Gastroparesis Updates on Pathogenesis and Management

( Nanlong Liu ),( Thomas Abell ) 대한간학회 2017 Gut and Liver Vol.11 No.5

Gastroparesis (Gp) is a chronic disease that presents with clinical symptoms of early satiety, bloating, nausea, vomit-ing, and abdominal pain. Along with these symptoms, an objective finding of delayed gastric emptying, along with a documented absence of gastric outlet obstruction, are re-quired for diagnosis. This article focuses on updates in the pathogenesis and management of Gp. Recent studies on full thickness biopsies of Gp patients have shed light on the complex interactions of the central, autonomic, and enteric nervous systems, which all play key roles in maintaining nor-mal gut motility. The management of Gp has evolved beyond prokinetics and antiemetics with the use of gastric electrical stimulators (GES). In addition, this review aims to introduce the concept of gastroparesis-like syndrome (GLS). GLS helps groups of patients who have the cardinal symptoms of Gp but have a normal or rapid emptying test. Recent tests have shown that patients with Gp and GLS have similar pathophys-iology, benefit greatly from GES placement, and likely should be treated in a similar manner. (Gut Liver 2017;11:579-589)

Acute beetroot juice supplementation does not attenuate knee extensor exercise muscle fatigue in a healthy young population

이승용,Mark G. Abel,Travis Thomas,T. Brock Symons,James W. Yates 한국운동영양학회 2019 Physical Activity and Nutrition (Phys Act Nutr) Vol.23 No.1

[Purpose] The effect of acute nitrate supplementation on muscle fatigue is largely unknown. This study aimed to evaluate the effect of acute nitrate supplementation on muscle fatigue. [Methods] Thirty-five recreationally active subjects consumed 140 ml of beetroot (BR) juice (nitrate: 8 mmol·d-1) or placebo (PL) 12 and 2.5 hours before two exercise sessions. Peak torque was measured during 50 repetitions, at maximal effort, and during concentric knee extensions at 90°·s-1. Blood pressure (BP) was recorded pre- and post-exercise. [Results] Peak torque, maximum work, rate of fatigue, and rate of work fatigue were similar between the BR and PL conditions. Post-exercise diastolic BP (BR: 67.2 ± 9.8 vs. PL: 64.5 ± 7.9 mmHg, p < 0.05) and mean arterial pressure (BR: 91.6 ± 9.3 vs. PL: 88.8 ± 8.2 mmHg, p < 0.05) were higher with BR supplementation. [Conclusion] These findings suggest that the acute intake of BR juice had no effect on knee extensor muscle strength or fatigue but increased BP in a healthy recreationally active population.

High-resolution Mapping of Hyperglycemia-induced Gastric Slow Wave Dysrhythmias

Peng Du,Gregory O’Grady,Niranchan Paskaranandavadivel,Shou-jiang Tang,Thomas Abell,Leo K Cheng 대한소화기 기능성질환∙운동학회 2019 Journal of Neurogastroenterology and Motility (JNM Vol.25 No.2

Background/Aims It is now recognised that gastric dysrhythmias are best characterised by their spatial propagation pattern. Hyperglycemia is an important cause of gastric slow wave dysrhythmia, however, the spatiotemporal patterns of dysrhythmias in this context have not been investigated. This study aims to investigate the relationship between hyperglycemia and the patterns of dysrhythmias by employing high-resolution (multi-electrode) mapping simultaneously at the anterior and posterior gastric serosa. Methods High-resolution mapping (8 × 16 electrodes per serosal) was performed in 4 anesthetized hounds. Baseline recordings (21 ± 8 minutes) were followed by intravenous injection of glucagon (0.5 mg per dose) and further recordings (59 ± 15 minutes). Blood glucose levels were monitored manually using a glucose sensing kit at regular 5-minute intervals. Slow wave activation maps, amplitudes, velocity, anisotropic ratio, and frequency were calculated. Differences were compared between baseline and post glucagon injection. Results Baseline slow waves propagated symmetrically and antegrade. The blood glucose levels were increased by an average of 112% compared to the baseline by the end of the recordings. All subjects demonstrated elevated incidence of slow wave dysrhythmias following injection compared to the baseline (48 ± 23% vs 6 ± 4%, P < 0.05). Dysrhythmias arose simultaneously or independently on anterior and posterior serosa. Spatial dysrhythmias occurred before and persisted after the onset and disappearance of temporal dysrhythmias. Conclusions Infusion of glucagon induced gastric slow wave dysrhythmias, which occurred across a heterogeneous range of patterns and frequencies. The spatial dysrhythmias of gastric slow waves were shown to be more prevalent and persisted over a longer period of time compared to the temporal dysrhythmias.

Temporary Endoscopic Stimulation in Gastroparesis-like Syndrome

( Sanjeev Singh ),( Jeff Mccrary ),( Archana Kedar ),( Stephen Weeks ),( Brian Beauerle ),( Andrew Weeks ),( Omer Endashaw ),( Chris Lahr ),( Warren Starkebaum ),( Thomas Abell ) 대한소화기기능성질환·운동학회 2015 Journal of Neurogastroenterology and Motility (JNM Vol.21 No.4

Background/Aims Gastroparesis-like syndrome (GLS) is defined as gastroparesis-like symptoms with normal gastric scintigraphy. While the efficacy of gastric electrical stimulation (GES) in gastroparesis is well known, the utility of GES in GLS is largely unknown. Our aim was to clarify the role of GES in GLS. We implanted consecutive patients with symptoms of gastroparesis with temporary gastric electrical stimulation and observed changes in gastric scintigraphy and total symptom score. Methods Five hundred and fifty-one patients suffering from symptoms of gastroparesis (nausea, vomiting, bloating/distension, anorexia/ early satiety, and abdominal pain) with negative endoscopy underwent gastric scintigraphy with analysis of 1) solid radionuclide gastric emptying at 1, 2, and 4 hours (% remaining); 2) area under the gastric emptying curve (AUC) at 1, 2, and 4hours; and 3) total gastric emptying test (GET) (the sum of 1, 2, and 4 hour values). Patients were stratified into: delayed gastric emptying, normal gastric emptying, and rapid gastric emptying (Appendix). Of the 551 patients in the larger cohort, 379 had implantation of temporary gastric electrical stimulation (tGES). Gastrointestinal symptoms and gastric emptying were com - pared pre and post tGES implantation. Results After tGES, 2 hour gastric retention decreased (P < 0.01) for the delayed patients, and increased (P < 0.001) for normal and rapid patients. These changes were accompanied by improvements (P < 0.001) in vomiting, nausea, and total symptom scores in all 3 subgroups. Conclusions Gastric electrical stimulation may be an effective therapy for treating the symptoms of gastroparesis with normal gastric emptying.Further exploration of endoscopic electrical stimulation as a treatment for gastroparesis-like symptoms with non-delayed gastric emptying is needed. (J Neurogastroenterol Motil 2015;21:520-527)

Gastric Electrical Stimulation Is an Option for Patients with Refractory Cyclic Vomiting Syndrome

( Inderpreet Grover ),( Richard Kim ),( Danielle C Spree ),( Christopher J Lahr ),( Archana Kedar ),( Shivangi Kothari ),( David Fleisher ),( Thomas L Abell ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2016 Journal of Neurogastroenterology and Motility (JNM Vol.22 No.4

Background/Aims Cyclic vomiting syndrome (CVS) is a disabling migraine variant manifesting as severe episodes of nausea and vomiting and often refractory to many therapies. Gastric electrical stimulation (GES), which can reduce nausea and vomiting in gastroparesis, may provide symptomatic relief for drug-refractory CVS. This study assessed the utility GES in reducing the symptoms of CVS and improving the quality of life. Methods A one-year, non-randomized, clinical study was conducted. Eleven consecutive patients with drug refractory, cyclic vomiting syndrome based on Rome III criteria and North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN), underwent treatment with temporary GES (Temp GES) and permanent GES (Perm GES). Post-treatment follow up was done up to one year after permanent gastric electrical stimulation therapy. Results Total symptom score decreased by 68% and 40% after temporary and permanent GES therapies, respectively. Hospital admission events significantly decreased to 1.50 (± 1.00) events from 9.14 (± 7.21) annual admissions prior to treatment with permanent GES. Vomiting episodes fell by 83% post Temp GES and 69% after Perm GES treatments. Mucosal electrogram values also changed after temporary stimulation. Conclusions In a small group of drug-refractory CVS patients, treatments with temporary and permanent GES significantly reduced the severity of gastrointestinal symptoms and frequency of hospital admissions.