Gastric Emptying and Subjective Symptoms of Nausea: Lack of Effects of a 5-Hydroxytryptamine-3 Antagonist Ondansetron on Gastric Emptying in Patients with Gastric Stasis Syndrome

Nielsen, Ole Haagen; Hvid-Jacobsen, K; Lund, P. A.; Langholz, Ebbe

doi:10.1159/000200337

Cited by 44 publications

(23 citation statements)

References 11 publications

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“…Special points Ondansetron is another drug that can be given intravenously for recurrent nausea and vomiting. Ondansetron is a 5HT 3 receptor antagonist that is effective in reducing the vomiting associated with chemotherapy, but it has much less efficacy in nausea and vomiting due to gastrointestinal causes [26]. Nevertheless, in some patients ondansetron may be used to try to break a nausea and vomiting cycle when all other therapies have failed.…”

Section: Ondansetron (Zofran)mentioning

confidence: 99%

Unexplained nausea and vomiting

Koch

2000

Curr Treat Options Gastro

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Nausea and vomiting are debilitating symptoms for patients, and can be challenging problems in diagnosis and management for physicians. Initial efforts must be made to establish a specific diagnosis that represents the pathophysiological cause of the nausea and vomiting. If a specific diagnosis is made (for example, antral ulceration), then specific therapy for the lesion will usually eradicate the nausea and vomiting associated with the specific disease. When standard gastrointestinal diseases are eliminated as a cause of nausea and vomiting, then gastric neuromuscular disorders (disorders of motility) should be considered as potential causes of these symptoms. Gastric neuromuscular disorders range from gastric dysrhythmias and abnormalities of gastric accommodation to frank gastroparesis. Treatments for nausea and vomiting due to gastric neuromuscular dysfunction include: 1) patient education and dietary counseling; 2) gastrokinetic drugs; 3) visceral, sensory afferent and CNS drugs; 4) gastrostomy for stomach venting; 5) jejunostomy for enteral feeding access; and 6) acustimulation and gastric pacemaker therapies. Treatment approaches based on the pathophysiology of gastric neuromuscular dysfunction(s) and on patient education aid in the successful management of unexplained nausea and vomiting.

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Section: Ondansetron (Zofran)mentioning

confidence: 99%

Unexplained nausea and vomiting

Koch

2000

Curr Treat Options Gastro

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“…P values indicate treatment effects between t ϭ 0 -60 min and t ϭ 60 -120 min. 29,30,39,41), accelerate (1), or delay (40) gastric emptying. A recent study (28) suggests that the suppression of antral waves by intraduodenal lipid infusion is mediated via a 5-HT pathway; intravenous granisetron (10 g/kg) attenuated the suppression of antral waves after intraduodenal lipid but not intraduodenal glucose in healthy young subjects.…”

Section: Discussionmentioning

confidence: 99%

Role of 5-hydroxytryptamine mechanisms in mediating the effects of small intestinal glucose on blood pressure and antropyloroduodenal motility in older subjects

Gentilcore

Little²,

Feinle‐Bisset³

et al. 2007

American Journal of Physiology-Gastrointestinal and Liver Physi

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Gentilcore D, Little TJ, Feinle-Bisset C, Samsom M, Smout AJ, Horowitz M, Jones KL. Role of 5-hydroxytryptamine mechanisms in mediating the effects of small intestinal glucose on blood pressure and antropyloroduodenal motility in older subjects. Am J Physiol Gastrointest Liver Physiol 293: G692-G698, 2007. First published August 9, 2007; doi:10.1152/ajpgi.00199.2007.-Postprandial hypotension is an important clinical problem, particularly in the elderly. 5-Hydroxytryptamine3 (5-HT3) mechanisms may be important in the regulation of splanchnic blood flow and blood pressure (BP), and in mediating the effects of small intestinal nutrients on gastrointestinal motility. The aims of this study were to evaluate the effects of the 5-HT3 antagonist granisetron on the BP, heart rate (HR), and antropyloroduodenal (APD) motility responses to intraduodenal glucose in healthy older subjects. Ten subjects (5 male, 5 female, aged 65-76 yr) received an intraduodenal glucose infusion (3 kcal/min) for 60 min (t ϭ 0 -60 min), followed by intraduodenal saline for a further 60 min (t ϭ 60 -120 min) on 2 days. Granisetron (10 g/kg) or control (saline) was given intravenously at t ϭ Ϫ25 min. BP (systolic and diastolic), HR, and APD pressures were measured. Pressure waves in the duodenal channel closest ("local") to the infusion site were quantified separately. During intraduodenal glucose, there were falls in systolic and diastolic BP and a rise in HR (P Ͻ 0.0001 for all); granisetron had no effect on these responses. Granisetron suppressed the number and amplitude (P Ͻ 0.05 for both) of local duodenal pressures during intraduodenal glucose. Otherwise, the effects of intraduodenal glucose on APD motility did not differ between study days. We conclude that in healthy older subjects, 5-HT3 mechanisms modulate the local duodenal motor effects of, but not the cardiovascular responses to, small intestinal glucose. heart rate; 5-hydroxytryptamine3; granisetron; intraduodenal glucose; antropyloroduodenal motility POSTPRANDIAL HYPOTENSION, defined as a fall in systolic blood pressure of Ն20 mmHg within 2 h of a meal that is sustained for at least 30 min, is now recognized as a major cause of morbidity and mortality (7, 16) by predisposing to a number of disorders, including syncope, transient ischemic attacks, stroke, and angina (16). Postprandial hypotension occurs more frequently than orthostatic hypotension (16), and those at greatest risk include the elderly and patients with autonomic dysfunction, the latter usually secondary to diabetes (16). Current treatment options are suboptimal.Several factors, including impaired regulation of splanchnic blood flow, the release of gastrointestinal hormones, and duodenal sympathetic nerve activity, have been identified as possible pathophysiological mechanisms in postprandial hypotension (16). The magnitude of the fall in blood pressure is dependent on meal composition; ingestion of carbohydrate, particularly glucose, has been reported to have the greatest suppressive effect on blood pressure (17). Th...

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“…Their efficacy in reducing nausea and vomiting has long been established via trials in their intended populations of patients receiving chemotherapy but few studies have been performed in the gastroparesis population. Ondansetron has been shown to not improve gastric emptying in both healthy patients and those with diabetic gastroparesis [67,68] and in one study of emergency room patients with nausea/vomiting referenced above, it was found to have the same efficacy as metoclopramide and promethazine [66]. The most recent progress made with this category of agents has been with the Sancuso Patch, a transdermal formulation of Granisetron that theoretically would be easier for patients with severe nausea than an oral agent.…”

Section: Histamine H1 Receptor Antagonistsmentioning

confidence: 99%

Current advances in treatment of gastroparesis

Malamood

Parkman

Schey

2015

Expert Opinion on Pharmacotherapy

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The numerous motor functions and neural inputs that control gastric motility are complex and not fully understood. Our lack of understanding of its pathophysiology has led to treatment options which are empirical, palliative and often ineffective. Newly intensified interest in the cellular pathophysiology behind gastroparesis provides promise for a new era of treatments. Identification of common cellular changes in gastroparesis has provided targets for treatment that may allow us to one day better treat the symptoms of gastroparesis related to its underlying pathophysiology. This is the future of gastroparesis therapy.

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Gastric Emptying and Subjective Symptoms of Nausea: Lack of Effects of a 5-Hydroxytryptamine-3 Antagonist Ondansetron on Gastric Emptying in Patients with Gastric Stasis Syndrome

Cited by 44 publications

References 11 publications

Unexplained nausea and vomiting

Unexplained nausea and vomiting

Role of 5-hydroxytryptamine mechanisms in mediating the effects of small intestinal glucose on blood pressure and antropyloroduodenal motility in older subjects

Current advances in treatment of gastroparesis

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