BACKGROUND Gastroparesis is a chronic motility disorder characterized by delayed gastric emptying in the absence of mechanical obstruction.Patients with refractory gastroparesis often require enteral nutrition support...BACKGROUND Gastroparesis is a chronic motility disorder characterized by delayed gastric emptying in the absence of mechanical obstruction.Patients with refractory gastroparesis often require enteral nutrition support,but traditional feeding methods such as nasojejunal tubes and percutaneous gastrojejunostomy tubes have significant limitations including frequent displacement,infection,and impact on quality of life.AIM To explore patients’experience post insertion of laparoscopic Roux-en-Y jejunostomy in a cohort of eight adult patients with idiopathic gastroparesis.METHODS Eight patients with idiopathic gastroparesis who underwent Roux-en-Y jejunostomy placement between 2019-2022 were interviewed about their pre-and post-procedure experiences.The procedure involves creating a jejunal limb anastomosed to the proximal jejunum in a Y-configuration,with the limb brought to the abdominal wall for feeding tube insertion.This is designed to reduce leakage by diverting intestinal contents away from the stoma.Topics included symptoms,nutrition,quality of life,and comparison to previous feeding methods.RESULTS Post-procedure,all patients reported improvements in nausea/vomiting,and 87.5%noted reduced abdominal pain.Weight stabilized and oral intake improved in 75%of patients.Most(87.5%)described improved social confidence,increased energy,and better work/school functioning.Three patients(37.5%)eventually maintained adequate oral nutrition without jejunostomy.Minor complications included leakage(37.5%)and hypergranulation tissue.Half the cohort used supplemental gastric venting.Most patients(87.5%)preferred Roux-en-Y jejunostomy over previous feeding tubes and would undergo the procedure again.CONCLUSION Despite some challenges,Roux-en-Y jejunostomy led to notable improvements in symptoms,nutrition,and quality of life for most patients with refractory gastroparesis.It may be a viable option for long-term enteral nutrition support in carefully selected patients.Further research is needed to optimize patient selection and manage complications.展开更多
To systematically review literature addressing three key psychologically-oriented controversies associated with gastroparesis.METHODSA comprehensive search of PubMed, CINAHL, and PsycINFO databases was performed to id...To systematically review literature addressing three key psychologically-oriented controversies associated with gastroparesis.METHODSA 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.RESULTSPrevalence 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.CONCLUSIONGastroparesis is associated with significant psychological distress and poor quality of life. Recommendations for future studies and the development of psychological interventions are provided.展开更多
文摘BACKGROUND Gastroparesis is a chronic motility disorder characterized by delayed gastric emptying in the absence of mechanical obstruction.Patients with refractory gastroparesis often require enteral nutrition support,but traditional feeding methods such as nasojejunal tubes and percutaneous gastrojejunostomy tubes have significant limitations including frequent displacement,infection,and impact on quality of life.AIM To explore patients’experience post insertion of laparoscopic Roux-en-Y jejunostomy in a cohort of eight adult patients with idiopathic gastroparesis.METHODS Eight patients with idiopathic gastroparesis who underwent Roux-en-Y jejunostomy placement between 2019-2022 were interviewed about their pre-and post-procedure experiences.The procedure involves creating a jejunal limb anastomosed to the proximal jejunum in a Y-configuration,with the limb brought to the abdominal wall for feeding tube insertion.This is designed to reduce leakage by diverting intestinal contents away from the stoma.Topics included symptoms,nutrition,quality of life,and comparison to previous feeding methods.RESULTS Post-procedure,all patients reported improvements in nausea/vomiting,and 87.5%noted reduced abdominal pain.Weight stabilized and oral intake improved in 75%of patients.Most(87.5%)described improved social confidence,increased energy,and better work/school functioning.Three patients(37.5%)eventually maintained adequate oral nutrition without jejunostomy.Minor complications included leakage(37.5%)and hypergranulation tissue.Half the cohort used supplemental gastric venting.Most patients(87.5%)preferred Roux-en-Y jejunostomy over previous feeding tubes and would undergo the procedure again.CONCLUSION Despite some challenges,Roux-en-Y jejunostomy led to notable improvements in symptoms,nutrition,and quality of life for most patients with refractory gastroparesis.It may be a viable option for long-term enteral nutrition support in carefully selected patients.Further research is needed to optimize patient selection and manage complications.
文摘To systematically review literature addressing three key psychologically-oriented controversies associated with gastroparesis.METHODSA 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.RESULTSPrevalence 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.CONCLUSIONGastroparesis is associated with significant psychological distress and poor quality of life. Recommendations for future studies and the development of psychological interventions are provided.
