the Antrum and Pylorus in Diabetic Male and Female Patients with Severe Gastroparesis

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Gastrointest. Disord. 2020, 2(3), 236-245; https://doi.org/10.3390/gidisord2030023 - 11 Aug 2020

Cited by 2 | Viewed by 1973

Abstract

Females dominate in the area of gastroparesis (GP), making up to 70–80% of these patients. One attractive hypothesis is that females have less smooth muscle reserve and thus less resilience to recover from an insult. Our aim was to investigate if there are [...] Read more.

Females dominate in the area of gastroparesis (GP), making up to 70–80% of these patients. One attractive hypothesis is that females have less smooth muscle reserve and thus less resilience to recover from an insult. Our aim was to investigate if there are gender differences in the number of interstitial cells of Cajal (ICC) in the antral and pyloric smooth muscle of diabetic (DM) patients with severe gastroparesis refractory to standard medical management. Full thickness antral and pyloric biopsies were obtained during surgery to implant a gastric electrical stimulation system and perform a pyloroplasty. Thirty-eight DM patients (66% females, n = 25; mean age 44) who failed medical therapies provided antral biopsies. Pyloric tissue samples were also collected from 29 of these patients (65% females, n = 19). Tissues were stained with H&E and c-Kit for the presence of ICC. ICC depletion was defined as less than 10 cells/HPF. In the antrum, 40% of females had significant ICC depletion, similar to 38% in males. In the pylorus, 68% of females had depletion of ICC, compared to 80% depletion in males. When combining both antral and pyloric smooth muscle regions, ICC depletion was similar in males (40%) when compared to females (38%). In diabetic patients with severe GP, females and males showed similar degrees of reduction in antral ICC, while more males had depletion of pyloric smooth muscle ICC compared to their female counterparts. Future larger studies should focus on whether differences in other smooth muscle biomarkers can be identified between males and females. Full article

(This article belongs to the Special Issue Gastroparesis)

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6 pages, 1632 KiB

Open AccessArticle

Efficacy and Safety of Dor Fundoplication in Patients with Severe Gastroparesis and Refractory Gastroesophageal Reflux Disease

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Gastrointest. Disord. 2020, 2(2), 134-139; https://doi.org/10.3390/gidisord2020013 - 07 May 2020

Cited by 2 | Viewed by 2972

Abstract

Poor quality of life is a major problem in patients with gastroesophageal reflux disease (GERD). Delayed gastric emptying in patients with severe gastroparesis (GP) worsens GERD symptoms and particularly nocturnal heartburn and regurgitation refractory to medical therapy. With limited therapeutic options, a Nissen [...] Read more.

Poor quality of life is a major problem in patients with gastroesophageal reflux disease (GERD). Delayed gastric emptying in patients with severe gastroparesis (GP) worsens GERD symptoms and particularly nocturnal heartburn and regurgitation refractory to medical therapy. With limited therapeutic options, a Nissen fundoplication may be considered but concerns for this surgery are inability to wretch and vomit post-op, increasing the risk of wrap rupture. Dor fundoplication, a 180–200 degree anterior wrap, may improve sphincter competency and provide symptom relieve while minimizing these concerns and avoiding vagal nerve damage. Full article

(This article belongs to the Special Issue Gastroparesis)

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12 pages, 543 KiB

Open AccessArticle

Endoscopic Botulinum Toxin for Gastroparesis: Results of a Retrospective Series

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Fabiënne G. M. Smeets

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Gastrointest. Disord. 2019, 1(1), 164-175; https://doi.org/10.3390/gidisord1010012 - 14 Dec 2018

Cited by 2 | Viewed by 3496

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 [...] Read more.

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. Full article

(This article belongs to the Special Issue Gastroparesis)

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Review

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8 pages, 889 KiB

Open AccessReview

Per Oral Pyloromyotomy for Gastroparesis: A Systematic Review of the Current Literature and Future Recommendations

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Luis O. Chavez

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Gian Galura

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Alejandro Robles

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Marco A. Bustamante-Bernal

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Richard McCallum

Gastrointest. Disord. 2020, 2(4), 415-422; https://doi.org/10.3390/gidisord2040038 - 26 Oct 2020

Cited by 2 | Viewed by 2621

Abstract

Background: Gastric per oral endoscopic myotomy (GPOEM) was developed as a therapeutic option for gastroparesis after the pylorus was identified as a key target for gastroparesis management. This study includes a systematic literature review of studies in which GPOEM was utilized as therapy [...] Read more.

Background: Gastric per oral endoscopic myotomy (GPOEM) was developed as a therapeutic option for gastroparesis after the pylorus was identified as a key target for gastroparesis management. This study includes a systematic literature review of studies in which GPOEM was utilized as therapy for gastroparesis. Methods: A literature search was conducted in three databases (MEDLINE, Scopus and Embase) of articles that included the keywords “GPOEM”, “Gastric per oral endoscopy myotomy” or “per oral pyloromyotomy” and “Gastroparesis” in the abstract or title. The search covered articles published until 29 February 2020. Results: A total of 139 articles were identified. Only 15 articles met the final inclusion criteria and were retrieved for qualitative data synthesis. Conclusion: GPOEM for gastroparesis is shown to have a high success rate among the studies but data interpretations are limited because of small sample sizes and short follow-up. Subjective and objective data prior to and post-GPOEM will be mandatory to establish credibility. The procedure is technically feasible and safe based on the limited studies available. Full article

(This article belongs to the Special Issue Gastroparesis)

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10 pages, 259 KiB

Open AccessReview

Gastroparesis in the Pediatric Patient: Children Are Not Little Adults

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Peter L. Lu

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Carlo Di Lorenzo

Gastrointest. Disord. 2020, 2(2), 86-95; https://doi.org/10.3390/gidisord2020008 - 22 Apr 2020

Cited by 5 | Viewed by 7327

Abstract

Although the definition of gastroparesis in children is the same as in adults, there are key differences between gastroparesis in these two populations in presentation, diagnosis, treatment and outcomes. Infants and younger children with gastroparesis tend to be male, present with vomiting as [...] Read more.

Although the definition of gastroparesis in children is the same as in adults, there are key differences between gastroparesis in these two populations in presentation, diagnosis, treatment and outcomes. Infants and younger children with gastroparesis tend to be male, present with vomiting as their primary symptom and are more likely to experience the resolution of their symptoms over time. Adolescents with gastroparesis tend to be female, present with abdominal pain as their primary symptom and have a less favorable short- and medium-term outcome, sharing some similarities with adults with gastroparesis. Despite the fact that validated diagnostic criteria for gastroparesis are lacking in infants and younger children, these age groups make up nearly half of children with gastroparesis in some studies. The diagnosis and treatment of children with gastroparesis has thus far relied heavily on research studies performed in adults, but it is becoming increasingly clear that gastroparesis in children is a distinct entity and there are limitations to the applicability of data obtained from adults to the care of children. Full article

(This article belongs to the Special Issue Gastroparesis)

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13 pages, 1832 KiB

Open AccessReview

Status of Brain Imaging in Gastroparesis

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Zorisadday Gonzalez

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Richard W. McCallum

Gastrointest. Disord. 2020, 2(2), 58-70; https://doi.org/10.3390/gidisord2020006 - 09 Apr 2020

Viewed by 5900

Abstract

The pathophysiology of nausea and vomiting in gastroparesis is complicated and multifaceted involving the collaboration of both the peripheral and central nervous systems. Most treatment strategies and studies performed in gastroparesis have focused largely on the peripheral effects of this disease, while our [...] Read more.

The pathophysiology of nausea and vomiting in gastroparesis is complicated and multifaceted involving the collaboration of both the peripheral and central nervous systems. Most treatment strategies and studies performed in gastroparesis have focused largely on the peripheral effects of this disease, while our understanding of the central nervous system mechanisms of nausea in this entity is still evolving. The ability to view the brain with different neuroimaging techniques has enabled significant advances in our understanding of the central emetic reflex response. However, not enough studies have been performed to further explore the brain–gut mechanisms involved in nausea and vomiting in patients with gastroparesis. The purpose of this review article is to assess the current status of brain imaging and summarize the theories about our present understanding on the central mechanisms involved in nausea and vomiting (N/V) in patients with gastroparesis. Gaining a better understanding of the complex brain circuits involved in the pathogenesis of gastroparesis will allow for the development of better antiemetic prophylactic and treatment strategies. Full article

(This article belongs to the Special Issue Gastroparesis)

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15 pages, 3533 KiB

Open AccessReview

Role of Gastric Electrical Stimulation in the Treatment of Gastroparesis

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Amal Shine

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Thomas L. Abell

Gastrointest. Disord. 2020, 2(1), 12-26; https://doi.org/10.3390/gidisord2010003 - 31 Jan 2020

Cited by 10 | Viewed by 3138

Abstract

Introduction: Gastric electrical stimulation (GES) is a surgically implanted treatment option for drug refractory gastroparesis syndromes. Evidence supporting use of GES and the pathophysiology of gastroparesis syndromes is not widely known. We conducted a descriptive review to elucidate the pathophysiology of gastroparesis syndromes, [...] Read more.

Introduction: Gastric electrical stimulation (GES) is a surgically implanted treatment option for drug refractory gastroparesis syndromes. Evidence supporting use of GES and the pathophysiology of gastroparesis syndromes is not widely known. We conducted a descriptive review to elucidate the pathophysiology of gastroparesis syndromes, with particular focus on gastrointestinal neuromodulation and the known mechanisms of action of GES. Methods: A descriptive review of PubMed, Web of Science and Cochrane Library was conducted using the keywords gastric electrical stimulation, gastroparesis, nausea, vomiting, neuromodulation, gastroparesis syndromes, central nervous system, gastric pacing and electrical stimulation. Results: 1040 potentially relevant articles were identified, of which 34 were included. These studies explored various central and peripheral effects of GES, as well as its effect on quality of life, hospital stay, mortality and health-related costs. Conclusion: Although evidence supporting gastrointestinal (GI) electrical stimulation and GI neuromodulation use is not widely known, GES does seem to offer significant improvement in symptom control, quality of life and other effects to many patients. GES exerts its effects through multiple central and peripheral mechanisms and has potential to modify the natural history of disease. Future work on gastroparetic syndromes and their treatment might be better focused in terms of pathophysiologic mechanisms. Improving outcomes with specific neuromodulation therapies, like GES, may offer improvements in health for many patients with refractory upper gastrointestinal symptoms. Full article

(This article belongs to the Special Issue Gastroparesis)

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12 pages, 305 KiB

Open AccessReview

Role of Gastric Emptying in Symptoms of Gastroparesis

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Asad Jehangir

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Henry P. Parkman

Gastrointest. Disord. 2019, 1(4), 391-402; https://doi.org/10.3390/gidisord1040032 - 19 Nov 2019

Cited by 13 | Viewed by 3773

Abstract

The symptoms of gastroparesis, such as nausea, vomiting, postprandial fullness, early satiety and abdominal pain, frequently impair the quality of life of the affected individuals. The diagnosis of gastroparesis is made after structural etiologies are ruled out and an assessment of gastric function [...] Read more.

The symptoms of gastroparesis, such as nausea, vomiting, postprandial fullness, early satiety and abdominal pain, frequently impair the quality of life of the affected individuals. The diagnosis of gastroparesis is made after structural etiologies are ruled out and an assessment of gastric function shows delayed gastric emptying. The role of the delay in gastric emptying in the pathogenesis of symptoms of gastroparesis has been debated, with some studies suggesting an association between delayed gastric emptying and the upper gastrointestinal symptoms, while others do not. The recent literature supports the importance of using reliable methods to assess gastric emptying, as delay in gastric emptying measured on a reliable test (4-h scintigraphy or breath test) is associated with the severity of upper gastrointestinal symptoms. In addition to measuring total gastric emptying, evaluation of regional gastric retention in the proximal and distal stomach and whole gut transit to assess small intestinal and colonic transit may provide additional useful information in patients with more generalized symptoms of gastrointestinal dysmotility. Full article

(This article belongs to the Special Issue Gastroparesis)

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