Gastroparesis in the Hospital Setting

Roux-en-Y jejunostomy in gastroparesis: Insight into patient perspectives and outcomes

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.

Lack of gastric emptying at autopsy eleven days after heat trauma in the sauna- a forensic autopsy case report

A man in his mid-70s passed out in a public 90-degree sauna and remained unconscious for at least half an hour. He suffered third-degree burns to approximately 50% of his body surface area. Despite immediate transport to a burn center and intensive care therapy, he did not regain consciousness and died eleven days later.When the body was opened, the lungs, liver, kidneys, and spleen showed changes consistent with the burns, intensive care therapy, and clinically suspected septic shock. The stomach contained approximately 200 ml of thickened chyme with coarse vegetable components. Such food components were not seen in the duodenum or in the following intestinal segments.Considering the overall circumstances, the stomach contents must have been the last meal the man had eaten before the sauna session. The problem of reduced gastrointestinal motility in burn patients is clinically recognized. Nevertheless, a complete failure of gastric emptying for eleven days after intensive care therapy has not been described before and shows that the use of gastric contents in forensic practice is inappropriate for drawing conclusions about the time interval between last food intake and death and thus for estimating the time of death.

Management of Dyspepsia and Gastroparesis in Patients with Diabetes. A Clinical Point of View in the Year 2021

Diabetes mellitus is a widespread disease, and represents an important public health burden worldwide. Together with cardiovascular, renal and neurological complications, many patients with diabetes present with gastrointestinal symptoms, which configure the so-called diabetic enteropathy. In this review, we will focus on upper gastrointestinal symptoms in patients with diabetes, with particular attention to dyspepsia and diabetic gastroparesis (DG). These two clinical entities share similar pathogenetic mechanisms, which include autonomic neuropathy, alterations in enteric nervous system and histological abnormalities, such as interstitial cells of Cajal depletion. Moreover, the differential diagnosis may be challenging because of overlapping clinical features. Delayed gastric emptying should be documented to differentiate between DG and dyspepsia and it can be assessed through radioactive or non-radioactive methods. The clinical management of dyspepsia includes a wide range of different approaches, above all Helicobacter pylori test and treat. As regards DG treatment, a central role is played by dietary modification and glucose control and the first-line pharmacological therapy is represented by the use of prokinetics. A minority of patients with DG refractory to medical treatment may require more invasive therapeutic approaches, including supplemental nutrition, gastric electric stimulation, pyloromyotomy and gastrectomy.