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Wang XJ, O’Connor M, Peck T, Johnston G, Prichard DO. Extensive scintigraphic gastric motor function testing with concurrent symptom recording predicts prospectively measured daily dyspeptic symptoms. Neurogastroenterol Motil 2024; 36:e14819. [PMID: 38816956 PMCID: PMC11344222 DOI: 10.1111/nmo.14819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 03/14/2024] [Accepted: 05/09/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Absent "organic" disease, dyspeptic symptoms may arise from abnormal gastric sensation, accommodation, motility or emptying (GE). Extensive gastric sensorimotor evaluation is rarely undertaken because testing is prolonged, invasive, poorly tolerated or unavailable. AIMS To investigate whether gastric antral motor function, evaluated with scintigraphy, predicts GE. To explore whether motor testing with symptom recording predicts day-to-day symptoms in patients with dyspepsia. METHODS GE was determined using a scintigraphic solid-meal protocol (296 kcal, 35% fat). Antral motility was estimated from 10 min of scintigraphic time-activity curves acquired 40 min after meal consumption. An antral motility index (MI) was derived from contraction amplitude and frequency. Intra-gastric distribution of the meal on scintograms at 1 h (IGD1) was determined. Meal-induced symptoms were evaluated by questionnaire. Patients completed the Gastroparesis Cardinal Symptom Index Daily Diary (GCSI-DD) for 14 days. RESULTS Twelve healthy participants and 23 prospectively recruited patients completed the study. Nine patients had delayed, and 2 had rapid, GE. In univariate analysis MI explained 42% of GE half-time. In multivariate analysis MI and GE half-time explained 25% of the variance in meal-induced symptoms. While scintigraphic evaluation of gastric motor function with symptom recording explained 80% of the variance in the GCSI-DD, meal-induced symptoms were the only significant predictor. However, among patients with delayed GE, MI, GE half-time, IGD1, and meal-induced symptoms all significantly predicted GCSI-DD. CONCLUSIONS Antral motility predicts GE. In exploratory analyses, only meal-induced symptoms predicted daily symptoms among patients with dyspepsia. However, motor function also predicted symptoms in patients with delayed GE.
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Affiliation(s)
- Xiao Jing Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael O’Connor
- Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Taylor Peck
- Division of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Geoffrey Johnston
- Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - David O. Prichard
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Gastroenterology and Hepatology, St James’ Hospital, Dublin, Ireland
- University of Dublin, Trinity College, Dublin, Ireland
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2
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Yip JLK, Balasuriya GK, Hill-Yardin EL, Spencer SJ. The gut-brain and gut-macrophage contribution to gastrointestinal dysfunction with systemic inflammation. Brain Behav Immun 2024; 119:867-877. [PMID: 38750700 DOI: 10.1016/j.bbi.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/24/2024] [Accepted: 05/12/2024] [Indexed: 05/19/2024] Open
Abstract
The gastrointestinal tract is one of the main organs affected during systemic inflammation and disrupted gastrointestinal motility is a major clinical manifestation. Many studies have investigated the involvement of neuroimmune interactions in regulating colonic motility during localized colonic inflammation, i.e., colitis. However, little is known about how the enteric nervous system and intestinal macrophages contribute to dysregulated motility during systemic inflammation. Given that systemic inflammation commonly results from the innate immune response against bacterial infection, we mimicked bacterial infection by administering lipopolysaccharide (LPS) to rats and assessed colonic motility using ex vivo video imaging techniques. We utilized the Cx3cr1-Dtr rat model of transient depletion of macrophages to investigate the role of intestinal macrophages in regulating colonic motility during LPS infection. To investigate the role of inhibitory enteric neurotransmission on colonic motility following LPS, we applied the nitric oxide synthase inhibitor, Nω-nitro-L-arginine (NOLA). Our results confirmed an increase in colonic contraction frequency during LPS-induced systemic inflammation. However, neither the depletion of intestinal macrophages, nor the suppression of inhibitory enteric nervous system activity impacted colonic motility disruption during inflammation. This implies that the interplay between the enteric nervous system and intestinal macrophages is nuanced, and complex, and further investigation is needed to clarify their joint roles in colonic motility.
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Affiliation(s)
- Jackson L K Yip
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Melbourne, VIC, Australia
| | - Gayathri K Balasuriya
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Melbourne, VIC, Australia; Department of Physiology and Cell Biology, Kobe University School of Medicine, Kobe, Japan
| | - Elisa L Hill-Yardin
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Melbourne, VIC, Australia
| | - Sarah J Spencer
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Melbourne, VIC, Australia.
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3
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Oczka D, Augustynek M, Penhaker M, Kubicek J. Electrogastrography measurement systems and analysis methods used in clinical practice and research: comprehensive review. Front Med (Lausanne) 2024; 11:1369753. [PMID: 39011457 PMCID: PMC11248517 DOI: 10.3389/fmed.2024.1369753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 06/03/2024] [Indexed: 07/17/2024] Open
Abstract
Electrogastrography (EGG) is a non-invasive method with high diagnostic potential for the prevention of gastroenterological pathologies in clinical practice. In this study, a review of the measurement systems, procedures, and methods of analysis used in electrogastrography is presented. A critical review of historical and current literature is conducted, focusing on electrode placement, measurement apparatus, measurement procedures, and time-frequency domain methods of filtration and analysis of the non-invasively measured electrical activity of the stomach. As a result, 129 relevant articles with primary aim on experimental diet were reviewed in this study. Scopus, PubMed, and Web of Science databases were used to search for articles in English language, according to the specific query and using the PRISMA method. The research topic of electrogastrography has been continuously growing in popularity since the first measurement by professor Alvarez 100 years ago, and there are many researchers and companies interested in EGG nowadays. Measurement apparatus and procedures are still being developed in both commercial and research settings. There are plenty variable electrode layouts, ranging from minimal numbers of electrodes for ambulatory measurements to very high numbers of electrodes for spatial measurements. Most authors used in their research anatomically approximated layout with two++ active electrodes in bipolar connection and commercial electrogastrograph with sampling rate of 2 or 4 Hz. Test subjects were usually healthy adults and diet was controlled. However, evaluation methods are being developed at a slower pace, and usually the signals are classified only based on dominant frequency. The main review contributions include the overview of spectrum of measurement systems and procedures for electrogastrography developed by many authors, but a firm medical standard has not yet been defined. Therefore, it is not possible to use this method in clinical practice for objective diagnosis. Systematic Review Registration https://www.prisma-statement.org/.
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Affiliation(s)
- David Oczka
- Department of Cybernetics and Biomedical Engineering, VSB-Technical University of Ostrava, Ostrava, Czechia
| | - Martin Augustynek
- Department of Cybernetics and Biomedical Engineering, VSB-Technical University of Ostrava, Ostrava, Czechia
| | - Marek Penhaker
- Department of Cybernetics and Biomedical Engineering, VSB-Technical University of Ostrava, Ostrava, Czechia
| | - Jan Kubicek
- Department of Cybernetics and Biomedical Engineering, VSB-Technical University of Ostrava, Ostrava, Czechia
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4
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Bor S, Kalkan İH, Savarino E, Rao S, Tack J, Pasricha J, Cangemi D, Schol J, Karunaratne T, Ghisa M, Ahuja NK, Lacy B. Prokinetics-safety and efficacy: The European Society of Neurogastroenterology and Motility/The American Neurogastroenterology and Motility Society expert review. Neurogastroenterol Motil 2024; 36:e14774. [PMID: 38462678 DOI: 10.1111/nmo.14774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 02/02/2024] [Accepted: 02/13/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Prokinetics are a class of pharmacological drugs designed to improve gastrointestinal (GI) motility, either regionally or across the whole gut. Each drug has its merits and drawbacks, and based on current evidence as high-quality studies are limited, we have no clear recommendation on one class or other. However, there remains a large unmet need for both regionally selective and/or globally acting prokinetic drugs that work primarily intraluminally and are safe and without systemic side effects. PURPOSE Here, we describe the strengths and weaknesses of six classes of prokinetic drugs, including their pharmacokinetic properties, efficacy, safety and tolerability and potential indications.
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Affiliation(s)
- Serhat Bor
- Division of Gastroenterology, School of Medicine & Ege Reflux Study Group, Ege University, Izmir, Turkey
| | - İsmail H Kalkan
- Department of Gastroenterology, School of Medicine, TOBB University of Economics and Technology, Ankara, Turkey
| | - Edoardo Savarino
- Gastroenterology Unit, Azienda Ospedale Università di Padova (AOUP), Padua, Italy
| | - Satish Rao
- Division of Gastroenterology and Hepatology, Digestive Health Center, Augusta University, Augusta, Georgia, USA
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Jay Pasricha
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - David Cangemi
- Division of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jolien Schol
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - Tennekon Karunaratne
- Division of Gastroenterology/Hepatology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Matteo Ghisa
- Digestive Endoscopy Unit, Division of Gastroenterology, Padua University Hospital, Padua, Italy
| | - Nitin K Ahuja
- Division of Gastroenterology, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Brian Lacy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
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5
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Tafti D, Farrell MB, Dearborn MC, Banks KP. Reexamining Compliance with Gastric Emptying Scintigraphy Guidelines: An Updated Analysis of the Intersocietal Accreditation Commission Database. J Nucl Med Technol 2024; 52:26-31. [PMID: 37316303 PMCID: PMC10924152 DOI: 10.2967/jnmt.123.265496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/10/2023] [Indexed: 06/16/2023] Open
Abstract
Many variables can influence the results of gastric emptying scintigraphy (GES). A lack of standardization causes variability, limits comparisons, and decreases the credibility of the study. To increase standardization, in 2009 the Society of Nuclear Medicine and Molecular Imaging (SNMMI) published a guideline for a standardized, validated GES protocol for adults based on a 2008 consensus document. Laboratories must closely follow the consensus guideline to provide valid and standardized results as an incentive to achieve consistency in patient care. As part of the accreditation process, the Intersocietal Accreditation Commission (IAC) evaluates compliance with such guidelines. The rate of compliance with the SNMMI guideline was assessed in 2016 and showed a substantial degree of noncompliance. The aim of this study was to reassess compliance with the standardized protocol across the same cohort of laboratories, looking for changes and trends. Methods: The IAC nuclear/PET database was used to extract GES protocols from all laboratories applying for accreditation from 2018 to 2021, 5 y after the initial assessment. The number of labs was 118 (vs. 127 in the initial assessment). Each protocol was again evaluated for compliance with the methods described in the SNMMI guideline. The same 14 variables were assessed in a binary fashion: patient preparation (4 variables-types of medications withheld, withholding of these medication for 48 h, blood glucose ≤ 200 mg/dL, blood glucose recorded), meal (5 variables-use of consensus meal, nothing by mouth for 4 h or more, meal consumed within 10 min, documentation of percentage of meal consumed, meal labeled with 18.5-37 MBq [0.5-1.0 mCi]), acquisition (2 variables-anterior and posterior projections obtained, imaging each hour out to 4 h), and processing (3 variables-use of the geometric mean, decay correction of data, and measurement of percentage retention). Results: Protocols from the 118 labs demonstrated that compliance is improving in some key areas but remains suboptimal in others. Overall, labs were compliant with an average of 8 of the 14 variables, with a low of 1-variable compliance at 1 site, and only 4 sites compliant with all 14 variables. Nineteen sites met an 80% threshold for compliance (11+ variables). The variable with the highest compliance was the patient's taking nothing by mouth for 4 h or more before the exam (97%). The variable with the lowest compliance was the recording of blood glucose values (3%). Notable areas of improvement include the use of the consensus meal, now 62% versus previously only 30% of labs. Greater compliance was also noted with measurement of retention percentages (instead of emptying percentages or half-times), with compliance by 65% of sites versus only 35% 5 y prior. Conclusion: Almost 13 y after the publication of the SNMMI GES guidelines, there is improving but still suboptimal protocol adherence among laboratories applying for IAC accreditation. Persistent variation in the performance of GES protocols may significantly affect patient management, as results may be unreliable. Using the standardized GES protocol permits interpretation of results in a consistent manner that allows interlaboratory comparisons and fosters acceptance of the test validity by referring clinicians.
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Affiliation(s)
- Dawood Tafti
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Radiology, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas; and
| | | | - M Cory Dearborn
- Department of Radiology, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas; and
| | - Kevin P Banks
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Radiology, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas; and
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6
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Srinivasan SS, Dosso J, Huang HW, Selsing G, Alshareef A, Kuosmanen J, Ishida K, Jenkins J, Madani WAM, Hayward A, Traverso G. An ingestible self-propelling device for intestinal reanimation. Sci Robot 2024; 9:eadh8170. [PMID: 38416855 DOI: 10.1126/scirobotics.adh8170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 01/31/2024] [Indexed: 03/01/2024]
Abstract
Postoperative ileus (POI) is the leading cause of prolonged hospital stay after abdominal surgery and is characterized by a functional paralysis of the digestive tract, leading to symptoms such as constipation, vomiting, and functional obstruction. Current treatments are mainly supportive and inefficacious and yield acute side effects. Although electrical stimulation studies have demonstrated encouraging pacing and entraining of the intestinal slow waves, no devices exist today to enable targeted intestinal reanimation. Here, we developed an ingestible self-propelling device for intestinal reanimation (INSPIRE) capable of restoring peristalsis through luminal electrical stimulation. Optimizing mechanical, material, and electrical design parameters, we validated optimal deployment, intestinal electrical luminal contact, self-propelling capability, safety, and degradation of the device in ex vivo and in vivo swine models. We compared the INSPIRE's effect on motility in models of normal and depressed motility and chemically induced ileus. Intestinal contraction improved by 44% in anesthetized animals and up to 140% in chemically induced ileus cases. In addition, passage time decreased from, on average, 8.6 days in controls to 2.5 days with the INSPIRE device, demonstrating significant improvement in motility. Luminal electrical stimulation of the intestine via the INSPIRE efficaciously restored peristaltic activity. This noninvasive option offers a promising solution for the treatment of ileus and other motility disorders.
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Affiliation(s)
- Shriya S Srinivasan
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Julien Dosso
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Hen-Wei Huang
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - George Selsing
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Amro Alshareef
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Johannes Kuosmanen
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Keiko Ishida
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Joshua Jenkins
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Wiam Abdalla Mohammed Madani
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Alison Hayward
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Giovanni Traverso
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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Pretorius L, Smith C. Green rooibos (Aspalathus linearis) promotes gut health: insight into mechanisms. JOURNAL OF ETHNOPHARMACOLOGY 2024; 319:117379. [PMID: 37923252 DOI: 10.1016/j.jep.2023.117379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/20/2023] [Accepted: 10/31/2023] [Indexed: 11/07/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Paralleling the increasing incidence of gastrointestinal disorders world-wide, therapeutic investigations of nutraceuticals to promote gastrointestinal health are gaining popularity. Although anecdotally well-known for its gut health promoting potential, sparse scientific evidence supports this action of Aspalathus linearis (Burm.f.) R. Dahlgren - or rooibos - at the gastrointestinal epithelial level. AIM OF THE STUDY Traditionally, rooibos is considered to exert antispasmodic, anti-inflammatory, and anti-nociceptive effects in the gut. However, the direct effect on intestinal epithelium is unknown. Thus, to assess the validity of anecdotal claims, two larval zebrafish models were utilized to evaluate effects of rooibos on intestinal health. MATERIALS AND METHODS Firstly, a larval zebrafish model of gastrointestinal inflammation (2-day TNBS-exposure) was employed. Co-administration of 6α-methylprednisolone served as an internal treatment control. Assessments included live imaging techniques and post-mortem immunofluorescent staining of epithelial tight junction proteins. In addition, whole body H2O2 and prostaglandin E2 assays were performed. Secondly, a gastrointestinal motility assay was performed, with known pro- and anti-kinetic mediators to assess the effect of rooibos to alter functional outcome in vivo. RESULTS Aqueous and ethanol extracts of green rooibos rescued TNBS-induced reductions in neutral red stained length of larval mid-intestines. Subsequent experiments confirmed the rescue capacity of the aqueous green rooibos extract regarding whole body oxidative and inflammatory status. Concerning tight junction proteins, only the aqueous green rooibos extract - and not prednisolone - normalized both zona occludens-1 and occludin expression levels when compared the TNBS group. In terms of gastrointestinal motility, the aqueous green rooibos extract significantly reduced the extent of gut motility dysregulation achieved by kinetic modulators. CONCLUSIONS Data indicates the potential of a 2 mg/ml aqueous extract of green rooibos to improve gastrointestinal integrity and functionality in vivo, suggesting beneficial effects of rooibos may already occur at the level of the gut. This provides some evidence to support indigenous knowledge.
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Affiliation(s)
- Lesha Pretorius
- Experimental Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7500, South Africa.
| | - Carine Smith
- Experimental Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7500, South Africa.
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Gastrointestinal Dysmotility in Critically Ill Patients: Bridging the Gap Between Evidence and Common Misconceptions. J Clin Gastroenterol 2022; 57:440-450. [PMID: 36227004 DOI: 10.1097/mcg.0000000000001772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Disruption of normal gastrointestinal (GI) function in critical illness is linked to increased morbidity and mortality, and GI dysmotility is frequently observed in patients who are critically ill. Despite its high prevalence, the diagnosis and management of GI motility problems in the intensive care unit remain very challenging, given that critically ill patients often cannot verbalize symptoms and the general lack of understanding of underlying pathophysiology. Common clinical presentations of GI dysmotility issues among critically ill patients include: (1) high gastric residual volumes, acid reflux, and vomiting, (2) abdominal distention, and (3) diarrhea. In this review, we discuss the differential diagnosis for intensive care unit patients with symptoms and signs concerning GI motility issues. There are many myths and longstanding misconceptions about the diagnosis and management of GI dysmotility in critical illness. Here, we uncover these myths and discuss relevant evidence in each subject area, with the goal of re-conceptualizing GI motility disorders in critical care and providing evidence-based recommendations for clinical care.
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Rutherford S, Gaschen F, Husnik R, Fletcher J, Gaschen L. Ultrasonographic evaluation of the effects of azithromycin on antral motility and gastric emptying in healthy cats. J Vet Intern Med 2022; 36:508-514. [PMID: 35150012 PMCID: PMC8965205 DOI: 10.1111/jvim.16385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/29/2022] [Accepted: 02/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background Erythromycin, a macrolide antibiotic with motilin agonist properties, shortens gastric emptying (GE) time in healthy cats. Azithromycin, another macrolide antibiotic, is effective for treatment of gastric paresis in people. Objectives To evaluate the effects of azithromycin on GE and gastric motility in healthy cats in comparison with erythromycin (positive control) and placebo. Animals Eight healthy purpose‐bred cats. Methods Prospective, blinded, crossover study. Cats received either azithromycin (3.5 mg/kg PO q24h), erythromycin (1 mg/kg PO q8h), or placebo for 24 hours before and during evaluation of GE. A validated method using ultrasound for sequential measurements of antral area as well as amplitude and frequency of contractions was used to assess GE and evaluate gastric antral motility postprandially over an 8‐hour period. Results GE was significantly faster (P < .05) after administration of azithromycin and erythromycin when compared to placebo in the late phase of fractional emptying from 75% (mean ± SD: 327 ± 51 minutes, 327 ± 22 minutes, and 367 ± 29 minutes, respectively), to 95% fractional emptying (399 ± 52 minutes, 404 ± 11 minutes, and 444 ± 24 minutes, respectively). The drugs had no significant effect on antral motility variables at any time point. Conclusions and Clinical Importance Azithromycin and erythromycin shorten GE time in a comparable manner in healthy cats. Evaluation of their efficacy in cats with gastric dysmotility is warranted.
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Affiliation(s)
- Stephanie Rutherford
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Frederic Gaschen
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Roman Husnik
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, Indiana, USA
| | | | - Lorrie Gaschen
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
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10
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Cho HY, Kim H, Yoon S, Lee HJ, Kim H, Lee HC, Kim WH, Jang JY. Effect of sugammadex on the recovery of gastrointestional motility after open pancreaticoduodenectomy: a single-center retrospective study. Minerva Anestesiol 2021; 87:1100-1108. [PMID: 34337915 DOI: 10.23736/s0375-9393.21.15668-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study aimed to investigate the association between sugammadex use and the occurrence of delayed passage of first flatus and oral intake tolerance following open pancreaticoduodenectomy (PD). METHODS We reviewed consecutive patients who underwent open PD between 2015 and 2019; subsequently, they were divided into the sugammadex (group S) and neostigmine with anticholinergics (group N) groups based on the reversal agent used. We performed stabilized inverse probability of treatment weighting (IPTW) analysis to adjust for baseline differences between the groups. We compared the delayed passage of first flatus, oral intake tolerance, and other postoperative outcomes between the groups before and after IPTW. RESULTS Of the 736 included patients, 309 (42.0%) received sugammadex. Stabilized IPTW revealed a significantly lower occurrence of delayed passage of first flatus in group S (19.5%) compared to group N (27.7%) (OR 0.61, 95% CI: 0.43-0.86, P = 0.005). Further, there was a significantly lower occurrence of delayed oral intake tolerance in group S (18.9%) than in group N (28.0%) (OR 0.65, 95% CI: 0.46-0.92, P = 0.016). CONCLUSIONS Compared to previous reversal agents, sugammadex use was significantly associated with a decrease in the occurrence of prolonged time to first flatus and oral intake tolerance following open PD.
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Affiliation(s)
- Hye-Yeon Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyerin Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Susie Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho-Jin Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea - .,Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hongbeom Kim
- Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyung-Chul Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Won H Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin-Young Jang
- Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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11
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Soliman H, Coffin B, Gourcerol G. Gastroparesis in Parkinson Disease: Pathophysiology, and Clinical Management. Brain Sci 2021; 11:831. [PMID: 34201699 PMCID: PMC8301889 DOI: 10.3390/brainsci11070831] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/16/2021] [Accepted: 06/22/2021] [Indexed: 02/07/2023] Open
Abstract
Patients with Parkinson disease (PD) experience a range of non-motor symptoms, including gastrointestinal symptoms. These symptoms can be present in the prodromal phase of the disease. Recent advances in pathophysiology reveal that α-synuclein aggregates that form Lewy bodies and neurites, the hallmark of PD, are present in the enteric nervous system and may precede motor symptoms. Gastroparesis is one of the gastrointestinal involvements of PD and is characterized by delayed gastric emptying of solid food in the absence of mechanical obstruction. Gastroparesis has been reported in nearly 45% of PD. The cardinal symptoms include early satiety, postprandial fullness, nausea, and vomiting. The diagnosis requires an appropriate test to confirm delayed gastric emptying, such as gastric scintigraphy, or breath test. Gastroparesis can lead to malnutrition and impairment of quality of life. Moreover, it might interfere with the absorption of antiparkinsonian drugs. The treatment includes dietary modifications, and pharmacologic agents both to accelerate gastric emptying and relieve symptoms. Alternative treatments have been recently developed in the management of gastroparesis, and their use in patients with PD will be reported in this review.
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Affiliation(s)
- Heithem Soliman
- Centre de Recherche sur l’Inflammation, Université de Paris, Inserm UMRS 1149, 75018 Paris, France;
- Département d’Hépato Gastro Entérologie, Hôpital Louis Mourier, DMU ESPRIT—GHU (AP-HP), 92700 Colombes, France
| | - Benoit Coffin
- Centre de Recherche sur l’Inflammation, Université de Paris, Inserm UMRS 1149, 75018 Paris, France;
- Département d’Hépato Gastro Entérologie, Hôpital Louis Mourier, DMU ESPRIT—GHU (AP-HP), 92700 Colombes, France
| | - Guillaume Gourcerol
- Centre Hospitalo-Universitaire de Rouen, INSERM UMR 1073, CIC-CRB 1404, 76000 Rouen, France;
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Dextran Sodium Sulphate-Induced Gastrointestinal Injury Further Aggravates the Impact of Galantamine on the Gastric Myoelectric Activity in Experimental Pigs. Pharmaceuticals (Basel) 2021; 14:ph14060590. [PMID: 34207410 PMCID: PMC8234489 DOI: 10.3390/ph14060590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 11/17/2022] Open
Abstract
Galantamine has been used as a treatment for Alzheimer disease. It has a unique, dual mode of action (inhibitor of acetylcholinesterase and allosteric modulator of nicotinic acetylcholine receptors). Nausea (in about 20%), vomiting (10%) and diarrhoea (5–7%) are the most common side effects. The aim of this study was to assess the effect of galantamine on porcine gastric myoelectric activity without (Group A) and with (Group B) dextran sodium sulphate (DSS)-induced gastrointestinal injury. Galantamine hydrobromide was administrated to twelve pigs as a single intragastric dose (24 mg). Gastric myoelectric activity was investigated by electrogastrography (EGG). Basal (15 min before galantamine administration) and study recordings after galantamine administration (300 min) were evaluated using a running spectral analysis. Results were expressed as dominant frequency of gastric slow waves and power analysis (areas of amplitudes). Altogether, 3780 one-minute EGG recordings were evaluated. In Group A, power was steady from basal values for 180 min, then gradually decreased till 270 min (p = 0.007). In Group B, there was a rapid gradual fall from basal values to those after 120 min (p = 0.007) till 300 min (p ˂ 0.001). In conclusion, galantamine alone revealed an unfavourable effect on porcine myoelectric activity assessed by gastric power. It can be a plausible explanation of galantamine-associated dyspepsia in humans. DSS caused further profound decrease of EGG power. That may indicate that underlying inflammatory, ischaemic or NSAIDs-induced condition of the intestine in humans can have aggravated the effect of galantamine on gastric myoelectric activity.
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13
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Kim B, Kwon H, Kim J, Kwon M, Lee J, Kim S, Nam J. The traditional medicine bojungikki-tang increases intestinal motility. Pharmacogn Mag 2021. [DOI: 10.4103/pm.pm_507_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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14
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Gastrointestinal dysfunction in the synucleinopathies. Clin Auton Res 2020; 31:77-99. [PMID: 33247399 DOI: 10.1007/s10286-020-00745-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/04/2020] [Indexed: 12/15/2022]
Abstract
Interest in gastrointestinal dysfunction in Parkinson's disease has blossomed over the past 30 years and has generated a wealth of investigation into this non-motor aspect of the disorder, research that has encompassed its pathophysiology, its clinical features, and its impact on quality of life. The question of gastrointestinal dysfunction in the other synucleinopathies has not received nearly as much attention, but information and knowledge are growing. In this review, the current knowledge, controversies, and gaps in our understanding of the pathophysiology of gastrointestinal dysfunction in Parkinson's disease and the other synucleinopathies will be addressed, and extended focus will be directed toward the clinical problems involving saliva management, swallowing, gastric emptying, small intestinal function, and bowel function that are so problematic in these disorders.
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15
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Pfeiffer RF, Isaacson SH, Pahwa R. Clinical implications of gastric complications on levodopa treatment in Parkinson's disease. Parkinsonism Relat Disord 2020; 76:63-71. [PMID: 32461054 DOI: 10.1016/j.parkreldis.2020.05.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/09/2020] [Accepted: 05/01/2020] [Indexed: 12/16/2022]
Abstract
Disorders of the gastrointestinal (GI) tract are common and distressing nonmotor symptoms of Parkinson's disease (PD) that can adversely affect levodopa absorption and lead to OFF periods, also known as motor fluctuations. Gastroparesis, which is primarily defined as delayed gastric emptying (DGE), and Helicobacter pylori infection, which is present with increased frequency in PD, are among the most common and important GI disorders reported in PD that may impair oral levodopa absorption and increase OFF time. Symptoms of gastroparesis include nausea, vomiting, postprandial bloating, fullness, early satiety, abdominal pain, and weight loss. DGE has been reported in a substantial fraction of individuals with PD. Symptoms of H. pylori infection include gastritis and peptic ulcers. Studies have found that DGE and H. pylori infection are correlated with delayed peak levodopa plasma levels and increased incidence of motor fluctuations. Therapeutic strategies devised to minimize the potential that gastric complications will impair oral levodopa absorption and efficacy in PD patients include treatments that circumvent the GI tract, such as apomorphine injection, levodopa intestinal gel delivery, levodopa inhalation powder, and deep brain stimulation. Other strategies aim at improving gastric emptying in PD patients, primarily including prokinetic agents.
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Affiliation(s)
- Ronald F Pfeiffer
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA.
| | - Stuart H Isaacson
- Parkinson's Disease and Movement Disorders Center of Boca Raton, Boca Raton, FL, USA
| | - Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
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Colletti PM. Using Intragastric Meal Distribution and Antral Contractility for Enhanced Gastric Emptying Analysis. J Nucl Med Technol 2019; 47:137. [DOI: 10.2967/jnmt.118.225029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/30/2019] [Indexed: 12/21/2022] Open
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Abstract
Gastroparesis is a chronic and debilitating neuromuscular disorder of the upper gastrointestinal tract. Symptoms of gastroparesis include nausea, vomiting, epigastric pain, early satiety, and weight loss. Treating gastroparesis can be difficult. Dietary changes may improve symptoms in patients with mild disease. A variety of medications can be used to treat symptoms of nausea and vomiting, although most have not been subjected to randomized controlled trials and only one is approved by the Food and Drug Administration (metoclopramide). Pain management is essential, as nearly 90% of patients report symptoms of epigastric pain. This article reviews treatment options for symptoms of gastroparesis.
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Affiliation(s)
- Christopher M Navas
- Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA.
| | - Nihal K Patel
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Brian E Lacy
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
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18
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Sharma M, Feuerhak K, Zinsmeister AR, Bharucha AE. A pharmacological challenge predicts reversible rectal sensorimotor dysfunctions in women with fecal incontinence. Neurogastroenterol Motil 2018; 30:e13383. [PMID: 29856103 PMCID: PMC6160337 DOI: 10.1111/nmo.13383] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/23/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND In order to understand the pathophysiology of rectal sensorimotor dysfunctions in women with fecal incontinence (FI) and rectal urgency, we evaluated the effects of a muscarinic antagonist and an adrenergic α2 agonist on these parameters. METHODS Firstly, rectal distensibility and sensation were evaluated with a barostat and sinusoidal oscillation at baseline and after randomization to intravenous saline or atropine in 16 healthy controls and 44 FI patients. Thereafter, FI patients were randomized to placebo or clonidine for 4 wk; rectal compliance and sensation were revaluated thereafter. The effect of atropine and clonidine on rectal functions and the relationship between them were evaluated. RESULTS At baseline, compared to controls, rectal capacity was lower (P = .03) while the mean pressure (P = .02) and elastance (P = .01) during sinusoidal oscillation were greater, signifying reduced distensibility, in FI. Compared to placebo, atropine increased (P ≤ .02) the heart rate in controls and FI and reduced (P = .03) the variability in rectal pressures during sinusoidal oscillation in controls. Clonidine increased rectal compliance (P = .04) and reduced rectal capacity (P = .03) in FI. The effects of atropine and clonidine on compliance (r = .44, P = .003), capacity (r = .34, P = .02), pressures during sinusoidal oscillation (r = .3, P = .057), pressure (r = .6, P < .0001), and volume sensory thresholds (r = .48, P = .003) were correlated. CONCLUSIONS The effects of atropine and clonidine on rectal distensibility and sensation were significantly correlated. A preserved response to atropine suggests that reduced rectal distensibility is partly reversible, mediated by cholinergic mechanisms, and may predict the response to clonidine, providing a pharmacological challenge.
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Affiliation(s)
- Mayank Sharma
- Division of Gastroenterology and Hepatology, Department of Medicine
| | - Kelly Feuerhak
- Division of Gastroenterology and Hepatology, Department of Medicine
| | - Alan R. Zinsmeister
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research
| | - Adil E. Bharucha
- Division of Gastroenterology and Hepatology, Department of Medicine
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19
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Orthey P, Dadparvar S, Parkman HP, Maurer AH. Enhanced Gastric Emptying Scintigraphy to Assess Fundic Accommodation Using Intragastric Meal Distribution and Antral Contractility. J Nucl Med Technol 2018; 47:138-143. [PMID: 30139887 DOI: 10.2967/jnmt.118.215566] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/17/2018] [Indexed: 12/14/2022] Open
Abstract
Gastric emptying scintigraphy (GES) as now commonly performed measures only total gastric emptying. Intragastric meal distribution (IMD) immediately after meal ingestion (t = 0 min) (IMD0) can assess fundic accommodation, and dynamic antral contraction scintigraphy (DACS) can assess antral motility. Our goals were to incorporate IMD and DACS into GES, compare IMD0 using gastric division into anatomic proximal and distal halves versus more physiologic separation of the antrum from the proximal stomach using DACS, and establish reference values. Methods: Healthy subjects (n = 20) underwent GES using a solid-liquid meal. DACS (1 frame/3 s) was performed for 20 min after each static imaging time. IMD0 was measured using both semiautomated software to divide the gastric long axis into anatomic halves and Fourier analysis to identify antral pixels with phasic contractions. Results: Using halving of the stomach, IMD0 averaged 0.75 ± 0.15 (SD). Using phasic contractions to define the antrum, mean IMD0 was 0.85 ± 0.14 (P = 0.004). Sustained antral contractions started at a mean of 11.24 ± 12.98 min after meal ingestion and originated in the gastric midbody with a starting location at 40.5% ± 10.8% from the distal to the proximal stomach along its long axis. Antral frequency and ejection fraction peaked 30 min after meal ingestion at 3.30 ± 0.71 contractions per minute and an ejection fraction of 30.3% ± 13.69%, when mean antral filling peaked at 36.7% ± 14%. Maximum antral contraction speed was 3.54 ± 0.90 mm/s at 60 min after meal ingestion. Gastric retention was 39.8% ± 12.8% at 2 h and 5.8% ± 6.0% at 4 h. Conclusion: Addition of DACS to GES permits physiologic characterization of both fundic accommodation and antral contractility to supplement routine GES.
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Affiliation(s)
- Perry Orthey
- Section of Gastroenterology, Department of Medicine, and Section of Nuclear Medicine, Department of Radiology, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Simin Dadparvar
- Section of Gastroenterology, Department of Medicine, and Section of Nuclear Medicine, Department of Radiology, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Henry P Parkman
- Section of Gastroenterology, Department of Medicine, and Section of Nuclear Medicine, Department of Radiology, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Alan H Maurer
- Section of Gastroenterology, Department of Medicine, and Section of Nuclear Medicine, Department of Radiology, Temple University School of Medicine, Philadelphia, Pennsylvania
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20
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Heyer GL, Boles LH, Harvey RA, Cismowski MJ. Gastric myoelectrical and neurohormonal changes associated with nausea during tilt-induced syncope. Neurogastroenterol Motil 2018; 30. [PMID: 28960795 DOI: 10.1111/nmo.13220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 09/07/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Nausea is a common prodromal symptom of neurally mediated syncope, but the biological factors linking nausea with syncope have not been studied. We aimed to characterize nausea during tilt-induced syncope by exploring related changes in gastric myoelectrical activity and plasma epinephrine, norepinephrine, and vasopressin concentrations across study phases of recumbency, tilt, syncope, and recovery. METHODS Electrogastrographic and plasma hormone changes were compared between patients with tilt-induced syncope and nausea (n = 18) and control subjects (n = 6) without symptoms or hemodynamic changes during tilt-table testing. KEY RESULTS Over a 4-minute period preceding syncope, sequential electrogastrography epochs demonstrated an increase over time in bradygastria (P = .003) and tachygastria (P = .014) power ratios, while the dominant frequency (P < .001) and the percent normogastria (P = .004) decreased. Syncope led to significant differences between cases and controls in electrogastrographic power ratios in each frequency range: bradygastria (P = .001), tachygastria (P = .005), and normogastria (P = .03). Nausea always followed electrogastrographic changes, and nausea resolution always preceded electrogastrographic normalization. Plasma vasopressin (676.5 ± 122.8 vs 91.2 ± 15.3 pg/mL, P = .012) and epinephrine (434 ± 91.3 vs 48.7 ± 2.5 pg/mL, P = .03), but not norepinephrine (P > .05), also differed with syncope between cases and controls. CONCLUSIONS AND INFERENCES The nausea related to tilt-induced syncope is temporally associated with changes in gastric myoelectrical activity and increases in plasma vasopressin and epinephrine. The biological mechanisms that induce syncope are physiologically distinct from other experimental models of nausea such as illusory self-motion, yet nausea with syncope appears to have similarly associated electrogastrographic and hormone changes. Thus, tilt-induced syncope could serve as an informative experimental model for nausea research.
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Affiliation(s)
- G L Heyer
- Division of Pediatric Neurology, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - L H Boles
- Department of Medicine, The Ohio State University, Columbus, OH, USA
| | - R A Harvey
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - M J Cismowski
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA.,Center for Cardiovascular Research, Nationwide Children's Hospital, Columbus, OH, USA
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Cholinergic signaling mediates the effects of xenin-25 on secretion of pancreatic polypeptide but not insulin or glucagon in humans with impaired glucose tolerance. PLoS One 2018; 13:e0192441. [PMID: 29466430 PMCID: PMC5821323 DOI: 10.1371/journal.pone.0192441] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 01/10/2018] [Indexed: 01/14/2023] Open
Abstract
We previously demonstrated that infusion of an intestinal peptide called xenin-25 (Xen) amplifies the effects of glucose-dependent insulinotropic polypeptide (GIP) on insulin secretion rates (ISRs) and plasma glucagon levels in humans. However, these effects of Xen, but not GIP, were blunted in humans with type 2 diabetes. Thus, Xen rather than GIP signaling to islets fails early during development of type 2 diabetes. The current crossover study determines if cholinergic signaling relays the effects of Xen on insulin and glucagon release in humans as in mice. Fasted subjects with impaired glucose tolerance were studied. On eight separate occasions, each person underwent a single graded glucose infusion- two each with infusion of albumin, Xen, GIP, and GIP plus Xen. Each infusate was administered ± atropine. Heart rate and plasma glucose, insulin, C-peptide, glucagon, and pancreatic polypeptide (PP) levels were measured. ISRs were calculated from C-peptide levels. All peptides profoundly increased PP responses. From 0 to 40 min, peptide(s) infusions had little effect on plasma glucose concentrations. However, GIP, but not Xen, rapidly and transiently increased ISRs and glucagon levels. Both responses were further amplified when Xen was co-administered with GIP. From 40 to 240 min, glucose levels and ISRs continually increased while glucagon concentrations declined, regardless of infusate. Atropine increased resting heart rate and blocked all PP responses but did not affect ISRs or plasma glucagon levels during any of the peptide infusions. Thus, cholinergic signaling mediates the effects of Xen on insulin and glucagon release in mice but not humans.
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Waluga M, Jonderko K, Domosławska E, Matwiejszyn A, Dzielicki M, Krusiec-Świdergoł B, Kasicka-Jonderko A. Effects of taste stimulation on gastric myoelectrical activity and autonomic balance. Saudi J Gastroenterol 2018; 24:100-108. [PMID: 29637917 PMCID: PMC5900469 DOI: 10.4103/sjg.sjg_419_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND/AIM Sham feeding, reproducing the cephalic phase of digestion, and involving combined visual, olfactory, and taste stimulation affects gastrointestinal motility and secretory functions of the digestive system, as well as the sympathetic/parasympathetic balance (SPB). In this study, we aimed to check if taste stimulation with a single flavor affects the gastric myoelectrical activity (GMA) and/or SPB. MATERIALS AND METHODS Eighteen healthy volunteers underwent, on four separate days, 30-min electrogastrographic and electrocardiographic recordings: basal, with stimulation - while keeping in the mouth an agar cube with taste-delivering substance, and postexposure. Concentrations of saccharose, NaCl, citric acid, and quinine hydrochloride within the cubes were adjusted to 100-fold the individual taste recognition thresholds. SPB was determined from the heart rate variability (HRV) analysis of the recorded electrocardiograms. RESULTS A moderate but statistically significant increase in tachygastria and bradygastria percentage time share was observed, regardless of the type of taste applied. Bitter taste elicited a considerable decrease in the normogastria time share (from 82.8 ± 2.5% to 73.5 ± 3.5%, P = 0.00076) and a diminution of the dominant frequency (from 3.07 ± 0.08 to 2.90 ± 0.10 cycles per minute (cpm) postexposure, P = 0.01). Sour taste brought about a drop of the dominant power (from 42.5 ± 1.1 to 40.1 ± 1.4 dB, P = 0.0015). Two tastes hindered propagation of the gastric slow waves - the average percentage of slow wave coupling decreased from 77.9 ± 3.1% to 69.5 ± 3.1% (P = 0.0078) and from 74.6 ± 2.5% to 68.2 ± 2.8% (P = 0.0054) with the bitter and the salty taste, respectively. Stimulation with sweet, salty, or sour taste evoked a significant decrease in the high frequency component of the HRV, whereas bitter taste did not affect the SPB. CONCLUSIONS Oral stimulation with tastes subjectively perceived as unpleasant brings about disturbances of the interdigestive GMA. This, however, does not coincide with its effect upon SPB.
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Affiliation(s)
- Marek Waluga
- Department of Basic Biomedical Science, School of Pharmacy, Medical University of Silesia, Sosnowiec, Poland
| | - Krzysztof Jonderko
- Department of Basic Biomedical Science, School of Pharmacy, Medical University of Silesia, Sosnowiec, Poland,Address for correspondence: Prof. Krzysztof Jonderko, Department of Basic Biomedical Science, School of Pharmacy, Medical University of Silesia, Sosnowiec, Poland. E-mail:
| | - Ewelina Domosławska
- Department of Basic Biomedical Science, School of Pharmacy, Medical University of Silesia, Sosnowiec, Poland
| | - Anna Matwiejszyn
- Department of Basic Biomedical Science, School of Pharmacy, Medical University of Silesia, Sosnowiec, Poland
| | - Marek Dzielicki
- Department of Basic Biomedical Science, School of Pharmacy, Medical University of Silesia, Sosnowiec, Poland
| | - Beata Krusiec-Świdergoł
- Department of Basic Biomedical Science, School of Pharmacy, Medical University of Silesia, Sosnowiec, Poland
| | - Anna Kasicka-Jonderko
- Department of Basic Biomedical Science, School of Pharmacy, Medical University of Silesia, Sosnowiec, Poland
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Abstract
Ingestion and digestion of food as well as expulsion of residual material from our gastrointestinal tract requires normal propulsive, i.e. motor, function. Hypomotility refers to inherited or acquired changes that come with decreased contractile forces or slower transit. It not only often causes symptoms but also may compromise nutritional status or lead to other complications. While severe forms, such as pseudo-obstruction or ileus, may have a tremendous functional impact, the less severe forms of hypomotility may well be more relevant, as they contribute to common disorders, such as functional dyspepsia, gastroparesis, chronic constipation, and irritable bowel syndrome (IBS). Clinical testing can identify changes in contractile activity, defined by lower amplitudes or abnormal patterns, and the related effects on transit. However, such biomarkers show a limited correlation with overall symptom severity as experienced by patients. Similarly, targeting hypomotility with pharmacological interventions often alters gut motor function but does not consistently improve symptoms. Novel diagnostic approaches may change this apparent paradox and enable us to obtain more comprehensive information by integrating data on electrical activity, mechanical forces, patterns, wall stiffness, and motions with information of the flow of luminal contents. New drugs with more selective effects or more specific delivery may improve benefits and limit adverse effects. Lastly, the complex regulation of gastrointestinal motility involves the brain-gut axis as a reciprocal pathway for afferent and efferent signaling. Considering the role of visceral input in emotion and the effects of emotion on visceral activity, understanding and managing hypomotility disorders requires an integrative approach based on the mind-body continuum or biopsychosocial model of diseases.
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Affiliation(s)
- Klaus Bielefeldt
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ashok Tuteja
- Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Salman Nusrat
- Department of Medicine, Oklahoma University Medical Center, Oklahoma City, OK, USA
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Ahlkvist L, Omar B, Pacini G, Ahrén B. Evidence for neural contribution to islet effects of DPP-4 inhibition in mice. Eur J Pharmacol 2016; 780:46-52. [PMID: 26997369 DOI: 10.1016/j.ejphar.2016.03.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/12/2016] [Accepted: 03/15/2016] [Indexed: 11/17/2022]
Abstract
It has been suggested that neural mechanisms may contribute to effects of the incretin hormones, and, therefore, also to the effects of dipeptidyl peptidase (DPP-4) inhibition. We therefore examined whether muscarinic mechanisms are involved in the stimulation of insulin secretion by DPP-4 inhibition. Fasted, anesthetized mice were given intraperitoneal saline or the muscarinic antagonist atropine (5mg/kg) before duodenal glucose (75mg/mouse), with or without the DPP-4 inhibitor NVPDPP728 (0.095mg/mouse), or before intravenous glucose (0.35g/kg) with or without co-administration with GLP-1 or glucose-dependent insulinotropic polypeptide (GIP) (both 3nmol/kg). Furthermore, isolated islets were incubated (1h) in 2.8 and 11.1mM glucose, with or without GIP or GLP-1 (both 100nM), in the presence or absence of atropine (100µM). Duodenal glucose increased circulating insulin and this effect was potentiated by DPP-4 inhibition. The increase in insulin achieved by DPP-4 inhibition was reduced by atropine by approximately 35%. Duodenal glucose also elicited an increase in circulating intact GLP-1 and GIP and this was augmented by DPP-4 inhibition, but these effects were not affected by atropine. Atropine did also not affect the augmentation by GLP-1 and GIP on glucose-stimulated insulin secretion from isolated islets. Based on these findings, we suggest that muscarinic mechanisms contribute to the stimulation of insulin secretion by DPP-4 inhibition through neural effects induced by GLP-1 and GIP whereas neural effects do not affect the levels of GLP-1 or GIP or the islet effects of the two incretin hormones.
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Affiliation(s)
- Linda Ahlkvist
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Bilal Omar
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Giovanni Pacini
- Metabolic Unit, Institute of Neurosciences, National Research Council, Padova, Italy
| | - Bo Ahrén
- Department of Clinical Sciences, Lund University, Lund, Sweden.
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Nam Y, Lee JM, Wang Y, Ha HS, Sohn UD. The effect of Flos Lonicerae Japonicae extract on gastro-intestinal motility function. JOURNAL OF ETHNOPHARMACOLOGY 2016; 179:280-290. [PMID: 26743226 DOI: 10.1016/j.jep.2015.12.056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 12/23/2015] [Accepted: 12/29/2015] [Indexed: 06/05/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Flos Lonicerae Japonicae is a well-known herb of traditional Chinese medicine that has been used for heat-clearing, detoxification, anti-inflammation, throat pain and gastro-intestinal (GI) disorder. In order to verify the effect of Flos Lonicerae Japonicae on GI disorder, we investigated the prokinetic effect of GC-7101 on GI motility function. MATERIALS AND METHODS GC-7101 is the standardized extract of Flos Lonicerae Japonicae. The contractile action of GC-7101 on feline esophageal smooth muscle cell (ESMC) was evaluated by measuring dispersed cell length. The isometric tension study was performed to investigate the effect of GC-7101 on feline lower esophageal sphincther (LES). The prokinetic effect of GC-7101 was investigated by gastric emptying (GE) and gastro-intestinal transit (GIT) in rats. RESULTS GC-7101 produced concentration-dependent contractions in ESMCs. Pretreatment with 5-HT3 and 5-HT4 receptor blocker (ondansetron and GR113808) inhibited the contractile responses of the GC-7101-induced ESMCs. In isometric tension study, GC-7101 recovered the HCl-induced decreased tone of LES muscle strips. The treatment of GC-7101 enhanced the carbachol-induced contractile responses and the electric field stimulation (EFS)-induced on-contraction. The oral administration of GC-7101 not only significantly accelerated GE and GIT in normal rats but also recovered the delayed GE and GIT, and its effect was more potent than that of conventional prokinetics (e.g., domperidone, a dopamine-receptor antagonist, and mosapride, a 5-HT4-receptor agonist). CONCLUSION GC-7101 revealed a prokinetic effect through enhancing the contractile responses of ESMCs, tone increases, enhancing the carbarchol- or EFS-induced contractile responses of LES muscle strips, and the acceleration of GE and GIT. We have identified the significant potential of GC-7101 for the development of new prokinetic drugs through this study.
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Affiliation(s)
- Yoonjin Nam
- Department of Pharmacology, College of Pharmacy, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul 156-784, Republic of Korea.
| | - Jong Mi Lee
- Department of Pharmacology, College of Pharmacy, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul 156-784, Republic of Korea.
| | - Yiyi Wang
- Department of Pharmacology, College of Pharmacy, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul 156-784, Republic of Korea.
| | - Hyun Su Ha
- Department of Pharmacology, College of Pharmacy, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul 156-784, Republic of Korea.
| | - Uy Dong Sohn
- Department of Pharmacology, College of Pharmacy, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul 156-784, Republic of Korea.
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Květina J, Tachecí I, Pavlík M, Kopáčová M, Rejchrt S, Douda T, Kuneš M, Bureš J. Use of electrogastrography in preclinical studies of cholinergic and anticholinergic agents in experimental pigs. Physiol Res 2015; 64:S647-52. [PMID: 26674291 DOI: 10.33549/physiolres.933227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Electrogastrography (EGG) is a non-invasive method for the assessment of gastric myoelectrical activity. Porcine EGG is comparable with human one. The purpose of this study was to evaluate the effect of atropine and neostigmine on the EGG in experimental pigs. Adult female pigs were administrated atropine (1.5 mg i.m., n=6) and neostigmine (0.5 mg i.m., n=6) after the baseline EGG, followed by a 90-min trial recording (MMS, Enschede, the Netherlands). Running spectral analysis was used for the evaluation. The results were expressed as dominant frequency of slow waves and EGG power (areas of amplitudes). Neostigmine increased continuously the dominant frequency and decreased significantly the EGG power. Atropine did not change the dominant frequency significantly. However, atropine increased significantly the EGG power (areas of amplitudes) from basal values to the maximum at the 10-20-min interval. After that period, the areas of amplitudes decreased significantly to the lowest values at the 60-90-min interval. In conclusion, cholinergic and anticholinergic agents affect differently EGG in experimental pigs.
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Affiliation(s)
- J Květina
- Second Department of Internal Medicine - Gastroenterology, University Teaching Hospital, Hradec Králové, Czech Republic.
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The effect of different doses of atropine on gastric myoelectrical activity in fasting experimental pigs. J Appl Biomed 2015. [DOI: 10.1016/j.jab.2015.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Youssef AS, Parkman HP, Nagar S. Drug-drug interactions in pharmacologic management of gastroparesis. Neurogastroenterol Motil 2015; 27:1528-41. [PMID: 26059917 DOI: 10.1111/nmo.12614] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 05/13/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Gastroparesis is a disorder characterized by delayed gastric emptying due to chronic abnormal gastric motility. The treatment of the disease often entails the co-administration of several classes of pharmacological agents. These agents may be metabolized via the same pathway. Inhibition or induction of a shared metabolic pathway leads to change in the systemic levels of prescribed drugs, possibly leading to undesired clinical outcomes. PURPOSE This review discusses different pharmacological treatment for gastroparesis patients and describes the potential for drug-drug interactions (DDIs) in some of the combinations that are currently used. Prokinetic agents such as metoclopramide and domperidone are the cornerstone in treatment of gastroparesis. Antiemetic agents such as promethazine and ondansetron are frequently administered to gastroparesis patients to reduce nausea and vomiting. Gastroparesis is prevalent in diabetic patients and therefore antidiabetic agents are also prescribed. Many of these co-administered drugs are metabolized via common drug metabolizing enzymes and this can trigger potential DDIs. The scientific literature was reviewed from the years 1975-2014 for original research articles and reviews that evaluated DDIs in gastroparesis. Many commonly prescribed combinations were predicted to cause potential DDIs in gastroparesis patients. This review will help inform about potential hazardous combinations. This information will hopefully lead to less adverse effects and more successful gastroparesis management.
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Affiliation(s)
- A S Youssef
- Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia, PA, USA
| | - H P Parkman
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, PA, USA
| | - S Nagar
- Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia, PA, USA
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From ischochymia to gastroparesis: proposed mechanisms and preferred management of dyspepsia over the centuries. Dig Dis Sci 2014; 59:1088-98. [PMID: 24715546 DOI: 10.1007/s10620-014-3144-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 03/26/2014] [Indexed: 12/12/2022]
Abstract
Dyspeptic symptoms are common with most patients suffering functional disorders that remain a therapeutic challenge for medical practitioners. Within the last three decades, gastric infection, altered motility, and hypersensitivity have gained and lost traction in explaining the development of functional dyspepsia. Considering these shifts, the aim of this review was to analyze changing understanding of and approaches to dyspepsia over a longer time period. Monographs, textbooks, and articles published during the last three centuries show that our understanding of normal gastric function has improved dramatically. With increased insight came new ideas about disease mechanisms, diagnostic options, and treatments. Despite shifts over time, the importance of functional abnormalities was recognized early on and explained in the context of societal influences and stressors, anxieties, and biological influences, thus resembling the contemporary biopsychosocial model of illness. Symptoms were often attributed to changes in secretion, motility, and sensation or perception with technological innovation often influencing proposed mechanisms and treatments. Many of the principles or even agents applied more than a century ago are still part of today's approach. This includes acid suppression, antiemetics, analgesics, and even non-pharmacologic therapies, such as gastric decompression or electrical stimulation of the stomach. This historical information does not only help us understand how we arrived at our current state of knowledge and standards of care, it also demonstrates that enthusiastic adoption of various competing explanatory models and the resulting treatments often did not survive the test of time. In view of the benign prognosis of dyspepsia, the data may function as a call for caution to avoid the potential harm of overly aggressive approaches or treatments with a high likelihood of adverse effects.
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Broad J, Góralczyk A, Mannur K, Dukes GE, Sanger GJ. Drugs acting at 5-HT4 , D2 , motilin, and ghrelin receptors differ markedly in how they affect neuromuscular functions in human isolated stomach. Neurogastroenterol Motil 2014; 26:851-61. [PMID: 24750304 DOI: 10.1111/nmo.12338] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 03/10/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Progress in identifying safer, effective drugs to increase gastric emptying is impeded by failed clinical trials. One potential reason for failure is lack of translation from animal models to the human condition. To make progress, the actions of existing drugs and new therapeutic candidates need to be understood in human isolated stomach. METHODS Neuromuscular activities were evoked in human gastric antrum circular muscle by electrical field stimulation (EFS), defined phenotypically using pharmacological tools. KEY RESULTS EFS evoked cholinergically mediated contractions, attenuated by simultaneous nitrergic activation. The 5-HT4 receptor agonist/D2 antagonist metoclopramide and the selective 5-HT4 agonist prucalopride, facilitated contractions in the absence (respectively, Emax 95 ± 29% and 42 ± 9%, n = 3-6 each concentration) and presence (139 ± 38%, 55 ± 13%, n = 3-5) of the NO synthase inhibitor L-NAME, without affecting submaximal contractions to carbachol; the 5-HT4 antagonist SB204070 prevented facilitation by metoclopramide 100 μM (respectively, -5 (range -26 to 34) and 167 (12-1327)% in presence and absence; n = 5-6). The selective motilin receptor agonist camicinal provided considerably greater facilitation (478 (12-2080)% at 30 μM, n = 8). Domperidone (0.001-100 μM; n = 3-6) and acylated or des-acylated ghrelin (1-300 nM; n = 2-4) had no consistent activity, even with protease inhibitors. CONCLUSIONS & INFERENCES 5-HT4 receptor agonists show different efficacies. Motilin receptor activation has greater potential to increase gastric emptying, whereas ghrelin and D2 receptor antagonism have no direct activity. Drugs stimulating human gastric motility directly can act regardless of disease mechanisms, whereas drugs without direct activity but an ability to block nausea/vomiting may be effective only if these symptoms exist.
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Affiliation(s)
- J Broad
- Neurogastroenterology Group, Blizard Institute, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Meissner K. Placebo responses on cardiovascular, gastrointestinal, and respiratory organ functions. Handb Exp Pharmacol 2014; 225:183-203. [PMID: 25304533 DOI: 10.1007/978-3-662-44519-8_11] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
It is widely acknowledged that placebo responses are accompanied by physiological changes in the central nervous system, but little is known about placebo responses on end organ functions. The present chapter aims to fill this gap by reviewing the literature on peripheral placebo responses. Overall, there is a wide range of placebo and nocebo responses on various organ functions of the cardiovascular, the gastrointestinal system, and the respiratory system. Most of these studies used expectation paradigms to elicit placebo and nocebo responses. Expectations can affect heart rate, blood pressure, coronary diameter, gastric motility, bowel motility, and lung function. Classical conditioning can induce placebo respiratory depression after prior exposure to opioid drugs, and habitual coffee drinkers show physiological arousal in response to coffee-associated stimuli. Similar to findings in placebo pain research, peripheral placebo responses can be target specific. The autonomic nervous system is a likely candidate to mediate peripheral placebo responses. Further studies are necessary to identify the brain mechanisms and pathways involved in peripheral placebo responses.
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Affiliation(s)
- Karin Meissner
- Institute of Medical Psychology, Ludwig-Maximilians-University Munich, Goethestrasse 31, 80336, Munich, Germany,
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Prior H, Ewart L, Bright J, Valentin JP. Refinement of the Charcoal Meal Study by Reduction of the Fasting Period. Altern Lab Anim 2012; 40:99-107. [DOI: 10.1177/026119291204000209] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this investigation was to determine whether a shorter fasting period than the one historically employed for the charcoal meal test, could be used when measuring gastric emptying and intestinal transit within the same animal, and to ascertain whether the scientific outcome would be affected by this benefit to animal welfare. Rats and mice were fasted for 0, 3, 6 or 18 hours before the oral administration of vehicle or atropine. One hour later, the animals were orally administered a charcoal meal, then 20 minutes later, they were killed and the stomach and small intestine were removed. Intestinal transit time (the position of the charcoal front as a percentage of the total length of the small intestine) and relative gastric emptying (weight of stomach contents) were measured. Rats and mice fasted for six hours showed results for gastric emptying and intestinal transit which were similar to those obtained in animals fasted for 18 hours. Reducing the fasting period reduced the body weight loss in both species, and mice on shorter fasts could be group-housed, as hunger-induced fighting was lessened. Therefore, a fasting period of six hours was subsequently adopted for charcoal meal studies at our institution.
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Affiliation(s)
- Helen Prior
- Safety Pharmacology, Global Safety Assessment, AstraZeneca UK Ltd, Mereside, Alderley Park, Macclesfield, Cheshire, UK
| | - Lorna Ewart
- Safety Pharmacology, Global Safety Assessment, AstraZeneca UK Ltd, Mereside, Alderley Park, Macclesfield, Cheshire, UK
| | - Jonathan Bright
- Safety Pharmacology, Global Safety Assessment, AstraZeneca UK Ltd, Mereside, Alderley Park, Macclesfield, Cheshire, UK
| | - Jean-Pierre Valentin
- Safety Pharmacology, Global Safety Assessment, AstraZeneca UK Ltd, Mereside, Alderley Park, Macclesfield, Cheshire, UK
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Chini P, Toskes PP, Waseem S, Hou W, McDonald R, Moshiree B. Effect of azithromycin on small bowel motility in patients with gastrointestinal dysmotility. Scand J Gastroenterol 2012; 47:422-7. [PMID: 22364597 DOI: 10.3109/00365521.2012.654402] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To investigate the effect of azithromycin (AZI) on small bowel activity in patients with gastrointestinal dysmotility (GID). MATERIAL AND METHODS Manometric data on a consecutive series of 21 patients was reviewed. Only those patients with gastroparesis and small bowel dysmotility as defined by antroduodenal manometric criteria were included. Pressure profiles were recorded in three stages: baseline period, fed state and postprandial after administration of erythromycin (ERY) and AZI. The measured parameters included the number and characteristics of activity fronts and migrating motor complexes (MMCs) including duration, amplitude and frequency of contractions. The data were analyzed using repeated measures analysis of variance for comparison of each medication. RESULTS AZI induced more MMCs in the duodenum with origin of activity fronts in the antrum than did ERY (18 patients with AZI, 10 patients with ERY). No significant difference between AZI and ERY was seen with respect to the amplitude of MMCs or number of cycles per minute. The average duration of activity fronts was longer with AZI compared with ERY (AZI mean 18.5 min, ERY mean 9.7 min, p < 0.02). CONCLUSIONS AZI induces activity fronts in the antrum followed by duodenal contractions more frequently than ERY in patients with GID. AZI potentially promises to be a prokinetic for treatment of small bowel dysmotility.
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Affiliation(s)
- Payam Chini
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, FL 32608, USA.
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Brun R, Michalek W, Surjanhata BC, Parkman HP, Semler JR, Kuo B. Comparative analysis of phase III migrating motor complexes in stomach and small bowel using wireless motility capsule and antroduodenal manometry. Neurogastroenterol Motil 2012; 24:332-e165. [PMID: 22292793 DOI: 10.1111/j.1365-2982.2011.01862.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Assessment of phase III MMC is often not performed due to the invasive nature of antroduodenal manometry used to detect it. The aim of the study was to evaluate the ability of wireless motility capsule (WMC) to detect phase III MMC and correlate it with the simultaneous measurements by antroduodenal manometry (ADM). METHODS Eighteen patients underwent simultaneous ADM and WMC. MMCs were identified first on ADM and then correlated with WMC events occurring simultaneously. Frequency of contractions per min, AUC, MI, and criteria for amplitude thresholds of contractions representing MCCs on WMC tracings were defined. KEY RESULTS In 18 patients, a total of 29 MMCs were recorded by ADM. WMC detected 86% of MMC events measured by ADM. Hundred percent (10/10) of MMCs in stomach were detected by WMC, whereas 79% (15/19) of MMCs were detected in SB. The sensitivity and specificity of WMC high amplitude contractions to represent phase III MMC were 90% and 71.8% in the stomach; 73.7% and 84.7% in SB, respectively, and negative predictive value was 99.9% in both regions. CONCLUSIONS & INFERENCES Wireless motility capsule was able to detect the phase III MMCs as the high amplitude contractions with good fidelity. WMC does not detect the propagation of MMC. Using the pressure thresholds, WMC can detect high amplitude contraction representing phase III MMC with favorable sensitivity/specificity profile and 99.9% negative predictive value. This observation may have clinical significance, as the absence of high amplitude contractions recorded by WMC during fasting state suggests absence of MMCs.
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Affiliation(s)
- R Brun
- Gastroenterology Unit, Massachusetts General Hospital, Boston, MA, USA
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Yin J, Chen JDZ. Electroacupuncture improves rectal distension-induced delay in solid gastric emptying in dogs. Am J Physiol Regul Integr Comp Physiol 2011; 301:R465-72. [DOI: 10.1152/ajpregu.00271.2010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The aim of this study was to investigate the effects and mechanisms of electroacupuncture (EA) on rectal distension (RD)-induced delay in solid gastric emptying in dogs. Gastric emptying of solids was assessed in 12 dogs chronically implanted with a duodenal cannula by collecting samples at different time points from the cannula and measuring the dried weights of the samples. Bethanechol and atropine were used to qualitatively validate the method. In separate experiments, gastric emptying of solids was measured in a number of sessions: control, RD, RD + sham-EA, RD + EA of 6 mA, RD + EA of 3 mA, and RD + EA + naloxone. The method of gastric emptying by collecting and drying gastric chyme from the duodenal cannula was found to be accurate and reliable. Using the method, we found gastric emptying to be accelerated with bethanechol (70.01 ± 8.10% vs. 82.61 ± 4.15%, P = 0.04, vs. control) and delayed with atropine (4.31 ± 1.57%, P < 0.001, vs. control). RD substantially and significantly delayed gastric emptying. EA, but not sham-EA, attenuated delayed gastric emptying induced by RD (sham-EA: 48.79 ± 9.47% vs. EA: 74.28 ± 5.96%, P < 0.01). The effect was more potent with EA of 6 mA than EA of 3 mA and blocked by naloxone. EA is able to attenuate RD-induced delay in gastric emptying of solids, and this ameliorating effect may be mediated via the opioid pathway. EA may have a therapeutic potential for treating delayed gastric emptying attributed to lower gut distension.
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Affiliation(s)
- Jieyun Yin
- Division of Gastroenterology, University of Texas Medical Branch, Galveston, Texas
| | - Jiande D. Z. Chen
- Division of Gastroenterology, University of Texas Medical Branch, Galveston, Texas
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Using pharmacokinetic modeling to determine the effect of drug and food on gastrointestinal transit in dogs. J Pharmacol Toxicol Methods 2011; 64:42-52. [DOI: 10.1016/j.vascn.2011.04.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 04/21/2011] [Accepted: 04/29/2011] [Indexed: 11/17/2022]
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Tack J, Janssen P. Acotiamide (Z-338, YM443), a new drug for the treatment of functional dyspepsia. Expert Opin Investig Drugs 2011; 20:701-12. [PMID: 21417958 DOI: 10.1517/13543784.2011.562890] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Functional dyspepsia (FD) is a highly prevalent condition with a major impact on quality of life and high socio-economic and healthcare costs. To date, no treatment of established efficacy in FD is available. Acotiamide (Z-338 or YM443) is a new drug under development for the treatment of FD. AREAS COVERED Acotiamide is a gastroprokinetic drug that enhances acetylcholine release in the enteric nervous system via muscarinic receptor antagonism and acetycholinesterase inhibition. In conscious rats and dogs, acotiamide enhanced gastric contractility and accelerated delayed gastric emptying. Although in healthy volunteers acotiamide did not affect gastric emptying, gastric emptying and gastric accommodation were enhanced in FD. Acotiamide was evaluated in FD in several clinical studies in different countries and these are supportive of a symptomatic benefit. The beneficial effect is most consistently found with the 100 mg dose (three times a day) and primarily involves the postprandial distress syndrome symptoms of postprandial fullness, early satiety and upper abdominal bloating. The mechanism underlying the symptomatic benefit with acotiamide is not fully established but may involve enhanced gastric accommodation and increased gastric emptying. EXPERT OPINION Compared to placebo, no adverse events have been reported in the current short-term studies, while acotiamide seems efficacious for treating postprandial distress syndrome symptoms in FD patients.
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Affiliation(s)
- Jan Tack
- University of Leuven, Translational Research Center for Gastrointestinal Disorders, Department of Pathophysiology, Leuven, Belgium.
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Binding sites of muscarinic and adrenergic receptors in gastrointestinal tissues of dairy cows suffering from left displacement of the abomasum. Vet J 2010; 186:328-37. [DOI: 10.1016/j.tvjl.2009.08.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Revised: 01/04/2009] [Accepted: 08/19/2009] [Indexed: 11/18/2022]
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Kim I, Cohen ND, Roussel A, Wang N. A two-component nonlinear mixed effects model for longitudinal data, with application to gastric emptying studies. Stat Med 2010; 29:1839-56. [PMID: 20658551 DOI: 10.1002/sim.3956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Gastric emptying studies are of great interest in human and veterinary medical research to evaluate effects of medications or diets for promoting gastrointestinal motility and to examine unintended side-effects of new or existing medications, diets, or procedures. Summarizing gastric emptying data is important to allow easier comparison between treatments or groups of subjects and comparisons of results among studies. The standard method for assessing gastric emptying is by using scintigraphy and summarizing the nonlinear emptying of the radioisotope. A popular model for fitting gastric emptying data is the power exponential model. This model can only describes a globally decreasing pattern and thus has the limitation of poorly describing localized intragastric events that can occur during emptying. Hence, we develop a new model for gastric emptying studies to improve population and individual inferences using a mixture of nonlinear mixed effects models. One mixture component is based on a power exponential model which captures globally decreasing patterns. The other is based on a locally extended power exponential model which captures both local bumping and rapid decay. We refer to this mixture model as a two-component nonlinear mixed effects model. The parameters in our model have clear graphical interpretations that provide a more accurate representation and summary of the curves of gastric emptying pattern. Two methods are developed to fit our proposed model: one is the mixture of an Expectation Maximization algorithm and a global two-stage method and the other is the mixture of an Expectation Maximization algorithm and the Monte Carlo Expectation Maximization algorithm. We compare our methods using simulation, showing that the two approaches are comparable to one another. For estimating the variance and covariance matrix, the second approach appears approximately more efficient and is also numerically more stable in some cases. Our new model and approaches are applicable for assessing gastric emptying in human and veterinary medical research and in many other biomedical fields such as pharmacokinetics, toxicokinetics, and physiological research. An example of gastric emptying data from equine medicine is used to demonstrate the advantage of our approaches.
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Affiliation(s)
- Inyoung Kim
- Department of Statistics, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061-0439, USA.
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Bharucha AE, Ravi K, Zinsmeister AR. Comparison of selective M3 and nonselective muscarinic receptor antagonists on gastrointestinal transit and bowel habits in humans. Am J Physiol Gastrointest Liver Physiol 2010; 299:G215-9. [PMID: 20395537 PMCID: PMC2904119 DOI: 10.1152/ajpgi.00072.2010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Although in vitro studies show that muscarinic M(3) receptors primarily mediate the effects of acetylcholine on gastrointestinal contractility, the muscarinic receptor subtypes regulating gastrointestinal motor activity and transit in humans in vivo are unclear. We hypothesized that muscarinic M(3)-specific but not nonspecific receptor antagonists would delay gastrointestinal and colonic transit in humans. In this parallel-group study, gastric emptying, small intestinal transit, and colonic transit were assessed by scintigraphy on days 4-6 in 72 healthy subjects (49 women) who received placebo (n = 16), the M(3) antagonist darifenacin ER [7.5 mg (n = 20) or 15 mg daily (n = 17)], or the nonspecific antagonist tolterodine [4 mg daily (n = 19)] for 6 days. Bowel habits were recorded by daily diaries. Both doses of darifenacin substantially delayed [P < 0.01 vs. placebo (for both doses), P < 0.01 vs. tolterodine (for 15 mg)] small intestinal transit, i.e., colonic filling at 6 h (placebo [59.6 +/- 6.4%, mean +/- SE], 7.5 mg ER [34.4 +/- 6.1%], 15 mg ER [20.4 +/- 6.3%)]. Darifenacin (15 mg) also delayed (P < 0.01 vs. placebo and tolterodine) half-time for ascending colonic emptying [placebo (12.0 +/- 1.5 h), 7.5 mg (18.6 +/- 1.9 h), 15 mg (22.9 +/- 2.6 h)] and colonic transit (geometric center) at 24 [placebo (2.8 +/- 0.2), 7.5 mg (2.4 +/- 0.2), 15 mg (1.9 +/- 0.2)] but not 48 h. Darifenacin did not affect gastric emptying and tolterodine did not affect bowel habits or gastrointestinal transit. With muscarinic antagonists used at clinically approved doses, these findings demonstrate that muscarinic M(3) receptors regulate small intestinal and colonic transit in humans; colonic effects are more pronounced in the right than left colon. At doses that affect small and large intestinal transit, M(3) antagonists do not affect gastric emptying in humans. The efficacy of darifenacin in diarrhea-predominant irritable bowel syndrome should be evaluated.
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Affiliation(s)
- Adil E. Bharucha
- 1Clinical and Enteric Neuroscience Translational and Epidemiological Research Program (C.E.N.T.E.R.) and
| | - Karthik Ravi
- 1Clinical and Enteric Neuroscience Translational and Epidemiological Research Program (C.E.N.T.E.R.) and
| | - Alan R. Zinsmeister
- 2Division of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
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Comparison of the effect of azithromycin versus erythromycin on antroduodenal pressure profiles of patients with chronic functional gastrointestinal pain and gastroparesis. Dig Dis Sci 2010; 55:675-83. [PMID: 19924535 DOI: 10.1007/s10620-009-1038-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Accepted: 10/26/2009] [Indexed: 02/06/2023]
Abstract
BACKGROUND Current pharmacologic treatments for gastroparesis have been disappointing due to the limited options available. Erythromycin ethylsuccinate is a potent prokinetic agent that stimulates gastric emptying. Recently, erythromycin has been linked to the occurrences of sudden cardiac death due to QT prolongation. Azithromycin is similar to erythromycin in structure but does not have significant drug-drug interactions as seen with erythromycin. PURPOSE This study aims to determine whether azithromycin stimulates antral activity in patients with chronic gastrointestinal pain and refractory gastroparesis. METHODS Small bowel manometric data on 30 patients undergoing clinical evaluation for chronic digestive problems or documented refractory gastroparesis were reviewed. Antral activity was measured after infusion of erythromycin 250 mg intravenous and azithromycin (500 or 250 mg intravenous) given at different intervals during the small bowel manometry. The parameters measured included the total duration of effect, mean amplitude of antral contractions, duration of the highest antral contraction phase, number of cycles per minute, and the motility index. RESULTS Comparison of erythromycin and azithromycin at similar doses showed a similar positive effect on antral activity. However, comparison of erythromycin and azithromycin at the higher dose of 500 mg showed that the mean amplitude, duration of antral activity, and motility index were significantly increased with azithromycin (P < 0.05). CONCLUSIONS Azithromycin stimulates antral activity similar to erythromycin and moreover has a longer duration of effect. However, unlike erythromycin, azithromycin does not have significant drug-drug interactions and maybe a potential new medication for the treatment of gastroparesis and gastrointestinal dysmotility.
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Yan R, Yan G, Guo X, Zhang G. A practical measuring system for intestinal pressure activity and its clinical application. Biomed Signal Process Control 2010. [DOI: 10.1016/j.bspc.2009.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Moleiro FC, Andreo MA, Santos RDCD, Moraes TDM, Rodrigues CM, Carli CBDA, Lopes FCM, Pellizzon CH, Carlos IZ, Bauab TM, Vilegas W, Hiruma-Lima CA. Mouririelliptica: validation of gastroprotective, healing and anti-Helicobacter pylori effects. JOURNAL OF ETHNOPHARMACOLOGY 2009; 123:359-368. [PMID: 19501267 DOI: 10.1016/j.jep.2009.03.040] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Revised: 03/21/2009] [Accepted: 03/25/2009] [Indexed: 05/27/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Mouriri elliptica Martius (Melastomataceae) is species reputed in folk medicine to heal gastric ulcer and gastritis. AIM OF THE STUDY Methanolic extract (ME) and ethyl acetate fraction (EAF) from leaves of Mouriri elliptica were evaluated for their gastroprotective, healing, immunological, toxicological and anti-Helicobacter pylori activities. MATERIAL AND METHODS The gastroprotective action of ME and EAF was evaluated in rodent experimental models and to elucidate mechanisms of action, the antisecretory action, involvements of NO, SH, PGE(2), anti-Helicobacter pylori action of ME was evaluated. We also used immunohistochemical (PCNA and COX-2) and immunomodulatory (murine peritoneal macrophages) assays to evaluate Mouriri elliptica effects. RESULTS ME present gastroprotective action without antisecretory effect. Otherwise, ME showed anti-Helicobacter pylori action (MIC=0.025mug/mL) and was able to inhibit NO production by macrophages. This species also accelerate the healing of ulcerated gastric mucosa by stimulating proliferation factors (PCNA), COX-2 and maintained basal PGE(2) level independent action of NSAID in gastric mucosa. The phytochemical investigation showed that this species possesses phenolic acid derivatives, acylglycoflavonoids and condensed tannins which probably influenced their pharmacological action. CONCLUSION All these results suggest the efficacy and safety of Mouriri elliptica in combating and healing gastric ulcer.
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Affiliation(s)
- Fábio Cruz Moleiro
- São Paulo State University-Departamento de Fisiologia, Instituto de Biociências, Cp 610, CEP 18618-000, UNESP, Botucatu, SP, Brazil
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Meissner K. Effects of placebo interventions on gastric motility and general autonomic activity. J Psychosom Res 2009; 66:391-8. [PMID: 19379955 DOI: 10.1016/j.jpsychores.2008.09.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 07/21/2008] [Accepted: 09/02/2008] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The study aimed to investigate placebo effects on gastric motility and to examine possible autonomic mediating mechanisms. METHODS Eighteen healthy volunteers received a placebo pill on three occasions together with the verbal suggestion that it would stimulate, relax, or not affect gastric activity. Electrogastrogram, electrocardiogram, and electrodermal activity recordings were conducted for 30 min prior to and following intervention. RESULTS Dominant frequency of the gastric slow wave decreased in the stimulant condition, and increased in the relaxant condition, the difference among conditions being significant. No differential effects of the interventions on cardiac interbeat intervals, heart rate variability, and skin conductance levels were observed. CONCLUSION Stomach relaxant and stimulant placebo interventions modulated gastric motility independently from changes in general autonomic activity.
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Affiliation(s)
- Karin Meissner
- Institute of Medical Psychology, Ludwig-Maximilians University, Munich, Germany.
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Khoo J, Rayner CK, Jones KL, Horowitz M. Pathophysiology and management of gastroparesis. Expert Rev Gastroenterol Hepatol 2009; 3:167-81. [PMID: 19351287 DOI: 10.1586/egh.09.10] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Gastroparesis is characterized by upper gastrointestinal symptoms associated with delayed gastric emptying, without mechanical obstruction. However, symptoms do not correlate well with the magnitude of delay in gastric emptying. Diabetes mellitus and surgery are the most common causes, although more than 30% of cases are idiopathic. Coordination of insulin action with nutrient delivery is important in diabetics, as postprandial blood glucose levels and gastric emptying are interdependent, and gastroparesis probably represents a major cause of poor glycemic control. Scintigraphy is the gold standard for measuring gastric emptying. Current treatment mainly involves the use of prokinetic drugs. Pyloric botulinum toxin injection and gastric electrical stimulation require more evidence from controlled studies before their use can be recommended. Surgical options remain inadequately studied.
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Affiliation(s)
- Joan Khoo
- Discipline of Medicine, University of Adelaide, Royal Adelaide Hospital, South Australia, Australia
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46
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A novel method for study of gastric mechanical functions in conscious mice. Dig Dis Sci 2009; 54:222-31. [PMID: 18618257 DOI: 10.1007/s10620-008-0362-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2008] [Accepted: 06/03/2008] [Indexed: 12/09/2022]
Abstract
A novel method has been developed for simultaneous study of gastric emptying, antral motility, and gastric muscle tone in conscious mice. Intragastric pressure was measured during infusion of an X-ray-opaque, viscous meal through a chronically implanted gastric fistula (0.25 ml/min). Compared with vehicle treatment, molsidomine (nitric oxide donor) and atropine (muscarinic receptor antagonist) treatment significantly reduced the area under the intragastric pressure curve (AUC) by 37 +/- 4% and 35 +/- 3%, respectively, (mean +/- S.E.M.) whereas N (G)-nitro-L-arginine methyl ester (L-NAME; nitric oxide synthase inhibitor) significantly increased the AUC by 20 +/- 3%. Atropine also significantly reduced the frequency and amplitude of stomach contraction-induced intragastric pressure waves while molsidomine only reduced the frequency. Gastric emptying, as assessed by X-ray imaging, was significantly delayed after L-NAME and atropine treatment. This methodology is the first to enable simultaneous assessment of gastric emptying, antral motility, and gastric tone in conscious mice and confirmed the important role of nitrergic and cholinergic innervation.
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Abstract
Gastroparesis is a relatively common and often disabling condition that is characterized by a broad range of clinical presentation ranging from dyspeptic symptoms to nausea, vomiting, abdominal pain, malnutrition, frequent hospitalizations and incapacitation. The treatment of gastroparetic symptoms can be challenging to the gastroenterologist and the intensity of therapy varies with the physician's knowledge. Hence the determination that a patient is refractory to 'standard medical therapy' is an assessment that is subspeciality-based and could differ around the world depending on medications available. In this article, we review the use of available prokinetics, antiemetic agents, the approach for analgesia in the context of gastroparesis, and also discuss potential and evolving pharmacotherapies. The progress has been relatively limited as far as availability of new medications for gastroparesis is concerned; however, active research in developing newer prokinetics holds great promise for the future of management of this challenging entity.
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Affiliation(s)
- Savio C Reddymasu
- University of Kansas Medical Center, Division of Gastrointestinal Motility, Department of Medicine, Kansas City, 3901 Rainbow Boulevard, KS-66160-7350, USA
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Ontsouka EC, Bruckmaier RM, Steiner A, Blum JW, Meylan M. Messenger RNA Levels and Binding Sites of Muscarinic Acetylcholine Receptors in Gastrointestinal Muscle Layers from Healthy Dairy Cows. J Recept Signal Transduct Res 2008; 27:147-66. [PMID: 17613726 DOI: 10.1080/10799890701417741] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Acetylcholine interacts with muscarinic receptors (M) to mediate gastrointestinal (GI) smooth muscle contractions. We have compared mRNA levels and binding sites of M(1)to M(5) in muscle tissues from fundus abomasi, pylorus, ileum, cecum, proximal loop of the ascending colon (PLAC), and external loop of the spiral colon (ELSC) of healthy dairy cows. The mRNA levels were measured by quantitative RT-PCR. The inhibition of [(3)H]-QNB (1-quinuclidinyl-[phenyl-4-(3)H]-benzilate) binding by M antagonists [atropine (M(1 - 5)), pirenzepine (M(1)), methoctramine (M(2)), 4-DAMP (M(3)), and tropicamide (M(4))] was used to identify receptors at the functional level. Maximal binding (B(max)) was determined through saturation binding with atropine as a competitor. The mRNA levels of M(1), M(2), M(3), and M(5) represented 0.2, 48, 50, and 1.8%, respectively, of the total M population, whereas mRNA of M(4) was undetectable. The mRNA levels of M(2) and of M(3) in the ileum were lower (P < 0.05) than in other GI locations, which were similar among each other. Atropine, pirenzepine, methoctramine, and 4-DAMP inhibited [(3)H]-QNB binding according to an either low- or high-affinity receptor pattern, whereas tropicamide had no effect on [(3)H]-QNB binding. The [(3)H]-QNB binding was dose-dependent and saturable. B(max) in fundus, pylorus, and PLAC was lower (P < 0.05) than in the ELSC, and in the pylorus lower (P < 0.05) than in the ileum. B(max) and mRNA levels were negatively correlated (r = -0.3; P < 0.05). In conclusion, densities of M are different among GI locations, suggesting variable importance of M for digestive functions along the GI tract.
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Affiliation(s)
- E C Ontsouka
- Clinic for Ruminants, Vetsuisse Faculty, University of Berne, CH-3012 Berne. Switzerland.
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Bharucha AE, Seide B, Guan Z, Andrews CN, Zinsmeister AR. Effect of tolterodine on gastrointestinal transit and bowel habits in healthy subjects. Neurogastroenterol Motil 2008; 20:643-8. [PMID: 18312543 DOI: 10.1111/j.1365-2982.2008.01089.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Clinical trials and observations suggest that constipation is an uncommon side effect of treating overactive bladder with the muscarinic receptor antagonist tolterodine. Because muscarinic antagonism inhibits gastrointestinal motor activity, we evaluated the effects of tolterodine on bowel habits, gastrointestinal and colonic transit in healthy subjects. In this double-blind study, 36 healthy subjects were randomized to tolterodine extended release (ER, 4 mg daily) or placebo for 6 days. Gastric emptying (GE), small bowel and colonic transit were assessed on days 4-6 by scintigraphy. Bowel habits were recorded by diaries. Tolterodine did not significantly affect half-time for GE (GE t(half)) [116 +/- 6 min (mean +/- SEM) for placebo vs 126 +/- 7 min for tolterodine], small bowel transit measured by colonic filling at 6 h (45 +/- 6% for placebo vs 36 +/- 6% for tolterodine) or the geometric center of colonic transit at 24 h (2.9 +/- 0.2 for placebo vs 2.6 +/- 0.3 for tolterodine). Subjects who received tolterodine had slightly fewer bowel movements (i.e. 1.34 +/- 0.1 stools per day for placebo vs 1.0 +/- 0.1 for tolterodine; P = 0.02 for treatment effect). Tolterodine did not significantly affect stool consistency or ease of defecation. At the therapeutic dose used to treat overactive bladder, tolterodine did not significantly affect gastrointestinal or colonic transit and had minor effects on bowel habits in healthy subjects. Further studies are necessary to elucidate whether these observations are explained by tolterodine effects at muscarinic receptors which stimulate and inhibit gastrointestinal motility.
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Affiliation(s)
- A E Bharucha
- Clinical and Enteric Neuroscience Translational and Epidemiological Research Program (CENTER), Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
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Cassilly D, Kantor S, Knight LC, Maurer AH, Fisher RS, Semler J, Parkman HP. Gastric emptying of a non-digestible solid: assessment with simultaneous SmartPill pH and pressure capsule, antroduodenal manometry, gastric emptying scintigraphy. Neurogastroenterol Motil 2008; 20:311-9. [PMID: 18194154 DOI: 10.1111/j.1365-2982.2007.01061.x] [Citation(s) in RCA: 212] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Gastric emptying of digestible solids occurs after trituration of food particles. Non-digestible solids are thought to empty with phase III of the migrating motor complex (MMC). The aim of this study was to determine if a non-digestible capsule given with a meal empties from the stomach with return of the fasting phase III MMC or during the fed pattern with the solid meal. Fifteen normal subjects underwent antroduodenal manometry and ingestion of a radiolabelled meal and SmartPill wireless pH and pressure capsule. In five subjects, emptying of the SmartPill was studied in the fasting period by ingesting the SmartPill with radiolabelled water. The SmartPill emptied from the stomach within 6 h in 14 of 15 subjects. SmartPill pressure recordings showed high amplitude phasic contractions prior to emptying. SmartPill gastric residence time (261 +/- 22 min) correlated strongly with time to the first phase III MMC (239 +/- 23 min; r = 0.813; P < 0.01) and correlated moderately with solid-phase gastric emptying (r = 0.606 with T-50% and r = 0.565 with T-90%). Nine of 14 subjects emptied the capsule with a phase III MMC. In five subjects, the SmartPill emptied with isolated distal antral contractions. In five subjects ingesting only water, SmartPill gastric residence time (92 +/- 44 min) correlated with the time to the first phase III MMC (87 +/- 30 min; r = 0.979; P < 0.01). The non-digestible SmartPill given with a meal primarily empties from the stomach with the return of phase III MMCs occurring after emptying the solid-phase meal. However, in some subjects, the SmartPill emptied with isolated antral contractions, an unappreciated mechanism for emptying of a non-digestible solid.
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Affiliation(s)
- D Cassilly
- Gastroenterology Section, Department of Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA
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