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Shrimpton AJ, Brown V, Vassallo J, Nolan JP, Soar J, Hamilton F, Cook TM, Bzdek BR, Reid JP, Makepeace CH, Deutsch J, Ascione R, Brown JM, Benger JR, Pickering AE. A quantitative evaluation of aerosol generation during cardiopulmonary resuscitation. Anaesthesia 2024; 79:156-167. [PMID: 37921438 PMCID: PMC10952244 DOI: 10.1111/anae.16162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 11/04/2023]
Abstract
It is unclear if cardiopulmonary resuscitation is an aerosol-generating procedure and whether this poses a risk of airborne disease transmission to healthcare workers and bystanders. Use of airborne transmission precautions during cardiopulmonary resuscitation may confer rescuer protection but risks patient harm due to delays in commencing treatment. To quantify the risk of respiratory aerosol generation during cardiopulmonary resuscitation in humans, we conducted an aerosol monitoring study during out-of-hospital cardiac arrests. Exhaled aerosol was recorded using an optical particle sizer spectrometer connected to the breathing system. Aerosol produced during resuscitation was compared with that produced by control participants under general anaesthesia ventilated with an equivalent respiratory pattern to cardiopulmonary resuscitation. A porcine cardiac arrest model was used to determine the independent contributions of ventilatory breaths, chest compressions and external cardiac defibrillation to aerosol generation. Time-series analysis of participants with cardiac arrest (n = 18) demonstrated a repeating waveform of respiratory aerosol that mapped to specific components of resuscitation. Very high peak aerosol concentrations were generated during ventilation of participants with cardiac arrest with median (IQR [range]) 17,926 (5546-59,209 [1523-242,648]) particles.l-1 , which were 24-fold greater than in control participants under general anaesthesia (744 (309-2106 [23-9099]) particles.l-1 , p < 0.001, n = 16). A substantial rise in aerosol also occurred with cardiac defibrillation and chest compressions. In a complimentary porcine model of cardiac arrest, aerosol recordings showed a strikingly similar profile to the human data. Time-averaged aerosol concentrations during ventilation were approximately 270-fold higher than before cardiac arrest (19,410 (2307-41,017 [104-136,025]) vs. 72 (41-136 [23-268]) particles.l-1 , p = 0.008). The porcine model also confirmed that both defibrillation and chest compressions generate high concentrations of aerosol independent of, but synergistic with, ventilation. In conclusion, multiple components of cardiopulmonary resuscitation generate high concentrations of respiratory aerosol. We recommend that airborne transmission precautions are warranted in the setting of high-risk pathogens, until the airway is secured with an airway device and breathing system with a filter.
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Affiliation(s)
- A. J. Shrimpton
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolUK
| | - V. Brown
- Critical Care, South Western Ambulance Service NHS Foundation TrustUK
- Great Western Air Ambulance CharityBristolUK
| | - J. Vassallo
- Institute of Naval MedicineGosportUK
- Academic Department of Military Emergency MedicineRoyal Centre for Defence MedicineBirminghamUK
| | - J. P. Nolan
- University of Warwick, Warwick Medical SchoolCoventryUK
- Department of Anaesthesia and Intensive Care MedicineRoyal United HospitalBathUK
| | - J. Soar
- Department of Anaesthesia and Intensive Care MedicineNorth Bristol NHS TrustBristolUK
| | - F. Hamilton
- MRC Integrative Epidemiology UnitUniversity of BristolUK
| | - T. M. Cook
- Department of Anaesthesia and Intensive Care MedicineRoyal United HospitalBathUK
| | - B. R. Bzdek
- School of ChemistryUniversity of BristolBristolUK
| | - J. P. Reid
- School of ChemistryUniversity of BristolBristolUK
| | - C. H. Makepeace
- Langford Vets and Translational Biomedical Research CentreUniversity of BristolUK
| | - J. Deutsch
- Langford Vets and Translational Biomedical Research CentreUniversity of BristolUK
| | - R. Ascione
- Translational Biomedical Research CentreUniversity of BristolBristolUK
- University Hospital Bristol Weston NHS TrustBristolUK
| | - J. M. Brown
- Department of Anaesthesia and Intensive Care MedicineNorth Bristol NHS TrustBristolUK
| | - J. R. Benger
- Faculty of Health and Applied SciencesUniversity of the West of EnglandBristolUK
| | - A. E. Pickering
- Department of AnaesthesiaUniversity Hospitals Bristol and WestonBristolUK
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolUK
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Parkman HP, Wilson LA, Silver P, Maurer AH, Sarosiek I, Bulat RS, Kuo B, Grover M, Farrugia G, Chumpitazi BP, Shulman RJ, Malik Z, Miriel LA, Tonascia J, Hamilton F, Abell TL, Pasricha PJ, McCallum RW, Koch KL. Relationships among intragastric meal distribution during gastric emptying scintigraphy, water consumption during water load satiety testing, and symptoms of gastroparesis. Am J Physiol Gastrointest Liver Physiol 2023; 325:G407-G417. [PMID: 37552206 PMCID: PMC10887845 DOI: 10.1152/ajpgi.00065.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/31/2023] [Accepted: 08/07/2023] [Indexed: 08/09/2023]
Abstract
Gastric emptying scintigraphy (GES) measures total gastric retention after a solid meal and can assess intragastric meal distribution (IMD). Water load satiety test (WLST) measures gastric capacity. Both IMD immediately after meal ingestion [ratio of proximal gastric counts after meal ingestion to total gastric counts at time 0 (IMD0)] and WLST (volume of water ingested over 5 min) are indirect measures of gastric accommodation. In this study, IMD0 and WLST were compared with each other and to symptoms of gastroparesis to gauge their clinical utility for assessing patients with symptoms of gastroparesis. Patients with symptoms of gastroparesis underwent GES to obtain gastric retention and IMD0, WLST, and filled out patient assessment of upper GI symptoms. A total of 234 patients with symptoms of gastroparesis were assessed (86 patients with diabetes, 130 idiopathic, 18 postfundoplication) and 175 (75%) delayed gastric emptying. Low IMD0 <0.568 suggesting initial rapid transit to the distal stomach was present in 8% and correlated with lower gastric retention, less heartburn, and lower volumes consumed during WLST. Low WLST volume (<238 mL) was present in 20% and associated with increased severity of early satiety, postprandial fullness, loss of appetite, and nausea. Low IMD0 is associated with less gastric retention and less heartburn. Volume of water consumed during WLST, while associated with IMD0, has associations with early satiety, postprandial fullness, loss of appetite, and nausea. Thus, IMD0 and WLST appear to overlap somewhat in their assessment of gastric physiology in adults with symptoms of gastroparesis but relate to different dyspeptic symptoms.NEW & NOTEWORTHY IMD0 and WLST were assessed for their clinical utility in assessing patients with symptoms of gastroparesis. Low IMD0 is associated with less gastric retention and less heartburn. Volume of water consumed during WLST, while associated with IMD0, has associations with early satiety, postprandial fullness, loss of appetite, and nausea. IMD0 and WLST appear to overlap somewhat in their assessment of gastric physiology in adults with symptoms of gastroparesis but relate to different dyspeptic symptoms.
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Affiliation(s)
- Henry P Parkman
- Gastroenterology Section, Temple University, Philadelphia, Pennsylvania, United States
| | - Laura A Wilson
- Gastroenterology Section, Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, United States
| | - Paul Silver
- Gastroenterology Section, Temple University, Philadelphia, Pennsylvania, United States
| | - Alan H Maurer
- Gastroenterology Section, Temple University, Philadelphia, Pennsylvania, United States
| | - Irene Sarosiek
- Gastroenterology Section, Texas Tech University Health Sciences Center, El Paso, Texas, United States
| | - Robert S Bulat
- Gastroenterology Section, Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, United States
| | - Braden Kuo
- Gastroenterology Section, Harvard Medical School, Boston, Massachusetts, United States
| | - Madhusudan Grover
- Gastroenterology Department, Mayo Clinic, Rochester, Minnesota, United States
| | - Gianrico Farrugia
- Gastroenterology Department, Mayo Clinic, Rochester, Minnesota, United States
| | - Bruno P Chumpitazi
- Gastroenterology Section, Baylor College of Medicine, Children's Nutrition Research Center, Houston, Texas, United States
| | - Robert J Shulman
- Gastroenterology Section, Baylor College of Medicine, Children's Nutrition Research Center, Houston, Texas, United States
| | - Zubair Malik
- Gastroenterology Section, Temple University, Philadelphia, Pennsylvania, United States
| | - Laura A Miriel
- Gastroenterology Section, Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, United States
| | - James Tonascia
- Gastroenterology Section, Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, United States
| | - Frank Hamilton
- Gastroenterology Section, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, United States
| | - Thomas L Abell
- Gastroenterology Section, University of Louisville, Louisville, Kentucky, United States
| | - Pankaj J Pasricha
- Gastroenterology Section, Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, United States
| | - Richard W McCallum
- Gastroenterology Section, Texas Tech University Health Sciences Center, El Paso, Texas, United States
| | - Kenneth L Koch
- Section of Gastroenterology, Wake Forest University, Winston-Salem, North Carolina, United States
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3
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Parkman HP, Yates KP, Sarosiek I, Bulat RS, Abell TL, Koch KL, Kuo B, Grover M, Farrugia G, Silver P, Abdullah A, Maurer AH, Malik Z, Miriel LA, Tonascia J, Hamilton F, Pasricha PJ, McCallum RW. Buspirone for early satiety and symptoms of gastroparesis: A multi-centre, randomised, placebo-controlled, double-masked trial (BESST). Aliment Pharmacol Ther 2023; 57:1272-1289. [PMID: 37052334 PMCID: PMC10202558 DOI: 10.1111/apt.17479] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/18/2023] [Accepted: 03/10/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Patients with gastroparesis and related disorders have symptoms including early satiety, postprandial fullness and bloating. Buspirone, a 5-HT1 receptor agonist, may improve fundic accommodation. AIM To determine if buspirone treatment improves early satiety and postprandial fullness in patients with symptoms of gastroparesis. METHODS This 4-week multi-centre clinical trial randomised patients with symptoms of gastroparesis and moderate-to-severe symptoms of fullness (Gastroparesis Cardinal Symptom Index [GCSI] early satiety/postprandial fullness subscore [ES/PPF]) to buspirone (10 mg orally) or placebo three times per day. The primary outcome was a change in the ES/PPF from baseline to 4 weeks. The primary analysis was per protocol intention-to-treat ANCOVA of between-group baseline vs. 4-week differences (DoD) in ES/PPF adjusted for baseline ES/PPF. Results are reported using both nominal and Bonferroni (BF) p values. RESULTS AND CONCLUSIONS Ninety-six patients (47 buspirone, 49 placeboes; 92% female, 50% delayed gastric emptying, 39% diabetic) were enrolled. There was no between-groups difference in the 4-week ES/PPF primary outcome: -1.16 ± 1.25 (SD) on buspirone vs -1.03 ± 1.29 (SD) on placebo (mean DoD: -0.11 [95% CI: -0.68, 0.45]; p = 0.69). Buspirone performed better than placebo in patients with severe-to-very severe bloating at baseline compared to patients with none to moderate: (ES/PPF DoD = -0.65 vs. 1.58, pTX*GROUP = 0.003; pBF = 0.07). Among individual GCSI symptoms, only bloating appeared to improve with buspirone vs. placebo. CONCLUSIONS Patients with moderate-to-severe early satiety/postprandial fullness and other symptoms of gastroparesis did not benefit from buspirone treatment to improve the ES/PPF primary outcome compared with placebo. There was a suggestion of the benefit of buspirone in patients with more severe bloating. TRIAL REGISTRATION ClinicalTrials.gov NCT0358714285.
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Affiliation(s)
| | | | - Irene Sarosiek
- Texas Tech University Health Sciences Center, El Paso, TX
| | | | | | | | | | | | | | | | | | | | | | | | | | - Frank Hamilton
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
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Parkman HP, Blackford AL, Murray HB, Yates KP, Grover M, Malik Z, Schey R, Bulat RS, Koch KL, Sarosiek I, Kuo B, Shulman RJ, Chumpitazi BP, Farrugia G, Miriel L, Tonascia J, Hamilton F, Pasricha PJ, McCallum RW, Abell TL. Characteristics and outcomes of patients with gastroparesis using enteral and/or exclusive parenteral nutrition. JPEN J Parenter Enteral Nutr 2023; 47:541-549. [PMID: 36871132 PMCID: PMC10164106 DOI: 10.1002/jpen.2493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 01/21/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Patients with gastroparesis (Gp) may need enteral nutrition (EN) or exclusive parenteral nutrition (PN). Among patients with Gp, we aimed to (1) identify the frequency of EN and exclusive PN use and (2) explore characteristics of patients using EN and/or exclusive PN compared with those using oral nutrition (ON), including changes over 48 weeks. METHODS Patients with Gp underwent history and physical examination, gastric emptying scintigraphy, water load satiety testing (WLST), and questionnaires assessing gastrointestinal symptoms and quality of life (QOL). Patients were observed 48 weeks. RESULTS Of 971 patients with Gp (idiopathic, 579; diabetic, 336; post-Nissen fundoplication, 51), 939 (96.7%) were using ON only, 14 (1.4%) using exclusive PN, and 18 (1.9%) using EN. Compared with patients receiving ON, patients receiving exclusive PN and/or EN were younger, had lower body mass index, and had greater symptom severity. Patients receiving exclusive PN and/or EN had lower physical QOL but not mental QOL or Gp-related QOL scores. Patients receiving exclusive PN and/or EN ingested less water during WLST but did not have worse gastric emptying. Of those who had been receiving exclusive PN and/or EN, 50% and 25%, respectively, resumed ON at 48-week follow-up. CONCLUSIONS This study describes patients with Gp requiring exclusive PN and/or EN for nutrition support, who represent a small (3.3%) but important subset of patients with Gp. Unique clinical and physiological parameters are associated with this subset and provide insight into the use of nutrition support in Gp.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Irene Sarosiek
- Texas Tech University Health Sciences Center, El Paso, TX
| | | | | | | | | | | | | | - Frank Hamilton
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
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5
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Koch KL, Van Natta M, Parkman HP, Grover M, Abell TL, McCallum RW, Shaltout HA, Sarosiek I, Farrugia G, Shulman RJ, Tonascia J, Miriel L, Hamilton F. Effect of liquid and solid test meals on symptoms and gastric myoelectrical activity in patients with gastroparesis and functional dyspepsia. Neurogastroenterol Motil 2023; 35:e14376. [PMID: 35411675 PMCID: PMC9884454 DOI: 10.1111/nmo.14376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/06/2022] [Accepted: 03/14/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Patients with gastroparesis (GP) and functional dyspepsia (FD) have similar symptoms, but the pathophysiology of postprandial symptoms remains uncertain. AIMS To compare symptoms and gastric myoelectrical activity (GMA) after liquid and solid test meals in patients with GP and FD. METHODS Patients enrolled in the Gastroparesis Clinical Research Consortium Registry were studied. Clinical characteristics were measured with standard questionnaires. GP was determined by 4-h solid-phase gastric scintigraphy. GMA was measured using electrogastrography before and after ingestion of a water load or nutrient bar on separate days. Symptoms were measured on visual analog scales. GMA responses to the water load for individual patients were also determined. RESULTS 284 patients with GP and 113 with FD were identified who ingested both test meals. Patients with GP and FD had similar maximal tolerated volumes of water [mean (SD) 378 (218) ml vs. 402 (226) ml, p = 0.23] and reported similar intensity of fullness, nausea, bloating, and abdominal discomfort after the test meals. Twenty-six percent and 19% of the patients with GP and FD, respectively, ingested subthreshold (<238 ml) volumes of water (p = 0.15). Gastric dysrhythmias were recorded in 66% of the GP and 65% of the FD patients after the water load. Symptoms and GMA were similar in both groups after ingestion of the nutrient bar. CONCLUSION The similarity in GMA responses and symptoms after ingestion of solid or liquid test meals suggests GP and FD are closely related gastric neuromuscular disorders.
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Affiliation(s)
- Kenneth L. Koch
- Section on Gastroenterology, Wake Forest University, Winston-Salem, NC
| | - Mark Van Natta
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Henry P. Parkman
- Section of Gastroenterology, Temple University, Philadelphia, PA
| | | | - Thomas L. Abell
- Digestive and Liver Health, University of Louisville, Louisville, KY
| | | | - Hossam A. Shaltout
- Cardiovascular Sciences Center, Wake Forest University, Winston-Salem, NC
| | - Irene Sarosiek
- Division of Gastroenterology, Texas Tech University, El Paso, TX
| | - Gianrico Farrugia
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Robert J. Shulman
- Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX
| | - James Tonascia
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Laura Miriel
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Frank Hamilton
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
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6
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Pasricha PJ, Grover M, Yates KP, Abell TL, Koch KL, McCallum RW, Sarosiek I, Bernard CE, Kuo B, Bulat R, Shulman RJ, Chumpitazi BP, Tonascia J, Miriel LA, Wilson LA, Van Natta ML, Mitchell E, Hamilton F, Farrugia G, Parkman HP. Progress in Gastroparesis - A Narrative Review of the Work of the Gastroparesis Clinical Research Consortium. Clin Gastroenterol Hepatol 2022; 20:2684-2695.e3. [PMID: 35688353 PMCID: PMC9691520 DOI: 10.1016/j.cgh.2022.05.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/15/2022] [Accepted: 05/05/2022] [Indexed: 01/27/2023]
Abstract
The Gastroparesis Clinical Research Consortium is a multicenter coalition created and funded by the National Institutes of Diabetes and Digestive and Kidney Disorders, with a mission to advance understanding of the pathophysiology of gastroparesis and develop an effective treatment for patients with symptomatic gastroparesis. In this review, we summarize the results of the published Gastroparesis Clinical Research Consortium studies as a ready and convenient resource for gastroenterologists and others to provide a clear understanding of the consortium's experience and perspective on gastroparesis and related disorders.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Braden Kuo
- Massachusetts General Hospital, Boston, Massachusetts
| | - Robert Bulat
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | | | | | | | | | - Frank Hamilton
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
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Wani S, Souza RF, Durkalski VL, Serrano J, Hamilton F, Shaheen NJ. Multicenter Randomized Controlled Trial of Surveillance Versus Endoscopic Therapy for Barrett's Esophagus With Low-grade Dysplasia: The SURVENT Trial: Study Rationale, Methodology, Innovation, and Implications. Gastroenterology 2022; 163:556-562.e4. [PMID: 35679951 PMCID: PMC9398991 DOI: 10.1053/j.gastro.2022.05.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/17/2022] [Accepted: 05/30/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Rhonda F. Souza
- Department of Medicine, Center for Esophageal Diseases, Baylor University Medical Center and Center for Esophageal Research, Baylor Scott & White Research Institute, Dallas, Texas
| | - Valerie L. Durkalski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Jose Serrano
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive Kidney Diseases, National Institute of Health, Bethesda, Maryland
| | - Frank Hamilton
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive Kidney Diseases, National Institute of Health, Bethesda, Maryland
| | - Nicholas J. Shaheen
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina
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8
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Parkman HP, Van Natta ML, Maurer AH, Koch KL, Grover M, Malik Z, Sarosiek I, Abell TL, Bulat R, Kuo B, Shulman RJ, Farrugia G, Miriel L, Tonascia J, Hamilton F, Pasricha PJ, McCallum RW. Postprandial symptoms in patients with symptoms of gastroparesis: roles of gastric emptying and accommodation. Am J Physiol Gastrointest Liver Physiol 2022; 323:G44-G59. [PMID: 35502871 PMCID: PMC9236865 DOI: 10.1152/ajpgi.00278.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Patients often are evaluated for gastroparesis because of symptoms occurring with meals. Gastric emptying scintigraphy (GES) is used for gastroparesis diagnosis, although results are not well correlated with gastroparesis symptoms. The aim of this study is to assess relationships between gastroparesis symptoms, gastric emptying (GE), and gastric accommodation (GA). Patients with symptoms of gastroparesis completed the Patient Assessment of Upper GI Symptoms (PAGI-SYM) and recorded symptoms during GES and water load satiety test (WLST), an indirect assessment for GA. A total of 109 patients with gastroparesis symptoms were assessed. Symptom severity increased after GES meal for stomach fullness, belching, nausea, abdominal burning, and abdominal pain. There was no difference in symptoms after meal between patients with delayed (n = 66) and normal (n = 42) GE. Diabetic patients (n = 26) had greater gastric retention than idiopathic patients (n = 78), but idiopathic patients had greater postprandial nausea, stomach fullness, and abdominal pain. Water consumed during WLST averaged 421 ± 245 mL. Idiopathic patients had greater nausea scores during WLST than diabetic patients. In comparison to those with normal water consumption (≥238 mL; n = 80), patients with impaired water ingestion (<238 mL; n = 26) had increased stomach fullness, early satiety, postprandial fullness, and loss of appetite on PAGI-SYM. Patients with delayed and normal GE had similar symptom profiles during GES and WLST. Idiopathic patients had less gastric retention but more symptoms after GES meal and after WLST compared with diabetic patients. Patients with impaired water consumption during WLST had increased symptoms by PAGI-SYM. These data suggest that impaired GA, rather than GE, may be important in explaining postprandial symptoms in patients with symptoms of gastroparesis.NEW & NOTEWORTHY Patients with delayed and normal gastric emptying (GE) had similar symptom profiles during gastric emptying scintigraphy (GES). Idiopathic patients with symptoms of gastroparesis had less gastric retention by GES; but more symptoms after GES meal and after water load satiety test (WLST) compared with diabetic patients. In patients with symptoms of gastroparesis, symptoms after WLST increased with decreasing water consumption. Early satiety and loss of appetite were associated with decreased water consumption during WLST. Thus, impaired accommodation and perhaps visceral hypersensitivity are important in explaining postprandial symptoms in gastroparesis.
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Affiliation(s)
- Henry P. Parkman
- 1Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Mark L. Van Natta
- 2Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Alan H. Maurer
- 1Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Kenneth L. Koch
- 3Department of Medicine, Wake Forest University Health Sciences, Winston-Salem, North Carolina
| | - Madhusudan Grover
- 4Department of Gastroenterology, School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Zubair Malik
- 1Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Irene Sarosiek
- 5Department of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Thomas L. Abell
- 6Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Robert Bulat
- 2Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Braden Kuo
- 7Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Robert J. Shulman
- 8Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Gianrico Farrugia
- 4Department of Gastroenterology, School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Laura Miriel
- 2Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, Maryland
| | - James Tonascia
- 2Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Frank Hamilton
- 9Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Pankaj J. Pasricha
- 2Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Richard W. McCallum
- 5Department of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
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9
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Parkman HP, Van Natta ML, Makol A, Grover M, McCallum RW, Malik Z, Koch KL, Sarosiek I, Kuo B, Shulman RJ, Farrugia G, Miriel L, Tonascia J, Hamilton F, Pasricha PJ, Abell TL. Prevalence and clinical correlates of antinuclear antibody in patients with gastroparesis. Neurogastroenterol Motil 2022; 34:e14270. [PMID: 34595805 PMCID: PMC8971139 DOI: 10.1111/nmo.14270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/21/2021] [Accepted: 08/31/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Autoimmunity may play a role in the pathogenesis of gastroparesis in a subset of patients. Antinuclear antibody (ANA) testing is often used to screen for autoimmune disorders. AIMS 1) Determine prevalence of a positive ANA in patients with gastroparesis; 2) Describe characteristics of idiopathic gastroparesis patients with positive ANA. METHODS Patients were assessed with gastric emptying scintigraphy (GES), symptom assessment via Patient Assessment of Upper GI Symptoms [PAGI-SYM], and blood tests-ANA, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP). RESULTS Positive ANA was seen in 148 of 893 (17%) patients with gastroparesis, being similar in idiopathic (16% of 536 patients), T1DM (16% of 162), T2DM (18% of 147), and postfundoplication (19% of 48 patients) gastroparesis. Among 536 patients with idiopathic gastroparesis, ANA titer 1:40-1:80 was seen in 33 (6%) patients, 1:160-1:320 in 36 (7%) patients, and ≥1:640 in 17 (3%) patients. Increasing ANA titer was associated with female gender (p = 0.05), Hispanic ethnicity (p = 0.02), comorbid rheumatoid arthritis (p = 0.02), systemic sclerosis (p = 0.004), and elevated ESR (p = 0.007). ANA positivity was associated with lower total GCSI (p = 0.007) and lower nausea/vomiting subscale (p = 0.0005), but not related to gastric emptying. CONCLUSIONS The prevalence of a positive ANA in patients with gastroparesis was high at ~17% and did not differ significantly based on etiology. In idiopathic patients, ANA positivity was associated with rheumatoid arthritis, systemic sclerosis, and elevated ESR. ANA-positive gastroparesis represents a subset who often have other autoimmune symptoms or disorders, but less severe nausea and vomiting.
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Affiliation(s)
| | | | | | | | | | | | | | - Irene Sarosiek
- Texas Tech University Health Sciences Center, El Paso, TX
| | | | | | | | | | | | - Frank Hamilton
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
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10
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Parkman HP, Sharkey E, McCallum RW, Hasler WL, Koch KL, Sarosiek I, Abell TL, Kuo B, Shulman R, Grover M, Farrugia G, Schey R, Tonascia J, Hamilton F, Pasricha PJ. Constipation in Patients With Symptoms of Gastroparesis: Analysis of Symptoms and Gastrointestinal Transit. Clin Gastroenterol Hepatol 2022; 20:546-558.e5. [PMID: 33130007 PMCID: PMC8079462 DOI: 10.1016/j.cgh.2020.10.045] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/20/2020] [Accepted: 10/24/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Constipation can be an important symptom in some patients with gastroparesis. The aims were to: 1) Determine prevalence of constipation and delayed colonic transit in patients with symptoms of gastroparesis; 2) Correlate severity of constipation to severity of symptoms of gastroparesis; and 3) Relate severity of constipation to GI transit delays assessed by gastric emptying scintigraphy (GES) and wireless motility capsule (WMC). METHODS Patients with symptoms of gastroparesis underwent gastric emptying scintigraphy (GES), wireless motility capsule (WMC) assessing gastric emptying, small bowel transit, and colonic transit, and questionnaires assessing symptoms using a modified Patient Assessment of Upper GI Symptoms [PAGI-SYM] and Rome III functional GI disorder questionnaire. RESULTS Of 338 patients with symptoms of gastroparesis, 242 (71.5%) had delayed gastric emptying by scintigraphy; 298 (88.2%) also met criteria for functional dyspepsia. Severity of constipation was severe/very severe in 34% patients, moderate in 24%, and none/very mild/mild in 42%. Increasing severity of constipation was associated with increasing symptoms of gastroparesis and presence of irritable bowel syndrome (IBS). Severity of constipation was not associated with gastric retention on GES or WMC. Delayed colonic transit was present in 108 patients (32% of patients). Increasing severity of constipation was associated with increasing small bowel transit time, colonic transit time, and whole gut transit time. CONCLUSIONS Severe/very severe constipation and delayed colon transit occurs in a third of patients with symptoms of gastroparesis. The severity of constipation is associated with severity of gastroparesis symptoms, presence of IBS, small bowel and colon transit delay, but not delay in gastric emptying. ClinicalTrials.gov Identifier: NCT01696747.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Frank Hamilton
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
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11
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Dunphy E, Button K, Hamilton F, Murray E. A feasibility RCT comparing TRAK-ACL digital rehabilitation intervention plus TAU versus TAU for knee anterior cruciate ligament reconstruction patients. Physiotherapy 2022. [DOI: 10.1016/j.physio.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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12
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Tütüncü S, Olma M, Kunze C, Dietzel J, Schurig J, Fiessler C, Malsch C, Haas TE, Dimitrijeski B, Doehner W, Hagemann G, Hamilton F, Honermann M, Jungehulsing GJ, Kauert A, Koennecke HC, Mackert BM, Nabavi D, Nolte CH, Reis JM, Schmehl I, Sparenberg P, Stingele R, Völzke E, Waldschmidt C, Zeise-Wehry D, Heuschmann PU, Endress M, Haeusler KG. Off-label-dosing of non-vitamin K-dependent oral antagonists in AF patients before and after stroke: results of the prospective multicenter Berlin Atrial Fibrillation Registry. J Neurol 2022; 269:470-480. [PMID: 34718884 PMCID: PMC8739306 DOI: 10.1007/s00415-021-10866-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022]
Abstract
AIMS We aimed to analyze prevalence and predictors of NOAC off-label under-dosing in AF patients before and after the index stroke. METHODS The post hoc analysis included 1080 patients of the investigator-initiated, multicenter prospective Berlin Atrial Fibrillation Registry, designed to analyze medical stroke prevention in AF patients after acute ischemic stroke. RESULTS At stroke onset, an off-label daily dose was prescribed in 61 (25.5%) of 239 NOAC patients with known AF and CHA2DS2-VASc score ≥ 1, of which 52 (21.8%) patients were under-dosed. Under-dosing was associated with age ≥ 80 years in patients on rivaroxaban [OR 2.90, 95% CI 1.05-7.9, P = 0.04; n = 29] or apixaban [OR 3.24, 95% CI 1.04-10.1, P = 0.04; n = 22]. At hospital discharge after the index stroke, NOAC off-label dose on admission was continued in 30 (49.2%) of 61 patients. Overall, 79 (13.7%) of 708 patients prescribed a NOAC at hospital discharge received an off-label dose, of whom 75 (10.6%) patients were under-dosed. Rivaroxaban under-dosing at discharge was associated with age ≥ 80 years [OR 3.49, 95% CI 1.24-9.84, P = 0.02; n = 19]; apixaban under-dosing with body weight ≤ 60 kg [OR 0.06, 95% CI 0.01-0.47, P < 0.01; n = 56], CHA2DS2-VASc score [OR per point 1.47, 95% CI 1.08-2.00, P = 0.01], and HAS-BLED score [OR per point 1.91, 95% CI 1.28-2.84, P < 0.01]. CONCLUSION At stroke onset, off-label dosing was present in one out of four, and under-dosing in one out of five NOAC patients. Under-dosing of rivaroxaban or apixaban was related to old age. In-hospital treatment after stroke reduced off-label NOAC dosing, but one out of ten NOAC patients was under-dosed at discharge. CLINICAL TRIAL REGISTRATION NCT02306824.
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Affiliation(s)
- Serdar Tütüncü
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Manuel Olma
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia Kunze
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Joanna Dietzel
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Schurig
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Cornelia Fiessler
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Würzburg, Germany
| | - Carolin Malsch
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Center, Clinical Trial Centre Würzburg, University of Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - Tobias Eberhard Haas
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Würzburg, Germany
| | | | - Wolfram Doehner
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- BCRT-Berlin Institute of Health Center for Regenerative Therapies, and Department of Cardiology (Virchow Klinikum), Charité-Universitätsmedizin Berlin, German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Georg Hagemann
- Department of Neurology, Helios Klinik Berlin-Buch, Berlin, Germany
| | - Frank Hamilton
- Department of Neurology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | - Martin Honermann
- Department of Neurology, Vivantes Klinikum Spandau, Berlin, Germany
| | | | - Andreas Kauert
- Department of Neurology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | | | | | - Darius Nabavi
- Department of Neurology, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Christian H Nolte
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Center for Cardiovascular Diseases (DZHK), Partner site Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Joschua Mirko Reis
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Würzburg, Germany
| | - Ingo Schmehl
- Department of Neurology, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
| | - Paul Sparenberg
- Department of Neurology, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
| | - Robert Stingele
- Department of Neurology, German Red Cross Hospital Berlin Köpenick, Berlin, Germany
| | - Enrico Völzke
- Department of Neurology, Schlosspark-Klinik Berlin, Berlin, Germany
| | | | | | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Center, Clinical Trial Centre Würzburg, University of Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - Matthias Endress
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Partner site Berlin, Berlin, Germany
- German Center for Cardiovascular Diseases (DZHK), Partner site Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
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13
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Shrimpton AJ, Brown JM, Gregson FKA, Cook TM, Scott DA, McGain F, Humphries RS, Dhillon RS, Reid JP, Hamilton F, Bzdek BR, Pickering AE. Quantitative evaluation of aerosol generation during manual facemask ventilation. Anaesthesia 2022; 77:22-27. [PMID: 34700360 PMCID: PMC8653000 DOI: 10.1111/anae.15599] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 01/13/2023]
Abstract
Manual facemask ventilation, a core component of elective and emergency airway management, is classified as an aerosol-generating procedure. This designation is based on one epidemiological study suggesting an association between facemask ventilation and transmission during the SARS-CoV-1 outbreak in 2003. There is no direct evidence to indicate whether facemask ventilation is a high-risk procedure for aerosol generation. We conducted aerosol monitoring during routine facemask ventilation and facemask ventilation with an intentionally generated leak in anaesthetised patients. Recordings were made in ultraclean operating theatres and compared against the aerosol generated by tidal breathing and cough manoeuvres. Respiratory aerosol from tidal breathing in 11 patients was reliably detected above the very low background particle concentrations with median [IQR (range)] particle counts of 191 (77-486 [4-1313]) and 2 (1-5 [0-13]) particles.l-1 , respectively, p = 0.002. The median (IQR [range]) aerosol concentration detected during facemask ventilation without a leak (3 (0-9 [0-43]) particles.l-1 ) and with an intentional leak (11 (7-26 [1-62]) particles.l-1 ) was 64-fold (p = 0.001) and 17-fold (p = 0.002) lower than that of tidal breathing, respectively. Median (IQR [range]) peak particle concentration during facemask ventilation both without a leak (60 (0-60 [0-120]) particles.l-1 ) and with a leak (120 (60-180 [60-480]) particles.l-1 ) were 20-fold (p = 0.002) and 10-fold (0.001) lower than a cough (1260 (800-3242 [100-3682]) particles.l-1 ), respectively. This study demonstrates that facemask ventilation, even when performed with an intentional leak, does not generate high levels of bioaerosol. On the basis of this evidence, we argue facemask ventilation should not be considered an aerosol-generating procedure.
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Affiliation(s)
- A. J. Shrimpton
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolUK
| | - J. M. Brown
- Department of Anaesthesia and Intensive Care MedicineNorth Bristol NHS TrustBristolUK
| | | | - T. M. Cook
- Department of Anaesthesia and Intensive Care MedicineRoyal United Hospital NHS TrustBathUK
| | - D. A. Scott
- Department of Critical CareUniversity of Melbourne; St. Vincent's Hospital MelbourneAustralia
| | - F. McGain
- Western HealthFootscrayVictoriaAustralia
| | - R. S. Humphries
- Climate Science CentreCSIRO Oceans and AtmosphereAspendaleVictoriaAustralia
| | - R. S. Dhillon
- Department of NeurosurgerySt Vincent's Hospital MelbourneFitzroyVictoriaAustralia
| | - J. P. Reid
- School of ChemistryUniversity of BristolBristolUK
| | - F. Hamilton
- Department of Population Health SciencesUniversity of BristolBristolUK
| | - B. R. Bzdek
- School of ChemistryUniversity of BristolBristolUK
| | - A. E. Pickering
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolUK
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14
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Shrimpton AJ, Gregson FKA, Brown JM, Cook TM, Bzdek BR, Hamilton F, Reid JP, Pickering AE. A quantitative evaluation of aerosol generation during supraglottic airway insertion and removal. Anaesthesia 2021; 76:1577-1584. [PMID: 34287820 DOI: 10.1111/anae.15542] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 12/30/2022]
Abstract
Many guidelines consider supraglottic airway use to be an aerosol-generating procedure. This status requires increased levels of personal protective equipment, fallow time between cases and results in reduced operating theatre efficiency. Aerosol generation has never been quantitated during supraglottic airway use. To address this evidence gap, we conducted real-time aerosol monitoring (0.3-10-µm diameter) in ultraclean operating theatres during supraglottic airway insertion and removal. This showed very low background particle concentrations (median (IQR [range]) 1.6 (0-3.1 [0-4.0]) particles.l-1 ) against which the patient's tidal breathing produced a higher concentration of aerosol (4.0 (1.3-11.0 [0-44]) particles.l-1 , p = 0.048). The average aerosol concentration detected during supraglottic airway insertion (1.3 (1.0-4.2 [0-6.2]) particles.l-1 , n = 11), and removal (2.1 (0-17.5 [0-26.2]) particles.l-1 , n = 12) was no different to tidal breathing (p = 0.31 and p = 0.84, respectively). Comparison of supraglottic airway insertion and removal with a volitional cough (104 (66-169 [33-326]), n = 27), demonstrated that supraglottic airway insertion/removal sequences produced <4% of the aerosol compared with a single cough (p < 0.001). A transient aerosol increase was recorded during one complicated supraglottic airway insertion (which initially failed to provide a patent airway). Detailed analysis of this event showed an atypical particle size distribution and we subsequently identified multiple sources of non-respiratory aerosols that may be produced during airway management and can be considered as artefacts. These findings demonstrate supraglottic airway insertion/removal generates no more bio-aerosol than breathing and far less than a cough. This should inform the design of infection prevention strategies for anaesthetists and operating theatre staff caring for patients managed with supraglottic airways.
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Affiliation(s)
- A J Shrimpton
- Pain and Critical Care Sciences and School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - F K A Gregson
- School of Chemistry, University of Bristol, Bristol, UK
| | - J M Brown
- Department of Anaesthesia and Intensive Care Medicine, North Bristol NHS Trust, Bristol, UK
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital NHS Trust, Bath, UK
| | - B R Bzdek
- School of Chemistry, University of Bristol, Bristol, UK
| | - F Hamilton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - J P Reid
- School of Chemistry, University of Bristol, Bristol, UK
| | - A E Pickering
- Pain and Critical Care Sciences and School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
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15
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Tütüncü S, Olma M, Kunze C, Dietzel J, Schurig J, Fiessler C, Malsch C, Haas TE, Dimitrijeski B, Doehner W, Hagemann G, Hamilton F, Honermann M, Jungehulsing GJ, Kauert A, Koennecke HC, Mackert BM, Nabavi D, Nolte CH, Reis JM, Schmehl I, Sparenberg P, Stingele R, Völzke E, Waldschmidt C, Zeise-Wehry D, Heuschmann PU, Endres M, Haeusler KG. Correction to: Off-label-dosing of non-vitamin K-dependent oral antagonists in AF patients before and after stroke: results of the prospective multicenter Berlin Atrial Fibrillation Registry. J Neurol 2021; 269:481-482. [PMID: 34837502 PMCID: PMC8738357 DOI: 10.1007/s00415-021-10907-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Serdar Tütüncü
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Manuel Olma
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia Kunze
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Joanna Dietzel
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Schurig
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Cornelia Fiessler
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Würzburg, Germany
| | - Carolin Malsch
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center, Clinical Trial Centre Würzburg, University of Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - Tobias Eberhard Haas
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Würzburg, Germany
| | | | - Wolfram Doehner
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,BCRT-Berlin Institute of Health Center for Regenerative Therapies, and Department of Cardiology (Virchow Klinikum), Charité-Universitätsmedizin Berlin, German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Georg Hagemann
- Department of Neurology, Helios Klinik Berlin-Buch, Berlin, Germany
| | - Frank Hamilton
- Department of Neurology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | - Martin Honermann
- Department of Neurology, Vivantes Klinikum Spandau, Berlin, Germany
| | | | - Andreas Kauert
- Department of Neurology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | | | | | - Darius Nabavi
- Department of Neurology, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Christian H Nolte
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Center for Cardiovascular Diseases (DZHK), Partner site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Joschua Mirko Reis
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Würzburg, Germany
| | - Ingo Schmehl
- Department of Neurology, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
| | - Paul Sparenberg
- Department of Neurology, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
| | - Robert Stingele
- Department of Neurology, German Red Cross Hospital Berlin Köpenick, Berlin, Germany
| | - Enrico Völzke
- Department of Neurology, Schlosspark-Klinik Berlin, Berlin, Germany
| | | | | | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center, Clinical Trial Centre Würzburg, University of Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - Matthias Endres
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Partner site Berlin, Berlin, Germany.,German Center for Cardiovascular Diseases (DZHK), Partner site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
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16
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Bondaronek P, Slee A, Hamilton F, Murray E. The public health potential of two popular apps to increase physical activity. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The rise of health apps created novel prospects for public health intervention on a wide scale. Despite the popularity of publicly available physical activity (PA) apps, little is known about their effectiveness. This study aimed to investigate the potential of the apps to increase PA. The objectives were: 1) to determine the feasibility of the trial, 2) explore the effects of the apps on behavioural and psychological outcomes
Methods
Feasibility randomised crossover trial of two popular apps. Inactive adults residing in London (UK) were eligible. The two interventions were: App A - 7 Minute Workout Challenge by Fitness Guide Inc., App B - One You Couch to 5k by Public Health England. After 1-week run-in period, participants were randomly allocated to one of the two assessment sequence (App A, B or App B, A).
Results
Out of 104 participants who were eligible and consented, 63.5% (66/104) were enrolled and randomised. The primary analysis of the accelerometer data showed that there were no significant differences between baseline and the interventions using the continuous variables. Sixteen of 51 participants (31.4%) increased their time in moderate to vigorous PA (MVPA) by 20% from baseline following the introduction of the intervention (95% CI = 19.1% to 45.39). Self-reported PA outcomes showed significant increase and sedentary behaviour decreased. Exercise self-efficacy and intentions increased whilst PA outcome expectancy decreased.
Conclusions
The impact of this two PA apps showed promising results with an impact observed for 20% increase in MVPA, self-reported PA, intentions and exercise self-efficacy. Yet, there was a variability in the outcomes observed.
Key messages
This pragmatic trial with participants classed as inactive showed that physical activity apps can increase physical activity. There was a variability of the physical activity outcome and there is a need to tailor digital tools to the users to impact physical activity on a wide scale.
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Affiliation(s)
- P Bondaronek
- Research, Translation & Innovation, Public Health England, London, UK
- Research Department of Primary Care & Population Health, University College London, London, UK
| | - A Slee
- Research Department of Primary Care & Population Health, University College London, London, UK
| | - F Hamilton
- Research Department of Primary Care & Population Health, University College London, London, UK
| | - E Murray
- Research Department of Primary Care & Population Health, University College London, London, UK
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17
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Hamilton F, Albur M, Noel A, MacGowan AP. Comment on: The case for 'conservative pharmacotherapy'. J Antimicrob Chemother 2021; 76:2489-2491. [PMID: 33993247 DOI: 10.1093/jac/dkab153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F Hamilton
- Bristol Centre for Antimicrobial Chemotherapy (BCARE), North Bristol NHS Trust, Bristol, UK.,MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - M Albur
- Bristol Centre for Antimicrobial Chemotherapy (BCARE), North Bristol NHS Trust, Bristol, UK
| | - A Noel
- Bristol Centre for Antimicrobial Chemotherapy (BCARE), North Bristol NHS Trust, Bristol, UK
| | - A P MacGowan
- Bristol Centre for Antimicrobial Chemotherapy (BCARE), North Bristol NHS Trust, Bristol, UK
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18
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Parkman HP, Wilson LA, Yates KP, Koch KL, Abell TL, McCallum RW, Sarosiek I, Kuo B, Malik Z, Schey R, Shulman RJ, Grover M, Farrugia G, Miriel L, Tonascia J, Hamilton F, Pasricha PJ. Factors that contribute to the impairment of quality of life in gastroparesis. Neurogastroenterol Motil 2021; 33:e14087. [PMID: 33493377 PMCID: PMC8310540 DOI: 10.1111/nmo.14087] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/12/2020] [Accepted: 01/06/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Understanding factors that impair quality of life (QOL) in gastroparesis is important for clinical management. AIMS (a) Determine QOL in patients with gastroparesis; (b) Determine factors that impair QOL. METHODS Gastroparetic patientsAQ6 underwent history and questionnaires assessing symptoms (PAGI-SYM and Rome III), QOL (SF-36v2 and PAGI-QOL), depression (Beck Depression Inventory [BDI]), and anxiety (State Trait Anxiety InventoryAQ7). KEY RESULTS 715 gastroparesis patients (256 diabetic (DG), 459 idiopathic (IG)) were evaluated. SF-36 physical component (PC) score averaged 33.3 ± 10.5; 41% had impaired score <30. SF-36 PC scores were similar between diabetic and idiopathic gastroparesis. Impaired SF-36 PC associated with increased nausea/vomiting and upper abdominal pain subscores, acute onset of symptoms, higher number of comorbidities, use of narcotic pain medications, and irritable bowel syndrome (IBS). SF-36 mental component (MC) score averaged 38.9 ± 13.0; 26% had impaired score <30. Poor SF-36 MC associated with diabetic etiology, higher Beck depression inventory, and state anxiety scores. PAGI-QOL score averaged 2.6 ± 1.1; 50% had a score of <2.6. Low PAGI-QOL associated with higher fullness, bloating, and upper abdominal pain subscores, more depression and Trait anxiety, smoking cigarettes, need for nutritional support, progressively worsening symptoms and periodic exacerbations. CONCLUSIONS & INFERENCES Multiple measures show poor QOL present in gastroparesis. Several areas impacted on reduced QOL: (a) Symptoms of nausea, vomiting, and abdominal pain, as well as IBS; (b) Etiology and acute onset and progressively worsening symptoms; (c) Comorbidities and psychological factors such as anxiety and depression; (d) Patient-related factors such as smoking. Targeting the modifiable factors may improve patient outcomes in gastroparesis.
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Affiliation(s)
| | | | | | | | | | | | - Irene Sarosiek
- Texas Tech University Health Sciences Center, El Paso, TX
| | | | | | | | | | | | | | | | | | - Frank Hamilton
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
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19
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Pasricha PJ, Grover M, Yates KP, Abell TL, Bernard CE, Koch KL, McCallum RW, Sarosiek I, Kuo B, Bulat R, Chen J, Shulman R, Lee L, Tonascia J, Miriel LA, Hamilton F, Farrugia G, Parkman HP, Bulat R, Burns R, Hernandez GB, McKnight M, Kuo B, Mendez A, Staller K, Thurler A, Velez C, Silvernale C, Parkman HP, Malik Z, Maurer A, Palit A, McCallum RW, Sarosiek I, Vega N, Vasquez D, Connery S, Espino K, Friedman M, Abell T, Stocker A, Cannon B, McElmurray L, Cooper K, McBride C, Koch K, Baxter L, Brown A, Stuart P, Abdullah A, Snape W, DeVole N, Earle K, Kirkeby K, Lee C, Lin M, Troyer D, von Bakonyi A, Shulman R, Chumpitazi B, Febo-Rodriguez L, Hollier J, Bouette C, Charron H, Nurko S, Wall S, Kane M, Williams K, Yossef-Salameh L, Woodley F, Farrugia G, Grover M, Bernard C, Serrano J, Hamilton F, Hall S, James S, Torrance R, Tonascia J, Adamo M, Belt P, Dodge J, Donithan M, Isaacson M, Lee L, Meinert J, Miriel L, Sharkey E, Smith J, Smith M, Sternberg A, Van Natta M, Wagoner A, Wilson L, Yamada G, Yates K. Functional Dyspepsia and Gastroparesis in Tertiary Care are Interchangeable Syndromes With Common Clinical and Pathologic Features. Gastroenterology 2021; 160:2006-2017. [PMID: 33548234 PMCID: PMC8547190 DOI: 10.1053/j.gastro.2021.01.230] [Citation(s) in RCA: 114] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 01/22/2021] [Accepted: 01/28/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND The aim of this study was to clarify the pathophysiology of functional dyspepsia (FD), a highly prevalent gastrointestinal syndrome, and its relationship with the better-understood syndrome of gastroparesis. METHODS Adult patients with chronic upper gastrointestinal symptoms were followed up prospectively for 48 weeks in multi-center registry studies. Patients were classified as having gastroparesis if gastric emptying was delayed; if not, they were labeled as having FD if they met Rome III criteria. Study analysis was conducted using analysis of covariance and regression models. RESULTS Of 944 patients enrolled during a 12-year period, 720 (76%) were in the gastroparesis group and 224 (24%) in the FD group. Baseline clinical characteristics and severity of upper gastrointestinal symptoms were highly similar. The 48-week clinical outcome was also similar but at this time 42% of patients with an initial diagnosis of gastroparesis were reclassified as FD based on gastric-emptying results at this time point; conversely, 37% of patients with FD were reclassified as having gastroparesis. Change in either direction was not associated with any difference in symptom severity changes. Full-thickness biopsies of the stomach showed loss of interstitial cells of Cajal and CD206+ macrophages in both groups compared with obese controls. CONCLUSIONS A year after initial classification, patients with FD and gastroparesis, as seen in tertiary referral centers at least, are not distinguishable based on clinical and pathologic features or based on assessment of gastric emptying. Gastric-emptying results are labile and do not reliably capture the pathophysiology of clinical symptoms in either condition. FD and gastroparesis are unified by characteristic pathologic features and should be considered as part of the same spectrum of truly "organic" gastric neuromuscular disorders. CLINICALTRIALS. GOV IDENTIFIER NCT00398801, NCT01696747.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Braden Kuo
- Massachusetts General Hospital, Boston, MA
| | - Robert Bulat
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Linda Lee
- Johns Hopkins University, Baltimore, MD
| | | | | | - Frank Hamilton
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
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20
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Parkman HP, Van Natta M, Yamada G, Grover M, McCallum RW, Sarosiek I, Farrugia G, Koch KL, Abell TL, Kuo B, Miriel L, Tonascia J, Hamilton F, Pasricha PJ. Body weight in patients with idiopathic gastroparesis. Neurogastroenterol Motil 2021; 33:e13974. [PMID: 32930463 PMCID: PMC8180181 DOI: 10.1111/nmo.13974] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/05/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The classic clinical picture of gastroparesis is a symptomatic patient losing weight. In addition, a number of patients with delayed gastric emptying are obese and/or gaining weight. Our aim was to investigate the factors impacting body weight in patients with idiopathic gastroparesis. METHODS In patients with idiopathic gastroparesis, detailed history and weight were acquired at enrollment and after 48 weeks. Questionnaires assessed symptoms, food intake, physical activity, and quality of life. Patients underwent laboratory testing, gastric emptying scintigraphy, and water load testing. RESULTS Of 138 patients with idiopathic gastroparesis, 10% were underweight (BMI < 18.5), 39% were normal weight (BMI 18.5-25), 20% were overweight with BMI 25 to 30 kg/m2 , and 29% were obese with BMI > 30 kg/m2 . Body weight at enrollment was positively associated with oral caloric consumption (P < .001), following a gastroparesis diet (P = .04), nutrition consultation (P = .001), upper abdominal pain (P = .01); and negatively associated with energy expenditure (P = .05), alcohol use (P = .003) and severity of bloating (P < .001). When followed over 48 weeks, 53% patients stayed stable (within 5% of baseline weight), 30% gained, and 17% lost weight. Weight gain over 48 weeks was positively associated with oral caloric consumption (P = .003) and constipation severity (P = .005) at enrollment, and negatively associated with lower abdominal pain severity (P = .007) at enrollment, and associated with improvement in inability to finish meal score (P < .001) at 48 weeks. CONCLUSIONS In this series of patients with idiopathic gastroparesis, 10% were underweight whereas 29% were obese. Over 48 weeks, 30% of patients increased their body weight ≥ 5%. Diet, activity, and symptoms are important factors associated with body weight in patients with idiopathic gastroparesis.
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Affiliation(s)
| | | | | | | | | | - Irene Sarosiek
- Texas Tech University Health Sciences Center, El Paso, TX
| | | | | | | | | | | | | | - Frank Hamilton
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
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21
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Haeusler KG, Tütüncü S, Kunze C, Schurig J, Malsch C, Harder J, Wiedmann S, Dimitrijeski B, Ebinger M, Hagemann G, Hamilton F, Honermann M, Jungehulsing GJ, Kauert A, Koennecke HC, Leithner C, Mackert BM, Masuhr F, Nabavi D, Rocco A, Schmehl I, Schmitz B, Sparenberg P, Stingele R, von Brevern M, Völzke E, Dietzel J, Heuschmann PU, Endres M. Oral anticoagulation in patients with atrial fibrillation and acute ischaemic stroke: design and baseline data of the prospective multicentre Berlin Atrial Fibrillation Registry. Europace 2020; 21:1621-1632. [PMID: 31397475 DOI: 10.1093/europace/euz199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/28/2019] [Indexed: 12/11/2022] Open
Abstract
AIMS The Berlin Atrial Fibrillation Registry was designed to analyse oral anticoagulation (OAC) prescription in patients with atrial fibrillation (AF) and acute ischaemic stroke. METHODS AND RESULTS This investigator-initiated prospective multicentre registry enrolled patients at all 16 stroke units located in Berlin, Germany. The ongoing telephone follow-up is conducted centrally and will cover 5 years per patient. Within 2014 and 2016, 1080 patients gave written informed consent and 1048 patients were available for analysis. Median age was 77 years [interquartile range (IQR) 72-83], 503 (48%) patients were female, and 254 (24%) had a transient ischaemic attack (TIA). Overall, 470 (62%) out of 757 patients with known AF and a (pre-stroke) CHA2DS2-VASc ≥ 1 were anticoagulated at the time of stroke. At hospital discharge, 847 (81.3%) of 1042 patients were anticoagulated. Thereof 710 (68.1%) received a non-vitamin K-dependent oral anticoagulant (NOAC) and 137 (13.1%) a vitamin K antagonist (VKA). Pre-stroke intake of a NOAC [odds ratio (OR) 15.6 (95% confidence interval, 95% CI 1.97-122)] or VKA [OR 0.04 (95% CI 0.02-0.09)], an index TIA [OR 0.56 (95% CI 0.34-0.94)] rather than stroke, heart failure [OR 0.49 (95% CI 0.26-0.93)], and endovascular thrombectomy at hospital admission [OR 12.9 (95% CI 1.59-104)] were associated with NOAC prescription at discharge. Patients' age or AF type had no impact on OAC or NOAC use, respectively. CONCLUSION About 60% of all registry patients with known AF received OAC at the time of stroke or TIA. At hospital discharge, more than 80% of AF patients were anticoagulated and about 80% of those were prescribed a NOAC.
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Affiliation(s)
- Karl Georg Haeusler
- Department of Neurology, Universitätsklinikum Würzburg, Josef-Schneider-Str. 11, Würzburg, Germany
| | - Serdar Tütüncü
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Germany
| | - Claudia Kunze
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Germany
| | - Johannes Schurig
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, Germany
| | - Carolin Malsch
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Germany.,Comprehensive Heart Failure Center, University of Würzburg, Clinical Trial Centre Würzburg, University Hospital Würzburg, Germany
| | - Janek Harder
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Germany
| | - Silke Wiedmann
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Germany.,Strategic Corporate Development, Charité-Universitätsmedizin Berlin, Germany
| | | | - Martin Ebinger
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Germany.,Department of Neurology, Medical Park Berlin Humboldtmühle, Berlin, Germany
| | - Georg Hagemann
- Department of Neurology, Helios Klinik Berlin-Buch, Berlin, Germany
| | - Frank Hamilton
- Department of Neurology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | - Martin Honermann
- Department of Neurology, Vivantes Klinikum Spandau, Berlin, Germany
| | - Gerhard Jan Jungehulsing
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Germany.,Department of Neurology, Jüdisches Krankenhaus Berlin, Germany
| | - Andreas Kauert
- Department of Neurology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | | | | | | | - Florian Masuhr
- Department of Neurology, Bundeswehrkrankenhaus Berlin, Germany
| | - Darius Nabavi
- Department of Neurology, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Andrea Rocco
- Department of Neurology, Charité - Universitätsmedizin Berlin, Germany
| | - Ingo Schmehl
- Department of Neurology, BG Klinikum Unfallkrankenhaus Berlin, Germany
| | - Bettina Schmitz
- Department of Neurology, Vivantes Humboldt-Klinikum, Berlin, Germany
| | - Paul Sparenberg
- Department of Neurology, BG Klinikum Unfallkrankenhaus Berlin, Germany
| | - Robert Stingele
- Department of Neurology, German Red Cross Hospital Berlin, Köpenick, Germany
| | | | - Enrico Völzke
- Department of Neurology, Schlosspark-Klinik Berlin, Germany
| | - Joanna Dietzel
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Germany.,Comprehensive Heart Failure Center, University of Würzburg, Clinical Trial Centre Würzburg, University Hospital Würzburg, Germany
| | - Matthias Endres
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Partner Site, Berlin, Germany.,German Center for Cardiovascular Diseases (DZHK), Partner Site, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
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22
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Nguyen L, Wilson LA, Miriel L, Pasricha PJ, Kuo B, Hasler WL, McCallum RW, Sarosiek I, Koch KL, Snape WJ, Farrugia G, Grover M, Clarke J, Parkman HP, Tonascia J, Hamilton F, Abell TL. Autonomic function in gastroparesis and chronic unexplained nausea and vomiting: Relationship with etiology, gastric emptying, and symptom severity. Neurogastroenterol Motil 2020; 32:e13810. [PMID: 32061038 PMCID: PMC7377964 DOI: 10.1111/nmo.13810] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/05/2019] [Accepted: 12/09/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Autonomic dysfunction can be present in patients with idiopathic and diabetic gastroparesis. The role of autonomic dysfunction relating to gastric emptying and upper gastrointestinal symptoms in patients with gastroparesis and chronic unexplained nausea and vomiting (CUNV) remains unclear. The aim of our study is to evaluate autonomic function in patients with gastroparesis and CUNV with respect to etiology, gastric emptying and symptom severity. METHODS We studied 242 patients with chronic gastroparetic symptoms recruited at eight centers. All patients had a gastric emptying scintigraphy within 6 months of the study. Symptom severity was assessed using the gastroparesis cardinal symptom index. Autonomic function testing was performed at baseline enrollment using the ANX 3.0 autonomic monitoring system which measures heart rate variability and respiratory activity measurements. KEY RESULTS Low sympathetic response to challenge (Valsalva or standing) was the most common abnormality seen impacting 89% diabetic and 74% idiopathic patients. Diabetics compared to idiopathics, exhibited greater global hypofunction with sympathetic (OR = 4.7, 95% CI 2.2-10.3; P < .001) and parasympathetic (OR = 7.2, 95% CI 3.4-15.0; P < .001) dysfunction. Patients with delayed gastric emptying were more likely to have paradoxic parasympathetic excessive during sympathetic challenge [(Valsalva or standing) 40% vs. 26%, P = .05]. Patients with more severe symptoms exhibited greater parasympathetic dysfunction compared to those with mild-moderate symptoms: resting sympathovagal balance [LFa/RFa 1.8 (1.0-3.1) vs. 1.2 (0.6-2.3), P = .006)] and standing parasympathetic activity [0.4 (0.1-0.8) vs. 0.6 (0.2-1.7); P = .03]. CONCLUSIONS Autonomic dysfunction was common in patients with gastroparesis and CUNV. Parasympathetic dysfunction was associated with delayed gastric emptying and more severe upper gastrointestinal symptoms. Conversely, sympathetic hypofunction was associated with milder symptoms. INFERENCES Gastroparesis and CUNV may be a manifestation of GI autonomic dysfunction or imbalance, such that sympathetic dysfunction occurs early on in the manifestation of chronic upper GI symptoms, while parasympathetic dysfunction results in more severe symptoms and delayed gastric emptying.
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Affiliation(s)
| | | | | | | | - Braden Kuo
- Harvard University, Boston, Massachusetts
- Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | | | | | | | | | | | | | | | - Frank Hamilton
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
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23
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Koch KL, Hasler WL, Van Natta M, Calles-Escandon J, Grover M, Pasricha PJ, Snape WJ, Parkman HP, Abell TL, McCallum RW, Nguyen LA, Sarosiek I, Farrugia G, Tonascia J, Lee L, Miriel L, Hamilton F. Satiety testing in diabetic gastroparesis: Effects of insulin pump therapy with continuous glucose monitoring on upper gastrointestinal symptoms and gastric myoelectrical activity. Neurogastroenterol Motil 2020; 32:e13720. [PMID: 31574209 PMCID: PMC7382784 DOI: 10.1111/nmo.13720] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/30/2019] [Accepted: 08/22/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Symptoms induced by caloric or non-caloric satiety test meals and gastric myoelectrical activity (GMA) have not been studied in patients with diabetic gastroparesis (DGP) before and after intense glucose management. AIMS We determined the effects of continuous subcutaneous insulin infusion (CSII) with continuous glucose monitoring (CGM) on GI symptoms, volume consumed, and GMA induced by the caloric meal satiety test (CMST) and water load satiety test (WLST) in DGP. METHODS Forty-five patients with DGP underwent CMST and WLST at baseline and 24 weeks after CSII with CGM. Subjects ingested the test meals until they were completely full. Visual analog scales were used to quantify pre- and postmeal symptoms, and GMA was recorded with cutaneous electrodes and analyzed visually and by computer. KEY RESULTS: At baseline and 24-week visits, nausea, bloating, abdominal discomfort, and fullness were immediately increased after CMST and WLST (Ps < 0.01). The meal volumes ingested were significantly less than normal controls at both visits in almost one-third of the subjects. After the CMST, the percentage 3 cycle per minute GMA increased and bradygastria decreased compared with WLST (Ps < 0.05). After treatment for 24 weeks meal volumes ingested, postmeal symptoms and GMA were no different than baseline. CONCLUSIONS AND INFERENCES: (a) Satiety test meals elicited symptoms of nausea, bloating, and abdominal discomfort; (b) CMST stimulated more symptoms and changes in GMA than WLST; and (c) CSII with CGM for 24 weeks did not improve symptoms, volumes ingested, or GMA elicited by the two satiety test meals in these patients with diabetic GP. Satiety tests in diabetic gastropresis are useful to study acute postprandial symptoms and GMA, but these measures were not improved by intensive insulin therapy.
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Affiliation(s)
- Kenneth L Koch
- Section on Gastroenterology, Wake Forest University, Winston-Salem, North Carolina
| | - William L Hasler
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan
| | - Mark Van Natta
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Pankaj J Pasricha
- Center for Neurogastroenterology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
| | - William J Snape
- California Pacific Medical Center, San Francisco, California
| | - Henry P Parkman
- Section of Gastroenterology, Temple University, Philadelphia, Pennsylvania
| | - Thomas L Abell
- Digestive and Liver Health, University of Louisville, Louisville, Kentucky
| | | | - Linda A Nguyen
- Division of Gastroenterology, Stanford University, Palo Alto, California
| | - Irene Sarosiek
- Division of Gastroenterology, Texas Tech University, El Paso, Texas
| | - Gianrico Farrugia
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - James Tonascia
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Linda Lee
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Laura Miriel
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Frank Hamilton
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
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24
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Coté GA, Durkalski-Mauldin VL, Serrano J, Klintworth E, Williams AW, Cruz-Monserrate Z, Arain M, Buxbaum JL, Conwell DL, Fogel EL, Freeman ML, Gardner TB, van Geenen E, Groce JR, Jonnalagadda SS, Keswani RN, Menon S, Moffatt DC, Papachristou GI, Ross A, Tarnasky PR, Wang AY, Wilcox CM, Hamilton F, Yadav D. SpHincterotomy for Acute Recurrent Pancreatitis Randomized Trial: Rationale, Methodology, and Potential Implications. Pancreas 2019; 48:1061-1067. [PMID: 31404020 PMCID: PMC6699897 DOI: 10.1097/mpa.0000000000001370] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES In patients with acute recurrent pancreatitis (ARP), pancreas divisum, and no other etiologic factors, endoscopic retrograde cholangiopancreatography (ERCP) with minor papilla endoscopic sphincterotomy (miES) is often performed to enlarge the minor papillary orifice, based on limited data. The aims of this study are to describe the rationale and methodology of a sham-controlled clinical trial designed to test the hypothesis that miES reduces the risk of acute pancreatitis. METHODS The SpHincterotomy for Acute Recurrent Pancreatitis (SHARP) trial is a multicenter, international, sham-controlled, randomized trial comparing endoscopic ultrasound + ERCP with miES versus endoscopic ultrasound + sham for the management of ARP. A total of 234 consented patients having 2 or more discrete episodes of acute pancreatitis, pancreas divisum confirmed by magnetic resonance cholangiopancreatography, and no other clear etiology for acute pancreatitis will be randomized. Both cohorts will be followed for a minimum of 6 months and a maximum of 48 months. RESULTS The trial is powered to detect a 33% risk reduction of acute pancreatitis frequency. CONCLUSIONS The SHARP trial will determine whether ERCP with miES benefits patients with idiopathic ARP and pancreas divisum. Trial planning has informed the importance of blinded outcome assessors and long-term follow-up.
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Affiliation(s)
| | | | - Jose Serrano
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Erin Klintworth
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - April W Williams
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Zobeida Cruz-Monserrate
- Division of Gastroenterology, Hepatology, and Nutrition
- Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Mustafa Arain
- Department of Medicine, University of California, San Francisco, San Francisco
| | - James L Buxbaum
- Department of Medicine, Keck School of Medicine of USC, Los Angeles, CA
| | | | - Evan L Fogel
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Martin L Freeman
- Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Timothy B Gardner
- Department of Medicine, Dartmouth Geisel School of Medicine, Lebanon, NH
| | - Erwin van Geenen
- Division of Gastroenterology and Hepatology, University Medical Center St Radboud, Nijmegen, Netherlands
| | - J Royce Groce
- Division of Gastroenterology, Hepatology, and Nutrition
| | | | - Rajesh N Keswani
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Shyam Menon
- Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Dana C Moffatt
- Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | | | - Andrew Ross
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA
| | | | - Andrew Y Wang
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA
| | - C Mel Wilcox
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Frank Hamilton
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Dhiraj Yadav
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
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25
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Parkman HP, Yamada G, Van Natta ML, Yates K, Hasler WL, Sarosiek I, Grover M, Schey R, Abell TL, Koch KL, Kuo B, Clarke J, Farrugia G, Nguyen L, Snape WJ, Miriel L, Tonascia J, Hamilton F, Pasricha PJ, McCallum RW. Ethnic, Racial, and Sex Differences in Etiology, Symptoms, Treatment, and Symptom Outcomes of Patients With Gastroparesis. Clin Gastroenterol Hepatol 2019; 17:1489-1499.e8. [PMID: 30404035 PMCID: PMC6500483 DOI: 10.1016/j.cgh.2018.10.050] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 10/22/2018] [Accepted: 10/28/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Gastroparesis is a chronic disorder of the stomach characterized by nausea, vomiting, early satiety, postprandial fullness, and abdominal pain. There is limited information on gastroparesis in minority populations. We assessed ethnic, racial, and sex variations in the etiology, symptoms, quality of life, gastric emptying, treatments, and symptom outcomes of patients with gastroparesis. METHODS We collected information from the National Institutes of Health Gastroparesis Consortium on 718 adult patients, from September 2007 through December 2017. Patients were followed every 4 or 6 months, when data were collected on medical histories, symptoms (based on answers to the PAGI-SYM questionnaires), and quality of life (based on SF-36). Follow-up information collected at 1 year (48 week) was used in this analysis. Comparisons were made between patients of self-reported non-Hispanic white, non-Hispanic black, and Hispanic ethnicities, as well as and between male and female patients. RESULTS Our final analysis included 552 non-Hispanic whites (77%), 83 persons of Hispanic ethnicity (12%), 62 non-Hispanic blacks (9%), 603 women (84%), and 115 men (16%). A significantly higher proportion of non-Hispanic blacks (60%) had gastroparesis of diabetic etiology than of non-Hispanic whites (28%); non-Hispanic blacks also had more severe retching (2.5 vs 1.7 score) and vomiting (2.9 vs 1.8 score) and a higher percentage were hospitalized in the past year (66% vs 38%). A significantly higher proportion of Hispanics had gastroparesis of diabetic etiology (59%) than non-Hispanic whites (28%), but Hispanics had less-severe nausea (2.7 vs 3.3 score), less early satiety (3.0 vs 3.5 score), and a lower proportion used domperidone (8% vs 21%) or had a peripherally inserted central catheter (1% vs 7%). A higher proportion of women had gastroparesis of idiopathic etiology (69%) than men (46%); women had more severe symptoms of stomach fullness (3.6 vs 3.1 score), early satiety (3.5 vs 2.9 score), postprandial fullness (3.7 vs 3.1 score), bloating (3.3 vs 2.6 score), stomach visibly larger (3.0 vs 2.1 score), and upper abdominal pain (2.9 vs 2.4 score). A lower proportion of women were hospitalized in past year (39% vs 53% of men). CONCLUSIONS In patients with gastroparesis, etiologies, symptom severity, and treatments vary among races and ethnicities and between sexes. ClinicalTrials.gov Identifier: NCT01696747.
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Affiliation(s)
- Henry P Parkman
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania.
| | - Goro Yamada
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Mark L Van Natta
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Katherine Yates
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - William L Hasler
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Irene Sarosiek
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Madhusudan Grover
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Ron Schey
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Thomas L Abell
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Kenneth L Koch
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Braden Kuo
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - John Clarke
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Gianrico Farrugia
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Linda Nguyen
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - William J Snape
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Laura Miriel
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - James Tonascia
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Frank Hamilton
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Pankaj J Pasricha
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Richard W McCallum
- Gastroenterology Section, Temple University School of Medicine, Philadelphia, Pennsylvania
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Lackner JM, Jaccard J, Keefer L, Brenner D, Firth R, Gudleski GD, Hamilton F, Katz LA, Krasner SS, Ma CX, Radziwon C, Sitrin MD. Improvement in Gastrointestinal Symptoms After Cognitive Behavior Therapy for Refractory Irritable Bowel Syndrome. Gastroenterology 2018; 155:47-57. [PMID: 29702118 PMCID: PMC6035059 DOI: 10.1053/j.gastro.2018.03.063] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 03/11/2018] [Accepted: 03/30/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS There is an urgent need for safe treatments for irritable bowel syndrome (IBS) that relieve treatment-refractory symptoms and their societal and economic burden. Cognitive behavior therapy (CBT) is an effective treatment that has not been broadly adopted into routine clinical practice. We performed a randomized controlled trial to assess clinical responses to home-based CBT compared with clinic-based CBT and patient education. METHODS We performed a prospective study of 436 patients with IBS, based on Rome III criteria, at 2 tertiary centers from August 23, 2010, through October 21, 2016. Subjects (41.4 ± 14.8 years old; 80% women) were randomly assigned to groups that received the following: standard-CBT (S-CBT, n = 146, comprising 10 weekly, 60-minute sessions that emphasized the provision of information about brain-gut interactions; self-monitoring of symptoms, their triggers, and consequences; muscle relaxation; worry control; flexible problem solving; and relapse prevention training), or 4 sessions of primarily home-based CBT requiring minimal therapist contact (MC-CBT, n = 145), in which patients received home-study materials covering the same procedures as S-CBT), or 4 sessions of IBS education (EDU, n = 145) that provided support and information about IBS and the role of lifestyle factors such as stress, diet, and exercise. The primary outcome was global improvement of IBS symptoms, based on the IBS-version of the Clinical Global Impressions-Improvement Scale. Ratings were performed by patients and board-certified gastroenterologists blinded to treatment allocation. Efficacy data were collected 2 weeks, 3 months, and 6 months after treatment completion. RESULTS A higher proportion of patients receiving MC-CBT reported moderate to substantial improvement in gastrointestinal symptoms 2 weeks after treatment (61.0% based on ratings by patients and 55.7% based on ratings by gastroenterologists) than those receiving EDU (43.5% based on ratings patients and 40.4% based on ratings by gastroenterologists) (P < .05). Gastrointestinal symptom improvement, rated by gastroenterologists, 6 months after the end of treatment also differed significantly between the MC-CBT (58.4%) and EDU groups (44.8%) (P = .05). Formal equivalence testing applied across multiple contrasts indicated that MC-CBT is at least as effective as S-CBT in improving IBS symptoms. Patients tended to be more satisfied with CBT vs EDU (P < .05) based on immediate posttreatment responses to the Client Satisfaction Questionnaire. Symptom improvement was not significantly related to concomitant use of medications. CONCLUSIONS In a randomized controlled trial, we found that a primarily home-based version of CBT produced significant and sustained gastrointestinal symptom improvement for patients with IBS compared with education. Clinicaltrials.gov no.: NCT00738920.
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Affiliation(s)
- Jeffrey M. Lackner
- Division of Gastroenterology, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY
| | - James Jaccard
- School of Social Work, New York University, New York, NY
| | - Laurie Keefer
- Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Darren Brenner
- Division of Gastroenterology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Rebecca Firth
- Division of Gastroenterology, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY
| | - Gregory D. Gudleski
- Division of Gastroenterology, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY
| | - Frank Hamilton
- Division of Digestive Disease and Nutrition, NIDDK, Bethesda, MD
| | - Leonard A. Katz
- Division of Gastroenterology, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY
| | - Susan S. Krasner
- Division of Gastroenterology, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY,Department of Anesthesiology, Jacobs School of Medicine, University at Buffalo, Buffalo, NY
| | - Chang-Xing Ma
- Department of Biostatistics, University at Buffalo, SUNY, Buffalo, NY
| | - Christopher Radziwon
- Division of Gastroenterology, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY
| | - Michael D. Sitrin
- Division of Gastroenterology, Department of Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, NY
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27
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Hamilton F, Arnold D, Baird A, Albur M, Whiting P. Early Warning Scores do not accurately predict mortality in sepsis: A meta-analysis and systematic review of the literature. J Infect 2018; 76:241-248. [PMID: 29337035 DOI: 10.1016/j.jinf.2018.01.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 12/30/2017] [Accepted: 01/06/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Early Warning Scores are used to evaluate patients in many hospital settings. It is not clear if these are accurate in predicting mortality in sepsis. We performed a systematic review and meta-analysis of multiple studies in sepsis. Our aim was to estimate the accuracy of EWS for mortality in this setting. METHODS PubMED, CINAHL, Cochrane, Web of Science and EMBASE were searched to October 2016. Studies of adults with sepsis who had EWS calculated using any appropriate tool (e.g. NEWS, MEWS) were eligible for inclusion. Study quality was assessed using QUADAS-2. Summary estimates were derived using HSROC analysis. RESULTS Six studies (4298 participants) were included. Results suggest that EWS cannot be used to predict which patients with sepsis will (positive likelihood ratio 1.79, 95% CI 1.53 to 2.11) or will not die (negative likelihood ratio 0.59, 95% CI 0.45 to 0.78). Two studies were rated as low risk of bias and one as unclear risk of bias on all domains. The other three studies were judged at high risk of bias in one domain. CONCLUSION Early Warning Scores are not sufficiently accurate to rule in or rule out mortality in patients with sepsis, based on the evidence available, which is generally poor quality.
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Affiliation(s)
- F Hamilton
- Department of Medicine, Weston Area Health Trust, UK.
| | - D Arnold
- Department of Medicine, North Bristol NHS Trust, UK
| | - A Baird
- Department of Critical Care, Gloucestershire Royal Hospital, UK
| | - M Albur
- Department of Microbiology, North Bristol NHS Trust, UK
| | - P Whiting
- NIHR CHLARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK; School of Social and Community Medicine, University of Bristol, UK
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28
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Siraj ES, Homko C, Wilson LA, May P, Rao AD, Calles J, Farrugia G, Hasler WL, Koch KL, Nguyen L, Snape WJ, Abell TL, Sarosiek I, McCallum RW, Pasricha PJ, Clarke J, Tonascia J, Hamilton F, Parkman HP. Islet Cell Associated Autoantibodies and C-Peptide Levels in Patients with Diabetes and Symptoms of Gastroparesis. Front Endocrinol (Lausanne) 2018; 9:32. [PMID: 29487566 PMCID: PMC5816742 DOI: 10.3389/fendo.2018.00032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 01/23/2018] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Individuals with diabetes are at increased risk for complications, including gastroparesis. Type 1 diabetes mellitus (T1DM) is an autoimmune disorder resulting in decreased beta-cell function. Glutamic acid decarboxylase-65 antibody (GADA) is the most commonly used test to assess autoimmunity while C-peptide level is used to assess beta-cell function. Patients with type 2 diabetes mellitus (T2DM), who are GADA positive, are labeled latent autoimmune diabetes in adults (LADA). OBJECTIVE To characterize patients with T1 and T2DM who have symptoms of gastroparesis using GADA and C-peptide levels and to look for association with the presence of gastroparesis and its symptom severity. DESIGN 113 T1DM and 90 T2DM patients with symptoms suggestive of gastroparesis were studied. Symptom severity was assessed using Gastroparesis Cardinal Symptom Index (GCSI). Serum samples were analyzed for GADA and C-peptide. RESULTS Delayed gastric emptying was present in 91 (81%) of T1DM and 60 (67%) of T2DM patients (p = 0.04). GADA was present in 13% of T2DM subjects [10% in delayed gastric emptying and 20% in normal gastric emptying (p = 0.2)]. Gastric retention and GCSI scores were mostly similar in GADA positive and negative T2DM patients. GADA was present in 45% of T1DM subjects [46% in delayed gastric emptying and 41% in normal gastric emptying (p = 0.81)]. Low C-peptide levels were seen in 79% T1DM patients and 8% T2DM. All seven T2DM patients with low C-peptide were taking insulin compared to 52% of T2DM with normal C-peptide. CONCLUSION GADA was present in 13% while low C-peptide was seen in 8% of our T2DM patients with symptoms of gastroparesis. Neither did correlate with degree of delayed gastric emptying or symptom severity. CLINICALTRIALSGOV IDENTIFIER NCT01696747.
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Affiliation(s)
- Elias S. Siraj
- Division of Endocrinology and Metabolic Disorders, Eastern Virginia Medical School, Norfolk, VA, United States
- *Correspondence: Elias S. Siraj,
| | - Carol Homko
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | | | - Patrick May
- Johns Hopkins University, Baltimore, MD, United States
| | - Ajay D. Rao
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Jorge Calles
- Case Western Reserve University, Cleveland, OH, United States
| | | | | | | | - Linda Nguyen
- Stanford University, Palo Alto, CA, United States
| | - William J. Snape
- California Pacific Medical Center, San Francisco, CA, United States
| | | | - Irene Sarosiek
- Texas Tech University Health Science Center, El Paso, TX, United States
| | | | | | - John Clarke
- Johns Hopkins University, Baltimore, MD, United States
| | | | - Frank Hamilton
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States
| | - Henry P. Parkman
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
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29
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Hoffmann S, Harms H, Ulm L, Nabavi DG, Mackert BM, Schmehl I, Jungehulsing GJ, Montaner J, Bustamante A, Hermans M, Hamilton F, Göhler J, Malzahn U, Malsch C, Heuschmann PU, Meisel C, Meisel A. Stroke-induced immunodepression and dysphagia independently predict stroke-associated pneumonia - The PREDICT study. J Cereb Blood Flow Metab 2017; 37:3671-3682. [PMID: 27733675 PMCID: PMC5718319 DOI: 10.1177/0271678x16671964] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Stroke-associated pneumonia is a frequent complication after stroke associated with poor outcome. Dysphagia is a known risk factor for stroke-associated pneumonia but accumulating evidence suggests that stroke induces an immunodepressive state increasing susceptibility for stroke-associated pneumonia. We aimed to confirm that stroke-induced immunodepression syndrome is associated with stroke-associated pneumonia independently from dysphagia by investigating the predictive properties of monocytic HLA-DR expression as a marker of immunodepression as well as biomarkers for inflammation (interleukin-6) and infection (lipopolysaccharide-binding protein). This was a prospective, multicenter study with 11 study sites in Germany and Spain, including 486 patients with acute ischemic stroke. Daily screening for stroke-associated pneumonia, dysphagia and biomarkers was performed. Frequency of stroke-associated pneumonia was 5.2%. Dysphagia and decreased monocytic HLA-DR were independent predictors for stroke-associated pneumonia in multivariable regression analysis. Proportion of pneumonia ranged between 0.9% in the higher monocytic HLA-DR quartile (≥21,876 mAb/cell) and 8.5% in the lower quartile (≤12,369 mAb/cell). In the presence of dysphagia, proportion of pneumonia increased to 5.9% and 18.8%, respectively. Patients without dysphagia and normal monocytic HLA-DR expression had no stroke-associated pneumonia risk. We demonstrate that dysphagia and stroke-induced immunodepression syndrome are independent risk factors for stroke-associated pneumonia. Screening for immunodepression and dysphagia might be useful for identifying patients at high risk for stroke-associated pneumonia.
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Affiliation(s)
- Sarah Hoffmann
- 1 NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Germany.,2 Department of Neurology, Charité - Universitätsmedizin Berlin, Germany
| | - Hendrik Harms
- 3 Department of Neurology, St.-Josefs Krankenhaus Potsdam, Germany
| | - Lena Ulm
- 1 NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Germany
| | - Darius G Nabavi
- 4 Department of Neurology, Vivantes Klinikum Neukölln, Berlin, Germany
| | | | - Ingo Schmehl
- 6 Department of Neurology, Unfallkrankenhaus Berlin, Germany
| | - Gerhard J Jungehulsing
- 7 Department of Neurology, Jüdisches Krankenhaus Berlin, Germany.,8 Center for Stroke Research (CSB), Charité - Universitätsmedizin Berlin, Germany
| | - Joan Montaner
- 9 Department of Neurology, Hospital Universitari Vall d'Hebron Barcelona, Spain
| | | | - Marcella Hermans
- 4 Department of Neurology, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Frank Hamilton
- 5 Department of Neurology, Vivantes Auguste Viktoria Klinikum, Berlin, Germany
| | - Jos Göhler
- 2 Department of Neurology, Charité - Universitätsmedizin Berlin, Germany
| | - Uwe Malzahn
- 10 Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany.,11 Clinical Trial Center Würzburg, University Hospital Würzburg, Germany
| | - Carolin Malsch
- 10 Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany.,12 Comprehensive Heart Failure Center, University of Würzburg, Germany
| | - Peter U Heuschmann
- 10 Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany.,11 Clinical Trial Center Würzburg, University Hospital Würzburg, Germany.,12 Comprehensive Heart Failure Center, University of Würzburg, Germany
| | - Christian Meisel
- 13 Department of Immunology, Charité - Universitätsmedizin Berlin, Germany.,14 Department of Immunology, Labor Berlin - Charité Vivantes GmbH, Berlin, Germany
| | - Andreas Meisel
- 1 NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Germany.,2 Department of Neurology, Charité - Universitätsmedizin Berlin, Germany.,8 Center for Stroke Research (CSB), Charité - Universitätsmedizin Berlin, Germany
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30
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Orthey P, Yu D, Van Natta ML, Ramsey FV, Diaz JR, Bennett PA, Iagaru AH, Fragomeni RS, McCallum RW, Sarosiek I, Hasler WL, Farrugia G, Grover M, Koch KL, Nguyen L, Snape WJ, Abell TL, Pasricha PJ, Tonascia J, Hamilton F, Parkman HP, Maurer AH. Intragastric Meal Distribution During Gastric Emptying Scintigraphy for Assessment of Fundic Accommodation: Correlation with Symptoms of Gastroparesis. J Nucl Med 2017; 59:691-697. [PMID: 28970332 DOI: 10.2967/jnumed.117.197053] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 08/23/2017] [Indexed: 12/11/2022] Open
Abstract
Impaired fundic accommodation (FA) limits fundic relaxation and the ability to act as a reservoir for food. Assessing intragastric meal distribution (IMD) during gastric emptying scintigraphy (GES) allows for a simple measure of FA. The 3 goals of this study were to evaluate trained readers' (nuclear medicine and radiology physicians) visual assessments of FA from solid-meal GES; develop software to quantify GES IMD; and correlate symptoms of gastroparesis with IMD and gastric emptying. Methods: After training to achieve a consensus interpretation of GES FA, 4 readers interpreted FA in 148 GES studies from normal volunteers and patients. Mixture distribution and κ-agreement analyses were used to assess reader consistency and agreement of scoring of FA. Semiautomated software was used to quantify IMD (ratio of gastric counts in the proximal stomach to those in the total stomach) at 0, 1, 2, 3, and 4 h after ingestion of a meal. Receiver-operating-characteristic analysis was performed to optimize the diagnosis of abnormal IMD at 0 min (IMD0) with impaired FA. IMD0, GES, water load testing, and symptoms were then compared in 177 patients with symptoms of gastroparesis. Results: Reader pairwise weighted κ-values for the visual assessment of FA averaged 0.43 (moderate agreement) for normal FA versus impaired FA. Readers achieved 84.0% consensus and 85.8% reproducibility in assessing impaired FA. IMD0 based on the division of the stomach into proximal and distal halves averaged 0.809 (SD, 0.083) for normal FA and 0.447 (SD, 0.132) (P < 0.01) for impaired FA. On the basis of receiver-operating-characteristic analysis, the optimal cutoff for IMD0 discrimination of normal FA from impaired FA was 0.568 (sensitivity, 86.7%; specificity, 91.7%). Of 177 patients with symptoms of gastroparesis, 129 (72.9%) had delayed gastric emptying; 25 (14.1%) had abnormal IMD0 Low IMD0 (impaired FA) was associated with increased early satiety (P = 0.02). Conclusion: FA can be assessed visually during routine GES with moderate agreement and high reader consistency. Visual and quantitative assessments of FA during GES can yield additional information on gastric motility to help explain patients' symptoms.
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Affiliation(s)
- Perry Orthey
- Section of Gastroenterology, Temple University, Philadelphia, Pennsylvania
| | - Daohai Yu
- Department of Clinical Sciences, Temple Clinical Research Institute, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Mark L Van Natta
- Data Coordinating Center, Johns Hopkins University, Baltimore, Maryland
| | - Frederick V Ramsey
- Department of Clinical Sciences, Temple Clinical Research Institute, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Jesus R Diaz
- Nuclear Medicine Section, Texas Tech University, El Paso, Texas
| | - Paige A Bennett
- Nuclear Medicine Section, Wake Forest University, Winston Salem, North Carolina
| | - Andrei H Iagaru
- Nuclear Medicine Section, Stanford University, Palo Alto, California
| | | | | | - Irene Sarosiek
- Section of Gastroenterology, Texas Tech University, El Paso, Texas
| | - William L Hasler
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan
| | | | | | - Kenneth L Koch
- Section of Gastroenterology, Wake Forest University, Winston Salem, North Carolina
| | - Linda Nguyen
- Division of Gastroenterology, Stanford University, Palo Alto, California
| | - William J Snape
- Division of Gastroenterology, California Pacific Medical Center, San Francisco, California
| | - Thomas L Abell
- Division of Gastroenterology, University of Louisville, Louisville, Kentucky
| | - Pankaj J Pasricha
- Section of Gastroenterology, Johns Hopkins University, Baltimore, Maryland
| | - James Tonascia
- Data Coordinating Center, Johns Hopkins University, Baltimore, Maryland
| | - Frank Hamilton
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland; and
| | - Henry P Parkman
- Section of Gastroenterology, Temple University, Philadelphia, Pennsylvania
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31
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Ulm L, Hoffmann S, Nabavi D, Hermans M, Mackert BM, Hamilton F, Schmehl I, Jungehuelsing GJ, Montaner J, Bustamante A, Katan M, Hartmann A, Ebmeyer S, Dinter C, Wiemer JC, Hertel S, Meisel C, Anker SD, Meisel A. The Randomized Controlled STRAWINSKI Trial: Procalcitonin-Guided Antibiotic Therapy after Stroke. Front Neurol 2017; 8:153. [PMID: 28484421 PMCID: PMC5402305 DOI: 10.3389/fneur.2017.00153] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 04/03/2017] [Indexed: 11/17/2022] Open
Abstract
Background Pneumonia is among the most common acute complications after stroke and is associated with poor long-term outcome. Biomarkers may help identifying stroke patients at high risk for developing stroke-associated pneumonia (SAP) and to guide early treatment. Aims This trial investigated whether procalcitonin (PCT) ultrasensitive (PCTus)-guided antibiotic treatment of SAP can improve functional outcome after stroke. Methods In this international, multicenter, randomized, controlled clinical trial with blinded assessment of outcomes, patients with severe ischemic stroke in the middle cerebral artery territory were randomly assigned within 40 h after symptom onset to PCTus-based antibiotic therapy guidance in addition to stroke unit care or standard stroke unit care alone. The primary endpoint was functional outcome at 3 months, defined according to the modified Rankin Scale (mRS) and dichotomized as acceptable (≤4) or unacceptable (≥5). Secondary endpoints included usage of antibiotics, infection rates, days of fever, and mortality. The trial was registered with http://ClinicalTrials.gov (Identifier NCT01264549). Results In the intention-to-treat-analysis based on 227 patients (112 in PCT and 115 in control group), 197 patients completed the 3-month follow-up. Adherence to PCT guidance was 65%. PCT-guided therapy did not improve functional outcome as measured by mRS (odds ratio 0.79; 95% confidence interval 0.45–1.35, p = 0.47). Pneumonia rate and mortality were similar in both groups. Days with fever tended to be lower (p = 0.055), whereas total number of days treated with antibiotics were higher (p = 0.004) in PCT compared to control group. A post hoc analysis including all PCT values in the intention-to-treat population demonstrated a significant increase on the first day of infection in patients with pneumonia and sepsis compared to patients with urinary tract infections or without infections (p < 0.0001). Conclusion PCTus-guided antibiotic therapy did not improve functional outcome at 3 months after severe ischemic stroke. PCT is a promising biomarker for early detection of pneumonia and sepsis in acute stroke patients.
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Affiliation(s)
- Lena Ulm
- NeuroCure Clinical Research Center, Charité - Universitaetsmedizin Berlin, Berlin, Germany.,Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia.,Department of Neurology and Center for Stroke Research Berlin, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Sarah Hoffmann
- NeuroCure Clinical Research Center, Charité - Universitaetsmedizin Berlin, Berlin, Germany.,Department of Neurology and Center for Stroke Research Berlin, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Darius Nabavi
- Department of Neurology, Vivantes Klinikum Neukoelln, Berlin, Germany
| | - Marcella Hermans
- Department of Neurology, Vivantes Klinikum Neukoelln, Berlin, Germany
| | | | - Frank Hamilton
- Department of Neurology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | - Ingo Schmehl
- Department of Neurology, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Gerhard-Jan Jungehuelsing
- Department of Neurology and Center for Stroke Research Berlin, Charité - Universitaetsmedizin Berlin, Berlin, Germany.,Department of Neurology, Juedisches Krankenhaus Berlin, Berlin, Germany
| | - Joan Montaner
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alejandro Bustamante
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mira Katan
- Department of Neurology, Universitaetsspital Zuerich, Zurich, Switzerland
| | - Andreas Hartmann
- Department of Neurology, Klinikum Frankfurt Oder, Frankfurt Oder, Germany
| | - Stefan Ebmeyer
- Thermo Fisher Scientific BRAHMS GmbH, Hennigsdorf, Germany
| | | | - Jan C Wiemer
- Thermo Fisher Scientific BRAHMS GmbH, Hennigsdorf, Germany
| | - Sabine Hertel
- Thermo Fisher Scientific BRAHMS GmbH, Hennigsdorf, Germany
| | - Christian Meisel
- Department of Immunology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Stefan D Anker
- Division of Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Centre Goettingen, Goettingen, Germany.,Centre for Clinical and Basic Research, IRCCS, Rome, Italy
| | - Andreas Meisel
- NeuroCure Clinical Research Center, Charité - Universitaetsmedizin Berlin, Berlin, Germany.,Department of Neurology and Center for Stroke Research Berlin, Charité - Universitaetsmedizin Berlin, Berlin, Germany
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Parkman HP, Hallinan EK, Hasler WL, Farrugia G, Koch KL, Nguyen L, Snape WJ, Abell TL, McCallum RW, Sarosiek I, Pasricha PJ, Clarke J, Miriel L, Tonascia J, Hamilton F. Early satiety and postprandial fullness in gastroparesis correlate with gastroparesis severity, gastric emptying, and water load testing. Neurogastroenterol Motil 2017; 29:10.1111/nmo.12981. [PMID: 27781342 PMCID: PMC5367988 DOI: 10.1111/nmo.12981] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 09/23/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Early satiety (ES) and postprandial fullness (PPF) are often present in gastroparesis, but the importance of these symptoms in gastroparesis has not been well-described. The aims were: (i) Characterize ES and PPF in patients with gastroparesis. (ii) Assess relationships of ES and PPF with etiology of gastroparesis, quality of life, body weight, gastric emptying, and water load testing. METHODS Gastroparetic patients filled out questionnaires assessing symptoms (PAGI-SYM) and quality of life (PAGI-QOL, SF-36v2). Patients underwent gastric emptying scintigraphy and water load testing. KEY RESULTS 198 patients with gastroparesis (134 IG, 64 DG) were evaluated. Early satiety was severe or very severe in 50% of patients. Postprandial fullness was severe or very severe in 60% of patients. Severity scores for ES and PPF were similar between idiopathic and diabetic gastroparesis. Increasing severity of ES and PPF were associated with other gastroparesis symptoms including nausea/vomiting, satiety/early fullness, bloating, and upper abdominal pain and GERD subscores. Increasing severity of ES and PPF were associated with increasing gastroparesis severity, decreased BMI, decreased quality of life from PAGI-QOL and SF-36 physical health. Increasing severity of ES and PPF were associated with increasing gastric retention of a solid meal and decreased volume during water load test. CONCLUSIONS & INFERENCES Early satiety and PPF are commonly severe symptoms in both diabetic and idiopathic gastroparesis. Early satiety and PPF severity are associated with other gastroparesis symptom severities, body weight, quality of life, gastric emptying, and water load testing. Thus, ES and PPF are important symptoms characterizing gastroparesis. ClinicalTrials.gov number: NCT NCT01696747.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Frank Hamilton
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
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Thaneeru P, Gamel AE, Harding S, Galvin S, Hamilton F, Kirk M, Devlin G. IMPACT: Improving Coronary Graft Patency with Postoperative Aspirin and Clopidogrel Versus Aspirin and Ticagrelor. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Parkman HP, Hallinan EK, Hasler WL, Farrugia G, Koch KL, Calles J, Snape WJ, Abell TL, Sarosiek I, McCallum RW, Nguyen L, Pasricha PJ, Clarke J, Miriel L, Lee L, Tonascia J, Hamilton F. Nausea and vomiting in gastroparesis: similarities and differences in idiopathic and diabetic gastroparesis. Neurogastroenterol Motil 2016; 28:1902-1914. [PMID: 27350152 PMCID: PMC5125878 DOI: 10.1111/nmo.12893] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 05/30/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Nausea and vomiting are classic symptoms of gastroparesis. It remains unclear if characteristics of nausea and vomiting are similar in different etiologies of gastroparesis. The aims of this article were as follows: to describe characteristics of nausea and vomiting in patients with gastroparesis and to determine if there are differences in nausea and vomiting in diabetic (DG) and idiopathic gastroparesis (IG). METHODS Gastroparetic patients enrolling in the NIDDK Gastroparesis Registry underwent assessment with history and questionnaires assessing symptoms, quality of life, and a questionnaire characterizing nausea and vomiting. KEY RESULTS Of 159 gastroparesis patients (107 IG, 52 DG), 96% experienced nausea, whereas 65% experienced vomiting. Nausea was predominant symptom in 28% and vomiting was predominant in 4%. Nausea was severe or very severe in 41%. PAGI-SYM nausea/vomiting subscore was greater with increased vomiting severity, but not nausea severity in DG than IG. Nausea was related to meals in 71%; lasting most of the day in 41%. Increasing nausea severity was related to decreased quality of life. Nausea often preceded vomiting in 82% of patients and vomiting often relieved nausea in 30%. Vomiting was more common in DG (81%) compared to IG (57%; p = 0.004). Diabetic patients more often had vomiting in the morning before eating, during the night, and when not eating. CONCLUSIONS & INFERENCES Nausea is present in essentially all patients with gastroparesis irrespective of cause and associated with decreased quality of life. In contrast, vomiting was more prevalent, more severe, and occurred more often in DG than IG. Thus, characteristics of vomiting differ in IG vs DG.
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Affiliation(s)
| | | | | | | | - K. L. Koch
- Wake Forest University; Winston-Salem NC USA
| | - J. Calles
- Wake Forest University; Winston-Salem NC USA
| | - W. J. Snape
- California Pacific Medical Center; San Francisco CA USA
| | | | | | | | - L. Nguyen
- Stanford University; Palo Alto CA USA
| | | | - J. Clarke
- Johns Hopkins University; Baltimore MD USA
| | - L. Miriel
- Johns Hopkins University; Baltimore MD USA
| | - L. Lee
- Johns Hopkins University; Baltimore MD USA
| | | | - F. Hamilton
- National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda MD USA
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Williams R, White P, Nieto J, Vieira D, Francois F, Hamilton F. Colorectal Cancer in African Americans: An Update. Clin Transl Gastroenterol 2016; 7:e185. [PMID: 27467183 PMCID: PMC4977418 DOI: 10.1038/ctg.2016.36] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 05/09/2016] [Indexed: 12/15/2022] Open
Abstract
This review is an update to the American College of Gastroenterology (ACG) Committee on Minority Affairs and Cultural Diversity's paper on colorectal cancer (CRC) in African Americans published in 2005. Over the past 10 years, the incidence and mortality rates of CRC in the United States has steadily declined. However, reductions have been strikingly much slower among African Americans who continue to have the highest rate of mortality and lowest survival when compared with all other racial groups. The reasons for the health disparities are multifactorial and encompass physician and patient barriers. Patient factors that contribute to disparities include poor knowledge of benefits of CRC screening, limited access to health care, insurance status along with fear and anxiety. Physician factors include lack of knowledge of screening guidelines along with disparate recommendations for screening. Earlier screening has been recommended as an effective strategy to decrease observed disparities; currently the ACG and American Society of Gastrointestinal Endoscopists recommend CRC screening in African Americans to begin at age 45. Despite the decline in CRC deaths in all racial and ethnic groups, there still exists a significant burden of CRC in African Americans, thus other strategies including educational outreach for health care providers and patients and the utilization of patient navigation systems emphasizing the importance of screening are necessary. These strategies have been piloted in both local communities and Statewide resulting in notable significant decreases in observed disparities.
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Affiliation(s)
- Renee Williams
- New York University School of Medicine, Bellevue Hospital Center, New York, USA
| | - Pascale White
- Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Jose Nieto
- Borland Groover Clinic, Jacksonville, Florida, USA
| | - Dorice Vieira
- New York University School of Medicine, Bellevue Hospital Center, New York, USA
| | - Fritz Francois
- New York University School of Medicine, Bellevue Hospital Center, New York, USA
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Koch KL, Hasler WL, Yates KP, Parkman HP, Pasricha PJ, Calles-Escandon J, Snape WJ, Abell TL, McCallum RW, Nguyen LA, Sarosiek I, Farrugia G, Tonascia J, Lee L, Miriel L, Hamilton F. Baseline features and differences in 48 week clinical outcomes in patients with gastroparesis and type 1 vs type 2 diabetes. Neurogastroenterol Motil 2016; 28:1001-15. [PMID: 26946489 PMCID: PMC5319426 DOI: 10.1111/nmo.12800] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 01/21/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND In studies of diabetic gastroparesis, patients with type 1 and type 2 diabetes mellitus (T1DM, T2DM) are often combined for analyses. We compared gastroparesis severity, healthcare utilization, psychological function, and quality of life in T1DM vs T2DM gastroparesis patients. METHODS Questionnaire, laboratory, and scintigraphy data from patients with gastroparesis and T1DM and T2DM from seven centers of the National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Clinical Research Consortium Registry were compared at enrollment and after 48 weeks. Multiple regression models assessed baseline and follow-up differences between diabetes subtypes. KEY RESULTS At baseline, T1DM patients (N = 78) had slower gastric emptying, more hospitalizations, more gastric stimulator implantations, higher hemoglobin A1c (HbA1c), and more anxiety vs T2DM patients (N = 59). Independent discriminators of patients with T1DM vs T2DM included worse gastroesophageal reflux disease, less bloating, more peripheral neuropathy, and fewer comorbidities (p ≤ 0.05). On follow-up, gastrointestinal (GI) symptom scores decreased only in T2DM (p < 0.05), but not in T1DM patients who reported greater prokinetic, proton pump inhibitor, anxiolytic, and gastric stimulator usage over 48 weeks (p ≤ 0.03). Gastrointestinal symptoms at baseline and 48 weeks with both subtypes were not associated with HbA1c, peripheral neuropathy, psychological factors, or quality of life. CONCLUSIONS & INFERENCES Baseline symptoms were similar in T1DM and T2DM patients, even though T1DM patients had worse gastric emptying delays and higher HbA1c suggesting other factors mediate symptom severity. Symptom scores at 48 weeks decreased in T2DM, but not T1DM patients, despite increased medical and surgical treatment utilization by T1DM patients. Defining causes of different outcomes in diabetic gastroparesis warrants further investigation.
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Affiliation(s)
- Kenneth L. Koch
- Section on Gastroenterology, Wake Forest University, Winston-Salem, NC
| | | | - Katherine P. Yates
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Henry P. Parkman
- Section of Gastroenterology, Temple University, Philadelphia, PA
| | - Pankaj J. Pasricha
- Center for Neurogastroenterology, Johns Hopkins Bayview Medical Center, Baltimore, MD
| | | | | | - Thomas L. Abell
- Digestive and Liver Health, University of Louisville, Louisville, KY
| | | | - Linda A. Nguyen
- Division of Gastroenterology, Stanford University, Palo Alto, CA
| | - Irene Sarosiek
- Division of Gastroenterology, Texas Tech University, El Paso, TX
| | - Gianrico Farrugia
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - James Tonascia
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Linda Lee
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Laura Miriel
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Frank Hamilton
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
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Devlin G, Williams G, Duncan T, Hamilton F, DeSilva S, Alexander J, Winning V, Arcus K. PT003 “A Heart Attack Is Not Always as Dramatic as You Think”. Results of a Public Awareness Campaign in New Zealand. Glob Heart 2016. [DOI: 10.1016/j.gheart.2016.03.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Hamilton F, Luxford G, Bott J. M2 Using a Transportable Oxygen Concentrator (TPOC) to facilitate prompt and safe hospital discharge. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Pasricha PJ, Yates KP, Nguyen L, Clarke J, Abell TL, Farrugia G, Hasler WL, Koch KL, Snape WJ, McCallum RW, Sarosiek I, Tonascia J, Miriel LA, Lee L, Hamilton F, Parkman HP. Outcomes and Factors Associated With Reduced Symptoms in Patients With Gastroparesis. Gastroenterology 2015; 149:1762-1774.e4. [PMID: 26299414 PMCID: PMC4663150 DOI: 10.1053/j.gastro.2015.08.008] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 07/10/2015] [Accepted: 08/11/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Gastroparesis is a chronic clinical syndrome characterized by delayed gastric emptying. However, little is known about patient outcomes or factors associated with reduction of symptoms. METHODS We studied adult patients with gastroparesis (of diabetic or idiopathic type) enrolled in the National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Clinical Research Consortium Gastroparesis Registry, seen every 16 weeks and treated according to the standard of care with prescribed medications or other therapies at 7 tertiary care centers. Characteristics associated with reduced symptoms, based on a decrease of 1 or more in the gastroparesis cardinal symptom index (GCSI) score after 48 weeks of care, were determined from logistic regression models. Data were collected from patients for up to 4 years (median, 2.1 y). RESULTS Of 262 patients, 28% had reductions in GCSI scores of 1 or more at 48 weeks. However, there were no significant reductions in GCSI score from weeks 48 through 192. Factors independently associated with reduced symptoms at 48 weeks included male sex, age 50 years and older, initial infectious prodrome, antidepressant use, and 4-hour gastric retention greater than 20%. Factors associated with no reduction in symptoms included overweight or obesity, a history of smoking, use of pain modulators, moderate to severe abdominal pain, a severe gastroesophageal reflex, and moderate to severe depression. CONCLUSIONS Over a median follow-up period of 2.1 years, 28% of patients treated for gastroparesis at centers of expertise had reductions in GCSI scores of 1 or greater, regardless of diabetes. These findings indicate the chronic nature of gastroparesis. We identified factors associated with reduced symptoms that might be used to guide treatment. ClinicalTrials.gov no: NCT00398801.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Linda Lee
- Johns Hopkins University, Baltimore, MD
| | - Frank Hamilton
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
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Parkman HP, Van Natta ML, Abell TL, McCallum RW, Sarosiek I, Nguyen L, Snape WJ, Koch KL, Hasler WL, Farrugia G, Lee L, Unalp-Arida A, Tonascia J, Hamilton F, Pasricha PJ. Effect of nortriptyline on symptoms of idiopathic gastroparesis: the NORIG randomized clinical trial. JAMA 2013; 310:2640-9. [PMID: 24368464 PMCID: PMC4099968 DOI: 10.1001/jama.2013.282833] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Gastroparesis remains a challenging syndrome to manage, with few effective treatments and a lack of rigorously controlled trials. Tricyclic antidepressants are often used to treat refractory symptoms of nausea, vomiting, and abdominal pain. Evidence from well-designed studies for this use is lacking. OBJECTIVE To determine whether treatment with nortriptyline results in symptomatic improvement in patients with idiopathic gastroparesis. DESIGN, SETTING, AND PARTICIPANTS The NORIG (Nortriptyline for Idiopathic Gastroparesis) trial, a 15-week multicenter, parallel-group, placebo-controlled, double-masked, randomized clinical trial from the National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Clinical Research Consortium (GpCRC), comparing nortriptyline with placebo for symptomatic relief in idiopathic gastroparesis. One hundred thirty patients with idiopathic gastroparesis were enrolled between March 2009 and June 2012 at 7 US academic medical centers. Patient follow-up was completed in October 2012. Inclusion criteria included delayed gastric emptying and moderate to severe symptom scores using the Gastroparesis Cardinal Symptom Index (GCSI). INTERVENTIONS Nortriptyline vs placebo. Study drug dose was increased at 3-week intervals (10, 25, 50, 75 mg) up to 75 mg at 12 weeks. MAIN OUTCOMES AND MEASURES The primary outcome measure of symptomatic improvement was a decrease from the patient's baseline GCSI score of at least 50% on 2 consecutive 3-week GCSI assessments during 15 weeks of treatment. RESULTS The primary symptomatic improvement outcome did not differ between 65 patients randomized to nortriptyline vs 65 patients randomized to placebo: 15 (23% [95% CI, 14%-35%]) in the nortriptyline group vs 14 (21% [95% CI, 12%-34%]) in the placebo group (P = .86). Treatment was stopped more often in the nortriptyline group (19 [29% {95% CI, 19%-42%}]) than in the placebo group (6 [9%] {95% CI, 3%-19%}]) (P = .007), but numbers of adverse events were not different (27 [95% CI, 18-39] vs 28 [95% CI, 19-40]) (P = .89). CONCLUSIONS AND RELEVANCE Among patients with idiopathic gastroparesis, the use of nortriptyline compared with placebo for 15 weeks did not result in improvement in overall symptoms. These findings do not support the use of nortriptyline for idiopathic gastroparesis. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00765895.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Linda Lee
- Johns Hopkins University, Baltimore, Maryland
| | | | | | - Frank Hamilton
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
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Maroski J, Katchanov J, Branding G, Hamilton F. Teaching NeuroImages: Conus medullaris involvement in cerebrospinal toxoplasmosis. Neurology 2013; 81:e165. [DOI: 10.1212/01.wnl.0000436616.58705.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Fulwood-Wood A, Hamilton F, Brockington S, George L. P5.048 Reaching Women Through the Integration of HIV Testing into Public Service Sites: Experiences from the Department of Motor Vehicles and Income Maintenance Center in Washington, DC. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.1092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hasler WL, Wilson LA, Parkman HP, Koch KL, Abell TL, Nguyen L, Pasricha PJ, Snape WJ, McCallum RW, Sarosiek I, Farrugia G, Calles J, Lee L, Tonascia J, Unalp-Arida A, Hamilton F. Factors related to abdominal pain in gastroparesis: contrast to patients with predominant nausea and vomiting. Neurogastroenterol Motil 2013; 25:427-38, e300-1. [PMID: 23414452 PMCID: PMC3907086 DOI: 10.1111/nmo.12091] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 12/24/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Factors associated with abdominal pain in gastroparesis are incompletely evaluated and comparisons of pain vs other symptoms are limited. This study related pain to clinical factors in gastroparesis and contrasted pain/discomfort- with nausea/vomiting-predominant disease. METHODS Clinical and scintigraphy data were compared in 393 patients from seven centers of the NIDDK Gastroparesis Clinical Research Consortium with moderate-severe (Patient Assessment of Upper Gastrointestinal Disorders Symptoms [PAGI-SYM] score ≥ 3) vs none-mild (PAGI-SYM < 3) upper abdominal pain and predominant pain/discomfort vs nausea/vomiting. KEY RESULTS Upper abdominal pain was moderate-severe in 261 (66%). Pain/discomfort was predominant in 81 (21%); nausea/vomiting was predominant in 172 (44%). Moderate-severe pain was more prevalent with idiopathic gastroparesis and with lack of infectious prodrome (P ≤ 0.05) and correlated with scores for nausea/vomiting, bloating, lower abdominal pain/discomfort, bowel disturbances, and opiate and antiemetic use (P < 0.05), but not gastric emptying or diabetic neuropathy or control. Gastroparesis severity, quality of life, and depression and anxiety were worse with moderate-severe pain (P ≤ 0.008). Factors associated with moderate-severe pain were similar in diabetic and idiopathic gastroparesis. Compared to predominant nausea/vomiting, predominant pain/discomfort was associated with impaired quality of life, greater opiate, and less antiemetic use (P < 0.01), but similar severity and gastric retention. CONCLUSIONS & INFERENCES Moderate-severe abdominal pain is prevalent in gastroparesis, impairs quality of life, and is associated with idiopathic etiology, lack of infectious prodrome, and opiate use. Pain is predominant in one fifth of gastroparetics. Predominant pain has at least as great an impact on disease severity and quality of life as predominant nausea/vomiting.
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Affiliation(s)
- W. L. Hasler
- University of Michigan; Ann Arbor; Michigan; USA
| | - L. A. Wilson
- Johns Hopkins University; Baltimore; Maryland; USA
| | | | - K. L. Koch
- Wake Forest University; Winston-Salem; North Carolina; USA
| | - T. L. Abell
- University of Mississippi; Jackson; Mississippi; USA
| | - L. Nguyen
- Stanford University; Palo Alto; California; USA
| | | | - W. J. Snape
- California Pacific Medical Center; San Francisco; California; USA
| | - R. W. McCallum
- Texas Tech University Health Sciences Center; El Paso; Texas; USA
| | - I. Sarosiek
- Texas Tech University Health Sciences Center; El Paso; Texas; USA
| | | | - J. Calles
- Wake Forest University; Winston-Salem; North Carolina; USA
| | - L. Lee
- Johns Hopkins University; Baltimore; Maryland; USA
| | - J. Tonascia
- Johns Hopkins University; Baltimore; Maryland; USA
| | | | - F. Hamilton
- National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda; Maryland; USA
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Parkman HP, Yates K, Hasler WL, Nguyen L, Pasricha PJ, Snape WJ, Farrugia G, Koch KL, Calles J, Abell TL, Sarosiek I, McCallum RW, Lee L, Unalp-Arida A, Tonascia J, Hamilton F. Cholecystectomy and clinical presentations of gastroparesis. Dig Dis Sci 2013; 58:1062-73. [PMID: 23456496 PMCID: PMC3891205 DOI: 10.1007/s10620-013-2596-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Accepted: 02/06/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Many patients with gastroparesis have had their gallbladders removed. AIM To determine if clinical presentations of patients with gastroparesis differ in those with prior cholecystectomy compared to patients who have not had their gallbladder removed. METHODS Gastroparetic patients were prospectively enrolled in the NIDDK Gastroparesis Registry. Detailed history and physical examinations were performed; patients filled out questionnaires including patient assessment of GI symptoms. RESULTS Of 391 subjects with diabetic or idiopathic gastroparesis (IG), 142 (36 %) had a prior cholecystectomy at the time of enrollment. Patients with prior cholecystectomy were more often female, older, married, and overweight or obese. Cholecystectomy had been performed in 27/59 (46 %) of T2DM compared to 19/78 (24 %) T1DM and 96/254 IG (38 %) (p = 0.03). Patients with cholecystectomy had more comorbidities, particularly chronic fatigue syndrome, fibromyalgia, depression, and anxiety. Postcholecystectomy gastroparesis patients had increased health care utilization, and had a worse quality of life. Independent characteristics associated with prior cholecystectomy included insidious onset (OR = 2.06; p = 0.01), more comorbidities (OR = 1.26; p < 0.001), less severe gastric retention (OR(severe) = 0.68; overall p = 0.03) and more severe symptoms of retching (OR = 1.19; p = 0.02) and upper abdominal pain (OR = 1.21; p = 0.02), less severe constipation symptoms (OR = 0.84; p = 0.02), and not classified as having irritable bowel syndrome (OR = 0.51; p = 0.02). Etiology was not independently associated with a prior cholecystectomy. CONCLUSIONS Symptom profiles in patients with and without cholecystectomy differ: postcholecystectomy gastroparesis patients had more severe upper abdominal pain and retching and less severe constipation. These data suggest that prior cholecystectomy is associated with selected manifestations of gastroparesis.
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Affiliation(s)
- Henry P Parkman
- Gastroenterology Section, Parkinson Pavilion, School of Medicine, Temple University, 8th Floor 3401 North Broad Street, Philadelphia, PA 19140, USA.
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O'Luanaigh C, O'Connell H, Chin AV, Hamilton F, Coen R, Walsh C, Walsh JB, Caokley D, Cunningham C, Lawlor BA. Loneliness and cognition in older people: the Dublin Healthy Ageing study. Aging Ment Health 2012; 16:347-52. [PMID: 22129350 DOI: 10.1080/13607863.2011.628977] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
INTRODUCTION While several studies have found a link between impaired cognition and social isolation, few have examined the relationship between cognition and loneliness. Loneliness has been thought to increase the risk of development of Alzheimer's dementia. AIM The aims of this study were to explore the relationship between loneliness and cognition and to determine whether specific cognitive domains are associated with loneliness. DESIGN Cross-sectional community-based study. PARTICIPANTS This study included 466 community-dwelling subjects with mean age 75.45 (SD 6.06) years, of which 208(44%) were males. RESULTS Loneliness was significantly associated with impaired global cognition independent of social networks and depression. The domains of psychomotor processing speed and delayed visual memory were specifically associated with self-reported loneliness. CONCLUSION This cross-sectional study demonstrated an association between loneliness and specific aspects of cognition independent of depression, social networks and other demographics. The mechanism for this association is unclear and warrants further investigation.
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Affiliation(s)
- C O'Luanaigh
- Mercer's Institute for Research in Ageing, St. James's Hospital, Dublin, Ireland.
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O'Luanaigh C, O'Connell H, Chin AV, Hamilton F, Coen R, Walsh C, Walsh JB, Coakley D, Molloy A, Scott J, Cunningham CJ, Lawlor BA. Loneliness and vascular biomarkers: the Dublin Healthy Ageing Study. Int J Geriatr Psychiatry 2012; 27:83-8. [PMID: 21370279 DOI: 10.1002/gps.2695] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Accepted: 01/04/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND Loneliness has been associated with poor physical health and a link has been suggested between the presence of loneliness, cardiovascular health and inflammatory markers. OBJECTIVE To investigate the association between vascular disease biomarkers and loneliness in a community-dwelling non-demented elderly population. DESIGN cross-sectional community based assessment. PARTICIPANTS 466 subjects with mean age 75.45 (SD, 6.06) years. 208 (44.6%) were male. RESULTS Higher levels of HbA1c, but not other vascular biomarkers were independently associated with being lonely. CONCLUSION Loneliness was associated with raised levels of HbA1c in a community dwelling elderly population. The mechanism for this association has yet to be elucidated but may reflect an abnormal stress response in people who are lonely.
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Affiliation(s)
- C O'Luanaigh
- Mercer's Institute for Research in Ageing, St. James's Hospital, Dublin 8, Ireland.
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Parkman HP, Yates K, Hasler WL, Nguyen L, Pasricha PJ, Snape WJ, Farrugia G, Koch KL, Calles J, Abell TL, McCallum RW, Lee L, Unalp-Arida A, Tonascia J, Hamilton F. Similarities and differences between diabetic and idiopathic gastroparesis. Clin Gastroenterol Hepatol 2011; 9:1056-64; quiz e133-4. [PMID: 21871247 PMCID: PMC3499102 DOI: 10.1016/j.cgh.2011.08.013] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Revised: 07/17/2011] [Accepted: 08/18/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Gastroparesis can be diabetic or idiopathic, yet little is known about differences in their presentation. We compared clinical characteristics, symptoms, and gastric emptying in patients with type 1 or type 2 diabetic (DG) or idiopathic (IG) gastroparesis. METHODS We analyzed data from 416 patients with gastroparesis who were enrolled in the National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Registry; 254 had IG (most were female and white), and 137 had DG (78 had type 1 and 59 had type 2). Registry data included detailed histories, physical examinations, results from gastric emptying scintigraphy, and responses to validated symptom questionnaires. RESULTS Patients with type 2 diabetes mellitus (DM) were an average of 13 years older at the onset of symptoms of gastroparesis and heavier than patients with IG. Patients with type 1 DM had more hospitalizations in the past year than patients with IG. Symptoms that prompted evaluation more often included vomiting for DG and abdominal pain for IG. Patients with DG had more severe retching and vomiting than those with IG, whereas patients with IG had more severe early satiety and postprandial fullness subscores. Compared with IG, gastric retention was greater in patients with type 1 DM. More than 50% of patients with type 1 DM had severe retention (>35% at 4 hours); they took prokinetic agents more frequently and were more likely to receive gastric electric stimulation. CONCLUSIONS There are similarities and differences in clinical characteristics of DG and IG. Gastroparesis is a heterogeneous disorder; its etiology affects symptoms and severity. Long-term studies are needed to determine whether the differences in symptoms and gastric emptying affect progression and treatment responses.
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Affiliation(s)
- Henry P Parkman
- Temple University, School of Medicine, Philadelphia, Pennsylvania 19140, USA.
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Koennecke HC, Belz W, Berfelde D, Endres M, Fitzek S, Hamilton F, Kreitsch P, Mackert BM, Nabavi DG, Nolte CH, Pohls W, Schmehl I, Schmitz B, von Brevern M, Walter G, Heuschmann PU. Factors influencing in-hospital mortality and morbidity in patients treated on a stroke unit. Neurology 2011; 77:965-72. [DOI: 10.1212/wnl.0b013e31822dc795] [Citation(s) in RCA: 223] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Hasler WL, Wilson LA, Parkman HP, Nguyen L, Abell TL, Koch KL, Pasricha PJ, Snape WJ, Farrugia G, Lee L, Tonascia J, Unalp-Arida A, Hamilton F. Bloating in gastroparesis: severity, impact, and associated factors. Am J Gastroenterol 2011; 106:1492-502. [PMID: 21483459 PMCID: PMC3137717 DOI: 10.1038/ajg.2011.81] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Bloating is commonly reported in gastroparesis, but its prevalence, impact, and associated factors are uninvestigated. We aimed to quantify the prevalence of bloating in gastroparesis and relate its severity to clinical factors and quality of life. METHODS Survey, examination, and scintigraphy data were compared in 335 gastroparesis patients from 6 centers of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Gastroparesis Clinical Research Consortium. Bloating severity was stratified using Gastroparesis Cardinal Symptom Index (GCSI) bloating subscale scores. RESULTS Bloating severity of at least mild (GCSI ≥2) and severe (GCSI ≥4) grades were reported by 76 and 41% of patients, respectively. Bloating severity related to female gender (P<0.0001) and overweight status (P=0.04) on regression analysis and correlated with intensity of nausea, postprandial fullness, visible distention, abdominal pain, and altered bowel function (P<0.05). Disease etiology, smoking status, and gastric emptying did not relate to bloating subset (P>0.05). Disease-specific quality of life and general measures of well-being were progressively impaired with increasing bloating severity (P=0.01). Probiotic use (P=0.03) and use of antidepressants with significant norepinephrine reuptake inhibitor activity (P=0.045) use related to bloating severity; antiemetic use trended higher with worsening bloating (P=0.06). CONCLUSIONS Bloating is prevalent in gastroparesis and is severe in many individuals. Bloating severity relates to female gender, body weight, and intensity of other symptoms. The symptom impairs quality of life but is not influenced by gastric emptying rates. Antiemetics, probiotics, and antidepressants with significant norepinephrine reuptake inhibitor activity may affect reports of bloating. These findings provide insight into this underappreciated symptom of gastroparesis.
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Affiliation(s)
- William L Hasler
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA.
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Yates KP, Hasler WL, Nguyan L, Pasricha PJ, Snape WJ, Farrugia G, Calles J, Koch KL, Abell TL, McCallum RW, Petito D, Parrish CR, Duffy F, Lee L, Unalp-Arida A, Tonascia J, Hamilton F. Dietary intake and nutritional deficiencies in patients with diabetic or idiopathic gastroparesis. Gastroenterology 2011; 141:486-98, 498.e1-7. [PMID: 21684286 PMCID: PMC3499101 DOI: 10.1053/j.gastro.2011.04.045] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 03/13/2011] [Accepted: 04/15/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Gastroparesis can lead to food aversion, poor oral intake, and subsequent malnutrition. We characterized dietary intake and nutritional deficiencies in patients with diabetic and idiopathic gastroparesis. METHODS Patients with gastroparesis on oral intake (N = 305) were enrolled in the National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Registry and completed diet questionnaires at 7 centers. Medical history, gastroparesis symptoms, answers to the Block Food Frequency Questionnaire, and gastric emptying scintigraphy results were analyzed. RESULTS Caloric intake averaged 1168 ± 801 kcal/day, amounting to 58% ± 39% of daily total energy requirements (TER). A total of 194 patients (64%) reported caloric-deficient diets, defined as <60% of estimated TER. Only 5 patients (2%) followed a diet suggested for patients with gastroparesis. Deficiencies were present in several vitamins and minerals; patients with idiopathic disorders were more likely to have diets with estimated deficiencies in vitamins A, B(6), C, K, iron, potassium, and zinc than diabetic patients. Only one-third of patients were taking multivitamin supplements. More severe symptoms (bloating and constipation) were characteristic of patients who reported an energy-deficient diet. Overall, 32% of patients had nutritional consultation after the onset of gastroparesis; consultation was more likely among patients with longer duration of symptoms and more hospitalizations and patients with diabetes. Multivariable logistic regression analysis indicated that nutritional consultation increased the chances that daily TER were met (odds ratio, 1.51; P = .08). CONCLUSIONS Many patients with gastroparesis have diets deficient in calories, vitamins, and minerals. Nutritional consultation is obtained infrequently but is suggested for dietary therapy and to address nutritional deficiencies.
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