Gastric emptying after autologous haemopoietic stem-cell transplantation: a prospective trial

Abstract

Summary:Gastroparesis may be involved in the pathophysiology of prolonged nausea and vomiting after haemopoietic stemcell transplantation (HSCT), but this has not been prospectively investigated. Gastric emptying (GE) was investigated in 20 patients before and 2 months after autologous HSCT. Gastrointestinal symptoms were graded prospectively and oral energy intake was recorded in parallel. Before transplant, all patients were asymptomatic and GE was within the reference range. Post transplant GE was delayed in three patients and three patients reported nausea and/or vomiting. Neither gastrointestinal symptoms nor oral energy intake post transplant discriminated between patients with or without delayed GE. Oral energy intake before transplant was lower (P ¼ 0.05), and there was a greater need for total parenteral nutrition (TPN) among patients who developed gastroparesis post transplant (Po0.05). Delayed GE after HSCT was found to be less common than had been believed from retrospective studies. Gastroparesis may be involved in some cases of prolonged nausea and vomiting after autologous HSCT but alternative explanations should be considered. Symptoms consistent with gastroparesis did not correlate with GE. Patients at risk of developing gastroparesis may be found among those with nutritional difficulties before and during the transplant course.

Better Outcome of Patients Undergoing Enteral Tube Feeding After Myeloablative Conditioning for Allogeneic Stem Cell Transplantation

“…One of the limitations of EN was vomiting, possibly related to the toxicity of conditioning and/or gastroparesis after SCT (23,24). The following moves improved tolerance to EN: 1) deferral of feeding tube insertion until the end of conditioningVideally the day after transplantation but before the onset of mucositisVleading to satisfactory tolerance of the device; 2) use of an NGT rather than a nasojejunal tube because of its ease of installation; and 3) a gradual increase in the infused volume, which may have overcome the gastroparesis effect (16,20).…”

Disposition of Two Oral Formulations of Cyclosporine in Pediatric Patients Receiving Hematopoietic Stem Cell Transplants

“…Alterations in duodenal epithelium have persisted as long as 12 weeks after transplantation. 23 In addition, gastroparesis may be covert in adults receiving HSCT, 24 or the symptoms may be subtle and dismissed or misunderstood. Therefore, gut and pancreatic function may substantially influence cyclosporine absorption and bioavailability and dramatically change over time as these processes improve or worsen.…”

Palliative care in BMT

“…34 Gastroparesis of uncertain etiology may be a primary cause of nausea in BMT. 35 Eagle et al 36 evaluated 151 transplant patients during a 1-year period and found that gastroparesis was a significant cause of persistent nausea in 12% of patients. Factors such as age, conditioning regimen, CMV antigenemia and acute GVHD were not significant; however, receiving allogeneic transplantation was a significant factor.…”