Epidemiology and Pathophysiology of Gastroparesis

Moshiree, Baha; Potter, Michael; Talley, Nicholas J.

doi:10.1016/j.giec.2018.08.010

Cited by 55 publications

(56 citation statements)

References 66 publications

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“…Delay in gastric emptying in the absence of mechanical obstruction is a common complication of gastroparesis. 1 Gastroparesis is a neuromuscular disorder of the upper gastrointestinal tract which is accompanied by nausea, vomiting, epigastric pain or discomfort, early satiety, abdominal bloating, postprandial fullness, and weight loss. 2 While the main etiology of gastroparesis is idiopathic, 3 diabetes, postoperative ileus, connective tissue diseases, and neurological disorders are the other causes of gastroparesis.…”

Section: Introductionmentioning

confidence: 99%

A Novel Approach in Spinal Cord Stimulation for Enhancing Gastric Motility: A Preliminary Study on Canines

Gharibani

Yang

et al. 2020

J Neurogastroenterol Motil

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Background/AimsGastroparesis is commonly seen in patients with diabetes and functional dyspepsia with no satisfactory therapies. Dysautonomia is one of the main reasons for the imbalanced motility. We hypothesized that spinal cord stimulation (SCS) is a viable therapy for gastroparesis via the autonomic modulation to improve gastric motility. The aim is to find an optimal method of SCS for treating gastroparesis. MethodsEight healthy-female dogs were implanted with a gastric cannula, a duodenal cannula, 2 multi-electrode spinal leads, and an implantable pulse generator. Gastric motility index (MI) was used to determine the best stimulation location/parameters of SCS. Optimized SCS was used to improve glucagon-induced gastroparesis. ResultsWith fixed parameters, SCS at Thoracic 10 (T10) was found most effective for increasing gastric MI (37.8%, P = 0.013). SCS was optimized with different parameters (pulse width: 0.05-0.6 msec, frequency: 5-500 Hz, motor threshold: 30-90%) on T10. Our findings revealed that 0.5 msec, 20 Hz with 90% motor threshold at T10 were the best parameters in increasing MI. Glucagon significantly delayed gastric emptying, and this inhibitory effect was partially blocked by SCS. Gastric emptying at 120 minutes was 25.6% in the control session and 15.7% in glucagon session (P = 0.007 vs control), while it was 22.9% with SCS session (P = 0.041 vs glucagon). SCS with the optimal parameters was found to maximally enhance vagal activity and inhibit sympathetic activity assessed by the spectral analysis of heart rate variability. ConclusionsSCS with optimized stimulation location and parameters improves gastric motility in healthy-dogs and accelerates gastric emptying impaired by glucagon via enhancing vagal activity. (J Neurogastroenterol Motil 2020;26:147-159)

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Section: Introductionmentioning

confidence: 99%

A Novel Approach in Spinal Cord Stimulation for Enhancing Gastric Motility: A Preliminary Study on Canines

Gharibani

Yang

et al. 2020

J Neurogastroenterol Motil

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“…From most common to least common: Idiopathic (30%‐50%) Diabetes mellitus (25%) Medications (22%) Postsurgical (7%) …”

Section: Introductionmentioning

confidence: 99%

“…One of the proposed mechanisms for GP in adults is macrophage driven loss of, or functional abnormalities in, the interstitial cells of Cajal (ICCs), which can lead to gastric dysmotility . Histological specimens from patients with diabetic and idiopathic GP showed a decrease in the number of ICCs, with remaining ICCs showing injury; an abnormal immune infiltrate containing macrophages; and a variable decrease in nerve fibers on immunohistochemistry and electron microscopy . Whether these same pathophysiologic findings are present in children with GP is unknown.…”

Section: Introductionmentioning

confidence: 99%

Childhood gastroparesis is a unique entity in need of further investigation

Febo‐Rodriguez

Chumpitazi

Shulman

2019

Neurogastroenterology Motil

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Background Despite increasing knowledge regarding gastroparesis (GP) in adults, little is known regarding the incidence, prevalence, and natural history of childhood GP. Exacerbating the knowledge gap in pediatric GP is both the lack of normative data for gastric emptying scintigraphy in children and lack of GP‐specific pediatric reported outcome measures. Purpose The aim of this article was to review the available literature on pediatric GP and identify similarities and differences with studies in adults. We performed a comprehensive search in MEDLINE and Google Scholar from inception to April 2019 for articles published in English using the following combination of keywords: gastroparesis, pediatric gastroparesis, outcomes, metoclopramide, erythromycin, domperidone, cisapride, and gastric neurostimulator. The limited available pediatric data, often retrospective, suggest marked differences between adult and pediatric GP in several aspects including etiology, concomitant co‐morbidities (eg, psychiatric disorders), clinical symptom presentation, diagnostic evaluation, response to therapies, and clinical outcome. Further research in pediatric GP is needed and holds the promise to further elucidate the mechanisms of this disorder in children and lead to pediatric‐focused therapies.

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“…Thus, gastroparesis remains a difficult disorder to treat, with only a few approved pharmacologic agents available to provide symptom control by targeting underlying peripheral or central mechanisms [15]. Additionally, gastroparesis poses a significant burden on the health-care system and greatly impacts the quality of life and well-being of patients afflicted with this disorder [16]. Although the incidence is not well-established [17], there is significant morbidity associated with gastroparesis with a notable increase in prevalence, incidence, and hospitalization rates over the last few decades.…”

Section: Introductionmentioning

confidence: 99%

Status of Brain Imaging in Gastroparesis

Gonzalez

McCallum

2020

Gastrointestinal Disorders

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The pathophysiology of nausea and vomiting in gastroparesis is complicated and multifaceted involving the collaboration of both the peripheral and central nervous systems. Most treatment strategies and studies performed in gastroparesis have focused largely on the peripheral effects of this disease, while our understanding of the central nervous system mechanisms of nausea in this entity is still evolving. The ability to view the brain with different neuroimaging techniques has enabled significant advances in our understanding of the central emetic reflex response. However, not enough studies have been performed to further explore the brain–gut mechanisms involved in nausea and vomiting in patients with gastroparesis. The purpose of this review article is to assess the current status of brain imaging and summarize the theories about our present understanding on the central mechanisms involved in nausea and vomiting (N/V) in patients with gastroparesis. Gaining a better understanding of the complex brain circuits involved in the pathogenesis of gastroparesis will allow for the development of better antiemetic prophylactic and treatment strategies.

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Epidemiology and Pathophysiology of Gastroparesis

Cited by 55 publications

References 66 publications

A Novel Approach in Spinal Cord Stimulation for Enhancing Gastric Motility: A Preliminary Study on Canines

A Novel Approach in Spinal Cord Stimulation for Enhancing Gastric Motility: A Preliminary Study on Canines

Childhood gastroparesis is a unique entity in need of further investigation

Status of Brain Imaging in Gastroparesis

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