Diabetic gastroparesis: what we have learned and had to unlearn in the past 5 years: Figure 1

Kashyap, Purna C.; Farrugia, Gianrico

doi:10.1136/gut.2009.199703

Cited by 163 publications

(134 citation statements)

References 119 publications

(109 reference statements)

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“…The enteric nervous system (ENS) is embedded in the bowel wall, and all pathophysiological factors described, i.e. loss of enteric neurons and ICCs [1,2], may be secondary to microvascular processes in a similar way. As early as 1965, it was shown that the arterioles and capillaries of the submucosa showed the same pathologic changes and thickening in long-term diabetes as the blood vessels of other organs [21].…”

Section: Discussionmentioning

confidence: 99%

“…Hyperglycemia per se affects gastrointestinal motility and prolongs the gastric emptying rate. In turn, gastroparesis and dysmotility may cause poor metabolic control in the patients by nonregular emptying rates [1,2]. The association between gastrointestinal dysmotility and retinopathy may thus be based on a poor glycemic control, with increased risk of developing retinopathy, rather than another common causality behind the two complications [4,5,10].…”

Section: Discussionmentioning

confidence: 99%

“…Studies have shown that up to 30% of patients with diabetes suffer from gastroparesis, which is characterized as prolonged gastric emptying without mechanical obstruction [1]. The pathophysiology is supposed to be multifactorial and includes vagal neuropathy, hyperglycemia, loss of enteric neurons, loss of neuronal nitric oxide expression, smooth muscle abnormalities, and disruption of the interstitial cell of Cajal (ICC) networks [1,2]. These changes may be secondary to the initial damage, and causality has not yet been clarified.…”

Section: Introductionmentioning

confidence: 99%

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Microangiopathy is Common in Submucosal Vessels of the Colon in Patients With Diabetes Mellitus

Sasor¹,

Ohlsson²

2014

Rev Diabet Stud

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■ Abstract OBJECTIVES:The pathophysiology behind gastrointestinal dysmotility in diabetes mellitus is unknown. Both esophageal dysmotility and gastroparesis have been shown to be associated with retinopathy, suggesting that microangiopathy is important in the common etiology. The aim of the present study was to examine whether patients with diabetes exhibit microangiopathy in the colon, and if present, to correlate microangiopathy with the clinical picture. METHODS: Consecutive patients subjected to colon surgery were identified in the southernmost districts of Skåne between January 2011 and May 2013. Medical records were scrutinized, and patients with a history of diabetes were noted. Gender, age, type of diabetes, treatment, complications, and other concomitant diseases were registered. Histopathologic reevaluation of surgical biopsies with morphometric analyses of submucosal vessels in the colon was performed. Morphometric examination and clinical data were compared with non-diabetic patients. RESULTS: Of 1135 identified patients during the time period studied, 95 patients with diabetes were recognized and included. Fifty-three non-diabetic, randomly chosen patients served as controls. The mean age was 71.8 ± 10.2 and 71.4 ± 9.5 years in diabetic and nondiabetic patients, respectively. Microangiopathy was found in 68.4% of diabetic patients and in 7.5% of non-diabetic patients (p < 0.001). The wall-to-lumen ratio was 0.31 (0.23-0.46) in patients with diabetes compared with 0.16 (0.12-0.21) in non-diabetic patients (p < 0.001). No clinical association with microangiopathy could be verified. CONCLU-SION: Microangiopathy in the colon is more common in diabetic than in non-diabetic patients. The clinical significance of microangopathy has yet to be clarified.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Microangiopathy is Common in Submucosal Vessels of the Colon in Patients With Diabetes Mellitus

Sasor¹,

Ohlsson²

2014

Rev Diabet Stud

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“…last but not least, loss of macrophages expressing heme oxygenase-1 9 . Rare causes of gastroparesis also could be Chagas disease, hypothyroidism, hyperparathyroidism, hypoparathyroidism, collagen vascular diseases, some neurological conditions like Parkinsonism or medication 4,10 .…”

Section: Etiopathogenesis Of Gastroparesismentioning

confidence: 99%

Diabetic gastroparesis - from diagnosis to gastric electrical stimulation treatment

et al. 2017

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Abstract. The most common known underlying cause of gastroparesis is diabetes mellitus. General symptoms and signs include nausea, vomiting, bloating and early satiety. The diagnosis of diabetic gastroparesis (DGP) is closely made based on clinical history, exclusion of gastrointestinal obstruction by endoscopy and abdominal ultrasound, and confirmation of delay in gastric emptying by gastric emptying scintigraphy. First-line interventions for DGP are dietary modifications and prokinetic-antiemetic therapy. In cases resistant to maximal medical therapy, gastric electrical stimulation is indicated.The aim is to alleviate both the severity and frequency of symptoms, improve gastric emptying, ameliorate patient's nutritional status and to optimize glycemic control.Key words: diabetes mellitus; electrical stimulation therapy; gastroparesis; scintigraphy Sažetak. Šećerna bolest je najučestaliji poznati uzrok gastropareze. Uobičajeni simptomi su mučnina, povraćanje, nadutost i rano postizanje sitosti. Postavljanje dijagnoze dijabetičke gastropareze (DGP) temelji se na kliničkoj prezentaciji bolesti, otklanjanju mogućnosti opstrukcije endoskopskim ili ultrazvučnim pregledom te na potvrdi usporenog pražnjenja želučanog sadržaja uz pomoć nalaza scintigrafije pražnjenja želuca. Prve terapijske odrednice za DGP su dijetoterapija te uvođenje prokinetika i antiemetika u kroničnu terapiju. Električna stimulacija želuca indicirana je u slučajevima rezistentnim na maksimalnu medikamentoznu terapiju. Cilj je ublažiti intenzitet i učestalost simptoma, poboljšati pražnjenje želuca i nutritivni status pacijenta te optimizirati kontrolu glikemije.

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“…For example, IBS has an estimated prevalence of 15-22% in Western society and by itself accounts for 3% of all primary care visits and up to 60% of the referrals for secondary care [Ford et al 2008]. GI motility disorders are also not standalone pathologies; they may be complications of other systemic illnesses, such as diabetes, which can result in diabetic gastroparesis in a subset of patients [Camilleri et al 2011;Kashyap and Farrugia, 2010]. Finally, intestinal pseudo-obstruction and other less common GI motility disorders are associated with substantial mortality risk.…”

mentioning

confidence: 99%

Targeting ion channels for the treatment of gastrointestinal motility disorders

Beyder

Farrugia

2011

Therap Adv Gastroenterol

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Gastrointestinal (GI) functional and motility disorders are highly prevalent and responsible for long-term morbidity and sometimes mortality in the affected patients. It is estimated that one in three persons has a GI functional or motility disorder. However, diagnosis and treatment of these widespread conditions remains challenging. This partly stems from the multisystem pathophysiology, including processing abnormalities in the central and peripheral (enteric) nervous systems and motor dysfunction in the GI wall. Interstitial cells of Cajal (ICCs) are central to the generation and propagation of the cyclical electrical activity and smooth muscle cells (SMCs) are responsible for electromechanical coupling. In these and other excitable cells voltage-sensitive ion channels (VSICs) are the main molecular units that generate and regulate electrical activity. Thus, VSICs are potential targets for intervention in GI motility disorders. Research in this area has flourished with advances in the experimental methods in molecular and structural biology and electrophysiology. However, our understanding of the molecular mechanisms responsible for the complex and variable electrical behavior of ICCs and SMCs remains incomplete. In this review, we focus on the slow waves and action potentials in ICCs and SMCs. We describe the constituent VSICs, which include voltagegated sodium (Na V ), calcium (Ca V ), potassium (K V , K Ca ), chloride (Cl -) and nonselective ion channels (transient receptor potentials [TRPs]). VSICs have significant structural homology and common functional mechanisms. We outline the approaches and limitations and provide examples of targeting VSICs at the pores, voltage sensors and alternatively spliced sites. Rational drug design can come from an integrated view of the structure and mechanisms of gating and activation by voltage or mechanical stress.Keywords: functional GI, GI motility, ion channel, voltage gated ion channel, potassium voltage gated ion channel, sodium voltage gated ion channel, calcium voltage gated ion channel, chloride channelGastrointestinal functional and motility disorders Gastrointestinal (GI) functional and motility disorders are common and commonly morbid. In the broadest sense, GI functional and motility disorders refer to a group of disorders whose symptomatology is related to motor, sensory or even secretory function of the GI tract. The term 'functional' refers to the subgroup of disorders that do not yet have a well-defined pathophysiology. This broad definition means that the symptoms are nonspecific and include nausea, vomiting, bloating, abdominal discomfort or pain, constipation or diarrhea. Some of the most common motility disorders encountered in practice are achalasia, gastroparesis, intestinal pseudo-obstruction and slow transit constipation. Common functional GI disorders such as functional dyspepsia and irritable bowel syndrome (IBS) are highly prevalent in the community. For example, IBS has an estimated prevalence of 15-22% in Western society and by it...

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Diabetic gastroparesis: what we have learned and had to unlearn in the past 5 years: Figure 1

Cited by 163 publications

References 119 publications

Microangiopathy is Common in Submucosal Vessels of the Colon in Patients With Diabetes Mellitus

Microangiopathy is Common in Submucosal Vessels of the Colon in Patients With Diabetes Mellitus

Diabetic gastroparesis - from diagnosis to gastric electrical stimulation treatment

Targeting ion channels for the treatment of gastrointestinal motility disorders

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