Gastroparesis:
Gespeichert in:
| Weitere Verfasser: | |
|---|---|
| Format: | Buch |
| Sprache: | English |
| Veröffentlicht: |
Philadelphia, Pa.
Elsevier
2015
|
| Schriftenreihe: | Gastroenterology clinics of North America
44,1 |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XVI, 201 S. Ill., graph. Darst. |
| ISBN: | 9780323356565 |
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Datensatz im Suchindex
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| adam_text | Titel: Gastroparesis
Autor: Parkman, Henry P
Jahr: 2015
Contents
Foreword: Gastroparesis
Gary W. Falk
Preface: Improving Our Understanding of Gastroparesis
Henry P. Parkman and Pankaj Jay Pasricha
Gastroparesis: Definitions and Diagnosis
Pankaj Jay Pasricha and Henry P. Parkman
Gastroparesis is a chronic symptomatic disorder of the stomach character-
ized by delayed emptying without evidence of mechanical obstruction.
Symptoms of gastroparesis include nausea, vomiting, early satiety,
postprandial fullness, and upper abdominal pain. The 3 main causes are
diabetic, postsurgical, and idiopathic. Diagnosis is confirmed by demon-
strating delayed gastric emptying. Gastric emptying rates measured by
gastric motor testing generally correlate poorly with symptoms and quality
of life in patients with gastroparesis. It may be appropriate to reconsider the
definition of gastroparesis, recognizing it as a broader spectrum of gastric
neuromuscular dysfunction.
Epidemiology and Natural History of Gastroparesis
Adil E. Bharucha
Gastroparesis is characterized by delayed gastric emptying and symptoms
thereof in the absence of gastric outlet obstruction. Most studies on the
epidemiology of gastroparesis have been conducted in selected case se-
ries rather than in the population at large. In the only community-based
study of gastroparesis in diabetes mellitus (DM), the average cumulative
incidence of symptoms and delayed gastric emptying over 10 years was
higher in type 1 DM (5%) than in type 2 DM (1 %) and controls (1 %). In
the United States, the incidence of hospitalizations related to gastroparesis
increased substantially between 1995 and 2004, and particularly after
2000.
Clinical Presentation and Pathophysiology of Gastroparesis
Linda Anh Nguyen and William J. Snape Jr
Gastroparesis is a heterogeneous disorder defined by delay in gastric
emptying. Symptoms of gastroparesis are nonspecific, including nausea,
vomiting, early satiety, bloating, and/or abdominal pain. Normal gastric mo-
tor function and sensory function depend on a complex coordination be-
tween the enteric and central nervous system. This article discusses the
pathophysiology of delayed gastric emptying and the symptoms of gastro-
paresis, including antropyloroduodenal dysmotility, impaired gastric ac-
commodation, visceral hypersensitivity, and autonomic dysfunction. The
underlying pathophysiology of gastroparesis is complex and multifactorial.
Contents
The article discusses how a combination of these factors leads to symp-
toms of gastroparesis.
Histologic Changes in Diabetic Gastroparesis
Gianrico Farrugia
The cellular abnormalities that lead to diabetic gastroparesis are increas-
ingly being understood. Several key cell types are affected by diabetes,
leading to gastroparesis. These changes include abnormalities in the
extrinsic innervation to the stomach, loss of key neurotransmitters at the
level of the enteric nervous system, smooth muscle abnormalities, loss of
interstitial cells of Cajal, and changes in the macrophage population resi-
dent in the muscle wall. This article reviews the current understanding
with a focus on data from human studies when available.
Diabetic Gastroparesis
Kenneth L. Koch and Jorge Calles-Escandon
Gastroparesis is a complication of long-standing type 1 and type 2 dia-
betes mellitus. Symptoms associated with gastroparesis include early
satiety, prolonged postprandial fullness, bloating, nausea and vomiting,
and abdominal pain. Mortality is increased in patients with diabetic gastro-
paresis. A subset of patients with diabetic gastroparesis have pyloro-
spasm that results in obstructive gastroparesis. Current treatment
approaches include improving glucose control with insulin and prescribing
antinauseant drugs, prokinetic agents, and gastric electric stimulation.
Future directions include improved diet counseling based on gastric
emptying rate, continuous insulin delivery systems with glucose sensor-
augmented monitoring, and drugs for correcting gastric neural and electric
abnormalities.
Idiopathic Gastroparesis
Henry P. Parkman
Gastroparesis is a chronic symptomatic disorder of the stomach charac-
terized by delayed emptying without evidence of mechanical obstruction.
Idiopathic gastroparesis refers to gastroparesis of unknown cause not
from diabetes; not from prior gastric surgery; not related to other endo-
crine, neurologic, rheumatologic causes of gastroparesis; and not related
to medications that can delay gastric emptying. There is overlap in the
symptoms of idiopathic gastroparesis and functional dyspepsia. Patients
with idiopathic gastroparesis often have a constellation of symptoms
including nausea, vomiting, early satiety, postprandial fullness, and upper
abdominal pain. Current treatment options of dietary management, proki-
netics agents, antiemetic agents, and symptom modulators do not
adequately address clinical need for idiopathic gastroparesis.
Other Forms of Gastroparesis: Postsurgical, Parkinson, Other Neurologic Diseases,
Connective Tissue Disorders
Eamonn M.M. Quigley
Although many surgical procedures originally associated with gastropare-
sis are less commonly performed nowadays, several more recently
Contents ix
developed upper abdominal procedures may be complicated by the devel-
opment of gastroparesis. Gastroparesis has been described in association
with neurologic disorders ranging from Parkinson disease to muscular dys-
trophy, and its presence may have important implications for patient man-
agement and prognosis. Although scleroderma is most frequently linked
with gastrointestinal motility disorder, gastroparesis has been linked to
several other connective tissue disorders. The management of these pa-
tients presents several challenges, and is best conducted in the context
of a dedicated and skilled multidisciplinary team.
Nutritional Considerations in the Patient with Gastroparesis 83
Carol Rees Parrish
Gastroparesis, or delayed gastric emptying, has many origins and can wax
and wane depending on the underlying cause. Not only do the symptoms
significantly alter quality of life, but the clinical consequences can also be
life threatening. Once a patient develops protracted nausea and vomiting,
providing adequate nutrition, hydration, and access to therapeutics such
as prokinetics and antiemetics can present an exceptional challenge to cli-
nicians. This article reviews the limited evidence available for oral nutrition,
as well as enteral and parenteral nutritional support therapies. Practical
strategies are provided to improve the nutritional depletion that often ac-
companies this debilitating condition.
Prokinetics in Gastroparesis 97
Andres Acosta and Michael Camilleri
Prokinetic agents are medications that enhance coordinated gastrointes-
tinal motility and transit of content in the gastrointestinal tract, mainly by
amplifying and coordinating the gastrointestinal muscular contractions.
In addition to dietary therapy, prokinetic therapy should be considered
as a means to improve gastric emptying and symptoms of gastroparesis,
balancing benefits and risks of treatment. In the United States, metoclo-
pramide remains the first-line prokinetic therapy, because it is the only
approved medication for gastroparesis. Newer agents are being devel-
oped for the management of gastroparesis. This article provides detailed
information about prokinetic agents for the treatment of gastroparesis.
Symptomatic Management for Gastroparesis: Antiemetics, Analgesics, and
Symptom Modulators 113
William L. Hasler
Although prokinetic agents typically are used for gastroparesis, anti-
emetic, analgesic, and neuromodulatory medications may help manage
nausea, vomiting, pain, or discomfort. Antiemetic benefits are supported
by few case reports. An open series reported symptom reductions with
transdermal granisetron in gastroparesis. Opiates are not advocated in
gastroparesis because they worsen nausea and delay emptying. Neuro-
modulators have theoretical utility, but the tricyclic agent nortriptyline
showed no benefits over placebo in an idiopathic gastroparesis
study raising doubts about this strategy. Neurologic and cardiac toxicities
of these medications are recognized. Additional controlled study is
Contents
warranted to define antiemetic, analgesic, and neuromodulator usefulness
in gastroparesis.
Pyloric Sphincter Therapy: Botulinum Toxin, Stents, and Pyloromyotomy
John O. Clarke and William J. Snape Jr
Gastroparesis is a syndrome characterized by delayed gastric emptying
with associated symptoms. Gastric emptying is a complex process and
pyloric dysfunction may play a key role in select subsets of patients with
gastroparesis. Diagnostic tests to measure pyloric physiology are now
available and have the potential to be more widely used in clinical practice.
Targeted therapies including botulinum toxin, transpyloric stent place-
ment, surgical pyloroplasty and endoscopic pyloromyotomy have been
developed. Data are emerging regarding efficacy and durability, but these
therapies may play a prominent role in select patients with gastroparesis
and pyloric dysfunction.
Complementary and Alternative Medicine for Gastroparesis
Linda A. Lee, Jiande Chen, and Jieyun Yin
Complementary and alternative medicine is of great interest to patients
with gastrointestinal disorders and some will choose to ask their health
care providers about those therapies for which some scientific evidence
exists. This review focuses on those therapies most commonly used by
patients, namely acupuncture/electroacupuncture and various herbal for-
mulations that have been the focus of clinical and laboratory investigation.
A discussion of their possible mechanisms of action and the results of clin-
ical studies are summarized.
Surgical Approaches to Treatment of Gastroparesis: Gastric Electrical Stimulation,
Pyloroplasty, Total Gastrectomy and Enteral Feeding Tubes
Irene Sarosiek, Brian Davis, Evelin Eichler, and Richard W. McCallum
Gastric electrical stimulation (GES) is neurostimulation; its mechanism of
action is affecting central control of nausea and vomiting and enhancing
vagal function. GES is a powerful antiemetic available for patients with re-
fractory symptoms of nausea and vomiting from gastroparesis of idiopathic
and diabetic causes. GES is not indicated as a way of reducing abdominal
pain in gastroparetic patients. The need for introducing a jejunal feeding
tube means intensive medical therapies are failing, and is an indication
for the implantation of the GES system, which should always be accompa-
nied by a pyloroplasty to guarantee accelerated gastric emptying.
Gastric Arrhythmias in Gastroparesis: Low- and High-Resolution Mapping of
Gastric Electrical Activity
Gregory O Grady and Thomas L. Abell
Gastric arrhythmias occur in gastroparesis but their significance is
debated. An improved understanding is currently emerging, including
newly-defined histopathologic abnormalities in gastroparesis. In particular,
the observation that interstitial cells of Cajal are depleted and injured pro-
vides mechanisms for arrhythmogenesis in gastroparesis. Electrogastrog-
raphy has been the dominant clinical method of arrhythmia analysis, but is
Contents xi
limited by summative nature, low signal quality, and incomplete sensitivity
and specificity. Recently, high-resolution (HR; multi-electrode) mapping
has emerged, providing superior spatial data on arrhythmic patterns and
mechanisms. However, HR mapping is invasive, and low-resolution ap-
proaches are being assessed as bridging techniques until endoscopic
mapping is achieved.
Future Directions in the Treatment of Gastroparesis 185
Pankaj Jay Pasricha
Understanding of gastroparesis is evolving, in part because of systematic
studies on the pathology, pathophysiology, and outcomes. It is clear that
simply accelerating gastric emptying may not effectively control symp-
toms in this syndrome and more creative approaches are required that
address aberrant sensation (vagal and spinal) as well as regional distur-
bances in motility. Further, with the growing recognition of a possible in-
flammatory basis, the prospects of disease modifying now seem realistic.
Index
191
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