Our analysis provides normative data for motility/contractility parameters. Log motility index summarises a number of measures. In future, the measurement of contractile activity with the wireless motility capsule may potentially aid in the diagnosis of disease states such as visceral myopathic disorders.

No abstract

G astroparesis is defined as a delay in gastric emptying in the absence of mechanical obstruction in the stomach. 1,2 Causes of gastroparesis can be postsurgical, secondary to medications (eg, opioids, anticholinergics, tricyclic antidepressants, beta-blockers, calcium channel blockers), postinfectious, idiopathic, or a complication of diabetes mellitus. The differential diagnoses of gastroparesis include cyclic vomiting syndrome and cannabinoid-induced hyperemesis. 3 The emergence of gastrointestinal (GI) complications of diabetes mellitus are a function of poor glycemic control rather than the longevity of the diagnosis. 4 The most common complication is diabetic gastroparesis (DG) and is often underrecognized. 5 The cardinal symptoms of DG are nausea, early satiety, vomiting, dyspepsia, and bloating. DG is associated with impaired glycemic control, marked psychological distress, and reduced quality of life. 6 This review paper provides a dual perspective of DG: firstly, that of the health care Abstract Gastroparesis is defined as a delay in gastric emptying in the absence of mechanical obstruction in the stomach. Gastroparesis has a number of causes, including postsurgical, secondary to medications, postinfectious, idiopathic, and as a complication of diabetes mellitus, where it is underrecognized. The cardinal symptoms of diabetic gastroparesis are nausea, early satiety, bloating, and vomiting. Diabetic gastroparesis is more common in females and has a cumulative incidence of 5% in type 1 diabetes and 1% in type 2 diabetes. It is associated with a reduction in quality of life and exerts a significant burden on health care resources. The pathophysiology of this disorder is incompletely understood. Diagnosis is made based on typical symptoms associated with the demonstration of delayed gastric emptying in the absence of gastric outlet obstruction. Gastric emptying scintigraphy is the gold standard for demonstrating delayed gastric emptying, but other methods exist including breath testing and the wireless motility capsule. Diabetic gastroparesis should be managed within a specialist multidisciplinary team, and general aspects involve dietary manipulations/nutritional support, pharmacological therapy, and surgical/endoscopic interventions. Specific pharmacological therapies include prokinetics and antiemetics, with several new medications in the drug development pipeline. Surgical/endoscopic interventions include botulinum toxin injection into the pylorus, gastric peroral endoscopic myotomy and gastric electrical stimulation. This article provides a detailed review and summary of the epidemiology, pathophysiology, investigation, and management of diabetic gastroparesis, and also gives an individual patient's perspective of living with this disabling disorder.

AIM:To study liver biopsy practice over two decades in a district general hospital in the United Kingdom. METHODS:We identified all patients who had at least one liver biopsy between 1986 and 2006 from the databases of the radiology and gastroenterology departments. Subjects with incomplete clinical data were excluded from the study. RESULTS:A total of 103 liver biopsies were performed. Clinical data was available for 88 patients, with 95 biopsies. Between 1986 and 1996, 18 (95%) out of the 19 liver biopsies performed were blind and 6 (33%) were for primary biliary cirrhosis. Between 1996 and 2006, 14 (18%) out of 76 biopsies were blind; and the indications were abnormal liver tests (33%), hepatitis C (12%) and targeted-biopsies (11%). Liver biopsies were unhelpful in 5 (5%) subjects. Pain was the most common complication of liver biopsy (5%). No biopsy-related mortality was reported. There was a trend towards more technical failures and complications with the blind biopsy technique. CONCLUSION:Liver biopsies performed in small district hospitals are safe and useful for diagnostic and staging purposes. Abnormal liver tests, non-alcoholic fatty liver disease and targeted biopsies are increasingly common indications. Ultrasound-guided liver biopsies are now the preferred method and are associated with fewer complications.

BackgroundThe majority of people in the UK die in hospital and many more die in hospital than are seen by the inpatient specialist palliative care team (SPCT).AimsTo assess the population of patients who die in hospital and to establish if there are specialist palliative care needs in patients not referred to SPCT.MethodsWe conducted a retrospective case note evaluation and collection of death certificate data of all 109 patients that died at Good Hope Hospital Birmingham in September 2012. We assigned Gold Standards Framework (GSF) prognostic indicator guidance to assess possible palliative care need. We assessed the time of admission to death.Results38/109 patients died within 48 hours of their admission and causes of death were from a range of conditions. Patients died in the emergency department or assessment units and had no SPCT involvement – 8 of these patients were known to a community SPCT, but only 1 patient was seen prior to death by the hospital SPCT. 14/38 scored 0 on GSF prognostic indicator guidance criteria (no indication of palliative care need), 15/38 scored 1, 6/38 scored 2, and 3/38 scored 3, suggesting they would benefit from a palliative care approach.ConclusionAssessment of palliative care need using the GSF guidance can identify many patients who might benefit from SPCT involvement as they die in hospital. Many patients die within 48 hours of arriving in hospital and emergency, acute medical/surgical physicians do not identify these patients as requiring SPCT involvement. Greater education in assessment of palliative care need for these clinicians may increase referral to SPCT and improve end of life care for this patient population. SPCT will need to alter working practices, including out of hours working, if we are to have a role in the care of this group of patients as they die.