Gastrointestinal symptoms and motility disorders in patients with systemic scleroderma

Ciaula, Agostino Di; Covelli, M.; Berardino, Massimo; Wang, David Q.–H.; Lapadula, Giovanni; Palasciano, Giuseppe; Portincasa, Piero

doi:10.1186/1471-230x-8-7

Cited by 61 publications

(55 citation statements)

References 65 publications

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“…One study has examined the muscular coat of the gastric wall in a case of SSc [17]. In addition, delayed gastric emptying and abnormal postcibal antral motility have been documented [18,19]. Two studies focusing on the same patients analysed morphological features: Type I and III collagen in the lamina propria has been observed to increase towards the lamina muscularis mucosae, which showed features of atrophy with wide areas of focal fibrosis surrounding smooth muscle cells [9].…”

Section: Discussionmentioning

confidence: 99%

“…Only a few studies [9,10,14,15,[17][18][19] have been performed on the stomachs of SSc patients, but there is even less literature concerning their duodenum [19,20]. One study described a significant increase in myoelectrical activity after water instillation in the duodenum and an absence of myoelectrical response after direct hormonal stimulation with secretin or pentagastrin [14,20].…”

Section: Discussionmentioning

confidence: 99%

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Gastrointestinal manifestation of systemic sclerosis—thickening of the upper gastrointestinal wall detected by endoscopic ultrasound is a valid sign

et al. 2009

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Objective. Gastrointestinal (GI) tract involvement has been observed in the majority of patients with SSc. This has been attributed to an accumulation of extracellular matrix within the GI walls. We visualized the walls of the oesophagus, stomach and duodenum with its layers and measured the thickness in SSc patients and control patients utilizing endoscopic ultrasound (EUS).Methods. Twenty-five SSc patients and 25 controls were evaluated. In addition to analysis of clinical symptoms, endoscopy and EUS (20-MHz miniprobe) were performed. The thickness of the complete wall was measured, and the mucosa, submucosa and muscularis were evaluated separately. Conclusions. The EUS revealed a significant thickening of the walls of the upper GI tract in SSc patients. Predominantly, the submucosa and muscularis are enlarged. These results strengthen the hypothesis that increased matrix deposition is an important aspect in the pathogenesis of GI involvement in SSc.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Gastrointestinal manifestation of systemic sclerosis—thickening of the upper gastrointestinal wall detected by endoscopic ultrasound is a valid sign

et al. 2009

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“…Gallbladder, gastric motility and orocecal transit time were studied simultaneously [26][27][28][29][30][31][32][33][34]. Time-dependent changes of fasting and postprandial gallbladder volumes (mL) and antral areas (cm 2 ) were measured from frozen sonograms on a portable scanner (Noblus, Hitachi Medical, Tokyo, Japan) equipped with a 3.5 MHz convex transducer.…”

Section: Gallbladder and Gastric Motilitymentioning

confidence: 99%

“…Factors such as the almond genotype [14,15], the growing region [16,17], the climatic conditions during the growing season [18], the harvest time [19], the storage conditions might influence the chemical J Gastrointestin Liver Dis, March 2018 Vol. 27 No 1: [31][32][33][34][35][36][37][38][39] composition of almonds and their nutraceutical effects. Given the high almond consumption, the Italian production cannot cover the whole domestic demand, and a significant amount of almonds must be imported.…”

Section: Introductionmentioning

confidence: 99%

Distinct Effects of two Almond Cultivars on Agreeability and Gastrointestinal Motility in Healthy Subjects: more than mere Nutraceuticals

Diella

Ciaula

Lorusso

et al. 2018

JGLD

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Background: Almonds are healthy nutraceuticals, which vary across different cultivars. We compared the composition, agreeability and gastrointestinal effects of two almond cultivars from different areas.Methods: Californian Carmel (CAcv) and local Apulian Filippo Cea (FCcv) cultivars were compared for the chemical composition and sensory evaluation according to visual analogue and semiquantitative scales in 60 volunteers. Gallbladder/gastric motility (ultrasonography) and orocecal transit time (H2-breath test) were studied in another 24 subjects by comparing the effects of a standard liquid test meal with isovolumetric almond test meals (24 g of CAcv or FCcv almonds).Results: Proteins prevailed in CAcv, while FCcv contained more lipids and 10-times more total phenol content than CAcv. For agreeability, CAcv scored higher than FCcv for smell, texture and appearance, although different perceptions existed in lean (scores for smell, taste, texture, appearance higher for CAcv than FCcv), obese (CAcv better than FCcv only for appearance) and elderly subjects (CAcv better than FCcv only for texture). Gallbladder emptying was stronger with FCcv than CAcv. Antral dilatation after ingestion of both cultivars was greater than the dilatation observed after the test meal. Gastric emptying, however, was similar after FCcv, CAcv and the test meal. The orocecal transit time in response to both cultivars was shorter than after the test meal.Conclusions: Differences in composition and effects of FCcv and CAcv cultivars support their potential use as valuable nutraceutical tools, to be confirmed in further clinical studies.

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“…Delayed gastric and small bowel emptying (most commonly affecting the duodenum) have been previously documented in scleroderma, occurring in up to 62.5% and 74% of patients, respectively, in one series. 16 Most cases of scleroderma are associated with cutaneous manifestations, in particular skin induration, which was absent in this patient. Systemic sclerosis sine scleroderma remains a possibility given the absence of cutaneous signs and a previous case report has documented megaduodenum in such a patient.…”

Section: Discussionmentioning

confidence: 99%

Gastroparesis in pregnancy: case report and literature review

et al. 2011

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Summary: Gastroparesis is a syndrome characterized by delayed gastric emptying in the absence of mechanical obstruction. The most common underlying aetiology is diabetes mellitus; however, many cases are idiopathic. Pregnancy per se is associated with gastrointestinal neuromuscular dysfunction; however, reports of gastroparesis arising during pregnancy are rare. We report a case of severe gastroparesis and proximal small bowel paresis presenting during pregnancy.Keywords: gastroenterology, high-risk pregnancy CASE REPORTA 24-year-old primigravida, at 10 weeks gestation, presented with nausea, vomiting, colicky right lower quadrant pain and an elevated white cell count. There was no history of fevers. She underwent uncomplicated laparoscopic appendicectomy; however, she was found to have congenital malrotation of the bowel, and the appendix, located in the right upper quadrant, was normal on histology. No cause of the right lower quadrant pain was identified.Post appendicectomy, the patient had ongoing symptoms and developed intractable large volume vomitus, initially containing 'old' food, and absence of bowel motions with minimal flatus. Two weeks later the patient presented to the emergency department with ongoing symptoms and 7 kg weight loss (8.1% of initial body weight, body mass index 31.6). The vital signs showed a blood pressure of 110/70 ( postural drop of 20 mmHg in systolic blood pressure), heart rate 96 beats per minute and temperature 37.18C. On examination the patient appeared unwell with clinical signs of dehydration and right lower quadrant abdominal tenderness with abdominal distension. There were no clinical features consistent with an autonomic or peripheral neuropathy. Laboratory tests were notable for the presence of a marked electrolyte disturbance, acute renal impairment with an elevated urea/ creatinine ratio (in keeping with dehydration) and deranged liver function tests (Table 1). The lipase and lactate were normal.The patient was prescribed antiemetic medication (metoclopramide, prochlorperazine and ondansetron), vitamin supplementation (thiamine and multivitamin), intravenous fluid therapy and kept nil by mouth. With hydration there was resolution of the postural drop, normalization of the renal and electrolyte disturbances, and improvement of the liver function tests. There was little change in symptomatology.An abdominal ultrasound showed a normal gallbladder, pancreas, spleen, kidneys and ureters with diffuse fatty infiltration of the liver (likely secondary to rapid weight loss). On day 8, an upper endoscopy performed showed a dilated stomach with a large amount of fluid residue. No focal abnormality was detected. The first and second parts of the duodenum were grossly dilated with an apparent transition point between segments D2 and D3 with no mucosal abnormality visualized. The distal D3 segment appeared normal. Gastric mucosal biopsy was normal. A diagnostic laparoscopy on day 9 revealed a dilated stomach with inflammatory adhesions at the duodenum, thought to be a point of obs...

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Gastrointestinal symptoms and motility disorders in patients with systemic scleroderma

Abstract: Background: Studies on gastrointestinal symptoms, dysfunctions, and neurological disorders in systemic scleroderma are lacking so far.

Cited by 61 publications

References 65 publications

Gastrointestinal manifestation of systemic sclerosis—thickening of the upper gastrointestinal wall detected by endoscopic ultrasound is a valid sign

Gastrointestinal manifestation of systemic sclerosis—thickening of the upper gastrointestinal wall detected by endoscopic ultrasound is a valid sign

Distinct Effects of two Almond Cultivars on Agreeability and Gastrointestinal Motility in Healthy Subjects: more than mere Nutraceuticals

Gastroparesis in pregnancy: case report and literature review

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