Gastroparesis in the 2020s: New Treatments, New Paradigms

Sharma, Amol; Coles, Michael; Parkman, Henry P.

doi:10.1007/s11894-020-00761-7

Cited by 23 publications

(27 citation statements)

References 88 publications

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“…It has been postulated that ICC, PDGFRα+ cells, and smooth muscle cells form a syncytium. This controls intracellular voltage-gated calcium (Ca 2+ ) in a cyclical manner leading to high-amplitude contractions [24].…”

Section: Review Overview Of the Pathophysiology Of Gastroparesismentioning

confidence: 99%

Gastroparesis: A Multidisciplinary Approach to Management

Egboh¹,

Abere²

2022

Cureus

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Gastroparesis is a neuromuscular disorder whose hallmark is delayed gastric emptying. It is a global challenge to the healthcare system because of poor treatment satisfaction for both the patients and clinicians, eventually leading to a reduction in the quality of life, with antecedent anxiety and depression. Although it is multifactorial in origin, diabetic, idiopathic, and drug-induced gastroparesis are the major risk factors. Disrupted interstitial cells of Cajal (ICC) and gastric dysrhythmia are pivotal to the pathogenesis, with most of the investigations targeted toward assessing gastric emptying and accommodation usually affected by distorted ICC and other neural networks. The treatment challenges can be overcome by a multidisciplinary approach involving gastroenterologists, gastrointestinal surgeons, biomedical engineers, nutritionists, psychologists, nurses, radionuclide radiologists, pharmacists, and family physicians. The exploration of the fundamental physiological processes underlying gastroparesis with the use of biomechanical materials should be given more attention by biomedical engineers to integrate innovative engineering with medicine for solving complex medical issues.

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Section: Review Overview Of the Pathophysiology Of Gastroparesismentioning

confidence: 99%

Gastroparesis: A Multidisciplinary Approach to Management

Egboh¹,

Abere²

2022

Cureus

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“…Anyway, the observation that degeneration or loss of ICC is involved in different GI dysmotilities underlines the importance of ICC regarding both pacemaking and neurotransmission [ 101 ]. In this view, gastroparesis also involves impaired fundal accommodation, abnormal small bowel transit, and delayed colonic transit and studies are in progress to determine the pathophysiology and the development of new therapeutic approaches [ 102 , 103 ]. In this perspective, help can also come from studies carried out on animal models.…”

Section: No In Gastric Motility and Dysmotilitymentioning

confidence: 99%

Nitric Oxide: From Gastric Motility to Gastric Dysmotility

Idrizaj

Traini

Vannucchi

et al. 2021

IJMS

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It is known that nitric oxide (NO) plays a key physiological role in the control of gastrointestinal (GI) motor phenomena. In this respect, NO is considered as the main non-adrenergic, non-cholinergic (NANC) inhibitory neurotransmitter responsible for smooth muscle relaxation. Moreover, many substances (including hormones) have been reported to modulate NO production leading to changes in motor responses, further underlying the importance of this molecule in the control of GI motility. An impaired NO production/release has indeed been reported to be implicated in some GI dysmotility. In this article we wanted to focus on the influence of NO on gastric motility by summarizing knowledge regarding its role in both physiological and pathological conditions. The main role of NO on regulating gastric smooth muscle motor responses, with particular reference to NO synthases expression and signaling pathways, is discussed. A deeper knowledge of nitrergic mechanisms is important for a better understanding of their involvement in gastric pathophysiological conditions of hypo- or hyper-motility states and for future therapeutic approaches. A possible role of substances which, by interfering with NO production, could prove useful in managing such motor disorders has been advanced.

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“…Diabetic gastroparesis is characterized by a loss of ICCs at the cellular level, which is negatively associated with the amount of CD206+ macrophages, which are considered to protect ICCs. The SIP syncytium (Smooth muscle cells are electrically coupled to ICC and PDGFRα(+) cells, forming an integrated unit called the SIP syncytium), rather than the ICC alone, is now recognized as the pace making unit in the pathophysiology of GP, and GP may be part of a pan-enteric autoimmune and/or autonomic disease with macrophage imbalance [ 30 , 31 ].…”

Section: Reviewmentioning

confidence: 99%

A Systematic Review of the Therapeutic Role of Gastric Pacemakers in Adults With Gastroparesis

Rajamanuri

Mannava

Chhabra

et al. 2021

Cureus

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Gastroparesis or gastric stasis is the delayed transit of the ingested contents through the stomach in the absence of mechanical obstruction. It can have multiple etiologies, most commonly idiopathic (ID) and diabetic (DM). Gastroparesis can cause significant distress to patients as it leads to symptoms like intractable nausea and vomiting, weight loss, abdominal bloating, early satiety, etc. The pathogenesis is mainly thought to be due to the dysfunction of the gastric pacemaker cells, i.e., interstitial cells of Cajal (ICC), and their interaction with the other gastric motor function regulatory components. There are several proposed treatment options for gastroparesis. Despite that, most patients remain refractory to medical treatment and require additional interventions for symptomatic relief. One such intervention is gastric electrical stimulation or gastric pacemaker, which aids in improving gastric motility. We have searched PubMed, PubMed Central (PMC), Medline, Science Direct, and Google Scholar for articles pertaining to the use of gastric electrical stimulation in gastroparesis published in the last 10 years. The keywords used include "gastroparesis", "gastric stasis", "gastric pacemaker'', "gastric electrical stimulation", "nausea", "vomiting", "abdominal bloating", "gastric neuromodulation". We have finally included twelve studies that were the most relevant to our research question and met the quality assessment criteria. Exclusion criteria consisted of pediatric population studies, studies conducted on animals, books, and grey literature. Overall, these twelve studies helped evaluate the impact of gastric pacemakers on symptoms of gastroparesis like nausea, vomiting, weight loss, abdominal bloating, and quality of life. We found that most studies favored gastric pacemakers, improving the incidence of nausea and vomiting in patients with gastroparesis. There was a marked improvement in the BMI as well. On the other hand, most open-labeled studies showed improved quality of life and Gastroparesis Cardinal Symptom Index (GCSI) scores, while randomized controlled trials and meta-analyses did not reflect the same result. In addition, some other parameters improved with gastric pacemakers, Inflammatory markers, insulin levels (especially in diabetics), and the number of hospitalizations. In conclusion, gastric pacemaker is a potential treatment option for patients with medically refractory gastroparesis. As noted from the results of our study, nausea/vomiting, weight loss, and overall GCSI scores have shown marked improvement with gastric electrical stimulation (GES). Nevertheless, more extensive research is needed to understand better the full extent of this device’s use as a viable treatment option for patients suffering from gastroparesis.

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Gastroparesis in the 2020s: New Treatments, New Paradigms

Cited by 23 publications

References 88 publications

Gastroparesis: A Multidisciplinary Approach to Management

Gastroparesis: A Multidisciplinary Approach to Management

Nitric Oxide: From Gastric Motility to Gastric Dysmotility

A Systematic Review of the Therapeutic Role of Gastric Pacemakers in Adults With Gastroparesis

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