ABSTRACT
Background: In pathological situations, such as acute myocardial infarction, disorders of motility of the proximal gut can trigger symptoms like nausea and vomiting. Acute myocardial infarction delays gastric emptying (GE) of liquid in rats. Objective: Investigate the involvement of the vagus nerve, α 1-adrenoceptors, central nervous system GABAB receptors and also participation of paraventricular nucleus (PVN) of the hypothalamus in GE and gastric compliance (GC) in infarcted rats. Methods: Wistar rats, N = 8-15 in each group, were divided as INF group and sham (SH) group and subdivided. The infarction was performed through ligation of the left anterior descending coronary artery. GC was estimated with pressure-volume curves. Vagotomy was performed by sectioning the dorsal and ventral branches. To verify the action of GABAB receptors, baclofen was injected via icv (intracerebroventricular). Intravenous prazosin was used to produce chemical sympathectomy. The lesion in the PVN of the hypothalamus was performed using a 1mA/10s electrical current and GE was determined by measuring the percentage of gastric retention (% GR) of a saline meal. Results: No significant differences were observed regarding GC between groups; vagotomy significantly reduced % GR in INF group; icv treatment with baclofen significantly reduced %GR. GABAB receptors were not conclusively involved in delaying GE; intravenous treatment with prazosin significantly reduced GR% in INF group. PVN lesion abolished the effect of myocardial infarction on GE. Conclusion: Gastric emptying of liquids induced through acute myocardial infarction in rats showed the involvement of the vagus nerve, alpha1- adrenergic receptors and PVN. .
Fundamento: Distúrbios da motilidade do intestino proximal no infarto agudo do miocárdio podem desencadear sintomas digestivos como náuseas e vômitos. O infarto do miocárdio ocasiona retardo do esvaziamento gástrico (EG) de líquido em ratos. Objetivo: Investigar se existe a influência do nervo vago (VGX), adrenoreceptores α-1, receptores GABAB do sistema nervoso central e participação do núcleo paraventricular (NPV) do hipotálamo no esvaziamento gástrico (EG) e complacência gástrica (CG) em ratos infartados. Métodos: Ratos Wistar (n = 8-15) foram divididos em: grupo infarto (INF), sham (SH) e subdivididos. O infarto foi realizado por ligadura da artéria coronária descendente anterior. A complacência gástrica foi estimada com curvas pressão-volume. Realizada vagotomia por secção dos ramos dorsal e ventral. Para verificar a ação dos receptores GABAB foi injetado baclofeno por via intra ventrículo-cerebral. Simpatectomia química foi realizada com prazosina intravenosa (iv), e na lesão do núcleo paraventricular do hipotálamo foi utilizada corrente elétrica de 1mA/10s, com esvaziamento gástrico determinado por medição da retenção gástrica (% RG) de uma refeição salina. Resultados: Não houve diferença significativa na CG. A vagotomia (VGX) reduziu significativamente a %RG; no grupo INF, o tratamento intra ventrículo-cerebral (ivc) com baclofeno reduziu significativamente a % RG; não houve conclusivamente envolvimento dos receptores GABAB em retardar o EG; o tratamento intravenoso com prazosina reduziu significativamente a %RG no grupo INF. A lesão do NPV aboliu o efeito do infarto do miocárdio no EG. Conclusão: O nervo vago, receptores α-adrenérgicos e núcleo paraventricular estão envolvidos no retardo do esvaziamento gástrico no infarto agudo do miocárdio em ratos. .
Subject(s)
Animals , Male , Gastric Emptying/physiology , Myocardial Infarction/physiopathology , Paraventricular Hypothalamic Nucleus/physiopathology , Receptors, Adrenergic, alpha-1/physiology , Receptors, GABA-B/physiology , Vagus Nerve/physiopathology , Adrenergic alpha-1 Receptor Antagonists/pharmacology , Baclofen/pharmacology , GABA-B Receptor Agonists/pharmacology , Gastroparesis/physiopathology , Myocardial Infarction/complications , Prazosin/pharmacology , Rats, Wistar , Time Factors , VagotomyABSTRACT
Context Gastroparesis is defined by delayed gastric emptying without mechanical obstruction of the gastroduodenal junction, which has been increasingly investigated. Nevertheless, knowledge on the relationships between etiology, symptoms and degree of delayed gastric emptying is limited. Objectives The demographic, clinical and etiological features of Brazilian patients with gastroparesis were studied and the relationships between these findings and the severity of gastric emptying were determined. Method This is a retrospective study of medical records of 41 patients with symptoms suggestive of gastroparesis admitted between 1998 and 2011, who had evidence of abnormally delayed gastric emptying on abdominal scintigraphy. Cases with idiopathic gastroparesis were compared with those of patients with neurologic disorders or diabetes mellitus, in whom autonomic neuropathy is likely to occur. Results The majority of the patients were women (75.6%) with a median age of 41 years and a long-term condition (median: 15 years). Twelve patients (29.3%) had a body mass index of less than 20 kg/m2. The most common presenting symptoms were dyspepsia (53.6%), nausea and vomiting (46.3%), weight loss (41.4%) and abdominal pain (24.3%). Regarding etiology, 16 patients had digestive disorders including idiopathic gastroparesis (n = 12), 12 had postoperative conditions, 11 had diseases of the nervous system, five had diabetes mellitus and in three cases gastroparesis was associated to a variety of conditions. In the majority of patients (65.8%) gastric emptying was severely delayed. There was no association between etiology of gastroparesis, type of presenting symptoms and the degree of delay in gastric emptying. Gastroparesis patients with proven (neurological conditions) or presumed (diabetes) nervous system involvements were significantly younger (P = 0.001), had more recent symptom onset (P = 0:03) and a trend towards more severe gastric empty ...
Contexto A gastroparesia é uma condição clínica definida por retarde anormal do esvaziamento gástrico, sem obstrução mecânica antro-piloro-duodenal, que vem sendo crescentemente estudada. No entanto, as relações entre etiologia, sintomas e grau de retarde do esvaziamento gástrico na gastroparesia são ainda pouco conhecidas. Objetivos Estudar as características demográficas, clínicas e etiológicas e o grau de retarde do esvaziamento gástrico em pacientes brasileiros com gastroparesia e comparar os casos idiopáticos com aqueles com doenças do sistema nervoso ou diabete melito, em que é alta a probabilidade de ocorrência de neuropatia autonômica. Método Estudo retrospectivo dos prontuários de 41 casos com sintomas sugestivos de gastroparesia admitidos entre 1998 e 2011, que tiveram comprovação de retarde anormal do esvaziamento gástrico em exame cintigráfico específico, que foi também revisto. Resultados Dentre os 41 casos, 31 (75,6%) eram mulheres; a mediana de idade foi de 41 anos e predominou quadro clínico de longa duração (mediana: 15 anos). Doze (29,26%) pacientes apresentavam índice de massa corporal inferior ao limite de 20 kg/m2. Os sintomas mais frequentes foram a dispepsia (53,6%), náuseas e vômitos (46,3%), perda de peso (41,4%) e dor abdominal (24,3%). Quanto à etiologia, 16 pacientes tinham afecções digestivas, incluindo a gastroparesia idiopática (n = 12), 12 eram de estados pós-operatórios, 11 tinham doenças do sistema nervoso, 5 tinham diabete melito e 3 eram de etiologias variadas. A maioria dos pacientes (65,8%) apresentou retarde do esvaziamento gástrico intenso ou muito intenso. Não houve qualquer associação entre etiologia da gastroparesia, sintomas apresentados e grau de retarde ...
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Gastric Emptying/physiology , Gastroparesis/physiopathology , Gastroparesis/etiology , Retrospective Studies , Severity of Illness IndexABSTRACT
Gastroparesia é definida como condição de média ocorrência, com significativa repercussão no bem-estar e no estado nutricional dos acometidos. Sua fisiopatologia é descrita ressaltando-se o papel central do aparato neuromuscular e dos diferentes mediadores químicos implicados no seu desencadeamento. Os aspectos diagnósticos da condição são abordados quanto às manifestações clínicas observadas e os variados métodos de investigação disponíveis. Por fim são apresentadas algumas opções terapêuticas, suas limitações e as novas perspectivas em andamento
Subject(s)
Humans , Gastroparesis/diagnosis , Gastroparesis/physiopathology , Gastroparesis/therapy , Digestive System DiseasesABSTRACT
Duchenne's muscular dystrophy (DMD) is an X-linked recessive disease. Clinical descriptions of the disorder focus principally on skeletal muscle degeneration. Another manifestation, which involves the gastrointestinal tract, may be fatal. But its prevalence remains undefined. We report here a case of acute gastroparesis associated with Duchenne's muscular dystrophy. In our case, the patient's symptoms were improved by prokinetic agents and timely decompression in life-threatening acute gastric dilatation.
Subject(s)
Humans , Male , Acute Disease , Adolescent , Contrast Media , Decompression , Gastric Emptying/physiology , Gastrointestinal Agents/therapeutic use , Gastrointestinal Motility/drug effects , Gastroparesis/diagnostic imaging , Gastroparesis/physiopathology , Gastroparesis/etiology , Muscular Dystrophies/complications , Radiography, AbdominalSubject(s)
Humans , Diabetes Mellitus/complications , Diabetic Neuropathies/complications , Esophageal Motility Disorders/diagnosis , Clonidine/therapeutic use , Colon/physiopathology , Constipation/etiology , Constipation/physiopathology , Diarrhea/etiology , Diarrhea/physiopathology , Domperidone/therapeutic use , Fecal Incontinence/etiology , Fecal Incontinence/physiopathology , Gastrointestinal Motility/physiology , Gastroparesis/drug therapy , Gastroparesis/etiology , Gastroparesis/physiopathology , Metoclopramide/therapeutic use , Diabetic Neuropathies/diagnosis , Diabetic Neuropathies/physiopathology , Autonomic Nervous System/physiopathology , Autonomic Nervous System/pathology , Deglutition Disorders/etiology , Deglutition Disorders/drug therapy , Esophageal Motility Disorders/etiology , Esophageal Motility Disorders/physiopathology , Gastric Emptying/physiology , Gallbladder/physiopathology , Gallbladder/pathologyABSTRACT
Gastric emptying time was investigated in 30 non insulin dependent diabetic patients [NIDD] using a non invasive technique; abdominal ultrasonography. They were subdivided into two groups, controlled diabetics [15 patients] and uncontrolled diabetic patients [15 patients]. Moreover, 10 apparently healthy subjects were included in the research as a control group. All patients had symptom[s] of gastroparesis [nausea, early satiety, vomiting etc]. The patients showed a significant delayed gastric emptying time when compared with healthy subjects, the mean of the latter is [3.3 +/- 0.3 hours]. The delay in gastric emptying is obvious in those with longer duration of diabetes mellitus, and is marked in the uncontrolled group [mean 5.4 +/- 0.7 hours] than the controlled diabetics [mean 4.1 +/- 0.3 hours]. Following domperidone administration for one month [one tablet 3-4 times a day]; gastric emptying time was shortened. That improvement was more significant in patients with uncontrolled diabetes [with much more delayed gastric emptying time] than those with controlled diabetes [with less delayed gastric emptying time] when either of them is compared to the normal healthy group. Inspite of significant improvement in symptom score after treatment, the total symptom score did not show significant correlation with improvement in gastric emptying time in the uncontrolled group denoting that symptoms of gastroparesis diabeticorum are not solely related to delayed emptying of the stomach and suggest that gastric dysrhythmia is to be considered in patients with long standing diabetes mellitus. Moreover, domperidone may restore the three cycles per minute gastric myoelectric activity rather than a prokinetic effect on gastric emptying rates