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Borner T, Pataro AM, De Jonghe BC. Central mechanisms of emesis: A role for GDF15. Neurogastroenterol Motil 2025; 37:e14886. [PMID: 39108013 PMCID: PMC11866100 DOI: 10.1111/nmo.14886] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 07/08/2024] [Accepted: 07/24/2024] [Indexed: 02/06/2025]
Abstract
BACKGROUND Nausea and emesis are ubiquitously reported medical conditions and often present as treatment side effects along with polymorbidities contributing to detrimental life-threatening outcomes, such as poor nutrition, lower quality of life, and unfavorable patient prognosis. Growth differentiation factor 15 (GDF15) is a stress response cytokine secreted by a wide variety of cell types in response to a broad range of stressors. Circulating GDF15 levels are elevated in a range of medical conditions characterized by cachexia and malaise. In recent years, GDF15 has gained scientific and translational prominence with the discovery that its receptor, GDNF family receptor α-like (GFRAL), is expressed exclusively in the hindbrain. GFRAL activation may results in profound anorexia and body weight loss, effects which have attracted interest for the pharmacological treatment of obesity. PURPOSE This review highlights compelling emerging evidence indicating that GDF15 causes anorexia through the induction of nausea, emesis, and food aversions, which encourage a perspective on GDF15 system function in physiology and behavior beyond homeostatic energy regulation contexts. This highlights the potential role of GDF15 in the central mediation of nausea and emesis following a variety of physiological, and pathophysiological conditions such as chemotherapy-induced emesis, hyperemesis gravidarum, and cyclic vomiting syndrome.
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Affiliation(s)
- Tito Borner
- Department of Biobehavioral Health Sciences, School of NursingUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of PsychiatryUniversity of Pennsylvania, Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of Biological Sciences, Human and Evolutionary Biology SectionUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Allison M. Pataro
- Department of Biobehavioral Health Sciences, School of NursingUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Bart C. De Jonghe
- Department of Biobehavioral Health Sciences, School of NursingUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of PsychiatryUniversity of Pennsylvania, Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
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Ghosh Situ S, Bhuia MS, Chowdhury R, Al Hasan S, Akber Ansari S, Aamer Ansari I, Ali A, Torequl Islam M. Synergistic Antiemetic Effects of Nerolidol on Domperidone, Hyoscine, and Ondansetron: In Vivo and in Silico Investigations on Receptor Binding Affinity. ChemistryOpen 2025; 14:e202400345. [PMID: 39533458 PMCID: PMC11891455 DOI: 10.1002/open.202400345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2024] [Revised: 10/16/2024] [Indexed: 11/16/2024] Open
Abstract
The present study was designed to measure the potential antiemetic properties of nerolidol (NDL) via in vivo and in silico studies. To induce emesis copper sulfate pentahydrate (CuSO4.5H2O) was administered at a dose of 50 mg/kg (orally) to 2-day-old chicks. The test sample (NDL) was given at two doses of 50 and 100 mg/kg. b.w. orally. Additionally, aprepitant (16 mg/kg), domperidone (6 mg/kg), hyoscine (21 mg/kg), ondansetron (5 mg/kg), and diphenhydramine (10 mg/kg) were given also orally as positive controls. To observe the modulatory effects of the test sample, combination therapies with reference drugs were also administered to three different groups of animals. Molecular docking and visualization of ligand-receptor interaction were performed against several emesis-inducing receptors (5HT3, D2, D3, H1, and M1-M5) using diverse computational tools. Pharmacokinetics and drug-likeness of the selected ligands were also calculated. Findings demonstrated that NDL significantly (p <0.05) dose-dependently lessens the mean number of retches and delays the emetic onset in the chicks. The combined drug therapy with ondansetron exposed better antiemetic activity. In addition, in silico analysis, NDL has greater binding affinity (-7.3 kcal/mol) against M2 and M3 receptors. In conclusion, NDL exerted mild antiemetic activity with synergistic properties through muscarinic receptors.
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Affiliation(s)
- Sharmita Ghosh Situ
- Department of PharmacyBangabandhu Sheikh Mujibur Rahman Science and Technology UniversityGopalganj8100Bangladesh
- Bioinformatics and Drug Innovation LaboratoryBioLuster Research Center Ltd., Gopalganj8100DhakaBangladesh
| | - Md. Shimul Bhuia
- Department of PharmacyBangabandhu Sheikh Mujibur Rahman Science and Technology UniversityGopalganj8100Bangladesh
- Bioinformatics and Drug Innovation LaboratoryBioLuster Research Center Ltd., Gopalganj8100DhakaBangladesh
| | - Raihan Chowdhury
- Department of PharmacyBangabandhu Sheikh Mujibur Rahman Science and Technology UniversityGopalganj8100Bangladesh
- Bioinformatics and Drug Innovation LaboratoryBioLuster Research Center Ltd., Gopalganj8100DhakaBangladesh
| | - Sakib Al Hasan
- Department of PharmacyBangabandhu Sheikh Mujibur Rahman Science and Technology UniversityGopalganj8100Bangladesh
- Bioinformatics and Drug Innovation LaboratoryBioLuster Research Center Ltd., Gopalganj8100DhakaBangladesh
| | - Siddique Akber Ansari
- Department of Pharmaceutical ChemistryCollege of PharmacyKing Saud UniversityRiyadh11451Saudi Arabia
| | - Irfan Aamer Ansari
- Department of Drug Science and TechnologyUniversity of TurinTurin10124Italy
| | - Arman Ali
- Department of PharmacyBangabandhu Sheikh Mujibur Rahman Science and Technology UniversityGopalganj8100Bangladesh
| | - Muhammad Torequl Islam
- Department of PharmacyBangabandhu Sheikh Mujibur Rahman Science and Technology UniversityGopalganj8100Bangladesh
- Bioinformatics and Drug Innovation LaboratoryBioLuster Research Center Ltd., Gopalganj8100DhakaBangladesh
- Pharmacy DisciplineKhulna UniversityKhulnaBangladesh
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Tan J, Wu H, Yang X, Yang Y, Zhang L, Wang P, Shi J, Lu Y, Gao Q, Shi R. A long-term follow-up study of gastric peroral endoscopic myotomy (G-POEM) in a large cohort of patients with postsurgical gastroparesis. Surg Endosc 2024; 38:7416-7425. [PMID: 39448403 PMCID: PMC11614976 DOI: 10.1007/s00464-024-11184-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 08/10/2024] [Indexed: 10/26/2024]
Abstract
INTRODUCTION Postoperative gastroparesis occurs after surgeries which affect the upper digestive tract. Gastric peroral endoscopic myotomy (G-POEM) is a treatment for postoperative gastroparesis. The present study boasts the long-term efficacy and safety of G-POEM in a large cohort of patients. PATIENTS AND METHODS Gastroparesis Cardinal Symptom Index (GCSI) and Gastroesophageal Reflux Disease Questionnaire (GERDQ) were utilized for the assessment of postsurgical gastroparesis symptoms. Gastroscope was used to observe the anastomotic site. Three-dimensional ultrasound was used to measure the morphological structure of the gastric antrum and pylorus tube. Gastric emptying time was calculated by analyzing the volume change of gastric antrum. RESULTS Significant clinical effectiveness of G-POEM was observed. The GCSI score, including each subscale score, showed significant decrease after G-POEM. Before G-POEM, there was a negative correlation between GCSI score and the inner diameter of pylorus, as well as a positive correlation with the length of pyloric tube. The similar results were found in the scores of nausea/vomiting and postprandial fullness/early satiety subscales. No correlation was observed between GCSI score and the emptying time, nor between the emptying time and the parameters of antrum morphology. After G-POEM, no correlation was found between GCSI (including subscales) score, the emptying time, and the parameters of antrum morphology. Patients who exhibited as clinical non-responders often accompanied with GERD symptoms. After G-POEM, the score of GERDQ decreased significantly. Either before or after G-POEM, no correlation was noticed between GERDQ scores, the emptying time and the parameters of antrum morphology. CONCLUSION The technique of G-POEM was demonstrated as a minimally invasive approach with the long-term efficacy and safety in therapying postoperative gastroparesis.
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Affiliation(s)
- Jiacheng Tan
- Department of Gastroenterology, Zhongda Hospital Southeast University, No. 87 Dingjiaqiao, Nanjing, 210009, Jiangsu, China
| | - Hailu Wu
- Department of Gastroenterology, Zhongda Hospital Southeast University, No. 87 Dingjiaqiao, Nanjing, 210009, Jiangsu, China
| | - Xinyi Yang
- Department of Gastroenterology, Zhongda Hospital Southeast University, No. 87 Dingjiaqiao, Nanjing, 210009, Jiangsu, China
| | - Yuling Yang
- Department of Gastroenterology, Zhongda Hospital Southeast University, No. 87 Dingjiaqiao, Nanjing, 210009, Jiangsu, China
| | - Ling Zhang
- Department of Gastroenterology, Zhongda Hospital Southeast University, No. 87 Dingjiaqiao, Nanjing, 210009, Jiangsu, China
| | - Panpan Wang
- Department of Gastroenterology, Zhongda Hospital Southeast University, No. 87 Dingjiaqiao, Nanjing, 210009, Jiangsu, China
| | - Jinjun Shi
- Department of Ultrasound, Zhongda Hospital Southeast University, Nanjing, 210009, Jiangsu, China
| | - Yanjia Lu
- Department of Ultrasound, Zhongda Hospital Southeast University, Nanjing, 210009, Jiangsu, China
| | - Qi Gao
- Department of Ultrasound, Zhongda Hospital Southeast University, Nanjing, 210009, Jiangsu, China
| | - Ruihua Shi
- Department of Gastroenterology, Zhongda Hospital Southeast University, No. 87 Dingjiaqiao, Nanjing, 210009, Jiangsu, China.
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Zhang Z, Yao Y, Zhu L. Assessing real-world safety of plecanatide: a pharmacovigilance study based on the FDA adverse event reporting system. Front Pharmacol 2024; 15:1500810. [PMID: 39654622 PMCID: PMC11625541 DOI: 10.3389/fphar.2024.1500810] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Accepted: 11/14/2024] [Indexed: 12/12/2024] Open
Abstract
Background Plecanatide is a selective gastrointestinal peptide used for the treatment of chronic idiopathic constipation (CIC) and irritable bowel syndrome with constipation (IBS-C). Given its widespread use, understanding the long-term safety of plecanatide in real-world settings is essential. Methods Data for this study were sourced from the United States Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) from the first quarter of 2017 to the second quarter of 2024. Disproportionality analysis methods were employed to quantify adverse event signals associated with plecanatide. Additionally, a Weibull distribution analysis was conducted to assess changes in adverse events over time. Sensitivity analyses were performed to enhance the robustness of the findings. Results A total of 861 cases associated with plecanatide were identified, including 2057 adverse event reports. Common positive adverse events included diarrhea, constipation, abdominal distension, dissatisfaction with treatment, rectal tenesmus, increased fecal volume, abnormal gastrointestinal sounds, and gastrointestinal motility disorders. The majority of adverse events related to plecanatide occurred within the first 7 days of treatment. Findings were consistent across sensitivity analyses. Conclusion This study preliminarily explores the safety of plecanatide in real-world applications, revealing significant new adverse event signals. These findings provide important safety references for clinicians prescribing plecanatide for CIC and IBS-C.
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Affiliation(s)
- Zhiyuan Zhang
- The Second Clinical College of Dalian Medical University, Dalian Medical University, Dalian, Liaoning, China
- The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, Jiangsu, China
| | - Yifan Yao
- The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, Jiangsu, China
| | - Li Zhu
- The Second Clinical College of Dalian Medical University, Dalian Medical University, Dalian, Liaoning, China
- The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, Jiangsu, China
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Mao P, Meng W, Mao T, Li H, Xu X, Jiang X, Yang H. Efficacy of thumbtack needle acupuncture combined with PCIA on patients after laparoscopic myomectomy: a randomized controlled trial. Front Med (Lausanne) 2024; 11:1485211. [PMID: 39629236 PMCID: PMC11611540 DOI: 10.3389/fmed.2024.1485211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Accepted: 10/25/2024] [Indexed: 12/07/2024] Open
Abstract
Background Pain and gastrointestinal dysfunction after laparoscopic myomectomy (LM) are significant issues that prevent this procedure from being classified as a "Day Surgery." This study aims to assess the effectiveness and safety of thumbtack needle acupuncture (TNA) combined with patient-controlled intravenous analgesia (PCIA) for promoting enhanced recovery after LM. Methods A total of 52 patients were enrolled in the study, divided into a treatment group receiving TNA and a control group. Both groups were administered PCIA without background sufentanil. For rescue analgesia or antiemetic needs, a bolus infusion of flurbiprofen axetil (50 mg) or intravenous metoclopramide (10 mg) was provided. The primary outcomes measured were the Visual Analog Scale (VAS) scores at awakening, as well as at 36 h, 48 h, and 60 h after LM. Secondary outcomes included VAS scores at 6 h, 12 h, 24 h, and 72 h after LM, total sufentanil consumption, the number of PCIA analgesic requests (attempts), the number of doses of rescue flurbiprofen axel analgesia required, preoperative anxiety scores, gastrointestinal function recovery assessment, first ambulation time, length of hospital stay, and patient satisfaction. Adverse events were also recorded. Results Compared to the control group, the treatment group showed significantly lower VAS scores, fewer analgesia attempts, reduced total sufentanil consumption, and a smaller number of rescue analgesia doses after LM, along with lower preoperative anxiety scores and higher satisfaction with pain management (p < 0.05). Gastrointestinal function recovery was enhanced in the treatment group, as indicated by earlier flatus and defecation, a lower incidence of postoperative nausea and vomiting (PONV), and a smaller number of metoclopramide doses required (p < 0.05). Additionally, ambulation occurred earlier, and the length of hospital stay was shorter in the treatment group (p < 0.05). No adverse events were observed in patients receiving TNA. Conclusion TNA is a safe intervention that effectively alleviates postoperative pain, decreases the total consumption of sufentanil, reduces preoperative anxiety, enhances the recovery of gastrointestinal function, and shortens the duration of hospitalization, making it an ideal adjunct treatment for postoperative recovery after LM. Further research is required to understand the mechanisms underlying this intervention. Clinical trial registration www.chictr.org.cn, ChiCTR2300069015.
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Affiliation(s)
- Peiyu Mao
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, China
| | - Weijie Meng
- Department of 16# Wards, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, China
| | - Tongxin Mao
- First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Hui Li
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, China
| | - Xuqun Xu
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, China
| | - Xuelu Jiang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, China
| | - Huadi Yang
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, China
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Wang M, Xiang YH, Liu M, Jiang S, Guo JY, Jin XY, Sun HF, Zhang N, Wang ZG, Liu JX. The application prospects of sacha inchi ( Plukenetia volubilis linneo) in rheumatoid arthritis. Front Pharmacol 2024; 15:1481272. [PMID: 39484157 PMCID: PMC11524839 DOI: 10.3389/fphar.2024.1481272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Accepted: 10/04/2024] [Indexed: 11/03/2024] Open
Abstract
Sacha Inchi (Plukenetia volubilis L) (SI) is a traditional natural medicine from tropical rainforests of Amazon region in South America. As a raw material for edible oil, it has various pharmacological effects such as antioxidant, anti-inflammatory, hypolipidemia, and blood pressure lowering, which have attracted increasing attentions of pharmacists. This has prompted researchers to explore its pharmacological effects for potential applications in certain diseases. Among these, the study of its anti-inflammatory effects has become a particularly interesting topic, especially in rheumatoid arthritis (RA). RA is a systemic autoimmune disease, and often accompanied by chronic inflammatory reactions. Despite significant progress in its treatment, there is still an urgent need to find effective anti-RA drugs in regard to safety. This review summarizes the potential therapeutic effects of SI on RA by modulating gut microbiota, targeting inflammatory cells and pathways, and mimicking biologic antibody drugs, predicting the application prospects of SI in RA, and providing references for research aimed at using SI to treat RA.
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Affiliation(s)
- Min Wang
- School of Pharmacy, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
- Sino-Pakistan Center on Traditional Chinese Medicine, School of Pharmaceutical Sciences, School of Basic Medical Sciences, China-Pakistan International Science and Technology Innovation Cooperation Base for Ethnic Medicine Development in Hunan Province, Hunan University of Medicine, Huaihua, Hunan, China
| | - Yin-Hong Xiang
- Sino-Pakistan Center on Traditional Chinese Medicine, School of Pharmaceutical Sciences, School of Basic Medical Sciences, China-Pakistan International Science and Technology Innovation Cooperation Base for Ethnic Medicine Development in Hunan Province, Hunan University of Medicine, Huaihua, Hunan, China
| | - Mei Liu
- Sino-Pakistan Center on Traditional Chinese Medicine, School of Pharmaceutical Sciences, School of Basic Medical Sciences, China-Pakistan International Science and Technology Innovation Cooperation Base for Ethnic Medicine Development in Hunan Province, Hunan University of Medicine, Huaihua, Hunan, China
- School of Pharmaceutical Sciences, University of South China, Hengyang, Hunan, China
| | - Shan Jiang
- School of Pharmacy, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
| | - Jia-ying Guo
- School of Pharmacy, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
| | - Xiao-yan Jin
- School of Pharmaceutical Sciences, Xinjiang medical University, Wulumuqi, Xinjiang, China
| | - Hui-feng Sun
- School of Pharmacy, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
| | - Ning Zhang
- School of Pharmacy, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
- Sino-Pakistan Center on Traditional Chinese Medicine, School of Pharmaceutical Sciences, School of Basic Medical Sciences, China-Pakistan International Science and Technology Innovation Cooperation Base for Ethnic Medicine Development in Hunan Province, Hunan University of Medicine, Huaihua, Hunan, China
| | - Zhi-Gang Wang
- School of Pharmacy, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
| | - Jian-xin Liu
- Sino-Pakistan Center on Traditional Chinese Medicine, School of Pharmaceutical Sciences, School of Basic Medical Sciences, China-Pakistan International Science and Technology Innovation Cooperation Base for Ethnic Medicine Development in Hunan Province, Hunan University of Medicine, Huaihua, Hunan, China
- School of Pharmaceutical Sciences, University of South China, Hengyang, Hunan, China
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Félix-Téllez FA, Velarde-Ruiz Velasco JA, Aldana-Ledesma JM, García-Jiménez ES, Morel-Cerda EC, Flores-Rendón AR, Remes-Troche JM. Chronic nausea and vomiting syndrome and impact on quality of life. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2024:S2255-534X(24)00078-1. [PMID: 39389830 DOI: 10.1016/j.rgmxen.2024.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/12/2024] [Indexed: 10/12/2024]
Abstract
INTRODUCTION AND AIM Chronic nausea and vomiting syndrome is a disorder of gut-brain interaction that affects the productive-age population. Our aim was to determine the association of this disorder with quality of life, workplace performance, and socioeconomic impact related to gastrointestinal health. METHODS A cross-sectional study on a Mexican population was conducted. The patients were classified as having chronic nausea and vomiting syndrome or other disorders of gut-brain interaction. A comparative analysis of quality of life, workplace productivity, annual medical consultations, and digestive health-related expenses was carried out, applying a logistic regression model. RESULTS One thousand patients were included, 79.2% of whom met the criteria for a disorder of gut-brain interaction. Of the 792 patients, 10.3% presented with chronic nausea and vomiting syndrome. Said syndrome was associated with a negative impact on usual activities (OR 4.34, 95% CI 1.90-9.30, p ≤ 0.001), pain/discomfort (OR 2.09, 95% CI 1.31-3.33, p ≤ 0.001), anxiety/depression (OR 2.08, 95% CI 1.30-3.40, p ≤ 0.001), workplace presenteeism (OR 3.96, 95% CI 2.47-6.44, p ≤ 0.001), and workplace absenteeism (OR 2.54, 95% CI 1.52-4.16, p ≤ 0.001). There was also a higher number of annual medical consultations for digestive health (p = 0.013), without generating a greater annual expense due to digestive health (p = 0.08). CONCLUSIONS Chronic nausea and vomiting syndrome produces a negative impact on quality of life, which could be secondary to its symptomatology or its association with anxiety and depression.
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Affiliation(s)
- F A Félix-Téllez
- Servicio de Gastroenterología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
| | - J A Velarde-Ruiz Velasco
- Servicio de Gastroenterología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico; Departamento de clínicas médicas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico.
| | - J M Aldana-Ledesma
- Servicio de Gastroenterología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
| | - E S García-Jiménez
- Servicio de Gastroenterología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
| | - E C Morel-Cerda
- Servicio de Gastroenterología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
| | - A R Flores-Rendón
- Instituto de Seguridad y Servicios Sociales de los Trabajadores del Gobierno y Municipios del Estado de Baja California, Hospital Mexicali, Mexicali, Baja California, Mexico
| | - J M Remes-Troche
- Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico
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Jin B, Han Y, Jiang Y, Zhang J, Shen W, Zhang Y. Acupuncture for nausea and vomiting during pregnancy: A systematic review and meta-analysis. Complement Ther Med 2024; 85:103079. [PMID: 39214380 DOI: 10.1016/j.ctim.2024.103079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 08/21/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Pregnant women commonly experience challenging nausea and vomiting, which significantly affect their general well-being and daily life. Although medication is often used for relief, it may not alleviate symptoms completely, emphasizing the need for complementary therapies. Acupuncture is one of the complementary treatments for nausea and vomiting of pregnancy (NVP). Studying the outcomes of acupuncture for NVP can shed light on this issue and inform treatment guidelines. Therefore, we systematically evaluated the effectiveness and safety of acupuncture in managing NVP, considering the traditional meridian and acupoint theories. METHODS PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang Database, Chinese Science and Technology Periodical Database, ClinicalTrials.gov, and the Chinese Clinical Trial Registry were searched on May 1, 2024. Randomized controlled trials (RCTs) that compared acupuncture for NVP with sham acupuncture, placebo, and Western medicine (WM) or acupuncture plus WM with WM alone were included. The risk of bias was assessed using the Cochrane risk-of-bias tool. A meta-analysis was conducted using RevMan 5.4.1, and the quality of evidence for each outcome was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS Twenty-four RCTs (with 26 publications) involving 2390 women were included. Acupuncture plus WM significantly led to a reduction in Pregnancy-Unique Quantification of Emesis (PUQE) scores and ineffective rates compared with WM alone (PUQE: mean difference [MD] -1.95, 95 % confidence interval [CI] -3.08 to -0.81, P = 0.0008, I2 = 90 %, six studies; ineffective rates: risk ratio [RR] 0.27, 95 % CI 0.19 to 0.39, P < 0.00001, I2 = 7 %, 16 studies). It also resulted in a greater improvement in ketonuria, shorter length of stay, and lower scores on the NVP Quality of Life and Chinese Medicine Syndrome Scale. Acupuncture was superior to WM in terms of reduction in ineffective rates (RR 0.50, 95 % CI 0.30 to 0.81, P = 0.006, I2 = 0 %, five studies). Acupuncture and WM had comparable results in improvement in PUQE scores (MD -0.80, 95 % CI -3.06 to 1.46, P = 0.49, I2 = 89 %, three studies) and ketonuria negative rates. The evidence is not clear regarding the impact of acupuncture on depression and anxiety compared with that of sham acupuncture. The incidence of severe adverse events was not significantly different between acupuncture and WM or sham acupuncture. Evidence certainty ranged from moderate to very low. Of the 24 RCTs, 19 used the Neiguan (PC6) acupoint, 16 used the Zusanli (ST36) acupoint, and 13 used the Zhongwan (CV12) acupoint. CONCLUSION According to the current systematic review and meta-analysis, acupuncture combined with WM may be a more effective treatment for NVP than WM alone. Furthermore, acupuncture may be as effective as WM. PC6, ST36, and CV12 are the most commonly used acupoints. Although more robust and larger studies are required, the current evidence supports the use of acupuncture in NVP treatment, as it has been demonstrated to be safe.
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Affiliation(s)
- Bao Jin
- Department of Obstetrics and Gynecology, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Yanhua Han
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Yue Jiang
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Jiao Zhang
- Department of Acupuncture and Moxibustion, Second Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Wenjuan Shen
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Yuehui Zhang
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China.
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Lacy BE, Cangemi DJ, Accurso JM, Axelrod S, Axelrod L, Navalgund A. A novel pilot study to evaluate the efficacy and safety of a wireless patch system in patients with chronic nausea and vomiting. Neurogastroenterol Motil 2024; 36:e14862. [PMID: 39038110 DOI: 10.1111/nmo.14862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 04/22/2024] [Accepted: 06/28/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Gastric sensorimotor disorders (functional dyspepsia [FD] and gastroparesis [GP]) are prevalent and burdensome. Prolonged ambulatory recording using a wireless patch may provide novel information in these patients. METHODS Consecutive adult patients (age ≥ 18 years) referred for gastric emptying scintigraphy (GES) were eligible for study inclusion. Patients were excluded if they had prior foregut surgery; were taking opioids or other medications known to affect gastric emptying; had a HgbA1C > 10; or were recently hospitalized. Three wireless motility patches were applied to the skin prior to GES. Patients wore the patches for 6 days while recording meals, symptoms, and bowel movements using an iPhone app. KEY RESULTS Twenty-three consecutive adults (87% women; mean age = 43.9 years; mean BMI = 26.7 kg/m2) were enrolled. A gastric histogram revealed three levels of gastric myoelectric activity: weak, moderate, and strong. Patients with delayed gastric emptying at 4 h had weak gastric myoelectrical activity. Patients with nausea and vomiting had strong intestinal activity. Those with FD had weak gastric and intestinal myoelectric activity, and a weak meal response in the stomach, intestine, and colon compared to those with nausea alone or vomiting alone. CONCLUSIONS AND INFERENCES Patients with FD, and those with delayed gastric emptying, had unique gastrointestinal myoelectrical activity patterns. Reduced postprandial pan-intestinal myoelectric activity may explain the symptoms of FD in some patients. Recording gastrointestinal activity over a prolonged period in the outpatient setting has the potential to identify unique pathophysiologic patterns and meal-related activity that distinguishes patients with distinct gastric sensorimotor disease states.
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Affiliation(s)
- Brian E Lacy
- Division of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - David J Cangemi
- Division of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Joseph M Accurso
- Division of Nuclear Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Steve Axelrod
- G-Tech Medical, Inc., Mountain View, California, USA
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10
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Qiu J, Cheng Z, Jiang Z, Gan L, Zhang Z, Xie Z. Immunomodulatory Precision: A Narrative Review Exploring the Critical Role of Immune Checkpoint Inhibitors in Cancer Treatment. Int J Mol Sci 2024; 25:5490. [PMID: 38791528 PMCID: PMC11122264 DOI: 10.3390/ijms25105490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/11/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
An immune checkpoint is a signaling pathway that regulates the recognition of antigens by T-cell receptors (TCRs) during an immune response. These checkpoints play a pivotal role in suppressing excessive immune responses and maintaining immune homeostasis against viral or microbial infections. There are several FDA-approved immune checkpoint inhibitors (ICIs), including ipilimumab, pembrolizumab, and avelumab. These ICIs target cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), programmed cell death protein 1 (PD-1), and programmed death ligand 1 (PD-L1). Furthermore, ongoing efforts are focused on developing new ICIs with emerging potential. In comparison to conventional treatments, ICIs offer the advantages of reduced side effects and durable responses. There is growing interest in the potential of combining different ICIs with chemotherapy, radiation therapy, or targeted therapies. This article comprehensively reviews the classification, mechanism of action, application, and combination strategies of ICIs in various cancers and discusses their current limitations. Our objective is to contribute to the future development of more effective anticancer drugs targeting immune checkpoints.
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Affiliation(s)
- Junyu Qiu
- College of Basic Medical, Nanchang University, Nanchang 330006, China; (J.Q.); (Z.C.); (Z.J.); (L.G.); (Z.Z.)
- Queen Mary School, Medical Department, Nanchang University, Nanchang 330031, China
| | - Zilin Cheng
- College of Basic Medical, Nanchang University, Nanchang 330006, China; (J.Q.); (Z.C.); (Z.J.); (L.G.); (Z.Z.)
- Queen Mary School, Medical Department, Nanchang University, Nanchang 330031, China
| | - Zheng Jiang
- College of Basic Medical, Nanchang University, Nanchang 330006, China; (J.Q.); (Z.C.); (Z.J.); (L.G.); (Z.Z.)
- Queen Mary School, Medical Department, Nanchang University, Nanchang 330031, China
| | - Luhan Gan
- College of Basic Medical, Nanchang University, Nanchang 330006, China; (J.Q.); (Z.C.); (Z.J.); (L.G.); (Z.Z.)
- Huan Kui School, Medical Department, Nanchang University, Nanchang 330031, China
| | - Zixuan Zhang
- College of Basic Medical, Nanchang University, Nanchang 330006, China; (J.Q.); (Z.C.); (Z.J.); (L.G.); (Z.Z.)
- Queen Mary School, Medical Department, Nanchang University, Nanchang 330031, China
| | - Zhenzhen Xie
- College of Basic Medical, Nanchang University, Nanchang 330006, China; (J.Q.); (Z.C.); (Z.J.); (L.G.); (Z.Z.)
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11
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Borner T, De Jonghe BC, Hayes MR. The antiemetic actions of GIP receptor agonism. Am J Physiol Endocrinol Metab 2024; 326:E528-E536. [PMID: 38477667 PMCID: PMC11194054 DOI: 10.1152/ajpendo.00330.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/08/2024] [Accepted: 03/10/2024] [Indexed: 03/14/2024]
Abstract
Nausea and vomiting are primitive aspects of mammalian physiology and behavior that ensure survival. Unfortunately, both are ubiquitously present side effects of drug treatments for many chronic diseases with negative consequences on pharmacotherapy tolerance, quality of life, and prognosis. One of the most critical clinical examples is the profound emesis and nausea that occur in patients undergoing chemotherapy, which continue to be among the most distressing side effects, even with the use of modern antiemetic medications. Similarly, antiobesity/diabetes medications that target the glucagon-like peptide-1 system, despite their remarkable metabolic success, also cause nausea and vomiting in a significant number of patients. These side effects hinder the ability to administer higher dosages for optimal glycemic and weight management and represent the major reasons for treatment discontinuation. Our inability to effectively control these side effects highlights the need to anatomically, molecularly, and functionally characterize novel neural substrates that drive and inhibit nausea and emesis. Here, we discuss clinical and preclinical evidence that highlights the glucose-dependent insulinotropic peptide receptor system as a novel therapeutic central target for the management of nausea and emesis.
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Affiliation(s)
- Tito Borner
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Department of Biological Sciences, Human and Evolutionary Biology Section, University of Southern California, Los Angeles, California, United States
| | - Bart C De Jonghe
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Matthew R Hayes
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
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12
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Chang SY, Jin GH, Sun HB, Yang D, Tang TY. Applications of gastric peroral endoscopic myotomy in the treatment of upper gastrointestinal tract disease. World J Gastrointest Surg 2024; 16:658-669. [PMID: 38577089 PMCID: PMC10989344 DOI: 10.4240/wjgs.v16.i3.658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/15/2024] [Accepted: 02/08/2024] [Indexed: 03/22/2024] Open
Abstract
Gastric peroral endoscopic myotomy (G-POME) is an emerging minimally invasive endoscopic technique involving the establishment of a submucosal tunnel around the pyloric sphincter. In 2013, Khashab et al used G-POME for the first time in the treatment of gastroparesis with enhanced therapeutic efficacy, providing a new direction for the treatment of gastroparesis. With the recent and rapid development of G-POME therapy technology, progress has been made in the treatment of gastroparesis and other upper digestive tract diseases, such as congenital hypertrophic pyloric stenosis and gastric sleeve stricture, with G-POME. This article reviews the research progress and future prospects of G-POME for the treatment of upper digestive tract gastrointestinal diseases.
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Affiliation(s)
- Shi-Yu Chang
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Guo-Hua Jin
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Hai-Bo Sun
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Dong Yang
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Tong-Yu Tang
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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13
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Li Z, Wu J, Song J, Wen Y. Ginger for treating nausea and vomiting: an overview of systematic reviews and meta-analyses. Int J Food Sci Nutr 2024; 75:122-133. [PMID: 38072785 DOI: 10.1080/09637486.2023.2284647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 11/13/2023] [Indexed: 03/28/2024]
Abstract
Ginger may be a potential remedy for nausea and vomiting. This review aimed to assess the reporting and methodological quality, and integrate the evidence in this field. A total of fifteen meta-analyses were analysed and met the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 guidelines, providing a relatively complete statement. However, methodological quality, assessed using the Assessment of Multiple Systematic Reviews-2 checklist, was deemed critically low to low. Our review's findings support ginger's effectiveness in managing chemotherapy-induced nausea and vomiting in cancer patients. It also reduces postoperative nausea and vomiting severity, decreasing the need for rescue antiemetics. Furthermore, ginger shows promise in alleviating pregnancy-related nausea and vomiting symptoms. The pooled evidence suggests ginger as a safe botanical option for managing nausea and vomiting, but it is important to improve the scientific quality of published meta-analyses in the future.
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Affiliation(s)
- Zhongyu Li
- Institute of Digestive Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Chinese Medicine, Eye Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiao Wu
- Department of Oncology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jinjie Song
- Department of Oncology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yandong Wen
- Institute of Digestive Diseases, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Chinese Medicine, Eye Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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14
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Lu H, Zhang Y, Liu P. Identifying new safety risk of human serum albumin: a retrospective study of real-world data. Front Pharmacol 2024; 15:1319900. [PMID: 38292942 PMCID: PMC10825956 DOI: 10.3389/fphar.2024.1319900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/03/2024] [Indexed: 02/01/2024] Open
Abstract
Objective: To mine and analyze the adverse reaction signals of human serum albumin (HSA) using the FDA adverse event reporting system (FAERS) database for the safe clinical use of this drug. Methods: Data cleaning and analysis of adverse event reports in the FAERS database for a total of 76 quarters from Q1 2004 to Q4 2022 were performed using the reporting odds ratio (ROR), Medicines and Healthcare Products Regulatory Agency (MHRA), and Bayesian confidence propagation neural network (BCPNN). Gender-differentiated signal detection was used to investigate the gender differences in the occurrence of HSA adverse events. Results: Through a combination of three methods, a total of 535 adverse event reports were identified. These reports involved 1,885 cases of adverse reactions, with respiratory, thoracic, and mediastinal disorders, as well as general disorders and administration site conditions, as the most common. One noteworthy new signal was the occurrence of transfusion-related acute lung injury. Additionally, gender-differentiated signals were present, with females experiencing paraesthesia, hypertension, pulmonary oedema, loss of consciousness, and vomiting. Conclusion: This study has revealed that HSA poses a risk of causing transfusion-related acute lung injury. It has also been observed that adverse reactions, including paraesthesia, hypertension, pulmonary oedema, loss of consciousness, and vomiting, are more prevalent in females. These findings should be taken into account when using HSA in a clinical setting.
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Affiliation(s)
- Hui Lu
- Shanghai RAAS Blood Products Co., Ltd., Shanghai, China
| | - Yuwei Zhang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Pengcheng Liu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
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15
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Torres G, Sheikh AA, Carpo BG, Sood RA, Mourad M, Leheste JR. Disgust sensitivity and psychopathic behavior: A narrative review. Transl Neurosci 2024; 15:20220358. [PMID: 39669227 PMCID: PMC11635422 DOI: 10.1515/tnsci-2022-0358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 09/22/2024] [Accepted: 09/24/2024] [Indexed: 12/14/2024] Open
Abstract
Humans live under constant threat from pathogenic microorganisms and minimizing such threat has been a major evolutionary selective force in shaping human behavior and health. A particular adaptive mechanism against the harm caused by parasites and their infectiousness is disgust sensitivity, which has evolved to detect and avoid poisonous foods as well as bodily secretions harboring virulent microorganisms. This ubiquitous and reflexive behavior requires the integration of several internal and external sensory signals between the brain, the autonomic nervous system (ANS), and the gastrointestinal tract. Although the emotional expression of disgust is experienced by almost all individuals, the neural mechanisms of sensory signals underlying disgust sensitivity may differ in certain psychiatric conditions. Psychopathy, for instance, is a personality disorder in which disgust sensitivity to contagious bodily secretions is apparently absent or downregulated from its atypical personality temperament. In this review, we provide convergent behavioral, anatomical, and cellular evidence to suggest that a fractured experience of disgust sensitivity might be an additional feature of psychopathic behavior. First, we discuss the neural networks of certain brain regions mediating the emotional states of disgust and then discuss the intersection of the ANS and gastrointestinal tract in the processing of disgust and its relevance to aberrant antisocial behavior. Together, this work highlights the interconnections between the brain and the bilateral body plan as an integrated cell network that is relevant for understanding common principles underlying function and dysfunction of disgust levels in psychiatric domains.
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Affiliation(s)
- German Torres
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine (NYITCOM), Old Westbury, New York, 11568, United States of America
| | - Amina A. Sheikh
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine (NYITCOM), Old Westbury, New York, 11568, United States of America
| | - Beatrice G. Carpo
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine (NYITCOM), Old Westbury, New York, 11568, United States of America
| | - Riya A. Sood
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine (NYITCOM), Old Westbury, New York, 11568, United States of America
| | - Mervat Mourad
- Department of Clinical Specialties, New York Institute of Technology College of Osteopathic Medicine (NYITCOM), Old Westbury, New York, 11568, United States of America
| | - Joerg R. Leheste
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine (NYITCOM), Old Westbury, New York, 11568, United States of America
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16
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Mandarino FV, Vespa E, Barchi A, Fasulo E, Sinagra E, Azzolini F, Danese S. Precision Endoscopy in Peroral Myotomies for Motility Disorders of the Upper Gastrointestinal Tract: Current Insights and Prospective Avenues-A Comprehensive Review. Life (Basel) 2023; 13:2143. [PMID: 38004283 PMCID: PMC10672509 DOI: 10.3390/life13112143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/28/2023] [Accepted: 10/29/2023] [Indexed: 11/26/2023] Open
Abstract
Our review delves into the realm of peroral endoscopic myotomies (POEMs) in the upper gastrointestinal tract (UGT). In recent years, POEMs have brought about a revolution in the treatment of UGT motility disorders. Esophageal POEM, the first to be introduced, has now been validated as the primary treatment for achalasia. Subsequently developed, G-POEM displays promising results in addressing refractory gastroparesis. Over time, multiple endoscopic myotomy techniques have emerged for the treatment of Zenker's diverticulum, including Z-POEM, POES, and hybrid approaches. Despite the well-established efficacy outcomes, new challenges arise in the realm of POEMs in the UGT. For esophageal POEM, the future scenario lies in customizing the myotomy extent to the minimum necessary, while for G-POEM, it involves identifying patients who can optimally benefit from the treatment. For ZD, it is crucial to validate an algorithm that considers various myotomy options according to the diverticulum's size and in relation to individual patients. These challenges align with the concept of precision endoscopy, personalizing the technique for each subject. Within our text, we comprehensively examine each myotomy technique, analyzing indications, outcomes, and adverse events. Additionally, we explore the emerging challenges posed by myotomies within the context of the evolving field of precision endoscopy.
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Affiliation(s)
- Francesco Vito Mandarino
- Department of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, 20132 Milan, Italy
| | - Edoardo Vespa
- Department of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, 20132 Milan, Italy
| | - Alberto Barchi
- Department of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, 20132 Milan, Italy
| | - Ernesto Fasulo
- Department of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, 20132 Milan, Italy
| | - Emanuele Sinagra
- Gastroenterology and Endoscopy Unit, Fondazione Istituto San Raffaele Giglio, 90015 Cefalù, Italy
| | - Francesco Azzolini
- Department of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, 20132 Milan, Italy
| | - Silvio Danese
- Department of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, 20132 Milan, Italy
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17
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Soliman H, Schalla MA, Coffin B, Gourcerol G. Gastric electrical stimulation is safe during pregnancy and delivery: Results from a French cohort. Neurogastroenterol Motil 2023; 35:e14657. [PMID: 37574861 DOI: 10.1111/nmo.14657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/16/2023] [Accepted: 07/21/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Gastric electrical stimulation (GES) is an effective therapy in medically refractory chronic nausea and vomiting. GES is assumed to be a contraindication for pregnancy. We examined the safety of GES during pregnancy and its clinical impact on vomiting symptoms. METHODS A retrospective study was performed in two tertiary centers including all female patients of childbearing age implanted with GES. Patients without pregnancy while on GES were asked about their desire and concerns about pregnancy. Patients who were pregnant while on GES therapy were interviewed about the course of the pregnancy and labor, as well as the health of the children. KEY RESULTS Among 91 patients implanted at childbearing age, 54 patients without pregnancy answered the questionnaire. Nine patients (16.7%) reported a desire for pregnancy and five patients (7.4%) reported worries about the safety of GES during pregnancy. Sixteen pregnancies were reported in 10 patients. All pregnancies ended in a live birth with premature birth in 12 pregnancies (75.0%). No health concern was currently noted in these children. No severe GES-related complications occurred during pregnancy with only pain at the implantation site reported during 3 pregnancies (18.8%). The severity and frequency of nausea and vomiting significantly increased during the first trimester (p = 0.04 and p = 0.005, respectively) and decreased after the delivery, becoming lower than before the pregnancy (p = 0.044 and p = 0.011, respectively). CONCLUSION & INFERENCES Patients are concerned regarding pregnancy while being treated with GES. No serious maternal or fetal complications related to GES were noted in our cohort.
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Affiliation(s)
- Heithem Soliman
- Service d'Hépato-Gastro-Entérologie, Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, DMU ESPRIT-GHU AP-HP-Nord, Colombes, France
- Department of Physiology, Université de Rouen Normandie, INSERM, ADEN UMR1073, "Nutrition, Inflammation and Microbiota-Gut-Brain Axis", CHU Rouen, Rouen, France
| | - Martha A Schalla
- Department of Gynecology and Obstetrics, HELIOS Kliniken GmbH, Rottweil, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Benoît Coffin
- Service d'Hépato-Gastro-Entérologie, Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, DMU ESPRIT-GHU AP-HP-Nord, Colombes, France
- Centre de Recherche sur l'Inflammation, Université Paris Cité, INSERM, Paris, France
| | - Guillaume Gourcerol
- Department of Physiology, Université de Rouen Normandie, INSERM, ADEN UMR1073, "Nutrition, Inflammation and Microbiota-Gut-Brain Axis", CHU Rouen, CIC-CRB 1404, Rouen, France
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18
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Ichkhanian Y, Al-Haddad MA, Jacobs CC, Schlachterman A, Yang J, Canakis A, Kim R, Guerson-Gil A, D'Souza LS, Alsheik E, Ginnebaugh BD, Khashab MA, Zuchelli T, McFarlin K, Piraka C. Gastric peroral endoscopic myotomy for management of refractory gastroparesis in patients with gastric neurostimulator devices: a multicenter retrospective case control study. Gastrointest Endosc 2023; 98:559-566.e1. [PMID: 37121364 DOI: 10.1016/j.gie.2023.04.2079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/28/2023] [Accepted: 04/19/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND AND AIMS Gastric neurostimulation (GNS) and gastric peroral myotomy (G-POEM), therapies for refractory gastroparesis, are associated with suboptimal outcomes. We studied the role of G-POEM as a salvage therapy in patients with refractory symptoms after GNS implantation. METHODS This was a multicenter, retrospective, matched case-control study. Consecutive patients with a GNS device and who underwent G-POEM as a salvage therapy for clinical failure (cases) and patients without GNS implantation and who underwent G-POEM for refractory gastroparesis (control) between October 2018 and August 2021 were included. The primary outcome was clinical success after G-POEM. RESULTS A total of 123 patients (mean age 45.7 ± 14.7 years; 88 female subjects [72%]) underwent G-POEM therapy during the study: 41 cases and 82 controls. Clinical success was achieved in 66% in the case group and 65% in the control group (P = .311), during a median total clinical follow-up time of 11.8 (interquartile range, 2.4-6.3) months. In the case group, the mean Gastroparesis Cardinal Symptom Index score decreased from 2.8 ± 1.8 to 1.5 ± 1.9 (P = .024), and gastric retention at 4 hours improved from 45% ± 25.8% to 16.6% ± 13.1% (P = .06). The mean delta improvement in the subscales of nausea/vomiting (1.3 ± .6 vs .9 ± 1.1, P = .044) and bloating (1.6 ± 1.3 vs 1.2 ± 1.4, P = .041) were significantly higher in cases than in controls. CONCLUSIONS Among patients with refractory symptoms after GNS, G-POEM can be a reasonable salvage therapy to provide further symptomatic relief with evidence of a potential additive effect of both G-POEM and GNS.
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Affiliation(s)
| | - Mohammad A Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA
| | - Chelsea C Jacobs
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA
| | - Alexander Schlachterman
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Juliana Yang
- Division of Gastroenterology and Hepatology, Vanderbilt University, Nashville, Tennessee, USA
| | - Andrew Canakis
- Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, Maryland, USA
| | - Raymond Kim
- Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, Maryland, USA
| | - Arcelia Guerson-Gil
- Division of Gastroenterology and Hepatology, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Lionel S D'Souza
- Division of Gastroenterology and Hepatology, Stony Brook University Hospital, Stony Brook, New York, USA
| | | | | | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland, USA (10)Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | | | - Kellie McFarlin
- Department of Surgery, Henry Ford Hospital, Detroit, Michigan, USA
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da Silva Goncalves dos Santos J, de Farias Meirelles B, de Souza da Costa Brum I, Zanchetta M, Xerem B, Braga L, Haiut M, Lanziani R, Musa TH, Cordovil K. First Clinical Nutrition Outpatient Consultation: A Review of Basic Principles in Nutritional Care of Adults with Hematologic Disease. ScientificWorldJournal 2023; 2023:9303798. [PMID: 37780637 PMCID: PMC10539097 DOI: 10.1155/2023/9303798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/11/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
METHODS A bibliographic survey was carried out between 2020 and 2022 using two databases: PubMed/MEDLINE and Scientific Electronic Library Online (SciELO) and the information source Academic Google, irrespective of language or geography. RESULTS In the first nutrition consultation (FNC), there should be an investigative direction focused on nutritional interventions in the short, medium, and long term. The record in the patient's medical record is relevant for carrying out the consultation, according to the recommendations of the normative councils of medicine and nutrition. The main steps to be followed are the investigation of the presence of food allergies and intolerances; the drugs/nutritional supplements in use; changes in the digestive tract; the presence or absence of picamalacia; and socioeconomic and lifestyle data. In addition, it is necessary to carry out laboratory evaluations, semiological assessment, anthropometric assessment, and assessment of food consumption. In the end, the nutritional approach should be composed of calculation of energy and macronutrient and micronutrient needs, intervention in nutritional status deviations, nutritional guidelines, and nutritional therapeutic planning of return, focusing on adherence to treatment. CONCLUSION The first nutrition consultation may represent investigative steps that help the clinical nutritionist in the management, allowing a longitudinal and specific nutritional therapeutic planning for patients assisted in large reference centers for hematological disease.
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Affiliation(s)
- Julia da Silva Goncalves dos Santos
- Institute of Hematology Arthur Siqueira Cavalcanti (Hemorio), Rio de Janeiro, RJ, Brazil
- Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | | | - Isabela de Souza da Costa Brum
- Institute of Hematology Arthur Siqueira Cavalcanti (Hemorio), Rio de Janeiro, RJ, Brazil
- Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Mariana Zanchetta
- Institute of Hematology Arthur Siqueira Cavalcanti (Hemorio), Rio de Janeiro, RJ, Brazil
| | - Bruna Xerem
- Institute of Hematology Arthur Siqueira Cavalcanti (Hemorio), Rio de Janeiro, RJ, Brazil
| | - Lucas Braga
- Institute of Hematology Arthur Siqueira Cavalcanti (Hemorio), Rio de Janeiro, RJ, Brazil
| | - Marcia Haiut
- Institute of Hematology Arthur Siqueira Cavalcanti (Hemorio), Rio de Janeiro, RJ, Brazil
| | - Renata Lanziani
- Institute of Hematology Arthur Siqueira Cavalcanti (Hemorio), Rio de Janeiro, RJ, Brazil
| | - Taha Hussein Musa
- Biomedical Research Institute, Darfur University College, Nyala, Sudan
| | - Karen Cordovil
- Institute of Hematology Arthur Siqueira Cavalcanti (Hemorio), Rio de Janeiro, RJ, Brazil
- Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
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20
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Borner T, Tinsley IC, Milliken BT, Doebley SA, Najjar NR, Kerwood DJ, De Jonghe BC, Hayes MR, Doyle RP. Creation of a Peptide Antagonist of the GFRAL-RET Receptor Complex for the Treatment of GDF15-Induced Malaise. J Med Chem 2023; 66:11237-11249. [PMID: 37506293 PMCID: PMC10461225 DOI: 10.1021/acs.jmedchem.3c00667] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Indexed: 07/30/2023]
Abstract
Growth differentiation factor 15 (GDF15) is a contributor to nausea, emesis, and anorexia following chemotherapy via binding to the GFRAL-RET receptor complex expressed in hindbrain neurons. Therefore, GDF15-mediated GFRAL-RET signaling is a promising target for improving treatment outcomes for chemotherapy patients. We developed peptide-based antagonists of GFRAL that block GDF15-mediated RET recruitment. Our initial library screen led to five novel peptides. Surface plasmon resonance and flow cytometric analyses of the most efficacious of this group, termed GRASP, revealed its capacity to bind to GFRAL. In vivo studies in rats revealed that GRASP could attenuate GDF15-induced nausea and anorexia resulting from cisplatin. Combined with Ondansetron, GRASP led to an even greater attenuation of the anorectic effects of cisplatin compared to either agent alone. Our results highlight the beneficial effects of GRASP as an agent to combat chemotherapy-induced malaise. GRASP may also be effective in other conditions associated with elevated levels of GDF15.
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Affiliation(s)
- Tito Borner
- Department
of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
- Department
of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Ian C. Tinsley
- Department
of Chemistry, Syracuse University, 111 College Place, Syracuse, New York 13244, United States
| | - Brandon T. Milliken
- Department
of Chemistry, Syracuse University, 111 College Place, Syracuse, New York 13244, United States
| | - Sarah A. Doebley
- Department
of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Nicholas R. Najjar
- Department
of Chemistry, Syracuse University, 111 College Place, Syracuse, New York 13244, United States
| | - Deborah J. Kerwood
- Department
of Chemistry, Syracuse University, 111 College Place, Syracuse, New York 13244, United States
| | - Bart C. De Jonghe
- Department
of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
- Department
of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Matthew R. Hayes
- Department
of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
- Department
of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Robert P. Doyle
- Department
of Chemistry, Syracuse University, 111 College Place, Syracuse, New York 13244, United States
- Departments
of Medicine and Pharmacology, State University
of New York, Upstate Medical University, Syracuse, New York 13245, United States
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21
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Sebaratnam G, Law M, Broadbent E, Gharibans AA, Andrews CN, Daker C, O’Grady G, Calder S, Keane C. It's a helluva journey: a qualitative study of patient and clinician experiences of nausea and vomiting syndromes. Front Psychol 2023; 14:1232871. [PMID: 37637892 PMCID: PMC10457000 DOI: 10.3389/fpsyg.2023.1232871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/17/2023] [Indexed: 08/29/2023] Open
Abstract
Background Chronic gastroduodenal disorders including, chronic nausea and vomiting syndrome, gastroparesis, and functional dyspepsia, are challenging to diagnose and manage. The diagnostic and treatment pathways for these disorders are complex, costly and overlap substantially; however, experiences of this pathway have not been thoroughly investigated. This study therefore aimed to explore clinician and patient perspectives on the current clinical pathway. Methods Semi-structured interviews were conducted between June 2020 and June 2022 with 11 patients with chronic nausea and vomiting syndrome alone (based on Rome IV criteria) and nine gastroenterologists who treat these conditions. Interviews were recorded, transcribed, and thematically analyzed using a reflexive, iterative, inductive approach. Five key patient themes were identified: (1) the impacts of their chronic gastroduodenal symptoms, (2) the complexity of the clinical journey, (3) their interactions with healthcare providers, (4) the need for advocacy, and (5) their experience of treatments. Five key clinician themes were also identified: (1) these conditions were seen as clinically complex, (2) there is an uncertain and variable clinical pathway, (3) the nuance of investigations, (4) these conditions were difficult to therapeutically manage, and (5) there are barriers to developing a therapeutic relationship. Conclusion Findings indicate that both patients and clinicians are dissatisfied with the current clinical care pathways for nausea and vomiting syndromes. Recommendations included the development of more clinically relevant and discriminant tests, standardization of the diagnostic journey, and the adoption of a multidisciplinary approach to diagnosis and treatment.
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Affiliation(s)
| | - Mikaela Law
- Alimetry Ltd., Auckland, New Zealand
- The Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Elizabeth Broadbent
- The Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Armen A. Gharibans
- Alimetry Ltd., Auckland, New Zealand
- The Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Christopher N. Andrews
- Alimetry Ltd., Auckland, New Zealand
- The Division of Gastroenterology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Charlotte Daker
- The Department of Gastroenterology, Waitematā District Health Board, Auckland, New Zealand
| | - Greg O’Grady
- Alimetry Ltd., Auckland, New Zealand
- The Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Stefan Calder
- Alimetry Ltd., Auckland, New Zealand
- The Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Celia Keane
- The Department of Surgery, The University of Auckland, Auckland, New Zealand
- The Department of Surgery, Northland District Health Board, Whangārei, New Zealand
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22
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Borner T, Doebley SA, Furst CD, Pataro AM, Halas JG, Gao X, Choi GK, Ramadan SA, Chow A, De Jonghe BC. Screening study of anti-emetics to improve GDF15-induced malaise and anorexia: Implications for emesis control. Physiol Behav 2023; 267:114229. [PMID: 37164246 PMCID: PMC10883415 DOI: 10.1016/j.physbeh.2023.114229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/05/2023] [Accepted: 05/06/2023] [Indexed: 05/12/2023]
Abstract
Considerable preclinical and clinical attention has focused on the food intake and body weight suppressive effects of growth differentiation factor 15 (GDF15) and its elevated blood levels as a consequence of disease states and disease treatment therapeutics. We have previously reported that exogenous administration of GDF15 induces anorexia through nausea and emesis in multiple species. Importantly, GDF15 signaling as a meditator of chemotherapy-induced anorexia and emesis has recently been demonstrated in both murine and nonhuman primate models. The mechanism, however, by which GDF15 induces malaise and the utility of existing therapeutic targets to counteract its effects remain largely unknown. Using a dose of GDF15 that mimics stimulated levels following chemotherapy administration and reliably induces malaise, we sought to screen anti-emetics that represent distinct pharmacotherapeutic classes hypothesized to reduce GDF15-induced effects in rats. Strikingly, our results showed that none of the tested compounds were effective at preventing GDF15-induced malaise. These results illustrate the complexity of GDF15 signaling mechanism and may have important implications for medical conditions characterized by elevated GDF15 levels and incomplete symptom control, such as chemotherapy-induced nausea and vomiting.
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Affiliation(s)
- Tito Borner
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA 19104, United States; Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, United States.
| | - Sarah A Doebley
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA 19104, United States
| | - C Daniel Furst
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA 19104, United States
| | - Allison M Pataro
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA 19104, United States
| | - Julia G Halas
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA 19104, United States
| | - Xing Gao
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA 19104, United States
| | - Grace K Choi
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA 19104, United States
| | - Sarah A Ramadan
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA 19104, United States
| | - Angela Chow
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA 19104, United States
| | - Bart C De Jonghe
- Department of Biobehavioral Health Sciences, University of Pennsylvania, School of Nursing, Philadelphia, PA 19104, United States; Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, United States
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23
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Borner T, Reiner BC, Crist RC, Furst CD, Doebley SA, Halas JG, Ai M, Samms RJ, De Jonghe BC, Hayes MR. GIP receptor agonism blocks chemotherapy-induced nausea and vomiting. Mol Metab 2023; 73:101743. [PMID: 37245848 PMCID: PMC10326744 DOI: 10.1016/j.molmet.2023.101743] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 05/30/2023] Open
Abstract
OBJECTIVE Nausea and vomiting remain life-threatening obstacles to successful treatment of chronic diseases, despite a cadre of available antiemetic medications. Our inability to effectively control chemotherapy-induced nausea and vomiting (CINV) highlights the need to anatomically, molecularly, and functionally characterize novel neural substrates that block CINV. METHODS Behavioral pharmacology assays of nausea and emesis in 3 different mammalian species were combined with histological and unbiased transcriptomic analyses to investigate the beneficial effects of glucose-dependent insulinotropic polypeptide receptor (GIPR) agonism on CINV. RESULTS Single-nuclei transcriptomics and histological approaches in rats revealed a topographical, molecularly distinct, GABA-ergic neuronal population in the dorsal vagal complex (DVC) that is modulated by chemotherapy but rescued by GIPR agonism. Activation of DVCGIPR neurons substantially decreased behaviors indicative of malaise in cisplatin-treated rats. Strikingly, GIPR agonism blocks cisplatin-induced emesis in both ferrets and shrews. CONCLUSION Our multispecies study defines a peptidergic system that represents a novel therapeutic target for the management of CINV, and potentially other drivers of nausea/emesis.
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Affiliation(s)
- Tito Borner
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Benjamin C Reiner
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Richard C Crist
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - C Daniel Furst
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Sarah A Doebley
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Julia G Halas
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Minrong Ai
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Ricardo J Samms
- Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Bart C De Jonghe
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Matthew R Hayes
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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24
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Nakatani JY, Pomerantz O, Stockinger D, Christe K, Hopkins L, Roberts JA, Reader RJ, Ardeshir A. Early-life behavioral features are associated with chronic emesis in rhesus macaques (Macaca mulatta). Am J Primatol 2023; 85:e23488. [PMID: 36975141 PMCID: PMC10231223 DOI: 10.1002/ajp.23488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/08/2023] [Accepted: 03/11/2023] [Indexed: 03/29/2023]
Abstract
Chronic emesis (CE) is a poorly understood condition in human and nonhuman primates that negatively impacts the quality of life. Early identification of risk factors for the development of CE is likely to improve the ability to manage CE cases successfully and is, therefore, desirable. Using a case-control study, we reviewed the necropsy records of the California National Primate Research Center and identified 24 animals with recorded CE, defined as five or more incidents of emesis in 1 month. A group of 89 healthy rhesus macaques (Macaca mulatta), comparable in age and percent time housed indoors, was similarly identified. Next, we investigated the association between the occurrence of CE during later stages of life after infancy and the behavioral temperament scores attained in infancy, age, sex, birth location, rearing condition, history of self-injurious behavior (SIB), and the number of lifetime sedation events. Our analysis revealed that CE was associated with degrees of temperament constructs obtained in infancy (data was available for n = 113), such as Confidence (odds ratio (OR) = 0.45, 95% CI: 0.18, 1.08, p = 0.07), Gentleness (OR = 0.47, 95% CI: 0.23, 0.96, p = 0.03), Nervousness (OR = 2.04, 95% CI: 0.98, 4.23, p = 0.05), and Vigilance (OR = 0.36, 95% CI: 015, 0.87, p = 0.02), suggesting that CE is linked to behavioral phenomenon measured in early life, long before it becomes a medical concern. Our data suggest that CE was positively correlated with a history of SIB (OR 4.26, 95% CI: 0.98, 18.47, p = 0.04). Accurate prediction of CE can then assist behavioral and colony management professionals in making informed decisions regarding the care of animals at risk of developing CE. Moreover, the novel information we reported here could have valuable implications in human medicine, where gastrointestinal distress is a common complaint affecting a person's quality of life.
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Affiliation(s)
- Jamie Y. Nakatani
- California National Primate Research Center, University of California, Davis, California, USA
| | - Ori Pomerantz
- California National Primate Research Center, University of California, Davis, California, USA
| | - Diane Stockinger
- California National Primate Research Center, University of California, Davis, California, USA
| | - Kari Christe
- California National Primate Research Center, University of California, Davis, California, USA
| | - Lincoln Hopkins
- California National Primate Research Center, University of California, Davis, California, USA
| | - Jeffrey A. Roberts
- California National Primate Research Center, University of California, Davis, California, USA
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Rachel J. Reader
- California National Primate Research Center, University of California, Davis, California, USA
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Amir Ardeshir
- California National Primate Research Center, University of California, Davis, California, USA
- Tulane National Primate Research Center, Tulane University, Covington, Louisiana, USA
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25
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Khashab MA, Wang AY, Cai Q. AGA Clinical Practice Update on Gastric Peroral Endoscopic Myotomy for Gastroparesis: Commentary. Gastroenterology 2023; 164:1329-1335.e1. [PMID: 37086247 DOI: 10.1053/j.gastro.2023.02.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 02/11/2023] [Accepted: 02/18/2023] [Indexed: 04/23/2023]
Abstract
DESCRIPTION The purpose of this American Gastroenterological Association (AGA) Institute Clinical Practice Update (CPU) is to review the available evidence and provide expert advice regarding cognitive, procedural, and post-procedural aspects of performing gastric peroral endoscopic myotomy for the treatment of refractory gastroparesis. METHODS This CPU was commissioned and approved by the AGA Institute Clinical Practice Updates Committee (CPUC) and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership and underwent internal peer review by the CPUC and external peer review through standard procedures of Gastroenterology. This expert commentary incorporates important as well as recently published studies in this field, and it reflects the experiences of the authors who are advanced endoscopists with expertise in treating patients by performing third-space endoscopy and gastric peroral endoscopic myotomy.
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Affiliation(s)
- Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Andrew Y Wang
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia.
| | - Qiang Cai
- Division of Gastroenterology and Hepatology, Louisiana State University Health Sciences at Shreveport, Shreveport, Louisiana
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26
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Roberts C, Hussein M, Poole E, Kolimarala V, Erlewyn-Lajeunesse M, Beattie RM, Sundrum F, Afzal N. Factors Affecting Delayed Gastric Emptying and Long-Term Outcomes of Children With Gastric Emptying. J Pediatr Gastroenterol Nutr 2023; 76:428-433. [PMID: 36727898 DOI: 10.1097/mpg.0000000000003708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Our study attempted to identify what factors best predict for delayed gastric emptying (DGE) and whether children respond to treatment. METHODS Children aged between 0 and 18 were included who had a gastric emptying scintigraphy (GES) study performed between 2009 and 2018. Baseline clinical details were recorded from clinic visit records regarding symptoms, medication, and past medical history. Results were analyzed using multivariate regression analysis and coefficient analysis. Children were followed up at 2 years to assess their symptoms and medication usage. RESULTS Two hundred and eighty-five children were included in the study of which 174 demonstrated DGE. All children had symptoms prior to GES, the most common symptom being that of vomiting and reflux symptoms which were present in over 90% of patients; other common symptoms like abdominal pain and nausea were seen commonly in around 30%. A genetic disorder and prior surgery were more common in children with DGE but there was no difference in presenting symptoms between normal and DGE groups. Regression analysis showed prior surgery and particularly prior abdominal surgery predicted for DGE and additionally predicted for those with highly DGE. Improvement in symptoms and reduction in medication usage was seen after 2 years. CONCLUSIONS This study provides one of the largest data sets looking at DGE in children. Prior surgery was found to be a key factor in predicting for highly DGE. Symptoms and medication usage did significantly reduce substantially after 2 years.
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Affiliation(s)
- Christopher Roberts
- From the Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Maryam Hussein
- From the Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
- University of Southampton, Southampton, UK
| | - Esme Poole
- From the Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
- University of Southampton, Southampton, UK
| | - Vinod Kolimarala
- From the Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | | | - R Mark Beattie
- From the Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Francis Sundrum
- the Department of Nuclear Medicine, University Hospital Southampton, Southampton, UK
| | - Nadeem Afzal
- From the Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
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27
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An H, Liu YC. Gastroparesis after video-assisted thoracic surgery: A case report. World J Clin Cases 2023; 11:1862-1868. [PMID: 36969994 PMCID: PMC10037284 DOI: 10.12998/wjcc.v11.i8.1862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 01/19/2023] [Accepted: 02/21/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Video-assisted thoracic surgery (VATS) lobectomy is a common treatment for patients with early-stage lung cancer. Some patients can experience slight gastrointestinal discomfort after lobectomy for a moment. Gastroparesis is a gastrointestinal disorder that can be severe; it is associated with an increased risk of aspiration pneumonia and impaired postoperative recovery. Here, we report a rare case of gastroparesis after VATS lobectomy.
CASE SUMMARY A 61-year-old man underwent VATS right lower lobectomy uneventfully but had an obstruction of the upper digestive tract 2 d after surgery. Acute gastroparesis was diagnosed after emergency computed tomography and oral iohexol X-ray imaging. After gastrointestinal decompression and administration of prokinetic drugs, the patient’s gastrointestinal symptoms improved. Since perioperative medication was applied according to the recommended dose and there was no evidence of electrolyte imbalance, intraoperative periesophageal vagal nerve injury was the most likely underlying cause of gastroparesis.
CONCLUSION Although gastroparesis is a rare perioperative complication following VATS, clinicians should be on the alert when patients complain about gastrointestinal discomfort. When surgeons resect paraesophageal lymph nodes with electrocautery, excessive ambient heat and compression of paraesophageal hematoma might induce vagal nerve dysfunction.
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Affiliation(s)
- Hang An
- Department of General Surgery, Peking University First Hospital, Beijing 100034, China
| | - Yu-Cun Liu
- Department of General Surgery, Peking University First Hospital, Beijing 100034, China
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28
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Gastroparesis: An Evidence-Based Review for the Bariatric and Foregut Surgeon. Surg Obes Relat Dis 2023; 19:403-420. [PMID: 37080885 DOI: 10.1016/j.soard.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023]
Abstract
Gastroparesis is a gastric motility disorder characterized by delayed gastric emptying. It is a rare disease and difficult to treat effectively; management is a dilemma for gastroenterologists and surgeons alike. We conducted a systematic review of the literature to evaluate current diagnostic tools as well as treatment options. We describe key elements in the pathophysiology of the disease, in addition to current evidence on treatment alternatives, including nutritional considerations, medical and surgical options, and related outcomes.
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29
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Manzotti C, Castellani M, Murgo A, Basilisco G. Duodenojejunal inflammation causing chronic vomiting in adult-onset Still's disease. BMJ Case Rep 2023; 16:16/2/e252345. [PMID: 36759043 PMCID: PMC9923262 DOI: 10.1136/bcr-2022-252345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Adult-onset Still's disease (AOSD) is a rare systemic autoinflammatory disease with a broad spectrum of clinical manifestations including fever, skin rash, arthralgia and neutrophilic leucocytosis. Small bowel inflammation in AOSD has been reported in association with Crohn's disease, coeliac disease and chronic intestinal pseudo-obstruction. We have here reported the first-time case of AOSD with small bowel involvement, presenting with chronic vomiting. Fluorodeoxyglucose total-body positron emission tomography/CT showed high uptake of the duodenum and first jejunal loop. Faecal calprotectin increased. Duodenal histology revealed neutrophilic infiltrate among duodenal enterocytes and severe chronic lymphoplasmacellular infiltrate of the lamina propria. Vomiting disappeared when duodenojejunal inflammation was controlled by immunomodulatory treatments for AOSD, suggesting a possible causal relation between duodenojejunal inflammation and the symptom.
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Affiliation(s)
- Cristina Manzotti
- Dipartimento di Fisiopatologia Medico-chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Massimo Castellani
- Medicina Nucleare, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonella Murgo
- Divisione di Reumatologia Clinica, ASST Gaetano Pini, Milan, Italy
| | - Guido Basilisco
- Gastroenterologia ed Endoscopia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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30
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Zhang Y, Wilkins JM, Bessette LG, York C, Wong V, Lin KJ. Antipsychotic Medication Use Among Older Adults Following Infection-Related Hospitalization. JAMA Netw Open 2023; 6:e230063. [PMID: 36800180 PMCID: PMC9938426 DOI: 10.1001/jamanetworkopen.2023.0063] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/03/2023] [Indexed: 02/18/2023] Open
Abstract
Importance There are limited data on discontinuation rates of antipsychotic medications (APMs) used to treat delirium due to acute hospitalization in the routine care of older adults. Objective To investigate discontinuation rates and patient characteristics of APMs used to treat delirium following infection-related hospitalization among older US adults. Design, Setting, and Participants This retrospective cohort study was conducted using US claims data (Optum's deidentified Clinformatics Data Mart database) for January 1, 2004, to May 31, 2022. Patients were aged 65 years or older without prior psychiatric disorders and had newly initiated an APM prescription within 30 days of an infection-related hospitalization. Statistical analysis was performed on December 15, 2022. Exposures New use (no prior use any time before cohort entry) of oral haloperidol and atypical APMs (aripiprazole, olanzapine, quetiapine, risperidone, etc). Main Outcomes and Measures The primary outcome was APM discontinuation, defined as a gap of more than 15 days following the end of an APM dispensing. Survival analyses and Kaplan-Meier analyses were used. Results Our study population included 5835 patients. Of these individuals, 790 (13.5%) were new haloperidol users (mean [SD] age, 81.5 [6.7] years; 422 women [53.4%]) and 5045 (86.5%) were new atypical APM users (mean [SD] age, 79.8 [7.0] years; 2636 women [52.2%]). The cumulative incidence of discontinuation by 30 days after initiation was 11.4% (95% CI, 10.4%-12.3%) among atypical APM users and 52.1% (95% CI, 48.2%-55.7%) among haloperidol users (P < .001 for difference between haloperidol vs atypical APMs). We observed an increasing trend in discontinuation rates from 2004 to 2022 (5% increase [95% CI, 3%-7%] per year) for haloperidol users (adjusted hazard ratio, 1.05 [1.03-1.07]; P < .001) but not for atypical APM users (1.00 [0.99-1.01]; P = .67). Prolonged hospitalization and dementia were inversely associated with the discontinuation of haloperidol and atypical APMs. Conclusions and Relevance The findings of this cohort study suggest that the discontinuation rate of newly initiated APMs for delirium following infection-related hospitalization was lower in atypical APM users than in haloperidol users, with prolonged hospitalization and dementia as major associated variables. The discontinuation rate was substantially higher in recent years for haloperidol but not for atypical APMs.
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Affiliation(s)
- Yichi Zhang
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - James M. Wilkins
- Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lily Gui Bessette
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cassandra York
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Vincent Wong
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kueiyu Joshua Lin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
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Chen L, He W, Liu X, Lv F, Li Y. Application of opioid-free general anesthesia for gynecological laparoscopic surgery under ERAS protocol: a non-inferiority randomized controlled trial. BMC Anesthesiol 2023; 23:34. [PMID: 36707777 PMCID: PMC9881250 DOI: 10.1186/s12871-023-01994-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/25/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) is now widely used in various surgical fields including gynecological laparoscopic surgery, but the advantages of opioid-free anesthesia (OFA) in gynecological laparoscopic surgery under ERAS protocol are inexact. AIMS This study aims to assess the effectiveness and feasibility of OFA technique versus traditional opioid-based anesthesia (OA) technique in gynecological laparoscopic surgery under ERAS. METHODS Adult female patients aged 18 ~ 65 years old undergoing gynecological laparoscopic surgery were randomly divided into OFA group (Group OFA, n = 39) with esketamine and dexmedetomidine or OA group (Group OA, n = 38) with sufentanil and remifentanil. All patients adopted ERAS protocol. The primary outcome was the area under the curve (AUC) of Visual Analogue Scale (VAS) scores (AUCVAS) postoperatively. Secondary outcomes included intraoperative hemodynamic variables, awakening and orientation recovery times, number of postoperative rescue analgesia required, incidence of postoperative nausea and vomiting (PONV) and Pittsburgh Sleep Quality Index (PSQI) perioperatively. RESULTS AUCVAS was (Group OFA, 16.72 ± 2.50) vs (Group OA, 15.99 ± 2.72) (p = 0.223). No difference was found in the number of rescue analgesia required (p = 0.352). There were no between-group differences in mean arterial pressure (MAP) and heart rate (HR) (p = 0.211 and 0.659, respectively) except MAP at time of surgical incision immediately [(Group OFA, 84.38 ± 11.08) vs. (Group OA, 79.00 ± 8.92), p = 0.022]. Times of awakening and orientation recovery in group OFA (14.54 ± 4.22 and 20.69 ± 4.92, respectively) were both longer than which in group OA (12.63 ± 3.59 and 18.45 ± 4.08, respectively) (p = 0.036 and 0.033, respectively). The incidence of PONV in group OFA (10.1%) was lower than that in group OA (28.9%) significantly (p = 0.027). The postoperative PSQI was lower than the preoperative one in group OFA (p = 0.013). CONCLUSION In gynecological laparoscopic surgery under ERAS protocol, OFA technique is non-inferior to OA technique in analgesic effect and intraoperative anesthesia stability. Although awakening and orientation recovery times were prolonged compared to OA, OFA had lower incidence of PONV and improved postoperative sleep quality. TRIAL REGISTRATION ChiCTR2100052761, 05/11/2021.
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Affiliation(s)
- Liang Chen
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
- Department of Anesthesiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Wensheng He
- Department of Anesthesiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Xue Liu
- Department of Anesthesiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Fahui Lv
- Department of Obstetrics and Gynaecology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Yuanhai Li
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China.
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Murphey CP, Shulgach JA, Amin PR, Douglas NK, Bielanin JP, Sampson JT, Horn CC, Yates BJ. Physiological changes associated with copper sulfate-induced nausea and retching in felines. Front Physiol 2023; 14:1077207. [PMID: 36744037 PMCID: PMC9892644 DOI: 10.3389/fphys.2023.1077207] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
Nausea is a common disease symptom, yet there is no consensus regarding its physiological markers. In contrast, the process of vomiting is well documented as sequential muscular contractions of the diaphragm and abdominal muscles and esophageal shortening. Nausea, like other self-reported perceptions, is difficult to distinguish in preclinical models, but based on human experience emesis is usually preceded by nausea. Here we focused on measuring gastrointestinal and cardiorespiratory changes prior to emesis to provide additional insights into markers for nausea. Felines were instrumented to chronically record heart rate, respiration, and electromyographic (EMG) activity from the stomach and duodenum before and after intragastric delivery of saline or copper sulfate (CuSO4, from 83 to 322 mg). CuSO4 is a prototypical emetic test agent that triggers vomiting primarily by action on GI vagal afferent fibers when administered intragastrically. CuSO4 infusion elicited a significant increase in heart rate, decrease in respiratory rate, and a disruption of gastric and intestinal EMG activity several minutes prior to emesis. The change in EMG activity was most consistent in the duodenum. Administration of the same volume of saline did not induce these effects. Increasing the dose of CuSO4 did not alter the physiologic changes induced by the treatment. It is postulated that the intestinal EMG activity was related to the retrograde movement of chyme from the intestine to the stomach demonstrated to occur prior to emesis by other investigators. These findings suggest that monitoring of intestinal EMG activity, perhaps in combination with heart rate, may provide the best indicator of the onset of nausea following treatments and in disease conditions, including GI disease, associated with emesis.
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Affiliation(s)
- Charles P. Murphey
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jonathan A. Shulgach
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Mechanical Engineering Department, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Pooja R. Amin
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Nerone K. Douglas
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - John P. Bielanin
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Jacob T. Sampson
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Charles C. Horn
- UPMC Hillman Cancer Center, Pittsburgh, PA, United States
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Bill J. Yates
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA, United States
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Zhang J, He Q, Mao D, Wang C, Huang L, Wang M, Zhang J. Efficacy and adverse reaction management of oncolytic viral intervention combined with chemotherapy in patients with liver metastasis of gastrointestinal malignancy. Front Oncol 2023; 13:1159802. [PMID: 37197423 PMCID: PMC10183573 DOI: 10.3389/fonc.2023.1159802] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/17/2023] [Indexed: 05/19/2023] Open
Abstract
Background The liver is a key target organ for colorectal and gastric cancer metastasis. One of the challenges in the treatment of colorectal and gastric cancers is the management of liver metastasis. This study aimed to investigate the efficacy, adverse effects, and coping strategies of oncolytic virus injection in patients with liver metastases of gastrointestinal malignancies. Methods We prospectively analyzed patients treated at Ruijin Hospital affiliated with Shanghai Jiao Tong University School of Medicine from June 2021 to October 2022. 47 patients with gastrointestinal cancer liver metastasis were included in the study. The data, including clinical manifestations, imaging, tumor markers, postoperative adverse reactions, psychological intervention, dietary guidance, and adverse reaction management were evaluated. Results Oncolytic virus injection was successful in all patients, and no drug injection-related deaths occurred. The adverse effects, such as fever, pain, bone marrow suppression, nausea, and vomiting, were mild and resolved subsequently. Based on the comprehensive intervention of nursing procedures, the postoperative adverse reactions of patients were effectively alleviated and treated. None of the 47 patients had any puncture point infections, and the pain caused by the invasive operation was relieved quickly. After 2 courses of oncolytic virus injection, postoperative liver MRI showed 5 partial remissions, 30 stable diseases, and 12 progressive diseases in target organs. Conclusion Interventions based on nursing procedures can ensure the smooth treatment of recombinant human adenovirus type 5 in patients with liver metastases of gastrointestinal malignant tumors. This is of great importance for clinical treatment and significantly reduces patient complications and improves the patient's quality of life.
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Affiliation(s)
- Jie Zhang
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qianyun He
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dongliang Mao
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Wang
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Huang
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Medical Center on Aging of Ruijin Hospital (MCARJH), Shanghai Jiao Tong University, School of Medicine, Shanghai, China
- *Correspondence: Mei Wang, ; Lei Huang,
| | - Mei Wang
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Mei Wang, ; Lei Huang,
| | - Jun Zhang
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Wise JL, Ingrosso MR, Ianiro G, Black CJ, Ford AC, Lacy BE. Response and Adverse Event Rates With Placebo in Gastroparesis: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2022; 21:1447-1461. [PMID: 36270614 DOI: 10.1016/j.cgh.2022.09.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Multiple drugs have been used to treat gastroparesis symptoms, yet their therapeutic benefits are poorly understood partly due to lack of insight into response and adverse event rates with placebo in randomized controlled trials (RCTs). We evaluated these issues systematically in drug trials for gastroparesis. METHODS We searched the medical literature through August 2, 2022 to identify RCTs comparing active drug with placebo in patients with gastroparesis. We assessed placebo response rates according to at least one of the following endpoints: improvement according to a composite outcome, nausea, vomiting, abdominal pain, bloating, or fullness, as well as total adverse events, and adverse events leading to withdrawal. We extracted data as intention-to-treat analyses with dropouts assumed to be treatment failures. We pooled placebo response and adverse event rates using a random effects model and expressed as proportions with 95% confidence intervals (CIs). RESULTS Thirty-five studies were eligible. Among 23 trials reporting a composite endpoint of improvement, the pooled placebo response rate was 29.3% (95% CI, 23.7%-35.2%). Pooled placebo response rates were higher in idiopathic compared with diabetic gastroparesis (34.2% vs 28.1%), among trials that did not use validated symptom questionnaires (31.2% vs 27.4%), and in RCTs of shorter duration (<4 weeks, 32.6% vs ≥9 weeks, 23.2%). Adverse events occurred in 33.8% (95% CI, 26.4%-41.8%) of patients with placebo, in 27 trials, and were less common in idiopathic compared with diabetic gastroparesis (17.9% vs 43.4%), trials of shorter duration (<4 weeks, 33.7% vs ≥9 weeks, 40.7%), and trials with lower randomization ratios of active drug to placebo (1:1, 26.7% vs 3:1, 50.5%). CONCLUSIONS This meta-analysis assessed placebo response and adverse event rates in gastroparesis. To accurately assess therapeutic gain, future trials should be a minimum of 8 weeks duration, use validated questionnaires, and distinguish gastroparesis subtypes.
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Affiliation(s)
- Journey L Wise
- Graduate Research Education Program, Mayo Clinic, Rochester, Minnesota.
| | - Maria Rosa Ingrosso
- Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianluca Ianiro
- Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Christopher J Black
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, United Kingdom; Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, United Kingdom
| | - Alexander C Ford
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, United Kingdom; Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, United Kingdom
| | - Brian E Lacy
- Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
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Sebaratnam G, Karulkar N, Calder S, Woodhead JS, Keane C, Carson DA, Varghese C, Du P, Waite SJ, Tack J, Andrews CN, Broadbent E, Gharibans AA, O’Grady G. Standardized system and App for continuous patient symptom logging in gastroduodenal disorders: Design, implementation, and validation. Neurogastroenterol Motil 2022; 34:e14331. [PMID: 35156270 PMCID: PMC9541247 DOI: 10.1111/nmo.14331] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/09/2022] [Accepted: 01/22/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Functional gastroduodenal disorders include functional dyspepsia, chronic nausea and vomiting syndromes, and gastroparesis. These disorders are common, but their overlapping symptomatology poses challenges to diagnosis, research, and therapy. This study aimed to introduce and validate a standardized patient symptom-logging system and App to aid in the accurate reporting of gastroduodenal symptoms for clinical and research applications. METHODS The system was implemented in an iOS App including pictographic symptom illustrations, and two validation studies were conducted. To assess convergent and concurrent validity, a diverse cohort with chronic gastroduodenal symptoms undertook App-based symptom logging for 4 h after a test meal. Individual and total post-prandial symptom scores were averaged and correlated against two previously validated instruments: PAGI-SYM (for convergent validity) and PAGI-QOL (for concurrent validity). To assess face and content validity, semi-structured qualitative interviews were conducted with patients. KEY RESULTS App-based symptom reporting demonstrated robust convergent validity with PAGI-SYM measures of nausea (rS =0.68), early satiation (rS =0.55), bloating (rS =0.48), heartburn (rS =0.47), upper gut pain (rS =0.40), and excessive fullness (rS =0.40); all p < 0.001 (n = 79). The total App-reported Gastric Symptom Burden Score correlated positively with PAGI-SYM (rS =0.56; convergent validity; p < 0.001), and negatively with PAGI-QOL (rS = -0.34; concurrent validity; p = 0.002). Interviews demonstrated that the pictograms had adequate face and content validity. CONCLUSIONS AND INFERENCES The continuous patient symptom-logging App demonstrated robust convergent, concurrent, face, and content validity when used within a 4-h post-prandial test protocol. The App will enable standardized symptom reporting and is anticipated to provide utility in both research and clinical practice.
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Affiliation(s)
| | | | - Stefan Calder
- The University of AucklandAucklandNew Zealand,Alimetry LtdAucklandNew Zealand
| | - Jonathan S.T. Woodhead
- Alimetry LtdAucklandNew Zealand,Maurice Wilkins Centre for Molecular BiodiscoveryAucklandNew Zealand
| | - Celia Keane
- The University of AucklandAucklandNew Zealand,Alimetry LtdAucklandNew Zealand
| | | | | | - Peng Du
- The University of AucklandAucklandNew Zealand,Alimetry LtdAucklandNew Zealand
| | | | - Jan Tack
- Department of GastroenterologyUniversity HospitalsLeuvenBelgium
| | - Christopher N. Andrews
- Alimetry LtdAucklandNew Zealand,Division of GastroenterologyCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | | | - Armen A. Gharibans
- The University of AucklandAucklandNew Zealand,Alimetry LtdAucklandNew Zealand
| | - Greg O’Grady
- The University of AucklandAucklandNew Zealand,Alimetry LtdAucklandNew Zealand
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Niriella MA, Jayasena H, Withanage M, Devanarayana NM, De Silva AP. Chronic nausea and vomiting: a diagnostic approach. Expert Rev Gastroenterol Hepatol 2022; 16:311-320. [PMID: 35303783 DOI: 10.1080/17474124.2022.2056016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 03/17/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Chronic nausea and vomiting (CNV) are commonly encountered symptoms in medical practice. CNV is the presenting symptom in a variety of gastrointestinal and non-gastrointestinal disorders. However, in a significant percentage of patients without an obvious underlying cause, CNV poses a significant diagnostic challenge to the evaluating physician. AREAS COVERED A comprehensive clinical history and physical examination form the foundation for further diagnostic work-up. In the present review, we discuss the diagnostic approach to CNV, highlighting the epidemiology, pathophysiology, causes, and modes of evaluation of this condition. Specific investigations, carefully guided by clinical assessment and tailored for each patient, would be more beneficial in diagnosing CNV than empirically performing a blanket of investigations. EXPERT OPINION Whilst CNV remains a historically challenging diagnostic and therapeutic dilemma, research into this topic is limited. Hence, there is a growing call for more research into diagnostic modalities for CNV. With scientific advancement and further research, it is hoped that easy-to-use, cheap, noninvasive novel diagnostic modalities for CNV will be available soon.
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Affiliation(s)
- Madunil A Niriella
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
- University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
| | - Hiruni Jayasena
- Department of Clinical Medicine, Faculty of Medicine, General Sir John Kotelawala Defence University, Rathmalana, Sri Lanka
| | - Maduri Withanage
- Gastroenterology Unit, Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Niranga M Devanarayana
- Department of Physiology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Arjuna P De Silva
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
- University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka
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Abstract
Establishing the cause of vomiting can be challenging in 10% of patients. In such situations, the clinicians need to consider non-gastrointestinal causes including metabolic and endocrine disorders. Clinical and laboratory clues may prompt further relevant tests that will lead to the correct diagnosis. We discuss three such patients with chronic vomiting.
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AGA Clinical Practice Update on Management of Medically Refractory Gastroparesis: Expert Review. Clin Gastroenterol Hepatol 2022; 20:491-500. [PMID: 34757197 DOI: 10.1016/j.cgh.2021.10.038] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 10/19/2021] [Accepted: 10/24/2021] [Indexed: 02/07/2023]
Abstract
DESCRIPTION Delayed gastric emptying on objective testing defines gastroparesis, but symptoms overlap with functional dyspepsia and do not correlate well with gastric emptying delay. This review outlines a strategy for defining, diagnosing, and managing refractory gastroparesis. METHODS The Best Practice Advice statements presented here were developed from review of existing literature combined with expert opinion to provide practical advice. Because this was not a systematic review, formal rating of the quality of evidence or strength of recommendations was not performed. BEST PRACTICE ADVICE.
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Soliman H, Mariano G, Duboc H, Giovinazzo D, Coffin B, Gourcerol G, Moszkowicz D. Gastric motility disorders and their endoscopic and surgical treatments other than bariatric surgery. J Visc Surg 2022; 159:S8-S15. [DOI: 10.1016/j.jviscsurg.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Verga MC, Mazza S, Azzolini F, Cereatti F, Conti CB, Drago A, Soro S, Elvo B, Grassia R. Gastric per-oral endoscopic myotomy: Indications, technique, results and comparison with surgical approach. World J Gastrointest Surg 2022; 14:12-23. [PMID: 35126859 PMCID: PMC8790331 DOI: 10.4240/wjgs.v14.i1.12] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/20/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
Gastroparesis is a chronic disease of the stomach that causes a delayed gastric emptying, without the presence of a stenosis. For 30 years the authors identified pylorospasm as one of the most important pathophysiological mechanisms determining gastroparesis. Studies with EndoFLIP, a device that assesses pyloric distensibility, increased the knowledge about pylorospasm. Based on this data, several pyloric-targeted therapies were developed to treat refractory gastroparesis: Surgical pyloroplasty and endoscopic approach, such as pyloric injection of botulinum and pyloric stenting. Notwithstanding, the success of most of these techniques is still not complete. In 2013, the first human gastric per-oral endoscopic myotomy (GPOEM) was performed. It was inspired by the POEM technique, with a similar dissection method, that allows pyloromyotomy. Therapeutical results of GPOEM are similar to surgical approach in term of clinical success, adverse events and post-surgical pain. In the last 8 years GPOEM has gained the attention of the scientific community, as a minimally invasive technique with high rate of clinical success, quickly prevailing as a promising therapy for gastroparesis. Not surprisingly, in referral centers, its technical success rate is 100%. One of the main goals of recent studies is to identify those patients that will respond better to the therapies targeted on pylorus and to choose the better approach for each patient.
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Affiliation(s)
- Maria Chiara Verga
- Gastroenterology and Digestive Endoscopy Unit, ASST Cremona, Cremona 26100, Italy
| | - Stefano Mazza
- Gastroenterology and Digestive Endoscopy Unit, ASST Cremona, Cremona 26100, Italy
| | - Francesco Azzolini
- Gastroenterology and Digestive Endoscopy Unit, Ospedale San Raffaele IRCCS, Milano 20132, Italy
| | - Fabrizio Cereatti
- Gastroenterology and Digestive Endoscopy Unit, ASST Cremona, Cremona 26100, Italy
| | | | - Andrea Drago
- Gastroenterology and Digestive Endoscopy Unit, ASST Cremona, Cremona 26100, Italy
| | - Sara Soro
- Gastroenterology and Digestive Endoscopy Unit, ASST Cremona, Cremona 26100, Italy
| | - Biagio Elvo
- Gastroenterology and Digestive Endoscopy Unit, ASST Cremona, Cremona 26100, Italy
| | - Roberto Grassia
- Gastroenterology and Digestive Endoscopy Unit, ASST Cremona, Cremona 26100, Italy
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Diagnostic Evaluation of Gastric Motor and Sensory Disorders. Am J Gastroenterol 2021; 116:2345-2356. [PMID: 35134012 DOI: 10.14309/ajg.0000000000001562] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 10/18/2021] [Indexed: 12/11/2022]
Abstract
Disorders of gastric motor and sensory function affect 10%-20% of the world's population and adversely impact nutrition, quality of life, work productivity, and health care costs. Classifying these disorders can be challenging given the heterogeneity of symptom presentation, the presence of symptoms unexplained by endoscopic, radiographic and/or laboratory evaluation, and overlap with other luminal gastrointestinal disorders. Accurately diagnosing these highly prevalent disorders relies upon an understanding of epidemiology and risk factors, the ability to take a careful clinical history focused on symptoms, and the presence of predisposing medical, surgical, and psychological conditions. A variety of diagnostic studies are now available to assess gastric motor function and identify maladaptive relaxation, accommodation, and abnormal sensation. FDA-approved treatment options are limited and thus many patients undergo a series of empirical treatment trials that target individual symptoms, often without much benefit. This article provides updated recommendations for identifying and classifying the most common gastric motor and sensory disorders using currently accepted diagnostic tests, and provides a brief supplemental overview on treatment options. "Things sweet to taste prove in digestion sour." -Shakespeare, Richard II, 1595.
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Wise JL, Vazquez-Roque MI, McKinney CJ, Zickella MA, Crowell MD, Lacy BE. Gastric Emptying Scans: Poor Adherence to National Guidelines. Dig Dis Sci 2021; 66:2897-2906. [PMID: 32418002 DOI: 10.1007/s10620-020-06314-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 05/02/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Accurately diagnosing gastroparesis relies upon gastric emptying scintigraphy (GES) being performed correctly. Jointly published protocol guidelines have long been available; however, the extent to which practitioners adhere to these guidelines is unknown. AIMS This study aimed to assess national compliance with established GES protocol guidelines. METHODS We developed a questionnaire addressing the key protocol measures outlined in the Consensus Recommendations for Gastric Emptying Scintigraphy. Survey questions addressed patient information collection (15), patient preparation and procedure protocol (16), meal content and preparation (7), imaging (3), interpretation (4), reporting (7), and institutional demographic data (7). The anonymous questionnaire was distributed electronically to members of the Society of Nuclear Medicine and Medical Imaging (SNMMI) and non-member recipients of the SNMMI daily email newsletter. One response per medical institution was permitted. RESULTS A total of 121 out of 872 potential medical institutions (MI) responded (13.9%); 49 (40.4%) were academic/teaching medical centers. The annual number (mean) of GES procedures was 199.9 (range 5-2000 GES/year). On average, MI performed 33.5/52 (64%) of protocol measures according to guidelines while academic medical centers performed 31.5/52 (61%) of protocol measures according to guidelines. Only 4 out of 88 MI (4.5%) performed GES while adhering to three critical measures: validated study duration; controlled blood glucose levels; and proper restriction of medications. CONCLUSIONS Low compliance with GES protocol guidelines, even among academic medical centers, raises the likely possibility of misdiagnosis and improper management of upper gastrointestinal symptoms. These results highlight a need for increased awareness of protocol guidelines for gastric scintigraphy.
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Affiliation(s)
- Journey L Wise
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Maria I Vazquez-Roque
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Caleb J McKinney
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Michael A Zickella
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Michael D Crowell
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ, USA
| | - Brian E Lacy
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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Hayes MR, Borner T, De Jonghe BC. The Role of GIP in the Regulation of GLP-1 Satiety and Nausea. Diabetes 2021; 70:1956-1961. [PMID: 34176783 PMCID: PMC8576421 DOI: 10.2337/dbi21-0004] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/01/2021] [Indexed: 11/18/2022]
Abstract
Gastric inhibitory peptide (GIP) is best known for its role as an incretin hormone in control of blood glucose concentrations. As a classic satiation signal, however, the literature illustrates a mixed picture of GIP involvement with an at best weak anorectic response profile being reported for GIP receptor (GIPR) signaling. Not surprisingly, the pursuit of exploiting the GIP system as a therapeutic target for diabetes and obesity has fallen behind that of the other gastrointestinal-derived incretin, glucagon-like peptide 1 (GLP-1). However, recent discoveries highlighted here support potential therapeutic advantages of combinatorial therapies targeting GIP and GLP-1 systems together, with perhaps the most surprising finding that GIPR agonism may have antiemetic properties. As nausea and vomiting are the most common side effects of all existing GLP-1 pharmacotherapies, the ability for GIP agonism to reduce GLP-1-induced illness behaviors but retain (if not enhance) weight loss and glycemic control may offer a new era in the treatment of obesity and diabetes.
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Affiliation(s)
- Matthew R Hayes
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
- Department of Biobehavioral Health Sciences, University of Pennsylvania, Philadelphia, PA
| | - Tito Borner
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
- Department of Biobehavioral Health Sciences, University of Pennsylvania, Philadelphia, PA
| | - Bart C De Jonghe
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
- Department of Biobehavioral Health Sciences, University of Pennsylvania, Philadelphia, PA
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Carpenter A, Levinthal DJ, Binion DG, Emerick T. Improvement of Cyclic Vomiting Syndrome with Outpatient Ketamine Infusions. Case Rep Gastroenterol 2021; 15:9-16. [PMID: 33613157 PMCID: PMC7879312 DOI: 10.1159/000510933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/11/2020] [Indexed: 01/18/2023] Open
Abstract
Cyclic vomiting syndrome (CVS) is a disorder characterized by recurrent flares of nausea and vomiting, often with significant abdominal pain, of several days duration. Although traditional prophylactic and abortive treatments for CVS are often successful, a subset of CVS patients with chronic abdominal pain may not respond as well to standard therapies. This report is the first, to our knowledge, to describe the use of outpatient ketamine infusions as therapy for refractory CVS. We describe a 63-year-old woman with history of CVS who presented with abdominal pain and recurrent episodes of nausea and vomiting. She first received ketamine during an inpatient admission for a CVS flare, with the aim of treating the abdominal pain. Given her improvement, she was offered a series of outpatient ketamine infusions, which led to a significant reduction in her symptoms. Thus, ketamine may be useful as both an abortive and prophylactic therapy in CVS. Prior reports have noted the anti-emetic effects of ketamine in the perioperative setting, and there is emerging evidence for the use of ketamine infusions for the treatment of chronic pain. However, this report is the first to describe ketamine as a potential prophylactic treatment for CVS.
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Affiliation(s)
- Anna Carpenter
- Department of Anesthesiology, West Virginia University Ruby Memorial Hospital, Morgantown, West Virginia, USA
| | - David J Levinthal
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - David G Binion
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Trent Emerick
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Shanker A, Bashashati M, Rezaie A. Gastric Electrical Stimulation for Treatment of Refractory Gastroparesis: the Current Approach to Management. Curr Gastroenterol Rep 2021; 23:2. [PMID: 33483775 PMCID: PMC7822763 DOI: 10.1007/s11894-020-00803-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 01/06/2023]
Abstract
Purpose of Review Gastroparesis is one of the more challenging entities in the landscape of gastroenterology, posing difficulties for both patients and physicians with regard to effective management and therapies. In this article, we reviewed various gastroparesis treatment options, with an emphasis on gastric electrical stimulation (GES). Recent Findings GES has demonstrated a significant reduction of cardinal symptoms in refractory gastroparetic patients, particularly nausea and vomiting, across multiple studies. However, GES has not been shown to conclusively decrease gastric emptying time in these patients. Such finding has led the investigators to analyze the impact of combining GES with pyloroplasty. While this treatment pathway is nascent, its results thus far reveal an amplified improvement of gastroparesis symptomatology in addition to significant reduction of gastric transit, compared to GES by itself. Summary Limited treatment choices are available for refractory gastroparesis. Combining GES with pyloroplasty holds promise but requires further assessment in large-scale trials to fully evaluate the risks and benefits.
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Affiliation(s)
- Aaron Shanker
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Mohammad Bashashati
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Ali Rezaie
- GI Motility Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Zacharakis G, Al-Ghamdi S, AlZahrani J, Almasoud A, Arahmane O, AlShehri A, Alharbi MH, Alsalmi MM, Alotibi SB, Algaradi YA, Alsadiq FN, Nikolaidis P. Effects of the Rome IV Criteria to Functional Dyspepsia Symptoms in Saudi Arabia: Epidemiology and Clinical Practice. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2020; 76:304-313. [PMID: 33361706 DOI: 10.4166/kjg.2020.110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/25/2020] [Accepted: 10/28/2020] [Indexed: 12/13/2022]
Abstract
Background/Aims Limited data is available in Saudi Arabia (SA) regarding the prevalence of functional dyspepsia (FD) symptoms and its subtypes, as defined by the ROME IV criteria. This study evaluated the burden of self-reported FD symptoms in the adult general population of SA and the current clinical practices. Methods A web-based national cross-sectional health survey of the general population of SA was conducted using the Rome IV Diagnostic Questionnaire for Functional Gastrointestinal Disorders in Adults with additional questions on the presence of symptoms compatible with functional heartburn (FH) and irritable bowel syndrome (IBS). The quality of life and somatization questionnaires were also included. Results Overall, 3,114 adults completed the questionnaire, but 303 (9.7%) were excluded due to inconsistent responses. Of the 2,811 consistent responders, 532 (18.3%) fulfilled the Rome IV criteria for FD symptoms. These were distributed into the FD subtypes as follows: 208 (7.4%) had postprandial distress syndrome, 228 (8.1%) had epigastric pain syndrome, and 96 (3.4%) had the overlapping variant. IBS-like symptoms were reported in 232 (44%) and FH in 102 (19%) 19% (102) of the subjects with functional dyspepsia. H. pylori-associated dyspepsia was reported by 25% (87/348). High somatization, lower quality of life scores, younger age, and female sex were associated more with the FD symptoms participants than those without. Approximately 1/5 respondents used over-the-counter medications to relieve the FD symptoms. Conclusions In this population-based survey, FD affected almost 1/5 of the responding adult population in SA, which was less than previously reported.
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Affiliation(s)
- Georgios Zacharakis
- Endoscopy Unit, Department of Internal Medicine, Prince Sattam bin Abdulaziz University Hospital, College of Medicine, Prince Sattam bin Abdulaziz University, Al Kharj, Saudi Arabia.,Endoscopy Unit, Department of Internal Medicine, Limassol General Hospital, St George's Medical School, University of Nicosia, Nicosia, Republic of Cyprus
| | - Sameer Al-Ghamdi
- Department of Family Medicine, College of Medicine, Prince Sattam bin Abulaziz University, Al Kharj, Saudi Arabia
| | - Jamaan AlZahrani
- Department of Family Medicine, College of Medicine, Prince Sattam bin Abulaziz University, Al Kharj, Saudi Arabia
| | - Abdulaziz Almasoud
- Endoscopy Unit, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Omar Arahmane
- Endoscopy Unit, King Khaled Hospital and Prince Sultan Center for Health Care, Al Kharj, Saudi Arabia
| | - Abdullah AlShehri
- Department of Family Medicine, AlKharj Military Hospital, Al Kharj, Saudi Arabia
| | - Moaz Hassan Alharbi
- Department of Internal Medicine, Security Forces Hospital, Riyadh, Saudi Arabia
| | | | | | - Yasameen Abdullah Algaradi
- Endoscopy Unit, Department of Internal Medicine, Prince Sattam bin Abdulaziz University Hospital, College of Medicine, Prince Sattam bin Abdulaziz University, Al Kharj, Saudi Arabia
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Cienfuegos JA, Vivas Pérez I, Rotellar F. Co-occurrence of compression syndromes: celiac axis stenosis, superior mesenteric artery and nutcracker syndrome. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 112:885. [PMID: 32755144 DOI: 10.17235/reed.2020.6945/2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Moreno Márquez et al. report an association between arcuate ligament syndrome (ALS) and the "nutcracker" phenomenon (compression of the left renal vein). The case illustrates the association between several syndromes, which all involve compression of vascular or gastrointestinal structures: arcuate ligament syndrome, superior mesenteric artery syndrome (SMAS) or Wilkie's syndrome, the "nutcracker" syndrome and May-Thurner syndrome (compression of the left iliac vein).
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Hu B, Zhou H, Zou X, Shi J, Li X, Tan L. A Comparison of Dexmedetomidine and Midazolam for the Prevention of Postoperative Nausea and Vomiting Caused by Hemabate in Cesarean Delivery: A Randomized Controlled Trial. Drug Des Devel Ther 2020; 14:2127-2133. [PMID: 32546975 PMCID: PMC7266306 DOI: 10.2147/dddt.s251525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To compare the efficacy of dexmedetomidine and midazolam in the prevention of postoperative nausea and vomiting (PONV) caused by hemabate in postpartum hemorrhage during cesarean delivery. Methods One hundred and five parturients with American Society of Anesthesiology (ASA) physical status I and II, aged 20–40 years, undergoing elective cesarean delivery under epidural anesthesia were randomly allocated into dexmedetomidine group (group D, n=35), midazolam group (group M, n=35) and control group (group C, n=35). Patients received an intrauterine injection of 250 μg hemabate and continuous intravenous infusion of 5 units oxytocin immediately following the delivery of the infant. At the same time, patients in group D received 1μg/kg intravenous dexmedetomidine, group M received 0.02 mg/kg intravenous midazolam and group C received 20 mL intravenous saline. Parameters such as the PONV, other adverse reactions (chest distress, flush, etc.) caused by hemabate, patient satisfaction, the sedation (OAA/S) scores, and the hemodynamic parameters were recorded in both groups. Results The PONV incidence in group D and group M was significantly lower compared with group C (6%, 17%, and 71% for group D, group M, and group C, respectively, P<0.05). The sedation (OAA/S) scores in group D and group M was significantly higher compared with group C (1.62±0.28, 1.75±0.31, and 1.00±0.00 for group D, group M, and group C, respectively, P<0.05). The patient satisfaction in group D and group M was significantly higher compared with group C (94%, 69%, and 46% for group D, group M, and group C, respectively, P<0.05). Furthermore, there were more patients satisfied with group D than group M (94% vs.69%, P<0.05). Conclusion Intravenous dexmedetomidine (1 μg/kg) and midazolam (0.02 mg/kg) were equally effective in preventing PONV introduced by hemabate and dexmedetomidine is superior to midazolam in patient satisfaction.
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Affiliation(s)
- Bailong Hu
- Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical University, Guiyang,People's Republic of China
| | - Haiyan Zhou
- Department of Clinical Research Centre, The Affiliated Hospital of Guizhou Medical University, Guiyang, People's Republic of China
| | - Xiaohua Zou
- Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical University, Guiyang,People's Republic of China
| | - Jing Shi
- Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical University, Guiyang,People's Republic of China
| | - Xingyu Li
- Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical University, Guiyang,People's Republic of China
| | - Li Tan
- Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical University, Guiyang,People's Republic of China
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Chronic vomiting in children: Etiology, diagnosis, and management. Indian J Gastroenterol 2020; 39:117-122. [PMID: 32385612 DOI: 10.1007/s12664-020-01035-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Siddiqui MT, Bilal M, Singh A, Olivier-Cabrera S, Lebovics E, Schorr-Lesnick B, Dworkin B, Kirby DF. Prevalence of cannabis use has significantly increased in patients with cyclic vomiting syndrome. Neurogastroenterol Motil 2020; 32:e13806. [PMID: 31990435 PMCID: PMC9206874 DOI: 10.1111/nmo.13806] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 01/02/2020] [Accepted: 01/03/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder which leads to multiple hospitalizations and causes significant impairment of quality of life. Cannabis use is common in patients with CVS, and there are limited data on the national trends in the prevalence of its use in the United States. METHODS We used the National Inpatient Sample (NIS) database from 2005 to 2014 and identified hospitalizations with a primary diagnosis of CVS by utilizing the International Classification of Diseases, 9th revision Clinical Modification (ICD-9 CM) coding system. The primary objective of the study was to analyze the prevalence and trends in cannabis use in CVS patients. We also assessed healthcare resource utilization associated with cannabis use. RESULTS A total of 129 090 hospitalizations with a primary diagnosis of CVS were identified and included in the study. In the United States, the overall rate of cannabis use among these patients was 104 per 1000 hospitalizations (N = 13 460). Over the last decade, the prevalence of cannabis use increased by 10-fold, from 2.2% in 2005 to 21.2% in 2014. CONCLUSION Our analysis of the national database suggests that nearly 1 in 5 CVS hospitalizations have concurrent cannabis use. This prevalence is significantly rising over the last decade, perhaps due to changing legislation and increased utilization of cannabis. Age younger than 35, male gender, African American and Native American race, personal history of alcohol abuse and tobacco use were some of the strongest predictors of cannabis use.
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Affiliation(s)
- Mohamed Tausif Siddiqui
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mohammad Bilal
- Department of Gastroenterology & Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Amandeep Singh
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sarah Olivier-Cabrera
- Department of Medicine, Division of Gastroenterology and Hepatology, New York Medical College, Valhalla, New York
| | - Edward Lebovics
- Department of Medicine, Division of Gastroenterology and Hepatology, New York Medical College, Valhalla, New York
| | - Beth Schorr-Lesnick
- Department of Medicine, Division of Gastroenterology and Hepatology, New York Medical College, Valhalla, New York
| | - Brad Dworkin
- Department of Medicine, Division of Gastroenterology and Hepatology, New York Medical College, Valhalla, New York
| | - Donald F Kirby
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
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