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Other Complications of Diabetes
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
The esophageal manifestations of diabetic neuropathy result in dysphagia and heartburn, but only in a minority of patients. Gastroparesis causes nausea, vomiting, early satiety, bloating, postprandial fullness, and upper abdominal pain. Delayed gastric emptying is a contributing factor of poor blood glucose control. It may be the first sign of gastroparesis. Intestinal enteropathy can cause constipation, diarrhea, and fecal incontinence. Impaired motility of the small intestine can lead to stasis syndrome, resulting in diarrhea, which can be intensified by hypermotility due to decreased sympathetic inhibition, pancreatic insufficiency, malabsorption of bile salts, and steatorrhea. Fecal incontinence may result from abnormal internal and external anal sphincter function due to neuropathy. Most patients with nonalcoholic fatty liver disease are asymptomatic, but some have malaise or right upper-quadrant fullness. The disease can range from a slight elevation of liver enzymes to severe liver disease with fibrosis and nodular regeneration, but this development is rare.
The Clinical Application of 5-HT Agonists and Antagonists in Gastrointestinal Disease
Published in T.S. Gaginella, J.J. Galligan, SEROTONIN and GASTROINTESTINAL FUNCTION, 2020
Timothy P. Roarty, Richard W. McCallum
Abell, et al. studied 21 patients (9 with gastroparesis; 12 with pseudo-obstruction) who first showed an improvement during a six-week double-blind, placebo-controlled study and were then entered into an open one-year trial of cisapride (10 mg t.i.d.).66 Gastric emptying for the entire group was improved at one year compared to study entry for both liquids and solids. This improvement was profound for liquids vs. solids in the gastroparesis group, and solids more than liquids in the pseudoobstruction group. Only the group with gastroparesis showed a significant improvement from baseline symptoms with significance in nausea, vomiting, and anorexia. Thus, this was the first study to demonstrate sustained improvement over a one-year period by cisapride on both gastric emptying and symptoms.
Neurofeedback in an Integrative Medical Practice
Published in Hanno W. Kirk, Restoring the Brain, 2020
20-year-old woman presented with 5-month history of nausea and vomiting spells that occurred at least daily. Associated symptoms included chronic fatigue, palpitations, flushing, diaphoresis, urgent need to defecate, syncope or near-syncope, anorexia, and 20 lb. weight loss. Medical work up included normal pelvic ultrasound, normal head and abdominal CT scans, normal colonoscopy, and unremarkable stool analysis. Upper endoscopy showed “reactive gastropathy.” Gastric emptying test was significant for markedly prolonged gastric emptying time and established a diagnosis of gastroparesis. Dynamic defecography demonstrated pelvic floor laxity with cystocele and rectocele. Blood work confirmed mild malnutrition with low albumin and vitamin D levels but had no signs of inflammation, hormonal dysfunction, or liver problems.
Effect of comorbid benign joint hypermobility and juvenile fibromyalgia syndromes on pediatric functional gastrointestinal disorders
Published in Postgraduate Medicine, 2023
Nilüfer Ülkü Şahin, Nihal Şahin, Merve Kılıç
Unlike other studies, we divided GI symptoms into upper and lower GI symptoms. We found that the most common symptom was postprandial epigastric bloating, which is an upper GI symptom and was seen in 88.3% patients. We observed that this symptom was more common in patients with dysautonomia and fibromyalgia as their sensorimotor functions are severely affected. We propose that the possible mechanism may be linked to having gastroparesis with dysmotility. Previous studies have found that patients with fibromyalgia did not have any alteration in the gastric emptying speed but they took a longer time to convert solid foods into a liquid form. Gastroparesis was thought to be caused by vagal nerve dysfunction, as seen in fibromyalgia [23]. Another study reported that patients with fibromyalgia have a different pathophysiology involving central amplification of peripheral sensory signals. The study also suggested that these patients should be evaluated for comorbid functional pain syndromes and mood disorders (anxiety and depression). It is thought to have a similar mechanism as that of hyperalgesia, which is a common symptom of functional abdominal pain and IBS [24].
Gastroparesis syndromes: emerging drug targets and potential therapeutic opportunities
Published in Expert Opinion on Investigational Drugs, 2023
Le Yu Naing, Matthew Heckroth, Prateek Mathur, Thomas L Abell
Therapies for gastroparesis syndromes beyond dietary changes have focused on medications that improve symptoms and, in some cases, gastric emptying. While focusing on gastric emptying is understandable, an uneven correlation with GI symptoms and gastric emptying has been found [154,155]. While some patients have benefited from available, that is, approved or off-label, medications, improvement is often modest and often minimally effective. The fact that no new ‘motility’ drugs for Gp have been approved in 40 years is concerning. In addition, few, if any, available or even investigational medications can be classified as disease modifying. Since detailed investigations into GpS are still relatively new, the natural history of GpS is not well known[12]. Thus, while the current approach may not be wrong, it is not necessarily optimal. It is important to have reviewed what is currently used and what is in trials, to know how to move forward.
The gut-brain axis and Parkinson disease: clinical and pathogenetic relevance
Published in Annals of Medicine, 2021
Elisa Menozzi, Jane Macnaughtan, Anthony H. V. Schapira
Dietary changes represent a first-line strategy to treat gastroparesis in PD. Adjusting fat intake in combination with high quality carbohydrates (starch), could improve the pattern of gastric emptying and thus levodopa bioavailability [76]. Levodopa absorption may also be benefitted by synchronising meal times in relation to oral levodopa dosing [77], such that patients are generally advised to take their medication about 30–45 min before eating [76]. In advanced PD stages, redistribution of daily protein intake (limited to evening hours) and/or restriction of daily protein intake, have been shown to increase levodopa bioavailability [78], reduce plasma levels of LNAA [78,79], improve motor fluctuations in 30–90% of PD patients [79–82] and reduce levodopa daily dose in 75% [78]. However, careful monitoring is necessary with long-term adherence to low-protein regimens, as these may increase the risk of nutritional complications such as weight loss and malnutrition [71]. Administration of dietary herb extract Rikkunshito has been evaluated in two small open-label trials. Contradictory results were found on DGE (improved in one study, no effect in the other), whereas effect on motor fluctuations was not evaluated [83,84].