Effect of endoscopic pyloric therapies for patients with nausea and vomiting and functional obstructive gastroparesis

Wellington, Jennifer; Scott, Blake; Kundu, Sarba; Stuart, Paula; Koch, Kenneth L.

doi:10.1016/j.autneu.2016.07.004

Cited by 58 publications

(39 citation statements)

References 25 publications

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“…The hypothesis of an impaired pyloric function as a factor in gastroparesis is also supported by Wellington et al, who found evidence for a subgroup of gastroparesis patients with a functional obstructive phenotype with a normal gastric pacemaker rhythm. Treatment with either endoscopic botulinum toxin injection or balloon dilation in this group gastroparesis patients resulted in symptom improvement in 75% of patients [38]. These results support the hypothesis that improvement of pyloric compliance and/or cross-sectional area by endoscopic treatment options are able to improve symptoms [30].…”

Section: Discussionsupporting

confidence: 77%

Endoscopic Botulinum Toxin for Gastroparesis: Results of a Retrospective Series

Smeets

Strijbos

Keszthelyi

et al. 2018

Gastrointestinal Disorders

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Beneficial effects of pyloric botulinum toxin injection have been described in a subgroup of gastroparesis patients. Our aim is to evaluate whether clinical, manometric and/or scintigraphic parameters are able to predict treatment outcome. Forty patients (67% female, age 49 (36–56) years) with decompensated gastroparesis treated with botulinum toxin were included in this retrospective analysis. Objective parameters were high-resolution antroduodenal manometry, gastric emptying rate (scintigraphy), and weight change. Subjective treatment outcome was assessed with a Global Physician Assessment Scale. Binary logistic regression analysis was performed to identify predictors for treatment outcome. Fourteen patients (35%) were symptom-responders, and 65% of patients were short-term weight-responders. For both subjective and objective treatment outcome, no differences were found in manometric and scintigraphic variables between responders and non-responders. Neither clinical nor manometric or scintigraphic variables could predict subjective and objective treatment outcome. In conclusion, symptom improvement is achieved in a subgroup of gastroparesis patients treated with endoscopic pyloric botulinum toxin. Although the majority of patients were able to maintain their baseline weight at short-term follow-up, a substantial group of patients needed nutritional interventions on long-term follow-up. However, none of the demographic, clinical, scintigraphic, or antroduodenal manometry variables were able to predict either subjective or objective treatment outcome.

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Section: Discussionsupporting

confidence: 77%

Endoscopic Botulinum Toxin for Gastroparesis: Results of a Retrospective Series

Smeets

Strijbos

Keszthelyi

et al. 2018

Gastrointestinal Disorders

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“…Although pediatric data are limited, two small studies document efficacy of pyloric balloon dilation in young children with delayed gastric emptying . A recent study of 33 adults with gastroparesis suggested that majority (78%) improved with either botulinum toxin injection or balloon dilation of pylorus after selecting patients with normal gastric myoelectrical activity based on EGG …”

Section: Resultsmentioning

confidence: 99%

Update on pediatric gastroparesis: A review of the published literature and recommendations for future research

Kovacic

Elfar

Rosen

et al. 2019

Neurogastroenterology Motil

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Background Due to scarcity of scientific literature on pediatric gastroparesis, there is a need to summarize current evidence and identify areas requiring further research. The aim of this study was to provide an evidence‐based review of the available literature on the prevalence, pathogenesis, clinical presentation, diagnosis, treatment, and outcomes of pediatric gastroparesis. Methods A search of the literature was performed using the Preferred Reporting Items for Systematic Reviews and Meta‐analyses guidelines with the following databases: PubMed, EMBASE, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, and Web of Science. Two independent reviewers screened abstracts for eligibility. Key Results Our search yielded 1085 original publications, 135 of which met inclusion criteria. Most articles were of retrospective study design. Only 12 randomized controlled trials were identified, all of which were in infants. The prevalence of pediatric gastroparesis is unknown. Gastroparesis may be suspected based on clinical symptoms although these are often non‐specific. The 4‐hour nuclear scintigraphy scan remains gold standard for diagnosis despite lack of pediatric normative comparison data. Therapeutic approaches include dietary modifications, prokinetic drugs, and postpyloric enteral tube feeds. For refractory cases, intrapyloric botulinum toxin and surgical interventions such as gastric electrical stimulation may be warranted. Most interventions still lack rigorous supportive data. Conclusions Diagnosis and treatment of pediatric gastroparesis are challenging due to paucity of published evidence. Larger and more rigorous clinical trials are necessary to improve outcomes.

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“…Abnormalities in pyloric distensibility have been reported in 36% of patients with severe GP [38]. Endoscopic pyloric therapy with botulinum toxin injection or balloon dilation improved symptoms in this idiopathic obstructive subtype GP [37].…”

Section: Discussionmentioning

confidence: 94%

“…In the current study endoscopy excluded pyloric stenosis in patients with GP and 3cpm GMA. Thus, these patients have a GP subtype termed idiopathic gastric outflow obstruction due to pyloric neuromuscular dysfunction [37]. Abnormalities in pyloric distensibility have been reported in 36% of patients with severe GP [38].…”

Section: Discussionmentioning

confidence: 99%

Gastric Myoelectrical Activity and Autonomic Nervous System Abnormalities in Patients with Chronic Unexplained Nausea and Vomiting and in Patients with Gastroparesis

Stefi

Koch

Brown

et al. 2019

IGH

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Background: Patients with chronic unexplained nausea and vomiting (CUNV) and Gastroparesis (GP) have similar symptoms, suggesting they share pathophysiological abnormalities along a continuum of disease.Objectives: To determine the incidence of gastric myoelectrical, accommodation dysfunction and autonomic abnormalities in patients with CUNV and GP.Methods: Outpatients with CUNV and GP who underwent standard 4-hr solid phase gastric emptying, upright tilt table test and electrogastrogram (EGG) recordings with water load satiety test (WLST) were identified from chart review. Subjects with normal emptying were in the CUNV group; those with delayed emptying were in the GP group. EGGs were recorded before and 30 minutes after the WLST and symptoms were recorded on a 100mm visual analog scale.Results: 44 patients (35 women and 9 men, ages 17-76 years) were identified: 24 had normal gastric emptying and CUNV and 20 had GP. Gastric dysrhythmias were found in 70% of CUNV and 69% of GP patients. Twenty percent of CUNV patients and 44% of GP patients ingested abnormally low volumes (< 300mL) during the WLST. Nausea increased similarly after the WLST in the subjects with CUNV and GP (Ps > 0.05). Postural orthostatic tachycardia syndrome (POTS) was diagnosed in 17% of CUNV patients and 20% of GP patients.Conclusions: Gastric myoelectrical and accommodation abnormalities and autonomic nervous system (ANS) dysfunctions frequently occur in subjects with CUNV and GP. These pathophysiological abnormalities support the idea that CUNV and GP occur along the same continuum of gastric neuromuscular dysfunction and may be targets for therapeutic approaches.

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Effect of endoscopic pyloric therapies for patients with nausea and vomiting and functional obstructive gastroparesis

Cited by 58 publications

References 25 publications

Endoscopic Botulinum Toxin for Gastroparesis: Results of a Retrospective Series

Endoscopic Botulinum Toxin for Gastroparesis: Results of a Retrospective Series

Update on pediatric gastroparesis: A review of the published literature and recommendations for future research

Gastric Myoelectrical Activity and Autonomic Nervous System Abnormalities in Patients with Chronic Unexplained Nausea and Vomiting and in Patients with Gastroparesis

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