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ObjectiveTo observe the effects of Hedysari Radix polysaccharide on the apoptosis of gastric sinus smooth muscle cells and explore the underlying mechanism via the insulin-like growth factor-1 （IGF-1）/phosphatidylinositol 3-kinase （PI3K）/serine-threonine kinase （Akt） pathway in the rat model of diabetic gastroparesis （DGP）. MethodSixty-two Wistar male rats were randomized into a blank group （n=12） and a modelling group （n=50）. The rat model of DGP was established by small-dose multiple intraperitoneal injections of streptozotocin combined with an irregular high-fat and high-sugar diet for 4 weeks. The modeled rats were randomized into model group， mosapride citrate （1.35 mg·kg-1）， and high-， medium-， and low-dose （200， 100， and 50 mg·kg-1， respectively） Hedysari Radix polysaccharide groups. The rats were administrated with corresponding drugs by gavage， and those in the blank and model groups with equal volumes of pure water by gavage once a day for 8 consecutive weeks. The random blood glucose and body mass were measured every 2 weeks， and gastric emptying rate was calculated. Hematoxylin-eosin （HE） staining was used to observe the pathological changes of smooth muscle in gastric antrum， and terminal deoxynucleoitidyl transferase-mediated nick-end labeling （TUNEL） was employed to detect the apoptosis of smooth muscle cells in the gastric antrum. The expression of IGF-1， phosphorylated （p）-PI3K， and p-Akt in the smooth muscle of gastric sinus tissue was detected by immunohistochemistry. Western blot was employed to determine the protein levels of IGF-1， p-PI3K/PI3K， p-Akt/Akt， B-cell lymphoma-2 （Bcl-2）， and Bcl-2-associated X protein （Bax） in the smooth muscle of the gastric antrum. ResultCompared with the blank group， the model group showed elevated random blood glucose at all time points （P<0.01）， decreased body mass and gastric emptying rate （P<0.01）， increased apoptotic index of smooth muscle cells in the gastric antrum （P<0.01）， down-regulated protein levels of IGF-1， p-PI3K/PI3K， p-Akt/Akt， and Bcl-2， and up-regulated protein level of Bax （P<0.01）. Compared with the model group， the 8 weeks of drug administration lowered the random blood glucose， increased the body mass and gastric emptying rate （P<0.05， P<0.01）， decreased the apoptotic index of smooth muscle cells in the gastric antrum （P<0.05， P<0.01）， up-regulated the protein levels of IGF-1， p-PI3K/PI3K， p-Akt/Akt， and Bcl-2， and down-regulated the protein level of Bax （P<0.05， P<0.01）. Compared with the mosapride citrate group，the administration of low-dose Hedysari Radix polysaccharide for 6 and 8 weeks lowered the random blood glucose and decreased the body mass （P<0.05， P<0.01），low and medium-dose Hedysari Radix polysaccharide decreased the gastric emptying rate and the apoptotic index of smooth muscle cells in the astragaloside low-dose group decreased （P<0.05）. The protein levels of IGF-1，p-PI3K/PI3K，p-Akt/Akt and Bcl-2（low dose）were down-regulated and the protein level of Bax was up-regulated by low doses of Hedysari Radix polysaccharide （P<0.05， P<0.01）. Compared with high-dose Hedysari Radix polysaccharide， low-dose Hedysari Radix polysaccharide elevated random blood glucose and reduced body mass after 6 and 8 weeks of administration （P<0.05， P<0.01）， and the low and medium doses decreased the gastric emptying rate， increased the apoptotic index of smooth muscle cells in the gastric antrum （P<0.05， P<0.01）， down-regulated the protein levels of IGF-1， p-PI3K/PI3K， p-Akt/Akt， and Bcl-2， and up-regulated the protein level of Bax （P<0.05， P<0.01）. Compared with the medium-dose group，the low-dose group of Hedysari Radix polysaccharide had lower body mass，lower gastric emptying rate in rats，higher apoptotic index of smooth muscle cells in gastric sinus tissue after 6 and 8 weeks of administration （P<0.05， P<0.01）， and lower protein expression of IGF-1，p-PI3K/PI3K，p-Akt/Akt. ConclusionHedysari Radix polysaccharide protects the smooth muscle cells in gastric antrum against apoptotic injury and promotes gastric motility by activating the IGF-1/PI3K/Akt signaling pathway， as manifested by the up-regulated expression of IGF-1， p-PI3K， p-Akt， and Bcl-2 and down-regulated expression of Bax.
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La gastroparesia diabética representa una de las complicaciones asociadas a la diabetes de larga evolución que conlleva al desarrollo de diversas condiciones nutricionales que aumentan la morbilidad y la mortalidad de los pacientes. Se caracteriza por retraso en el vaciamiento gástrico, y por consiguiente, disminución de la absorción nutricional, así como, intolerancia a la vía oral por manifestaciones sugerentes de un cuadro de obstrucción intestinal debido al cúmulo de alimentos. Su diagnóstico se confirma mediante evidencia del retraso de vaciamiento por gammagrafía y su tratamiento involucra procinéticos, antieméticos, e incluso, procedimientos quirúrgicos. Se presenta el caso de un paciente de sexo masculino, de 75 años de edad que, tras el descarte dirigido e intencional de patología obstructiva como sospecha inicial ante el cuadro presentado, se realizó diagnóstico de gastroparesia diabética severa. Se describen hallazgos del abordaje diagnóstico implementado en el caso y se realiza revisión de literatura. Es importante la presentación de este caso porque resulta sumamente importante describir las herramientas diagnósticas a implementar para realizar un diagnóstico confirmatorio oportuno de este padecimiento.
Diabetic gastroparesis represents one of the complications associated with long-standing diabetes that leads to the development of various nutritional conditions that increase the morbidity and mortality of patients. It is characterized by delayed gastric emptying, and consequently, decreased nutritional absorption, as well as intolerance to the oral route due to manifestations suggestive of intestinal obstruction due to accumulation of food. Its diagnosis is confirmed by evidence of delayed emptying by scintigraphy and its treatment involves prokinetics, antiemetics, and even surgical procedures. We present the case of a 75-year-old male patient who, after the directed and intentional ruling out of obstructive pathology as an initial suspicion in view of the presented condition, was diagnosed with severe diabetic gastroparesis. Findings of the diagnostic approach implemented in the case are described and a literature review is performed. The presentation of this case is important because it is extremely important to describe the diagnostic tools to be implemented to make a timely confirmatory diagnosis of this condition.
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Delayed gastric emptying (DGE) is a common complication after pancreaticoduodenectomy (PD). The etiology and pathogenesis of DGE have not been fully elucidated in China and globally, and the majority of patients can be cured after general symptomatic treatment. This article reviews the risk factors and pathophysiological mechanisms of DGE after PD, in order to provide a reference for the effective management of DGE after PD in clinical practice.
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ABSTRACT Pulmonary aspiration of gastric residues during anesthesia is a potentially fatal complication for which no specific treatment is available. The primary way to prevent its occurrence in the context of elective surgeries is adherence to fasting protocols. However, some clinical conditions can prolong the gastric emptying time, and the risk of aspiration may exist despite adequate fasting. Recognizing the risk factors for gastroparesis allows the adoption of preventive methods and is the primary way to reduce morbidity and mortality from pulmonary aspiration. In this scenario, the anesthesiologist can investigate the gastric content by using ultrasound, adjust the anesthetic technique, and even postpone elective surgeries. Here, we describe incidental computed tomography finding of solid contents in the stomach of a patient without prior identification of the risk factors for gastroparesis. The patient underwent elective renal nodule ablation under general anesthesia after fasting for 9 hours. During the procedure, solid contents in the stomach were noted on computed tomography. Subsequently, it was discovered that the patient had been using semaglutide for 6 days and had not disclosed this information. Semaglutide use may represent a new and significant risk factor for anesthesia-related pulmonary aspiration. Until studies provide information on the appropriate perioperative management of patients using semaglutide, anesthesiologists need to adopt preventive measures to avoid aspiration. Awareness of this potential association and open communication among patients, physicians, and anesthesia teams are essential for enhancing patient safety.
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La prucaloprida acelera el vaciamiento gástrico en adultos con gastroparesia. No existen estudios con este medicamento en niños con gastroparesia. Se presenta un niño de 8 años que consultó por síntomas posprandiales de un mes de duración, con diagnóstico de gastroparesia por gammagrafía de vaciamiento gástrico. No mejoró con metoclopramida, domperidona, eritromicina y esomeprazol. Recibió prucaloprida durante dos períodos (durante 178 y 376 días) a dosis de 0,03-0,04 mg/kg/día. Presentó mejoría en el seguimiento con el índice cardinal de síntomas de gastroparesia y gammagrafías de vaciamiento gástrico. Por la buena respuesta, la prucaloprida podría ser una opción terapéutica en la gastroparesia pediátrica.
Prucalopride has been used in adults with gastroparesis, accelerating gastric emptying. There are no studies with this drug in gastroparetic children. An 8-year-old boy is presented who consulted for a month of postprandial symptoms, with a diagnosis of gastroparesis by gastric emptying scintigraphy. He did not improve with metoclopramide, domperidone, erythromycin, and esomeprazole. He received prucalopride for two periods (for 178 and 376 days) at doses: 0.03 - 0.04 mg/kg/day, presenting improvement in the follow-up with the cardinal gastroparesis symptom index and gastric emptying scintigraphy. Due to the good response, prucalopride may be a therapeutic option in pediatric gastroparesis.
Subject(s)
Humans , Male , Child , Benzofurans/therapeutic use , Gastroparesis/diagnosis , Gastroparesis/drug therapy , Domperidone/therapeutic use , Gastric EmptyingABSTRACT
At present, comprehensive treatment dominated by surgical procedures is an important measure for colon cancer to obtain the chance of cure. Surgical intervention, while removing the tumor, carries the risk of postoperative gastroparesis (PG) . Because of the low incidence rate and insignificant early clinical symptoms, early stage PG is often overlooked clinically. However, PG can increase the risk of malnutrition, delay postoperative antitumor treatment, and increase the risk of tumor recurrence and metastasis. This review focuses on the mechanisms, clinical risk factors, preventive measures, and advances in treatment of PG due to colon cancer. Aim to increase the clinician's adequate attention to PG in colon cancer and from a surgical point to reduce the risk of gastroparesis in colon cancer by optimizing the surgical strategy.
Subject(s)
Humans , Colonic Neoplasms/surgery , Digestive System Surgical Procedures/adverse effects , Gastroparesis/therapy , Neoplasm Recurrence, LocalABSTRACT
Objective:To study the clinical efficacy of acupuncture at Zusanli (ST 36)combined with Traditional Chinese Medicine (TCM) enema in the treatment of gastroparesis syndrome after gastrointestinal tumor operation.Methods:A total of 96 patients with gastroparesis syndrome after gastrointestinal tumor surgery in our hospital from June 2016 to May 2021, who met the inclusion criteria, were randomly divided into three groups by random drawing, with 32 in each group. The control group took mosapride citrate tablets orally, the TCM enema group added TCM enema on the basis of the control group, and the combined group added acupuncture Zusanli (ST 36)on the basis of the TCM enema group. All three groups were treated continuously for 4 weeks. The main syndromes were scored before and after treatment. The levels of serum gastrin (GAS), motilin (MTL) and somatostatin (SS) were detected by radioimmunoassay. The gastric electrophysiological parameters (waveform response area, waveform frequency and average amplitude) were detected by intelligent dual channel gastrointestinal electrograph, the adverse reactions during treatment were recorded, and the clinical efficacy was evaluated.Results:The total effective rate was 96.9% (31/32) in the combined group, 81.3% (26/32) in the TCM enema group and 68.8% (22/32) in the control group. There was significant difference among the three groups ( χ2=8.72, P=0.013). The scores of abdominal fullness and distention, fatigue, belching acid reflux, dry mouth and bitter mouth in the combined group were significantly lower than those in the TCM enema group and the control group ( F values were 16.39, 13.21, 11.28 and 10.23, respectively, P<0.001). After treatment, the levels of GAS [(140.62±15.19) ng/L vs. (128.79±14.34) ng/L, (115.98±12.40) ng/L, F=21.09], MTL [(268.66±28.21) ng/L vs. (245.89±25.24) ng/L, (230.78±22.43) ng/L, F=30.29] and SS [(70.58±8.17) ng/L vs. (65.50±7.76) ng/L, (59.73±7.05) ng/L, F=33.19] in the combined group were significantly higher than those in the TCM enema group and the control group ( P<0.01). The waveform response area [(172.62±17.14) μV/s vs. (158.56± 15.32) μV/s, (145.48±14.13) μV/s, F=20.24], waveform frequency [(3.86±0.61) cpm vs. (3.29±0.50) cpm, (3.01±0.63) cpm, F=13.17] and average amplitude [(86.51±8.98) μV vs. (75.70±7.93) μV, (68.65±7.46) μV, F=28.11] were significantly higher than those in TCM enema group and control group ( P<0.01). During the treatment period, the incidence of adverse reactions was 18.8% (6/32) in the combined group, 15.6% (5/32) in the TCM enema group and 12.5% (4/32) in the control group. There was no significant difference between the three groups ( χ2=0.47, P=0.789). Conclusion:Acupuncture at Zusanli (ST 36) combined with TCM enema can improve the TCM syndrome scores, gastrointestinal hormone level and gastric electrophysiological parameters of patients with gastroparesis syndrome after gastrointestinal tumor operation, improve the curative effect with safety.
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OBJECTIVE@#To observe the effect of electroacupuncture (EA) at "Zusanli" (ST 36) combined with mosapride on gastric emptying rate and gastric motility in the rats with diabetic gastroparesis.@*METHODS@#Using random number table method, 68 male SD rats were divided into a blank group (12 rats) and a model establishment group (56 rats). In the model establishment group, the models of diabetic gastroparesis were established with intraperitoneal injection of streptozotocin combined with high-fat and high-sugar diet. Six weeks later, the successful rat models in the model establishment group were randomized into a model group, an EA group, a mosapride group and a combined treatment group, 12 rats in each one. In the EA group, EA was exerted at "Zusanli" (ST 36) (disperse-dense wave, 2 Hz/15 Hz in frequency, 2 mA in intensity) for 20 min. In the mosapride group, mosapride was intervened with intragastric administration (2 mg/kg). In the combined treatment group, electroacupuncture at "Zusanli" (ST 36) was combined with intragastric administration of mosapride. The intervention was given once daily in each group. There was 1 day at interval after 6-day intervention, consecutively for 5 weeks. At the end of intervention, the random blood glucose, gastric emptying rate and the data of gastric motility (average intra-gastric pressure, amplitude and frequency of gastric motility) were detected.@*RESULTS@#Compared with the blank group, blood glucose was increased in the model group (P<0.001). Blood glucose was reduced in the EA group, the mosapride group and the combined treatment group as compared with the model group separately (P<0.001, P<0.01), whereas, compared with the mosapride group, blood glucose was decreased in the combined treatment group (P<0.05). In comparison with the blank group, the gastric emptying rate, the average intra-gastric pressure and the amplitude of gastric motility were all decreased in the model group (P<0.001) and the frequency of gastric motility was increased (P<0.001). Gastric emptying rate, the average intra-gastric pressure and the amplitude of gastric motility were increased in the EA group, the mosapride group and the combined treatment group (P<0.01, P<0.05, P<0.001) and the frequency of gastric motility was decreased (P<0.001) as compared with the model group respectively. Compared with the EA group, the average intra-gastric pressure and the amplitude of gastric motility were increased in the combined treatment group (P<0.001). In comparison with the mosapride group, the gastric emptying rate, the average intra-gastric pressure, the amplitude and frequency of gastric motility in the combined treatment group, as well as the frequency of gastric motility in the EA group were all increased (P<0.05, P<0.001, P<0.01).@*CONCLUSION@#Electroacupuncture at "Zusanli" (ST 36) combined with intragastric administration of mosapride could regulate blood glucose and improve the gastric motility in the rats with diabetic gastroparesis. The effect is better than either simple electroacupuncture or mosapride.
Subject(s)
Animals , Male , Rats , Acupuncture Points , Benzamides , Diabetes Mellitus/therapy , Electroacupuncture , Gastrointestinal Motility/physiology , Gastroparesis/etiology , Morpholines , Rats, Sprague-DawleyABSTRACT
Background: Gastroparesis with its varied etiology is one of the major health issues in India. Poor correlation between delayed gastric emptying and its symptoms is well-known. This study was planned to evaluate the proportion of confirmed gastroparesis by scintigraphy among patients with suggestive clinical features, their underlying aetiologies and clinical profiling in a real-world setting in India. Settings and Design: Patients clinically diagnosed with gastroparesis, presenting varyingdegreesofsymptoms for at least 12-weeks, were enrolled in this multic-entric,cross-sectional, clinico-epidemiological study. Results: Overall, 196/201 enrolled patients underwent gastric scintigraphy; 88 (45%) were found to be scintigraphically positive and 108 (55%) patients were only clinically positive. Underlying etiologies of gastroparesis were idiopathic (51.2%), type-2 diabetes (44.8%), type-1 diabetes (2.5%) and psychological conditions (1.5%). Most patients presented symptoms like postprandial fullness (75.6%), bloating (50.7%), abdominal pain (45.3%), nausea (41.3%), abdominal discomfort (40.3%), early satiety (37.8%) and vomiting (17.9%) of moderate severity. Common dietary risk factors were fatty diet (66.7%), fiber-rich food (57.7%) and carbonated drinks (18.9%). Weight loss (6.5%), esophagitis (5.5%) and electrolyte disturbances (0.5%) were the associated complications. About 89.8% were on proton-pump inhibitors, followed by prokinetics (51.8%) and antiemetics (8.4%). The mean PAGI-QoL score was 3.6 ± 0.94, suggesting a moderate effect of gastroparesis on QoL. Conclusion: Poor correlation exists between gastric scintigraphy and gastrointestinal symptoms, thus reiterating the significance of the clinical diagnosis of gastroparesis, especially in diabetes. Only about half of the patients were prescribed prokinetics, emphasizing the need for appropriate pharmacotherapy using prokinetics for holistic management of gastroparesis.
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Sarcina ventriculi is a gram-positive bacterium, able to survive in extreme low pH environment. It's first description dates from 1842, by John Goodsir. Since then, just a few cases have been reported. In veterinary medicine, especially in ruminants, it causes bloating, vomiting, gastric perforation and death of the animal. It is commonly associated with delayed gastric emptying or obstruction to gastric outlet, although it's pathogenicity in humans is not fully understood. We report two cases with identification of the bacteria in gastric specimens stained with hematoxylin-eosin staining, in different clinical settings. The first patient is a young female patient, presenting cardiac arrest and death after gastric perforation and the second patient an adult male presenting with gastric adenocarcinoma, treated with partial gastrectomy followed by adjuvant chemoradiation. In our literature review, we identified forty-five cases reporting Sarcina ventriculi appearance, with a sudden increase since 2010.
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Humans , Male , Female , Adolescent , Middle Aged , Sarcina/pathogenicity , Clostridium Infections/pathology , Gastroparesis/complicationsABSTRACT
Abstract Background: Abdominal symptoms in patients with primary Sjögren syndrome (pSS) are poorly documented. The objective of the study was to describe the abdominal symptoms of patients with pSS and to assess their association with characteristics of the disease. Methods: One hundred and fifty patients with pSS were evaluated using a composite global symptom score for abdominal symptoms and their severity. Data concerning the clinical and biological characteristics of pSS and abdominal disorders were also collected. Results: Of the patients with pSS, 95% suffered from abdominal symptoms (median global symptom score 7.5 ±5.5 points out of 30). More than half of the patients experienced abdominal tension (68%), upper abdominal pain (54%), abdominal discomfort (58%) and/or constipation (54%). Regarding the pSS activity, in relation to European League Against Rheumatism (EULAR) Sjogren syndrome disease activity index score items, general and central nervous system involvement wereassociated with a high global symptom score. The EULAR Sjogren Syndrome Patient Reported Index (ESSPRI) symptom score was positively correlated with the global symptom score (p < 0.01). Multivariate analysis showed a significant association between a high global symptom score and SSA seronegativity, gastroparesis, and ESSPRI score (p < 0.01 for each). Conclusions: The majority of patients with pSS suffered abdominal symptoms. There is currently no therapeutic recommendation because of the lack of information on the underlying pathophysiological mechanisms. Trial registration: NCT03157011. Date of registration: July 17, 2017.(AU)
Subject(s)
Humans , Quality of Life , Sjogren's Syndrome/etiology , Abdominal Pain , Gastroparesis/etiologyABSTRACT
Objective:To investigate the characteristics of gastrointestinal (GI) symptom spectrum in patients with Parkinson′s disease (PD), and to help the early identification of gastrointestinal symptoms and management of PD.Methods:One hundred PD patients in the Department of Neurology, Peking Union Medical College Hospital from January 2017 to August 2017 were enrolled in this study. They were assessed by face-to-face GI dysfunction questionnaire, including eight common symptoms involved in oropharynx, upper and lower digestive tract. The Spearman correlation analysis was performed.Results:The age of PD patients was (61.9±10.5) years, the ratio of male to female was 53∶47 and the disease duration was 4.0 (2.0, 6.0) years. There were 42 cases of Hoehn-Yahr (H-Y) stage 1, 30 cases of H-Y stage 2 and 28 cases of H-Y stage 3 and above (24 cases of H-Y stage 3, three cases of H-Y stage 4 and one case of H-Y stage 5). Totally 58% (58/100) of PD patients had one or more GI symptoms. Constipation (42%, 42/100), dysdefecation (38%, 38/100) and salivation (28%, 28/100) were the top three of most common GI symptoms. Lower GI symptoms were the most common (57%, 57/100), followed by oropharyngeal symptoms (33%, 33/100), and upper GI symptoms (27%, 27/100). GI symptoms could appear in H-Y stage 1 patients, 26.1% (11/42) of which had 1-2 kinds of GI symptoms and over 20% of which had more than three kinds of GI symptoms. A total of 39.3% (11/28) of PD patients with H-Y stage ≥3 had more than three kinds of GI symptoms. The Gastroparesis Cardinal Symptom Index (GCSI) score in patients with upper GI symptoms was 3.0 (2.0,6.5). The constipation symptom score in patients with constipation and dysdefecation was 19.0 (12.0,27.3). As for the clinical type of constipation, 66.7% (38/57) of them were mixed, 21.0% (12/57) were slow transit and 12.3% (7/57) were dysdefecation. In 38.6% (22/57) of the constipated patients, constipation symptoms occurred earlier than PD motor symptoms. Correlation analysis showed that H-Y stage was positively correlated with the course of PD, the number of GI symptoms, salivation, constipation, dysdefecation and constipation symptom scores.Conclusions:Constipation, dysdefecation and salivation were the most common GI symptoms in PD patients. PD patients had at least one GI symptom in the early stage (H-Y stage 1). Lower GI symptoms were more common than oropharyngeal symptoms and upper GI symptoms. With the development of PD, the number of GI symptoms, salivation, constipation and dysdefecation were aggravated, which were important for early symptomatic identification and disease management.
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Objective:This study aims to investigate the clinical efficacy of Modified Xiangsha Liu Junzitang in the treatment of diabetic gastroparesis （DGP） and its influence on gastrointestinal hormones and oxidative stress. Method:In this study， 128 patients were randomly divided into control group （64 cases） and observation group （64 cases） . Patients in two groups took domperidone tablets orally 30 minutes before meals， 10 mg/time， 3 times/day. Patients in control group took Shenling Baizhusan San， 6 g/time， twice a day. Patients in observation group were prescribed addition and subtraction therapy of Modified Xiangsha Liu Junzitang， 1 dose/day. The course of treatment for both groups was 4 weeks. Before and after treatment， scores of gastroparesis cardinal symptom index （GCSI）， and gastric emptying test and electrogastrogram were noted. Before the treatment， scores of traditional Chinese medicine （TCM） syndrome and health survey summary were graded（SF-36）. The levels of gastrin （GAS）， motilin （MTL）， vasoactive intestinal peptide （VIP）， somatostatin （SS）， superoxide dismutase （SOD）， reactive oxygen species （ROS） and malondialdehyde （MDA） were measured before and after treatment. And adverse reactions during treatment were recorded. Result:The scores of postprandial abdominal distension/early satiety， nausea and vomiting， abdominal distention and the total scores of GCSI in the observation group were lower than those in control group （<italic>P</italic><0.01）. The gastric emptying rate in observation group was higher than that in control group （<italic>P</italic><0.01）， and the score of TCM syndromes was lower than that of control group （<italic>P</italic><0.01）. The scores of SF-36 in observation group were higher than those in control group （<italic>P</italic><0.01）. The frequency of gastric electricity and gastric electric vibration before and after the meal in observation group were higher than that in control group （<italic>P</italic><0.01）. The levels of GAS， MTL， VIP， ROS and MDA in observation group were lower than those in control group （<italic>P</italic><0.01）， while the levels of SS and SOD were higher than that of control group （<italic>P</italic><0.01）. The total effective rate in observation group was 93.75% （60/64）， which was higher than 79.69% （51/64） （<italic>χ</italic><sup>2</sup>=5.494， <italic>P</italic><0.05） in control group （<italic>P</italic><0.01）. And no adverse reactions were found in the clinical observation. Conclusion:Modified Xiangsha Liu Junzitang combined with prokinetic drugs in the treatment of DGP patients can reduce the clinical symptoms of DGP， enhance gastrointestinal motility， improve the gastric emptying rate， improve the quality of life， regulate the level of gastrointestinal hormones， and reduce the damage of autonomic nerve caused by oxidative stress， with good comprehensive clinical effect and safety in application.
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Objective: To investigate the mechanisms of electroacupuncture (EA) at Zusanli (ST 36), Liangmen (ST 21) and Sanyinjiao (SP 6) in intervening diabetic gastroparesis (DGP) based on calcium-activated chloride channel. Methods: Forty Sprague-Dawley rats were randomly divided into four groups, including a normal control group (group A), a model group (group B), an EA group (group C) and a metoclopramide group (group D), with 10 rats in each group. A single intraperitoneal injection of 2％ streptozotocin (STZ) combined with 8-week high-glucose high-fat diet was used to establish a DGP rat model. After intervention, gastrointestinal propulsive rate was observed; the expression level of transmembrane protein 16A (TMEM16A) was examined by immunohistochemistry; the Ca2+ concentration in interstitial cells of Cajal (ICCs) was detected by immunofluorescence; and whole-cell patch-clamp technique was applied to detect the current intensity of calcium-activated chloride channel (ICaCC) in ICCs in gastric antrum. Results: After modeling, the blood glucose levels in group B, group C and group D were significantly increased compared with group A (all P<0.01); after intervention, compared with group B, the blood glucose levels in group C and group D were significantly decreased (P<0.05, P<0.01); the intra-group comparison of blood glucose level between after modeling and after intervention found significant difference only in group C (P<0.01). The gastrointestinal propulsive rates in group B, group C and group D were significantly different from that in group A (P<0.01 or P<0.05); the gastrointestinal propulsive rates were markedly higher in group C and group D than in group B (P<0.01, P<0.01). The expressions of TMEM16A in group B and group C were decreased compared with group A (P<0.01, P<0.05); the expressions of TMEM16A in group C and group D were increased compared with group B (P<0.01, P<0.05). The fluorescence intensity of Ca2+ was significantly lower in group B than in group A (P<0.01); the fluorescence intensity of Ca2+ was significantly higher in group C and group D than in group B (P<0.01, P<0.05). ICaCC in ICCs in group B was significantly decreased compared with group A; ICaCC in group C and group D were increased compared with group B. Conclusion: EA at Zusanli (ST 36), Liangmen (ST 21) and Sanyinjiao (SP 6) can significantly improve gastrointestinal motility in DGP rats by up-regulating the ICaCC in ICCs.
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ABSTRACT Systemic sclerosis (SSc) is a systemic autoimmune disease in which gastrointestinal manifestations are a frequent complication. Gastrointestinal involvement is present in up to 90 % of patients. The most affected areas are the esophagus and the anorectal tract. Reflux, heartburn and dysmotility are the leading causes of gastrointestinal discomfort. Disordered anorectal function can occur early in the course of SSc and is an important factor in the development of fecal incontinence. Current recommendations to treat gastrointestinal disorders in SSc include the use of proton pump inhibitors, prokinetics and rotating antibiotics. This review discusses the proposed pathophysiological mechanisms, the clinical presentation, the different diagnostic techniques and the current management of the involvement of each section of the gastrointestinal tract in SSc.
RESUMEN La esclerosis sistémica (ES) es una enfermedad autoinmune sistémica en la que las manifestaciones gastrointestinales son una complicación frecuente. El compromiso gastrointestinal está presente hasta en 90% de los pacientes. Las áreas más afectadas son el esófago y el tracto anorrectal. El reflujo, la pirosis y la dismotilidad son las principales causas de malestar gastrointestinal. La función anorrectal alterada puede presentarse temprano en el curso de la ES y es un factor importante en el desarrollo de incontinencia fecal. Las recomendaciones actuales para tratar los trastornos gastrointestinales en la ES incluyen el uso de inhibidores de la bomba de protones, procinéticos y de antibióticos en forma rotativa. Esta revisión discute los mecanismos fisiopatológicos propuestos, la presentación clínica, las diferentes técnicas de diagnóstico y el manejo actual del compromiso de cada sección del tracto gastrointestinal en la ES.
Subject(s)
Humans , Adult , Middle Aged , Aged , Aged, 80 and over , Scleroderma, Systemic , Gastrointestinal Diseases , Autoimmune Diseases , Causality , DiagnosisABSTRACT
Resumen El vaciamiento gástrico normal refleja un esfuerzo coordinado entre diferentes regiones del estómago y el duodeno, y también una modulación extrínseca por parte del sistema nervioso central y factores del intestino distal. Los principales eventos relacionados con el vaciamiento gástrico normal incluyen el fondo de relajación para acomodar la comida, contracciones antrales para triturar partículas grandes de comida, contracción pilórica para permitir la liberación de comida del estómago y coordinación antropiloroduodenal de los fenómenos motores de relajación. La dismotilidad gástrica incluye el vaciamiento tardío del estómago (gastroparesia), vaciamiento gástrico acelerado (síndrome de dumping) y otras disfunciones motoras, como el deterioro del fondo de distensión, que se encuentra con mayor frecuencia en la dispepsia funcional. Los síntomas de la gastroparesia son inespecíficos y pueden simular otros trastornos estructurales.
Abstract Normal gastric emptying reflects a coordinated effort between different regions of the stomach and the duodenum, and also an extrinsic modulation by the central nervous system and distal bowel factors. The main events related to normal gastric emptying include relaxation of the fundus to accommodate food, antral contractions to triturate large food particles, the opening of the pyloric sphincter to allow the release of food from the stomach, and anthropyloroduodenal coordination for motor relaxation. Gastric dysmotility includes delayed emptying of the stomach (gastroparesis), accelerated gastric emptying (dumping syndrome), and other motor dysfunctions, e.g., deterioration of the distending fundus, most often found in functional dyspepsia. The symptoms of gastroparesis are nonspecific and may mimic other structural disorders.
Subject(s)
Humans , Therapeutics , Gastroparesis , Diagnosis , Dumping Syndrome , LiteratureABSTRACT
An eighty-five years old man complained of difficulty in swallowing for relatively dry food items and water with occasional episodes of vomiting. He was a diabetic and hypertensive patient on treatment for long, suddenly reported pain and discomfort in the abdomen with inability to pass urine. All the parameters were within normal limits except prostate being 70 ml enlarged. He was catheterized with diagnosis of BPH with chronic urinary retention. TURP was advised but the case did not consent for it. On close scrutiny of detailed history, it was observed that the patient was on self-medication of homeopathic drugs which were causing smooth muscle relaxation of bladder and GIT, causing difficulty in deglutition and constipation. On discontinuation of drugs, these effects disappeared and the case did not need any further catheterization, concluding that the acute urinary retention was caused by self-medication induced constipation. It is hence inferred that self-medication with homeopathic medicines should be avoided specially by elderly as aging effects and co-morbid condition often coexist.
ABSTRACT
Emphysematous gastritis (EG) is a rare and potentially lethal process caused by invasive, gas-producing bacteria leading to inflammation and gas dissection of the stomach. The most common etiologic agents are Clostridium infections, but other organisms, including enterobacteria, staphylococcus, and fungi have also been identified. We report the first case of EG due to Sarcina ventriculi in a solid organ transplant recipient, who presented with epigastric pain and vomiting. The patient had a history of type 1 diabetes mellitus (DM) with recurrent episodes of ketoacidosis and systemic diabetic complications, including severe gastroparesis. CT scan studies demonstrated EG with venous air, and endoscopy showed severe gastritis and ulcerations. In the gastric biopsies, abundant Sarcina ventriculi were noted in areas of mucosal/submucosal necrosis. Antibiotic treatment was instituted at admission, and subsequent endoscopy demonstrated the disappearance of Sarcina, with some improvement of the gastric inflammation; however, the patient developed septic shock with multiorgan failure and expired. This case highlights the need to consider other infectious etiologies in transplant patients, in addition to the well-known opportunistic infections.
Subject(s)
Humans , Adult , Diabetes Complications , Transplant Recipients , Infections/etiology , Autopsy , Opportunistic Infections/etiology , Cholestasis , Clostridium Infections , Liver Failure , Fatal Outcome , Gastroparesis/complications , Renal Insufficiency/complications , Graft RejectionABSTRACT
RESUMEN El síndrome de Pinza Aortomesentérica o "Síndrome de Wilkie" es una entidad muy rara, se caracteriza por una pérdida de peso impor-tante y vómitos de alimentos parcialmente digeridos. La sospecha diagnóstica se fundamenta por la presencia de factores predisponen-tes y/o de riesgo. Estudios imagenológicos como un esofagogastroduodeno seriado y ecografía Doppler permiten su confirmación. El tratamiento primario se apoya en una adecuada nutrición. Frente al fracaso del tratamiento médico, se indica el manejo quirúrgico con diferentes técnicas para resolver la oclusión. Se presenta el caso de una adolescente con oclusión gastroduodenal crónica, fallo en el tratamiento médico y resolución quirúrgica con buenos resultados.Palabras claves: Síndrome de la arteria mesentérica superior, obstrucción duodenal, reflujo duodenogástrico, laparotomía, anastomosis quirúrgica; gastroparesia.
ABSTRACT Superior mesenteric artery syndrome or "Wilkie syndrome" is a very rare entity, characterized by significant weight loss and vomiting of partially digested food. The diagnostic suspicion is based on the presence of predisposing and/or risk factors. Imaging studies such as serial esophagogastroduodenum and Doppler ultrasound allow its confirmation. The primary treatment is supported by adequate nutrition. Following the failure of medical treatment, surgical management is indicated with different techniques to resolve the occlusion. We present the case of a teenager with chronic gastroduodenal occlusion, failure in medical treatment and surgical resolution with good results.Keywords: Superior mesenteric artery syndrome; duodenal obstruction; duodenogastric reflux; laparotomy; anastomosis, surgical; gas-troparesis