Gastric accommodation and emptying in evaluation of patients with upper gastrointestinal symptoms

Bredenoord, Albert J.; Chial, Heather J.; Camilleri, Michael; Mullan, Brian P.; Murray, Joseph A.

doi:10.1016/s1542-3565(03)00130-7

Cited by 218 publications

(136 citation statements)

References 37 publications

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“…Even though most patients exhibited a response to botulinum toxin in this study, a substantial number of individuals derived no benefit. This observation is consistent with studies that have characterized other potential pathogenic factors in symptom production in gastroparesis including impaired relaxation of the gastric fundus, alterations in perception of gastric distention, and abnormal burst contractile patterns in the small intestine [22][23][24][25].…”

Section: Discussionsupporting

confidence: 91%

Factors Associated with Symptom Response to Pyloric Injection of Botulinum Toxin in a Large Series of Gastroparesis Patients

2009

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Case series report symptom reductions after pyloric botulinum toxin injection in gastroparesis, but small controlled trials show no benefit. Factors that enhance response to therapy are undefined. A retrospective analysis of 179 gastroparetics undergoing pyloric botulinum toxin injection from 2001 to 2007 assessed responses relating to drug dosing, demographic factors, comorbidities, and gastric function. Overall, there was a decrease in gastroparetic symptoms 1-4 months after pyloric botulinum toxin injection in 92 patients (51.4%). Increasing the botulinum toxin dose significantly improved clinical responses of patients who provided information on symptoms after therapy (100 units: 54.2%; 200 units: 76.7%; P=0.02). Other factors that improved response to botulinum toxin included female gender, age <50 years, and nondiabetic nonpostsurgical etiology (all P<0.05). Eighty-seven patients received 307 follow-up injections. A clinical response to a second injection was observed in 73.4% of evaluable patients. In conclusion, responses to pyloric botulinum toxin depended on dose and were maintained on repeat injection. Subgroup analyses defined subgroups likely to benefit. These findings provide the foundation for large, controlled trials of high-dose botulinum toxin in selected gastroparesis subsets.

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Section: Discussionsupporting

confidence: 91%

Factors Associated with Symptom Response to Pyloric Injection of Botulinum Toxin in a Large Series of Gastroparesis Patients

2009

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“…13 However, a later study from the same group confirmed the prevalence of impaired accommodation in patients with functional dyspepsia, but did not find an association with the presence or absence of symptoms based on a medical chart review. 62 In addition, a SPECT study on gastric volumes in a community of patients with dyspepsia did not show a marked difference in preprandial and postprandial gastric volumes compared with healthy controls. 63 To clarify some of the controversy, several studies investigated the effects of inducing impaired accommodation in healthy people on food tolerance and postprandial symptoms.…”

Section: Role Of Impaired Accommodation In Symptom Generationmentioning

confidence: 89%

“…Early satiety associated with early distal redistribution Bredenoord 62 Functional dyspepsia 151 SPECT imaging Impaired accommodation in 43% None Castillo 63 Dyspeptic subjects in the community 35 SPECT imaging None NA SPECT, single-photon emission computed tomography; NA, not applicable. *Patients were selected on the basis of symptoms of severe postprandial bloating.…”

Section: Pathogenesis Of Impaired Accommodationmentioning

confidence: 99%

Impaired gastric accommodation and its role in dyspepsia

Kindt

Tack

2006

Gut

192

209

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“…Note that different subgroups may have either impaired gastric emptying or impaired gastric accommodation, or both. Reproduced with permission from [20]. …”

Section: Functional Dyspepsiamentioning

confidence: 99%

“…There are several important principles: first, the nature and calorie content of the meal determine the rate of emptying [16]; second, whatever method is used, it should be characterized by robust normal data and performance characteristics [17,18]; third, the gastric emptying breath test (GEBT) requires accurate and validated methods for deriving gastric emptying parameters from 13 CO 2 enrichment [19]; fourth, both delayed and accelerated gastric emptying (fig. 1) may be associated with the same upper gastrointestinal symptoms such as fullness, nausea and bloating [20,21]. …”

Section: Diagnosismentioning

confidence: 99%

Functional Dyspepsia and Gastroparesis

Camilleri¹

2016

Dig Dis

Self Cite

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Background: Upper gastrointestinal disorders typically present with common symptoms. The most relevant non-mucosal diseases are gastroparesis, functional dyspepsia and rumination syndrome. The literature pertaining to these 3 conditions was reviewed. Key Messages: Gastroparesis is characterized by delayed gastric emptying in the absence of mechanical obstruction of the stomach. The cardinal symptoms include postprandial fullness (early satiety), nausea, vomiting and bloating. The most frequently encountered causes of these symptoms are mechanical obstruction (pyloric stenosis), iatrogenic disease, gastroparesis, functional dyspepsia, cyclical vomiting and rumination syndrome. The most common causes of gastroparesis are neuropathic disorders such as diabetes, idiopathic, post-vagotomy and scleroderma among myopathic disorders. Principles of management of gastroparesis include exclusion of mechanical obstruction with imaging and iatrogenic causes with careful medication and past surgical history. Prokinetics and anti-emetics are the mainstays of treatment. Functional dyspepsia is characterized by the same symptoms as gastroparesis; in addition to delayed gastric emptying, pathophysiological abnormalities include accelerated gastric emptying, impaired gastric accommodation and gastric or duodenal hypersensitivity to distension and nutrients. Novel treatments include tricyclic antidepressants in patients with normal gastric emptying, acotiamide (acetyl cholinesterase inhibitor) and 5-HT_1A receptor agonists such as buspirone. Rumination syndrome is characterized by repetitive regurgitation of gastric contents occurring within minutes after a meal. Episodes often persist for 1-2 h after the meal, and the regurgitant consists of partially digested food that is recognizable in its taste. Regurgitation is typically effortless or preceded by a sensation of belching. This has been summarized as a ‘meal in, meal out, day in, day out' behavior for weeks or months, differentiating rumination from gastroparesis. Patients often have a background of psychological disorder or a prior eating disorder. Treatment is based on behavioral modification. Conclusion: Precise identification of the cause and pathophysiology of upper gastrointestinal symptoms is essential for optimal management.

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Gastric accommodation and emptying in evaluation of patients with upper gastrointestinal symptoms

Cited by 218 publications

References 37 publications

Factors Associated with Symptom Response to Pyloric Injection of Botulinum Toxin in a Large Series of Gastroparesis Patients

Factors Associated with Symptom Response to Pyloric Injection of Botulinum Toxin in a Large Series of Gastroparesis Patients

Impaired gastric accommodation and its role in dyspepsia

Functional Dyspepsia and Gastroparesis

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