Gastroparesis is a severe diabetic complication,caused by a progressive multifactorial enteric neuropathy.To make an early diagnosis in patients at risk of diabetic gastroparesis is crucial for slow down its progressi...Gastroparesis is a severe diabetic complication,caused by a progressive multifactorial enteric neuropathy.To make an early diagnosis in patients at risk of diabetic gastroparesis is crucial for slow down its progression towards full-blown disease source of further complications and requesting effective,but unsafe,drugs as well as invasive surgical treatments.This aim can be achieved by detecting its first signal represented by the gastric emptying(GE)delay,by using,among the tests to measure GE,the simple,safe,reliable,and easily available one,that is realtime ultrasonography,possibly done annually.Once the GE delay has been identified,it is necessary to evaluate with endoluminal functional lumen imaging probe or manometry whether it depends on pylorospasm,which should be treated by means of non-surgical endoscopic therapies.If,instead,it depends on initial gastropathy,detected by electrogastrograhic body surface gastric mapping,it should be treated with the safest prokinetic drugs and with the newly emerging treatments,thus distancing heavy medical and surgical treatments,while waiting for future solutions.展开更多
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
BACKGROUND Diabetic gastroparesis(DGP)disrupts gastric motility.Electroacupuncture(EA)at Zusanli(ST36)may alleviate DGP symptoms via neural pathways.AIM To investigate how EA current intensities at ST36 regulate neura...BACKGROUND Diabetic gastroparesis(DGP)disrupts gastric motility.Electroacupuncture(EA)at Zusanli(ST36)may alleviate DGP symptoms via neural pathways.AIM To investigate how EA current intensities at ST36 regulate neural pathways and improve gastric motility in DGP models.METHODS A DGP model was established using intraperitoneal injection of streptozotocin.Gastrointestinal motility was measured in rats after 2 weeks of continuous EA at ST36.Current intensity was selected as 0.5 mA,1 mA,and 3 mA.Gastric electrodynamics were detected by recording and analyzing the number of gastric discharges.The gastric emptying rate and propulsion rate of the small intestine were measured to assess dynamic gastrointestinal function.Hematoxylin-eosin staining was conducted to measure histopathological changes in the gastric sinus.Reverse transcription-polymerase chain reaction was conducted to determine mRNA levels of Rho guanine nucleotide-binding protein A and Rho-associated coiled-coil forming protein kinase.Western blotting was conducted to determine the expression levels of choline acetyltransferase,tyrosine hydroxylase,Rho guanine nucleotide-binding protein A,and Rho-associated coiled-coil forming protein kinase.Immunofluorescence staining in the stomach was conducted to detect the distribution of C-kit,an interstitial cell of Cajal marker.An enzymelinked immunosorbent assay was conducted to detect serum levels of acetylcholine and norepinephrine.RESULTS Treatment with EA improved gastric emptying and gastric smooth muscle disorders in rats with DGP,mitigated pathological damage,and restored the function of interstitial cells of Cajal.In addition,different current intensities of EA affected gastrointestinal function of rats with DGP.The 0.5 mA,1 mA,and 3 mA EA groups all improved gastrointestinal function.0.5 mA EA increased acetylcholine levels by increasing protein expression of choline acetyltransferase(P<0.05),thereby upregulating vagus nerve activity and enhancing parasympathetic nerve regulation.3 mA EA increased norepinephrine levels(P<0.05)by increasing protein expression of tyrosine hydroxylase,thereby activating the sympathetic nervous pathway.1 mA coordinated the function of the vagus and sympathetic nerves to improve gastrointestinal motility.CONCLUSION EA with ST36 improved gastric motility in rats with DGP.0.5 mA EA activated the vagus nerve,while 3 mA EA regulated gastrointestinal motility by activating the sympathetic nerves.展开更多
BACKGROUND Gastroparesis may repeatedly induce diabetic ketoacidosis(DKA),and the differential diagnosis of these diseases is challenging because of similar gastrointestinal symptoms.If DKA is accompanied by gastropar...BACKGROUND Gastroparesis may repeatedly induce diabetic ketoacidosis(DKA),and the differential diagnosis of these diseases is challenging because of similar gastrointestinal symptoms.If DKA is accompanied by gastroparesis,patients present with persistent gastrointestinal symptoms without relief and may even experience recurrent DKA.Misdiagnosis results in poor treatment outcomes and prognosis.We hypothesized that biomarkers or screening tools can be identified by comparing the clinical data between DKA alone and DKA+gastroparesis to facilitate early screening.AIM To achieve early detection and diagnosis of DKA+gastroparesis to enable early treatment aimed at relieving gastrointestinal symptoms and preventing reinduction of DKA.METHODS We conducted a case-control study in which 15 patients hospitalized for DKA at the Endocrinology Department of Peking Union Medical College Hospital and diagnosed with DKA and gastroparesis between December 1999 and January 2023(DKA+gastroparesis group)were included.Then,we selected 60 DKA patients without DKA as a control group(DKA alone group)based on gender,age,disease course,and diabetes subtype in a 1:4 matching ratio.Clinical manifestations and physical and laboratory examination results were statistically compared between the groups.RESULTS The DKA+gastroparesis group was composed of nine males and six females,with a mean age of 35±11 years,while the DKA alone group included 34 males and 26 females,with a mean age of 34±17 years.In the DKA+gastroparesis group,urine ketone levels normalized,while gastrointestinal symptoms persisted despite treatment,and the tests indicated lower glycosylated hemoglobin levels(HbA1c;7.07%vs 11.51%,P<0.01),largest amplitude of glycemic excursions(5.86 vs 17.41,P<0.01),standard deviation of blood glucose(SDBG;2.69 vs 5.83,P<0.01),and coefficient of blood glucose variation(0.31 vs 0.55,P=0.014)compared with the DKA alone group.Probable gastroparesis was considered at HbA1c<8.55%.Besides,the patients in the DKA+gastroparesis group had lower body mass index(19.28 kg/m^(2) vs 23.86 kg/m^(2),P=0.02)and higher high density lipoprotein cholesterol level(2.34 mmol/L vs 1.05 mmol/L,P=0.019)compared to the DKA alone group,but no difference was observed in the remaining lipid profiles between the two groups.CONCLUSION Gastroparesis should be considered in DKA patients who fail to have improved gastrointestinal symptoms after ketone elimination and acidosis correction,particularly when the HbA1c level is<8.55%.展开更多
Diabetic Gastroparesis(DGP)is one of the common chronic complications of diabetes mellitus,with main clinical manifestations such as nausea,vomiting,postprandial fullness,and delayed gastric emptying.It seriously affe...Diabetic Gastroparesis(DGP)is one of the common chronic complications of diabetes mellitus,with main clinical manifestations such as nausea,vomiting,postprandial fullness,and delayed gastric emptying.It seriously affects patients’quality of life and nutritional status.This paper systematically sorts out the application evidence of Traditional Chinese Medicine(TCM)nursing in DGP,verifies its effectiveness from three aspects:evidence from ancient literature,modern clinical studies,and results of Meta-analyses.It also elaborates on specific nursing methods including Syndrome Differentiation-Based Nursing,characteristic technical nursing,and health guidance,analyzes the existing problems in current research,and puts forward future development directions,so as to provide a reference for the clinical promotion and standardization of TCM nursing for DGP.展开更多
BACKGROUND Diabetic gastroparesis(DGP),characterized by delayed gastric emptying and impaired motility,poses significant therapeutic challenges due to its complex neural and molecular pathophysiology.Emerging evidence...BACKGROUND Diabetic gastroparesis(DGP),characterized by delayed gastric emptying and impaired motility,poses significant therapeutic challenges due to its complex neural and molecular pathophysiology.Emerging evidence suggests that electroacupuncture(EA)at ST36 modulates gastrointestinal function;however,the precise neuromolecular pathways underlying its efficacy in DGP remain incompletely defined.AIM To elucidate the neural mechanisms underlying EA at ST36 improving DGP gastric motility through the nucleus tractus solitarius(NTS)-vagal axis.METHODS The DGP model was established via a single high-dose intraperitoneal injection of 2%streptozotocin combined with an 8-week high-sugar/high-fat diet.Interventions included EA at ST36,pharmacological modulation[choline acetyltransferase(ChAT)agonist polygalacic acid(PA)and inhibitor antagonist alpha-NETA],and subdiaphragmatic vagotomy.Post-intervention observations included body weight and blood glucose levels.Gastric emptying was evaluated using phenol red assays,gastric slow-wave recordings,and dynamic positron emission tomography-computed tomography imaging.Histopathological analysis(hematoxylineosin staining)and molecular assessments(Western blot,immunofluorescence)were performed to quantify gastric smooth muscle-associated factors[neuronal nitric oxide synthase(nNOS),cluster of differentiation 117(C-kit),stem cell factor(SCF)]and vagal targets[ChAT,α7 nicotinic acetylcholine receptor(α7nAChR)]in the ST36 acupoint region,L4-L6 spinal segments,and NTS.Gastrointestinal peptides[gastrin(Gas),motilin(MLT)and vasoactive intestinal peptide(VIP)]were measured via enzyme-linked immunosorbent assay.RESULTS The study found that EA significantly increased the rate of gastric emptying,restored the slow-wave rhythms of the stomach,and improved the architecture of the smooth muscles in the stomach.This was evidenced by a reduction in inflammatory infiltration and an increase in the expression of nNOS,C-kit,and SCF.Mechanistically,EA activated vagal targets(ChAT andα7nAChR)at ST36,transmitting signals via spinal segments L4-L6 to the NTS,subsequently regulating gastrointestinal peptides(Gas,MLT,VIP)and restoring interstitial cells of Cajal(ICCs)function via subdiaphragmatic vagal efferent pathways.It is crucial to note that subdiaphragmatic vagotomy led to the abrogation of EA-induced enhancements in gastric motility and ICC recovery,thereby confirming the indispensable role of vagal efferent signalling.CONCLUSION EA provides a novel molecular mechanism for improving gastrointestinal motility in DGP via a peripheral stimulation(ST36),spinal afferent(L4-L6),brainstem integration(NTS),vagal efferent(gastric)circuit.展开更多
Diabetic gastrointestinal neuropathy is a diabetes-related complication,associated with a complex interplay of hyperglycemic damage,autoimmune responses,oxidative stress,gastrointestinal hormones,and vascular insuffic...Diabetic gastrointestinal neuropathy is a diabetes-related complication,associated with a complex interplay of hyperglycemic damage,autoimmune responses,oxidative stress,gastrointestinal hormones,and vascular insufficiency.Patients with diabetes should be monitored and therapeutic intervention introduced to prevent neuropathy due to diabetes prior to“the point of no return”.Determining gastric bioelectrical activity by body surface gastric mapping may be a promising option to monitor diabetic gastrointestinal neuropathy.展开更多
Background: Gastroparesis is one of the complications of diabetes mellitus, and long-term gastroparesis seriously affects patients quality of life. Most of the patients can be relieved after lifestyle improvement and ...Background: Gastroparesis is one of the complications of diabetes mellitus, and long-term gastroparesis seriously affects patients quality of life. Most of the patients can be relieved after lifestyle improvement and medication, but refractory gastroparesis is difficult to relieve, and is still a challenge in clinical treatment. Aim: To report a case of a patient with diabetic nephropathy combined with refractory gastroparesis, and to analyse the mechanism, diagnosis, severity grading, treatment of refractory gastroparesis in conjunction with a review of the literature, and to investigate the causes of recurrent nausea and vomiting in diabetic nephropathy patients with refractory diabetic gastroparesis and the possible effective treatment options. Case Presentation: The patient was hospitalised for recurrent nausea and vomiting and diagnosed with diabetic nephropathy and gastroparesis. Symptoms recurred after medication and peritoneal dialysis, and the patients symptoms were relieved after multifaceted interventions. Conclusion: Diabetic nephropathy and refractory gastroparesis can both manifest as digestive tract symptoms, and in the face of this complex disease, it is necessary to analyse the various etiological factors and take comprehensive treatment measures.展开更多
Objective To explore the effect of acupuncture combined with Chinese medicine on expression of interstitial cells of Cajal（ICC）, substance P（SP） and nerve nitric oxide synthase（nNOS） in diabetic gastroparesis mi...Objective To explore the effect of acupuncture combined with Chinese medicine on expression of interstitial cells of Cajal（ICC）, substance P（SP） and nerve nitric oxide synthase（nNOS） in diabetic gastroparesis mice. Methods Eighty Kunming male mice were randomly divided into normal group（group A, 15 mice）, diabetic gastroparesis model mice group（group B, 12 mice）, acupuncture combined with Chinese medicine group（group C, 12 mice）, Chinese medicine group（group D, 13 mice） and western medicine group（group E, 13 mice）. The mice were intraperitoneally injected with steptozotocin and fed with high-fat diet-induced irregular except the normal group mice, that made mouse model of diabetic gastroparesis. And then, the ACM group were treated by acupuncture at the acupoints of Housanli（后三里 ST 36） and Zhōngw n（中脘 CV 12） combined with Chinese medicine, the CM group were only treated by Chinese medicine; the WM group were treated by domperidone and vitamin B 6. Numbers and expression of ICC, SP and n NOS were detected by immunohistochemical methods. Results After treatment, compared with normal group, ICC and SP indexes of model group were significantly reduced. Compared with model group, all indexes in ACM and CM groups were improved significantly（P0.05, P0.01）, but only the positive area and average optical density value in c-Kit and SP in WM group increased obviously（P0.05）. Compared with ACM group, no significant difference in c-Kit and SP of CM group were observed（P0.05）, but expression of nNOS were increased markedly（P0.01）. Besides, c-Kit and SP expressions of WM group were significantly induced was increased remarkably（P0.01）. Conclusion Acupuncture combined with Chinese medicine have much better therapeutic effects for diabetic gastroparesis mice, which may be due to repairing ICC damage, upregulating the expression of SP and lowering the expression of nNOS.展开更多
Objective To observe clinical efficacy of acupuncture-moxibustion combined with cupping on postsurgical gastroparesis of abdominal cancer. Methods Thirty-six cases of postsurgical gastroparesis of abdominal cancer wer...Objective To observe clinical efficacy of acupuncture-moxibustion combined with cupping on postsurgical gastroparesis of abdominal cancer. Methods Thirty-six cases of postsurgical gastroparesis of abdominal cancer were treated with （1） acupuncture at Weishiu （胃俞 BL 21）, Shangwan （上脘 CV 13）, Zhangwan （中脘CV 12）, Xiawan （下脘 CV 10） and Tianshu （天枢 ST 25） to dredging the meridians, （2） quick cupping on local area to promote gastrointestinal motility and （3） mild moxibustion at CV 12, Shanque （神阙 CV 8） and Zusanli （足三里 ST 36）. The treatment was given once a day, 5 times made a course. The clinical efficacy was assessed after two courses of treatment. Results After the treatment, 27 cases were cured, 6 cases were effective and 3 cases were failed, and the total effective rate was 91.7% （33/36）. Conclusion The acupuncture-moxibustion combined with cupping has remarkable clinical efficacy on postsurgical gastroparesis of abdominal cancer.展开更多
AIM: To assess the current clinical evidence of the effectiveness of Xiangshaliujunzi Decoction (XSLJZD) for the treatment of diabetic gastroparesis (DGP).
Objective:To investigate risk factors of gastroparesis syndrome(PGS) after abdominal nongastroduodenal operation and its prevention.Methods:Clinical data of 22 patients with PGS after abdominal non-gastroduodenal oper...Objective:To investigate risk factors of gastroparesis syndrome(PGS) after abdominal nongastroduodenal operation and its prevention.Methods:Clinical data of 22 patients with PGS after abdominal non-gastroduodenal operation was analyzed retrospectively,and compared with the patients of non-PGS after abdominal non-gastroduodenal operation during the same time.The possible influencing factors of PCS were analyzed by single factor analysis and logistic regression analysis.Results:All t3 selected factors related with PGS,including age,disease category (benign and malignant),operation time,intraoperative blood loss,postoperative analgesic pump, postoperative enteral nutrition time,postoperative parenteral nutrition time,perioperative blood glucose level,perioperative nutrition status(anaemia or lower proleinemia),pylorus obstruction before surgery,intra-abdominal infection after surgery,and spiritual factor were related with PGS.The statistical analysis showed that the difference was statistical significant(P【0.05),and gender had no correlation with PCS(P】0.05);non-conditional multivariate analysis showed that malignant tumor,perioperative nutrition status,pylorus obstruction,operation time,blood loss, intra-abdominal infection after surgery,and mental factor were significant related with PGS as dependent variable and related risk factors in single factor analysis as independent variables (P 【0.05).Conclusions:PGS is a result of multiple factors,and among these factors,malignant tumor,poor nutrition status,pylorus obstruction before surgery,longer operation—time,more blood loss,intra-abdominal infection after surgery,and mental factor are major risk factors of PGS.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
Recently, diabetic gastroparesis(DGP) has received much attention as its prevalence is increasing in a dramatic fashion and management of patients with DGP represents a challenge in the clinical practice due to the li...Recently, diabetic gastroparesis(DGP) has received much attention as its prevalence is increasing in a dramatic fashion and management of patients with DGP represents a challenge in the clinical practice due to the limited therapeutic options. DGP highlights an interrelationship between the gastric emptying and pancreatic secretory function that regulate a wide range of digestive and metabolic functions, respectively. It well documented that both gastric emptying and pancreatic secretion are under delicate control by multiple neurohormonal mechanisms including extrinsic parasympathetic pathways and gastrointestinal(GI) hormones. Interestingly, the latter released in response to various determinants that related to the rate and quality of gastric emptying. Others and we have provided strong evidence that the central autonomic nuclei send a dual output(excitatory and inhibitory) to the stomach and the pancreas in response to a variety of hormonal signals from the abdominal viscera. Most of these hormones released upon gastric emptying to provide feedback, and control this process and simultaneously regulate pancreatic secretion and postprandial glycemia. These findings emphasize an important link between gastric emptying and pancreatic secretion and its role in maintaining homeostatic processes within the GI tract. The present review deals with the neurohormonal-coupled mechanisms of gastric emptying and pancreatic secretory function that implicated in DGP and this provides new insights in our understanding of the pathophysiology of DGP. This also enhances the process of identifying potential therapeutic targets to treat DGP and limit the complications of current management practices.展开更多
Refractory diabetic gastroparesis(DGP),a disorder that occurs in both type 1 and type 2 diabetics,is associated with severe symptoms,such as nausea and vomiting,and results in an economic burden on the health care sys...Refractory diabetic gastroparesis(DGP),a disorder that occurs in both type 1 and type 2 diabetics,is associated with severe symptoms,such as nausea and vomiting,and results in an economic burden on the health care system.In this article,the basic characteristics of refractory DGP are reviewed,followed by a discussion of therapeutic modalities,which encompasses the definitions and clinical manifestations,pathogenesis,diagnosis,and therapeutic efficacy evaluation of refractory DGP.The diagnostic standards assumed in this study are those set forth in the published literature due to the absence of recognized diagnosis criteria that have been assessed by an international organization.The therapeutic modalities for refractory DGP are as follows:drug therapy,nutritional support,gastricelectrical stimulation,pyloric botulinum toxin injection,endoscopic or surgical therapy,and traditional Chinese treatment.The therapeutic modalities may be used alone or in combination.The use of traditional Chinese treatments is prevalent in China.The effectiveness of these therapies appears to be supported by preliminary evidence and clinical experience,although the mechanisms that underlie these effects will require further research.The purpose of this article is to explore the potential of combined Western and traditional Chinese medicine treatment methods for improved patient outcomes in refractory DGP.展开更多
Per oral endoscopic pyloromyotomy(POP),also known as gastric per-oral endoscopic myotomy(GPOEM),is a novel procedure with promising potential for the treatment of gastroparesis.As more data emerge and the procedure is...Per oral endoscopic pyloromyotomy(POP),also known as gastric per-oral endoscopic myotomy(GPOEM),is a novel procedure with promising potential for the treatment of gastroparesis.As more data emerge and the procedure is becoming more recognized in clinical practice,its safety and efficacy need to be carefully evaluated.Appropriate patient selection for favorable clinical success prediction after GPOEM also needs additional research.This review aims to systemically summarize the existing data on clinical outcomes of POP.Symptomatologic responses to the procedure,its adverse effects,procedural techniques,and predictive factors of clinical success are also discussed.展开更多
Gastroparesis(GP) is a common disease seen in gastroenterology practice particularly in western countries, and it may be underdiagnosed. The available drug therapies for this condition are quite disappointing. Botulin...Gastroparesis(GP) is a common disease seen in gastroenterology practice particularly in western countries, and it may be underdiagnosed. The available drug therapies for this condition are quite disappointing. Botulinum toxin type A(BT) has been found to be effective therapy in various spastic disorders of smooth muscle of gastrointestinal tract. However, the benefits of BT injections in GP have been unclear. Several retrospective and open label studies have shown clinical advantages of intrapyloric Botulinum toxin type A injections, while two small randomized trials did not show positive results. Therefore, the available published studies yielded conflicting results leading to fading out of botox therapy for GP. We recognize possible clinical benefit of BT injections without any disadvantages of this treatment. We are calling for revisiting the endoscopy guided botox therapy in refractory GP. In this review we discuss important features of these studies pointing out differences in results among them. Differences in patient selection, doses and method of administration of botox toxin in the prior studies may be the cause of conflicting results. The mechanism of action, indications, efficacy and side-effects of BT are reviewed. Finally, we recognize limited evidence to recommend BT in GP and calling attention for future research in this field since no advances in drug management had been made in the last two decades.展开更多
Gastroparesis refers to abnormal gastric motility characterized by delayed gastric emptying in the absence of mechanical obstruction. The most common etiologies include diabetes, post-surgical and idiopathic. The most...Gastroparesis refers to abnormal gastric motility characterized by delayed gastric emptying in the absence of mechanical obstruction. The most common etiologies include diabetes, post-surgical and idiopathic. The most common symptoms are nausea, vomiting and epigastric pain. Gastroparesis is estimated to affect 4% of the population and symptomatology may range from little effect on daily activity to severe disability and frequent hospitalizations. The gold standard of diagnosis is solid meal gastric scintigraphy. Treatment is multimodal and includes dietary modification, prokinetic and anti-emetic medications, and surgical interventions. New advances in drug therapy, and gastric electrical stimulation techniques have been introduced and might provide new hope to patients with refractory gastroparesis. In this comprehensive review, we discuss gastroparesis with emphasis on the latest developments; from the perspective of the practicing clinician.展开更多
AIM To examine the relationship of chronic scheduled opioid use on symptoms, healthcare utilization and employment in gastroparesis(Gp) patients. Methods Patients referred to our tertiary care academic center from May...AIM To examine the relationship of chronic scheduled opioid use on symptoms, healthcare utilization and employment in gastroparesis(Gp) patients. Methods Patients referred to our tertiary care academic center from May 2016 to July 2017, with established diagnosis or symptoms suggestive of Gp filled out the Patient Assessment of Upper GI Symptoms, abdominal pain and demographics questionnaires, and underwent gastric emptying and blood tests. They were asked about taking pain medicines and the types, doses, and duration. We used Mann Whitney U test, Analysis of Variance, Student's t test and χ2 tests where appropriate for data analyses.RESULTS Of 223 patients with delayed gastric emptying, 158(70.9%) patients were not taking opioids(Gp NO), 22(9.9%) were taking opioids only as needed, while 43(19.3%) were on chronic(> 1 mo) scheduled opioids(Gp CO), of which 18 were taking opioids forreasons that included gastroparesis and/or stomach pain. Median morphine equivalent use was 60 mg per day. Gp CO reported higher severities of many gastrointestinal symptoms compared to Gp NO including nausea(mean ± SE of mean of 4.09 ± 0.12 vs 3.41 ± 0.12, P = 0.011), retching(2.86 ± 0.25 vs 1.98 ± 0.14, P = 0.003), vomiting(2.93 ± 0.24 vs 2.07 ± 0.15, P = 0.011), early satiety(4.17 ± 0.19 vs 3.57 ± 0.12, P = 0.004), post-prandial fullness(4.14 ± 0.18 vs 3.63 ± 0.11, P = 0.022), loss of appetite(3.64 ± 0.21 vs 3.04 ± 0.13, P = 0.039), upper abdominal pain(3.86 ± 0.20 vs 2.93 ± 0.13, P = 0.001), upper abdominal discomfort(3.74 ± 0.19 vs 3.09 ± 0.13, P = 0.031), heartburn during day(2.55 ± 0.27 vs 1.89 ± 0.13, P = 0.032), heartburn on lying down(2.76 ± 0.28 vs 1.94 ± 0.14, P = 0.008), chest discomfort during day(2.42 ± 0.20 vs 1.83 ± 0.12, P = 0.018), chest discomfort at night(2.40 ± 0.23 vs 1.61 ± 0.13, P = 0.003), regurgitation/reflux during day(2.77 ± 0.25 vs 2.18 ± 0.13, P = 0.040) and bitter/acid/sour taste in the mouth(2.79 ± 0.27 vs 2.11 ± 0.14, P = 0.028). Gp CO had a longer duration of nausea per day(median of 7 h vs 4 h for Gp NO, P = 0.037), and a higher number of vomiting episodes per day(median of 3 vs 2 for Gp NO, P = 0.002). Their abdominal pain more frequently woke them up at night(78.1% vs 57.3%, P = 0.031). They had a lower employment rate(33.3% vs 54.2%, P = 0.016) and amongst those who were employed less number of working hours per week(median of 23 vs 40, P = 0.005). They reported higher number of hospitalizations in the last 1 year(mean ± SE of mean of 2.90 ± 0.77 vs 1.26 ± 0.23, P = 0.047). CONCLUSION Gp CO had a higher severity of many gastrointestinal symptoms, compared to Gp NO. Hospitalization rates were more than 2-fold higher in Gp CO than Gp NO.Gp CO also had lower employment rate and working hours, when compared to Gp NO.展开更多
文摘Gastroparesis is a severe diabetic complication,caused by a progressive multifactorial enteric neuropathy.To make an early diagnosis in patients at risk of diabetic gastroparesis is crucial for slow down its progression towards full-blown disease source of further complications and requesting effective,but unsafe,drugs as well as invasive surgical treatments.This aim can be achieved by detecting its first signal represented by the gastric emptying(GE)delay,by using,among the tests to measure GE,the simple,safe,reliable,and easily available one,that is realtime ultrasonography,possibly done annually.Once the GE delay has been identified,it is necessary to evaluate with endoluminal functional lumen imaging probe or manometry whether it depends on pylorospasm,which should be treated by means of non-surgical endoscopic therapies.If,instead,it depends on initial gastropathy,detected by electrogastrograhic body surface gastric mapping,it should be treated with the safest prokinetic drugs and with the newly emerging treatments,thus distancing heavy medical and surgical treatments,while waiting for future solutions.
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.
基金Supported by National Natural Science Foundation of China,No.82205298Natural Science Foundation of Hunan Province,No.2023JJ30462+1 种基金Hunan Provincial Department of Science and Technology,No.2023SK2045,No.22JBZ007,No.Z2023XJYQ07,No.B2024007,and No.Z2023JB012024 Graduate Innovation Topics,No.2024CX031.
文摘BACKGROUND Diabetic gastroparesis(DGP)disrupts gastric motility.Electroacupuncture(EA)at Zusanli(ST36)may alleviate DGP symptoms via neural pathways.AIM To investigate how EA current intensities at ST36 regulate neural pathways and improve gastric motility in DGP models.METHODS A DGP model was established using intraperitoneal injection of streptozotocin.Gastrointestinal motility was measured in rats after 2 weeks of continuous EA at ST36.Current intensity was selected as 0.5 mA,1 mA,and 3 mA.Gastric electrodynamics were detected by recording and analyzing the number of gastric discharges.The gastric emptying rate and propulsion rate of the small intestine were measured to assess dynamic gastrointestinal function.Hematoxylin-eosin staining was conducted to measure histopathological changes in the gastric sinus.Reverse transcription-polymerase chain reaction was conducted to determine mRNA levels of Rho guanine nucleotide-binding protein A and Rho-associated coiled-coil forming protein kinase.Western blotting was conducted to determine the expression levels of choline acetyltransferase,tyrosine hydroxylase,Rho guanine nucleotide-binding protein A,and Rho-associated coiled-coil forming protein kinase.Immunofluorescence staining in the stomach was conducted to detect the distribution of C-kit,an interstitial cell of Cajal marker.An enzymelinked immunosorbent assay was conducted to detect serum levels of acetylcholine and norepinephrine.RESULTS Treatment with EA improved gastric emptying and gastric smooth muscle disorders in rats with DGP,mitigated pathological damage,and restored the function of interstitial cells of Cajal.In addition,different current intensities of EA affected gastrointestinal function of rats with DGP.The 0.5 mA,1 mA,and 3 mA EA groups all improved gastrointestinal function.0.5 mA EA increased acetylcholine levels by increasing protein expression of choline acetyltransferase(P<0.05),thereby upregulating vagus nerve activity and enhancing parasympathetic nerve regulation.3 mA EA increased norepinephrine levels(P<0.05)by increasing protein expression of tyrosine hydroxylase,thereby activating the sympathetic nervous pathway.1 mA coordinated the function of the vagus and sympathetic nerves to improve gastrointestinal motility.CONCLUSION EA with ST36 improved gastric motility in rats with DGP.0.5 mA EA activated the vagus nerve,while 3 mA EA regulated gastrointestinal motility by activating the sympathetic nerves.
基金Supported by National High Level Hospital Clinical Research Funding,No.2022-PUMCH-B-015the Chinese Academy of Medical Sciences(CAMS)Innovation Fund for Medical Sciences,No.2021-I2M-C&T-B-003.
文摘BACKGROUND Gastroparesis may repeatedly induce diabetic ketoacidosis(DKA),and the differential diagnosis of these diseases is challenging because of similar gastrointestinal symptoms.If DKA is accompanied by gastroparesis,patients present with persistent gastrointestinal symptoms without relief and may even experience recurrent DKA.Misdiagnosis results in poor treatment outcomes and prognosis.We hypothesized that biomarkers or screening tools can be identified by comparing the clinical data between DKA alone and DKA+gastroparesis to facilitate early screening.AIM To achieve early detection and diagnosis of DKA+gastroparesis to enable early treatment aimed at relieving gastrointestinal symptoms and preventing reinduction of DKA.METHODS We conducted a case-control study in which 15 patients hospitalized for DKA at the Endocrinology Department of Peking Union Medical College Hospital and diagnosed with DKA and gastroparesis between December 1999 and January 2023(DKA+gastroparesis group)were included.Then,we selected 60 DKA patients without DKA as a control group(DKA alone group)based on gender,age,disease course,and diabetes subtype in a 1:4 matching ratio.Clinical manifestations and physical and laboratory examination results were statistically compared between the groups.RESULTS The DKA+gastroparesis group was composed of nine males and six females,with a mean age of 35±11 years,while the DKA alone group included 34 males and 26 females,with a mean age of 34±17 years.In the DKA+gastroparesis group,urine ketone levels normalized,while gastrointestinal symptoms persisted despite treatment,and the tests indicated lower glycosylated hemoglobin levels(HbA1c;7.07%vs 11.51%,P<0.01),largest amplitude of glycemic excursions(5.86 vs 17.41,P<0.01),standard deviation of blood glucose(SDBG;2.69 vs 5.83,P<0.01),and coefficient of blood glucose variation(0.31 vs 0.55,P=0.014)compared with the DKA alone group.Probable gastroparesis was considered at HbA1c<8.55%.Besides,the patients in the DKA+gastroparesis group had lower body mass index(19.28 kg/m^(2) vs 23.86 kg/m^(2),P=0.02)and higher high density lipoprotein cholesterol level(2.34 mmol/L vs 1.05 mmol/L,P=0.019)compared to the DKA alone group,but no difference was observed in the remaining lipid profiles between the two groups.CONCLUSION Gastroparesis should be considered in DKA patients who fail to have improved gastrointestinal symptoms after ketone elimination and acidosis correction,particularly when the HbA1c level is<8.55%.
文摘Diabetic Gastroparesis(DGP)is one of the common chronic complications of diabetes mellitus,with main clinical manifestations such as nausea,vomiting,postprandial fullness,and delayed gastric emptying.It seriously affects patients’quality of life and nutritional status.This paper systematically sorts out the application evidence of Traditional Chinese Medicine(TCM)nursing in DGP,verifies its effectiveness from three aspects:evidence from ancient literature,modern clinical studies,and results of Meta-analyses.It also elaborates on specific nursing methods including Syndrome Differentiation-Based Nursing,characteristic technical nursing,and health guidance,analyzes the existing problems in current research,and puts forward future development directions,so as to provide a reference for the clinical promotion and standardization of TCM nursing for DGP.
基金Supported by the Natural Science Foundation of Hunan Province,China,No.2023JJ30462Hunan Provincial Department of Science and Technology,No.2023SK2045,No.22JBZ007 and No.Z2023JB01Graduate Research and Innovation Projects of Hunan Province,No.2024CX031.
文摘BACKGROUND Diabetic gastroparesis(DGP),characterized by delayed gastric emptying and impaired motility,poses significant therapeutic challenges due to its complex neural and molecular pathophysiology.Emerging evidence suggests that electroacupuncture(EA)at ST36 modulates gastrointestinal function;however,the precise neuromolecular pathways underlying its efficacy in DGP remain incompletely defined.AIM To elucidate the neural mechanisms underlying EA at ST36 improving DGP gastric motility through the nucleus tractus solitarius(NTS)-vagal axis.METHODS The DGP model was established via a single high-dose intraperitoneal injection of 2%streptozotocin combined with an 8-week high-sugar/high-fat diet.Interventions included EA at ST36,pharmacological modulation[choline acetyltransferase(ChAT)agonist polygalacic acid(PA)and inhibitor antagonist alpha-NETA],and subdiaphragmatic vagotomy.Post-intervention observations included body weight and blood glucose levels.Gastric emptying was evaluated using phenol red assays,gastric slow-wave recordings,and dynamic positron emission tomography-computed tomography imaging.Histopathological analysis(hematoxylineosin staining)and molecular assessments(Western blot,immunofluorescence)were performed to quantify gastric smooth muscle-associated factors[neuronal nitric oxide synthase(nNOS),cluster of differentiation 117(C-kit),stem cell factor(SCF)]and vagal targets[ChAT,α7 nicotinic acetylcholine receptor(α7nAChR)]in the ST36 acupoint region,L4-L6 spinal segments,and NTS.Gastrointestinal peptides[gastrin(Gas),motilin(MLT)and vasoactive intestinal peptide(VIP)]were measured via enzyme-linked immunosorbent assay.RESULTS The study found that EA significantly increased the rate of gastric emptying,restored the slow-wave rhythms of the stomach,and improved the architecture of the smooth muscles in the stomach.This was evidenced by a reduction in inflammatory infiltration and an increase in the expression of nNOS,C-kit,and SCF.Mechanistically,EA activated vagal targets(ChAT andα7nAChR)at ST36,transmitting signals via spinal segments L4-L6 to the NTS,subsequently regulating gastrointestinal peptides(Gas,MLT,VIP)and restoring interstitial cells of Cajal(ICCs)function via subdiaphragmatic vagal efferent pathways.It is crucial to note that subdiaphragmatic vagotomy led to the abrogation of EA-induced enhancements in gastric motility and ICC recovery,thereby confirming the indispensable role of vagal efferent signalling.CONCLUSION EA provides a novel molecular mechanism for improving gastrointestinal motility in DGP via a peripheral stimulation(ST36),spinal afferent(L4-L6),brainstem integration(NTS),vagal efferent(gastric)circuit.
文摘Diabetic gastrointestinal neuropathy is a diabetes-related complication,associated with a complex interplay of hyperglycemic damage,autoimmune responses,oxidative stress,gastrointestinal hormones,and vascular insufficiency.Patients with diabetes should be monitored and therapeutic intervention introduced to prevent neuropathy due to diabetes prior to“the point of no return”.Determining gastric bioelectrical activity by body surface gastric mapping may be a promising option to monitor diabetic gastrointestinal neuropathy.
文摘Background: Gastroparesis is one of the complications of diabetes mellitus, and long-term gastroparesis seriously affects patients quality of life. Most of the patients can be relieved after lifestyle improvement and medication, but refractory gastroparesis is difficult to relieve, and is still a challenge in clinical treatment. Aim: To report a case of a patient with diabetic nephropathy combined with refractory gastroparesis, and to analyse the mechanism, diagnosis, severity grading, treatment of refractory gastroparesis in conjunction with a review of the literature, and to investigate the causes of recurrent nausea and vomiting in diabetic nephropathy patients with refractory diabetic gastroparesis and the possible effective treatment options. Case Presentation: The patient was hospitalised for recurrent nausea and vomiting and diagnosed with diabetic nephropathy and gastroparesis. Symptoms recurred after medication and peritoneal dialysis, and the patients symptoms were relieved after multifaceted interventions. Conclusion: Diabetic nephropathy and refractory gastroparesis can both manifest as digestive tract symptoms, and in the face of this complex disease, it is necessary to analyse the various etiological factors and take comprehensive treatment measures.
基金Supported by Suzhou Science and Technology Bureau Project:SYS 201365
文摘Objective To explore the effect of acupuncture combined with Chinese medicine on expression of interstitial cells of Cajal（ICC）, substance P（SP） and nerve nitric oxide synthase（nNOS） in diabetic gastroparesis mice. Methods Eighty Kunming male mice were randomly divided into normal group（group A, 15 mice）, diabetic gastroparesis model mice group（group B, 12 mice）, acupuncture combined with Chinese medicine group（group C, 12 mice）, Chinese medicine group（group D, 13 mice） and western medicine group（group E, 13 mice）. The mice were intraperitoneally injected with steptozotocin and fed with high-fat diet-induced irregular except the normal group mice, that made mouse model of diabetic gastroparesis. And then, the ACM group were treated by acupuncture at the acupoints of Housanli（后三里 ST 36） and Zhōngw n（中脘 CV 12） combined with Chinese medicine, the CM group were only treated by Chinese medicine; the WM group were treated by domperidone and vitamin B 6. Numbers and expression of ICC, SP and n NOS were detected by immunohistochemical methods. Results After treatment, compared with normal group, ICC and SP indexes of model group were significantly reduced. Compared with model group, all indexes in ACM and CM groups were improved significantly（P0.05, P0.01）, but only the positive area and average optical density value in c-Kit and SP in WM group increased obviously（P0.05）. Compared with ACM group, no significant difference in c-Kit and SP of CM group were observed（P0.05）, but expression of nNOS were increased markedly（P0.01）. Besides, c-Kit and SP expressions of WM group were significantly induced was increased remarkably（P0.01）. Conclusion Acupuncture combined with Chinese medicine have much better therapeutic effects for diabetic gastroparesis mice, which may be due to repairing ICC damage, upregulating the expression of SP and lowering the expression of nNOS.
文摘Objective To observe clinical efficacy of acupuncture-moxibustion combined with cupping on postsurgical gastroparesis of abdominal cancer. Methods Thirty-six cases of postsurgical gastroparesis of abdominal cancer were treated with （1） acupuncture at Weishiu （胃俞 BL 21）, Shangwan （上脘 CV 13）, Zhangwan （中脘CV 12）, Xiawan （下脘 CV 10） and Tianshu （天枢 ST 25） to dredging the meridians, （2） quick cupping on local area to promote gastrointestinal motility and （3） mild moxibustion at CV 12, Shanque （神阙 CV 8） and Zusanli （足三里 ST 36）. The treatment was given once a day, 5 times made a course. The clinical efficacy was assessed after two courses of treatment. Results After the treatment, 27 cases were cured, 6 cases were effective and 3 cases were failed, and the total effective rate was 91.7% （33/36）. Conclusion The acupuncture-moxibustion combined with cupping has remarkable clinical efficacy on postsurgical gastroparesis of abdominal cancer.
基金Supported by National Natural Science Foundation of ChinaNo.81173259+2 种基金National Basic Research Program of China973 ProgramNo.2010CB530600
文摘AIM: To assess the current clinical evidence of the effectiveness of Xiangshaliujunzi Decoction (XSLJZD) for the treatment of diabetic gastroparesis (DGP).
基金supported by 2011Mandatory Planning Projeet of Scientifieand Teehologieal Bureau of Zhangjiakou City(111100111)
文摘Objective:To investigate risk factors of gastroparesis syndrome(PGS) after abdominal nongastroduodenal operation and its prevention.Methods:Clinical data of 22 patients with PGS after abdominal non-gastroduodenal operation was analyzed retrospectively,and compared with the patients of non-PGS after abdominal non-gastroduodenal operation during the same time.The possible influencing factors of PCS were analyzed by single factor analysis and logistic regression analysis.Results:All t3 selected factors related with PGS,including age,disease category (benign and malignant),operation time,intraoperative blood loss,postoperative analgesic pump, postoperative enteral nutrition time,postoperative parenteral nutrition time,perioperative blood glucose level,perioperative nutrition status(anaemia or lower proleinemia),pylorus obstruction before surgery,intra-abdominal infection after surgery,and spiritual factor were related with PGS.The statistical analysis showed that the difference was statistical significant(P【0.05),and gender had no correlation with PCS(P】0.05);non-conditional multivariate analysis showed that malignant tumor,perioperative nutrition status,pylorus obstruction,operation time,blood loss, intra-abdominal infection after surgery,and mental factor were significant related with PGS as dependent variable and related risk factors in single factor analysis as independent variables (P 【0.05).Conclusions:PGS is a result of multiple factors,and among these factors,malignant tumor,poor nutrition status,pylorus obstruction before surgery,longer operation—time,more blood loss,intra-abdominal infection after surgery,and mental factor are major risk factors of PGS.
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.
文摘Recently, diabetic gastroparesis(DGP) has received much attention as its prevalence is increasing in a dramatic fashion and management of patients with DGP represents a challenge in the clinical practice due to the limited therapeutic options. DGP highlights an interrelationship between the gastric emptying and pancreatic secretory function that regulate a wide range of digestive and metabolic functions, respectively. It well documented that both gastric emptying and pancreatic secretion are under delicate control by multiple neurohormonal mechanisms including extrinsic parasympathetic pathways and gastrointestinal(GI) hormones. Interestingly, the latter released in response to various determinants that related to the rate and quality of gastric emptying. Others and we have provided strong evidence that the central autonomic nuclei send a dual output(excitatory and inhibitory) to the stomach and the pancreas in response to a variety of hormonal signals from the abdominal viscera. Most of these hormones released upon gastric emptying to provide feedback, and control this process and simultaneously regulate pancreatic secretion and postprandial glycemia. These findings emphasize an important link between gastric emptying and pancreatic secretion and its role in maintaining homeostatic processes within the GI tract. The present review deals with the neurohormonal-coupled mechanisms of gastric emptying and pancreatic secretory function that implicated in DGP and this provides new insights in our understanding of the pathophysiology of DGP. This also enhances the process of identifying potential therapeutic targets to treat DGP and limit the complications of current management practices.
基金Supported by Grant from the National Basic Research Program of China,"973"Program,No.2010CB530600
文摘Refractory diabetic gastroparesis(DGP),a disorder that occurs in both type 1 and type 2 diabetics,is associated with severe symptoms,such as nausea and vomiting,and results in an economic burden on the health care system.In this article,the basic characteristics of refractory DGP are reviewed,followed by a discussion of therapeutic modalities,which encompasses the definitions and clinical manifestations,pathogenesis,diagnosis,and therapeutic efficacy evaluation of refractory DGP.The diagnostic standards assumed in this study are those set forth in the published literature due to the absence of recognized diagnosis criteria that have been assessed by an international organization.The therapeutic modalities for refractory DGP are as follows:drug therapy,nutritional support,gastricelectrical stimulation,pyloric botulinum toxin injection,endoscopic or surgical therapy,and traditional Chinese treatment.The therapeutic modalities may be used alone or in combination.The use of traditional Chinese treatments is prevalent in China.The effectiveness of these therapies appears to be supported by preliminary evidence and clinical experience,although the mechanisms that underlie these effects will require further research.The purpose of this article is to explore the potential of combined Western and traditional Chinese medicine treatment methods for improved patient outcomes in refractory DGP.
文摘Per oral endoscopic pyloromyotomy(POP),also known as gastric per-oral endoscopic myotomy(GPOEM),is a novel procedure with promising potential for the treatment of gastroparesis.As more data emerge and the procedure is becoming more recognized in clinical practice,its safety and efficacy need to be carefully evaluated.Appropriate patient selection for favorable clinical success prediction after GPOEM also needs additional research.This review aims to systemically summarize the existing data on clinical outcomes of POP.Symptomatologic responses to the procedure,its adverse effects,procedural techniques,and predictive factors of clinical success are also discussed.
文摘Gastroparesis(GP) is a common disease seen in gastroenterology practice particularly in western countries, and it may be underdiagnosed. The available drug therapies for this condition are quite disappointing. Botulinum toxin type A(BT) has been found to be effective therapy in various spastic disorders of smooth muscle of gastrointestinal tract. However, the benefits of BT injections in GP have been unclear. Several retrospective and open label studies have shown clinical advantages of intrapyloric Botulinum toxin type A injections, while two small randomized trials did not show positive results. Therefore, the available published studies yielded conflicting results leading to fading out of botox therapy for GP. We recognize possible clinical benefit of BT injections without any disadvantages of this treatment. We are calling for revisiting the endoscopy guided botox therapy in refractory GP. In this review we discuss important features of these studies pointing out differences in results among them. Differences in patient selection, doses and method of administration of botox toxin in the prior studies may be the cause of conflicting results. The mechanism of action, indications, efficacy and side-effects of BT are reviewed. Finally, we recognize limited evidence to recommend BT in GP and calling attention for future research in this field since no advances in drug management had been made in the last two decades.
文摘Gastroparesis refers to abnormal gastric motility characterized by delayed gastric emptying in the absence of mechanical obstruction. The most common etiologies include diabetes, post-surgical and idiopathic. The most common symptoms are nausea, vomiting and epigastric pain. Gastroparesis is estimated to affect 4% of the population and symptomatology may range from little effect on daily activity to severe disability and frequent hospitalizations. The gold standard of diagnosis is solid meal gastric scintigraphy. Treatment is multimodal and includes dietary modification, prokinetic and anti-emetic medications, and surgical interventions. New advances in drug therapy, and gastric electrical stimulation techniques have been introduced and might provide new hope to patients with refractory gastroparesis. In this comprehensive review, we discuss gastroparesis with emphasis on the latest developments; from the perspective of the practicing clinician.
文摘AIM To examine the relationship of chronic scheduled opioid use on symptoms, healthcare utilization and employment in gastroparesis(Gp) patients. Methods Patients referred to our tertiary care academic center from May 2016 to July 2017, with established diagnosis or symptoms suggestive of Gp filled out the Patient Assessment of Upper GI Symptoms, abdominal pain and demographics questionnaires, and underwent gastric emptying and blood tests. They were asked about taking pain medicines and the types, doses, and duration. We used Mann Whitney U test, Analysis of Variance, Student's t test and χ2 tests where appropriate for data analyses.RESULTS Of 223 patients with delayed gastric emptying, 158(70.9%) patients were not taking opioids(Gp NO), 22(9.9%) were taking opioids only as needed, while 43(19.3%) were on chronic(> 1 mo) scheduled opioids(Gp CO), of which 18 were taking opioids forreasons that included gastroparesis and/or stomach pain. Median morphine equivalent use was 60 mg per day. Gp CO reported higher severities of many gastrointestinal symptoms compared to Gp NO including nausea(mean ± SE of mean of 4.09 ± 0.12 vs 3.41 ± 0.12, P = 0.011), retching(2.86 ± 0.25 vs 1.98 ± 0.14, P = 0.003), vomiting(2.93 ± 0.24 vs 2.07 ± 0.15, P = 0.011), early satiety(4.17 ± 0.19 vs 3.57 ± 0.12, P = 0.004), post-prandial fullness(4.14 ± 0.18 vs 3.63 ± 0.11, P = 0.022), loss of appetite(3.64 ± 0.21 vs 3.04 ± 0.13, P = 0.039), upper abdominal pain(3.86 ± 0.20 vs 2.93 ± 0.13, P = 0.001), upper abdominal discomfort(3.74 ± 0.19 vs 3.09 ± 0.13, P = 0.031), heartburn during day(2.55 ± 0.27 vs 1.89 ± 0.13, P = 0.032), heartburn on lying down(2.76 ± 0.28 vs 1.94 ± 0.14, P = 0.008), chest discomfort during day(2.42 ± 0.20 vs 1.83 ± 0.12, P = 0.018), chest discomfort at night(2.40 ± 0.23 vs 1.61 ± 0.13, P = 0.003), regurgitation/reflux during day(2.77 ± 0.25 vs 2.18 ± 0.13, P = 0.040) and bitter/acid/sour taste in the mouth(2.79 ± 0.27 vs 2.11 ± 0.14, P = 0.028). Gp CO had a longer duration of nausea per day(median of 7 h vs 4 h for Gp NO, P = 0.037), and a higher number of vomiting episodes per day(median of 3 vs 2 for Gp NO, P = 0.002). Their abdominal pain more frequently woke them up at night(78.1% vs 57.3%, P = 0.031). They had a lower employment rate(33.3% vs 54.2%, P = 0.016) and amongst those who were employed less number of working hours per week(median of 23 vs 40, P = 0.005). They reported higher number of hospitalizations in the last 1 year(mean ± SE of mean of 2.90 ± 0.77 vs 1.26 ± 0.23, P = 0.047). CONCLUSION Gp CO had a higher severity of many gastrointestinal symptoms, compared to Gp NO. Hospitalization rates were more than 2-fold higher in Gp CO than Gp NO.Gp CO also had lower employment rate and working hours, when compared to Gp NO.
