Reporte de un caso de tratamiento de gastroparesia pediátrica con prucaloprida: una terapia novedosa / A case report of prucalopride treatment in pediatric gastroparesis: a novel therapy

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.

New Paradigm for Treatment of Chronic Hepatitis C Virus Infection / 대한소화기학회지

No abstract available.

Gastroparesia y dispepsia funcional: diagnóstico y tratamiento / Gastroparesis and functional dyspepsia: diagnosis and treatment

Gastroparesis corresponds to the clinical picture of a non-obstructive alteration in gastric emptying. The most common causes are idiopathic, postsurgical and diabetes mellitus. Endoscopy and gastric emptying scintigraphy are necessary for diagnosis. Fractionating the diet and avoiding fat are recommended actions. Prokinetics are fundamental in gastroparesis therapy. Domperidone is the first choice because it has a better safety profile. It is advisable to rotate prokinetics. In refractory cases it is suggested to try other prokinetics (such as erythromycin or prucalopride), effective management of nausea and nutrition optimization. In selected cases, therapies such as electrical stimulation could be evaluated. Functional dyspepsia is defined as symptoms that probably originate in the gastroduodenal region, having ruled out other possibilities. Therefore, endoscopy should show no alterations that could explain the symptoms. The most frequently encountered pathophysiological alterations are slow gastric emptying, impaired accommodation and hypersensitivity. None has been linked unequivocally to a pattern of symptoms. It is suggested to start with proton-pump inhibitors therapy. In refractory cases, prokinetics should be added. If there is no adequate response, 24-hour pH monitoring and gastric emptying should be ordered. In case of altered gastric emptying, adjust prokinetics. If gastric emptying is normal, bupirone or mianserin could be used.

La gastroparesia corresponde a un cuadro clínico debido a mal vaciamiento gástrico no obstructivo del estómago. Sus causas más frecuentes son idiopática, diabetes mellitus y postquirúrgica. La endoscopia y el cintigrama de vaciamiento gástrico son necesarios para el diagnóstico. Se recomienda fraccionar la dieta y evitar las grasas. Los procinéticos son fundamentales en el tratamiento de la gastroparesia. La domperidona es la primera opción por su mejor perfil de seguridad. Es aconsejable rotar los procinéticos. En casos refractarios se puede intentar otros procinéticos (como eritromicina o prucalopride), manejar específicamente las náuseas y optimizar la nutrición. En casos seleccionados se puede intentar terapias como estimulación eléctrica. La dispepsia funcional está definida por síntomas que probablemente se originan en la región gastroduodenal, habiendo descartado otras posibilidades. Por esto, requiere un estudio endoscópico sin alteraciones que expliquen los síntomas. Los hallazgos fisiopatológicos más frecuentemente encontrados son alteraciones del vaciamiento gástrico, trastornos de la acomodación e hipersensibilidad. Ninguno de ellos ha sido asociado inequívocamente a algún patrón de síntomas. Se sugiere iniciar tratamiento con inhibidores de la bomba de protones. En casos refractarios, es aconsejable agregar procinéticos. Si no hay adecuada respuesta, se sugiere estudiar con una ph-metría de 24 horas y vaciamiento gástrico. En caso de vaciamiento alterado, ajustar los procinéticos. En caso de vaciamiento normal, se sugiere uso de buspirona o mianserina.

A Case of Acute Phlegmonous Gastritis Causing Gastroparesis and Cured with Medical Treatment Alone / 대한소화기학회지

Acute phlegmonous gastritis is an uncommon disease, often fatal condition characterized by suppurative bacterial infection of the gastric wall. It has a high mortality rate mainly because the diagnosis is usually made late. Until recently, gastrectomy in combination with antibiotics was recommended. We had experienced a case of 66-year-old man presented with epigastric pain, nausea, vomiting, and hematemesis, followed by aspiration pneumonia. At upper gastrointestinal endoscopy, the gastric lumen was narrow, and the mucosa was severely inflamed, which was erythematous, swelled, and showed necrotic areas covered with purulent exudate. Klebsiella oxytoca and Acinetobacter lwoffii were isolated in the gastric tissue culture. Contrast-enhanced computerized tomography scan of abdomen demonstrated diffuse gastric wall thickening and an intramural abscess in the gastric antral wall. Although delayed gastric emptying by gastroparesis prolonged the in-hospital period, the only medical treatment with antibiotics alone successfully cured the patient without gastrectomy.

Gastroparesia: temas de atualização e revisão em clínica médica / Gastroparesis: themes of updating and revision in medical clinic

Gastroparesia é uma dificuldade no esvaziamento gástrico sem que haja qualquer obstrução mecânica ao livre trânsito gastroduodenal. Trata-se de condição estritamente relacionada à função do estômago, podendo decorrer de distúrbios neural (p. ex.: diabetes mellitus), eletrolítico (p. ex.: hipopotassemia) ou hormonal (p. ex.: hipotireoidismo), dentre outros. Náuseas, vômitos, plenitude pós-prandial e saciedade precoce estão presentes. Não existe exame laboratorial capaz de identificar a gastroparesia, no entanto, eles podem indicar a etiologia da mesma. A radiografia simples de abdome pode demonstrar distensão gástrica; a seriografia gastroduodenal, bem como a endoscopia digestiva, são mais úteis na avaliação de obstrução mecânica. Na atualidade, o padrão ouro para o diagnóstico da gastroparesia é cintilografia gástrica.

Gastroparesis is a difficulty in gastric emptying without any mechanical obstruction gastroduodenal. Is is strictly related to the condition of the stomach, likely to arise of neural disorder (diabetes mellitus), electrolytic (hipopotassemy), or hormone (hypothyroidism), among others. Nausea, vomiting, early postprandial and early satiety are present. There is no laboratory examination identifies the gastroparesis, however, they can indicate the etiology. The simple radiography may demonstrate abdominal distension, gastroduodenal seriography, as well digestive endoscopy, are most useful in evaluating mechanical obstruction. Today the gold standard for the diagnosis of gastroparesis is gastric scintigraphy.

Terapia nutricional na gastroparesia diabética: [revisão] / Terapia nutricional para la gastroparesia diabética: [revisión] / Nutrition therapy for diabetic gastroparesis: [review]

O diabetes mellitus (DM) é condição causal da neuropatia autonômica, complicação crônica decorrente da ausência de um controle glicêmico eficiente ao longo dos anos. A gastroparesia consequentemente à neuropatia é um dos distúrbios de motilidade mais comuns entre os diabéticos e afeta cerca de 58% dos indivíduos com DM. Apesar dos avanços no conhecimento relacionado à sua fisiopatologia, a gastroparesia diabética ainda constitui uma complicação de difícil abordagem clínica, com sucesso terapêutico limitado. Seu tratamento inclui medidas dietéticas e nutricionais e o uso de drogas pró-cinéticas. O rigoroso controle glicêmico, juntamente a medidas dietéticas, constitui o eixo central da prevenção e da terapêutica da gastroparesia. A dieta direcionada ao paciente com DM tem por objetivo contribuir para a normalização da glicemia, atingir e manter o peso corpóreo adequado para o indivíduo, diminuir os fatores de risco cardiovascular, prevenir as complicações agudas e crônicas do DM e promover a saúde por meio de nutrição adequada. O manejo nutricional na gastroparesia diabética implica em modificações na consistência da dieta, oferecimento de pequenos volumes durante as refeições, exclusão de alimentos não tolerados e de difícil digestão, utilização de suplementos líquidos se os alimentos sólidos não forem tolerados, e nutrição enteral e parenteral se necessário. Este teve como objetivo realizar uma revisão bibliográfica sobre a terapia nutricional na gastroparesia diabética, complicação pouco conhecida, entretanto, bastante prevalente entre os pacientes diabéticos. A pesquisa bibliográfica foi realizada em diferentes bases de dados, utilizando artigos nacionais e internacionais, datados a partir do ano de 1988.

La diabetes mellitus (DM) es una condición causal de la neuropatía autonómica, las complicaciones crónicas derivadas de la falta de un control de glucosa en sangre eficaz en los últimos años. La gastroparesia la neuropatía es una consecuencia de trastornos de la motilidad más común entre los diabéticos y afecta a alrededor del 58% de las personas con DM. A pesar de los avances en los conocimientos relacionados con la fisiopatología, la gastroparesia diabética sigue siendo una complicación de difícil abordaje clínico, con un éxito terapéutico limitado. Su tratamiento incluye medidas nutricionales y dietéticas y el uso de fármacos procinéticos. El control estricto de la glucemia, junto con las medidas dietéticas, es el eje de la prevención y el tratamiento de la gastroparesia. La dieta dirigida a los pacientes diabéticos tiene como objetivo contribuir a la normalización de la glucosa en la sangre para lograr y mantener un peso corporal adecuado para la persona, reducir los factores de riesgo cardiovascular, la prevención de complicaciones agudas y crónicas de la diabetes y promover la salud a través de una nutrición adecuada. Manejo nutricional en la gastroparesia diabética implica cambios en la consistencia de la dieta, ofrecer pequeñas cantidades con las comidas, excluidos los alimentos no se tolera y difícil de digerir, el uso de suplementos líquidos que los alimentos sólidos no se toleran, y es la nutrición enteral y parenteral es necesario. Este objetivo de llevar a cabo una revisión bibliográfica sobre la terapia nutricional en la gastroparesia diabética, una complicación poco conocida, sin embargo, bastante frecuente entre los pacientes diabéticos. La búsqueda bibliográfica se realizó en diferentes bases de datos, el uso de artículos nacionales e internacionales, que data del año 1988.

Diabetes mellitus (DM) is a causal condition of autonomic neuropathy, chronic complications arising from the absence of an effective blood glucose control over the years. The gastroparesis the neuropathy is a consequence of motility disorders more common among diabetics and affects about 58% of individuals with DM. Despite advances in knowledge related to its pathophysiology, diabetic gastroparesis is still a complication of difficult clinical approach, with limited therapeutic success. His treatment includes nutritional and dietary measures and use of prokinetic drugs. Strict glycemic control, along with dietary measures, is the lynchpin of prevention and treatment of gastroparesis. The diet aimed at the diabetic patients aims to contribute to the normalization of blood glucose to achieve and maintain appropriate body weight for the individual, reduce cardiovascular risk factors, prevention of acute and chronic complications of diabetes and promote health through adequate nutrition. Nutritional management in diabetic gastroparesis involves changes in diet consistency, offer small amounts with meals, excluding food is not tolerated and difficult to digest, use of liquid supplements that solid foods are not tolerated, and enteral and parenteral nutrition is necessary. This aimed to conduct a literature review on nutritional therapy in diabetic gastroparesis, a complication little known, however, quite prevalent among diabetic patients. The literature search was performed in different databases, using national and international articles, dating from the year 1988.

Itopride and pantoprazole outcomes in diabetic gastroparesis trial (IPOD trial).

The most common cause of gastroparesis is diabetes mellitus. The present study was carried out to asses the combination of itopride and pantoprazole in the treatment of diabetic gastroparesis. The study was an open label, multicentre, conducted in 743 patients with diabetic gastroparesis for a period of 3 weeks. The efficacy parameters included nausea, vomiting, early satiety, bloating, postprandial fullness, epigastric pain and regurgitation. The patients were evaluated based on the frequency and severity of symptoms and compared with the baseline scores. There were significant improvement in severity as well as the frequency of all the symptom parameters of the disease (p<0.001). The physicians' evaluation to the therapy was rated either excellent or good.

Antroduodenal manometry: experience from a tertiary care center.

BACKGROUND: Though antroduodenal manometry (ADM) is an important research tool, experience on its clinical utility is scanty. METHODS: All ADM performed as a clinical service, using an 8-channel water perfusion system were retrospectively analyzed. Impact on clinical management was classified as: (1) new diagnosis made, (2) change in management (new drug, decision regarding surgical treatment), (3) further special investigation done, (4) referral to another specialty. RESULTS: ADM was successful in 32/33 (97%) patients (age 30 years [range 8-71]); 6 patients were < 12 years old. Clinical impression before ADM was: chronic intestinal pseudo-obstruction (CIPO) in 16 (50%), suspected gastroparesis in 11 (34.3%), dyspepsia in 5 (15.6%). Consequent to ADM in patients with CIPO, a new diagnosis was made in two (intestinal neuronal dysplasia and celiac disease), new drugs were started in five, surgery was performed in three and specific referral was sought in three. ADM confirmed gastroparesis in 9 of 11 patients. A new diagnosis was made in three patients, new drugs were started in three, and three were referred. In five dyspeptic patients, ADM was normal and no therapy was suggested. Overall, eleven patients with CIPO and four with gastroparesis benefited after ADM. CONCLUSION: ADM was found useful in CIPO and gastroparesis, helped in decision making regarding surgery; however in nonspecific indications its utility was limited.

Motility disorders of the gastrointestinal tract.

Over the past decades our knowledge of normal and abnormal gastrointestinal motility has increased tremendously. The availability of manometry to study bowel contraction patterns, laparoscopy to perform full thickness bowel biopsies for histological examination, have added to the investigative armamentarium and helped better diagnose motility disorders. However, the development of newer therapies for bowel motility disorders has been disappointingly slow. Newer modalities such as gastric and bowel pacing provides some hope for the future. In this article we have provided an overview of some of the common motility disorders in children and discussed their management.

Management of diabetic gastroparesis.

Diabetic gastroparesis is a long term complication of diabetes mellitus which could basically be defined as dysregulated gastric emptying leading to various pathological, biochemical and clinical changes in absence of any structural changes. Symptoms include nausea, vomiting, bloating, epigastric pain, anorexia, weight loss and so on. For symptomatic gastroparesis prokinetic drugs like metoclopramide, domperidone, cisapride, erythromycin and itcopride are used. Itopride is currently emerging as a prokinetic drug of choice. There is also scope of surgery.

Current perspectives on the management of gastroparesis.

Gastroparesis is a condition of abnormal gastric motility characterised by delayed gastric emptying in the absence of mechanical outlet obstruction. It is seen commonly in people with diabetes but is idiopathic in a third of patients. Symptoms include nausea and vomiting, post-prandial fullness and early satiety, and abdominal bloating and discomfort. Investigations fall into three categories: gastric emptying studies, intraluminal pressure measurements and recording of gastric myoelectrical activity. Nuclear scintigraphy is considered the gold standard for diagnosing and quantifying delayed gastric emptying. Treatment options include diet and behavioural changes, prokinetic drugs and surgical interventions. New advances in drug therapy and gastric electrical stimulation techniques hold considerable promise.

Idiopathic gastroparesis

This case report describes a young female with idiopathic gastroparesis, who presented with persistent vomiting and weight loss. Treatment with erythromycin and tegaserod led to the recovery from symptoms and weight gain

Gastroparesia: mecanismo, diagnóstico e tratamento / Gastroparesis: mechanisms, diagnostic and treatment

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

Colocación de sondas transpilóricas a ciegas en pacientes críticos / Placement to transpyloric catheters to blind in critical patients

La alimentación enteral precoz tendría ciertos efectos beneficiosos en pacientes severamente injuriados, pero estos pacientes suelen tener gastroparesia (retardo de la evacuación gástrica) que dificulta o imposibilita la alimenación enteral en el estómago y obliga a colocar una sonda transpilórica, mediante ayuda endoscópica o radioscópica o con alguna técnica "a ciegas". Objetivo: evaluar la eficacia de una técnica para colocar sondas transpilóricas y el rol que cumplen en el éxito o fracaso de la técnica la situación clínica y varios procedimientos terapéuticos, reconocidos como factores que alteran la evacuación gastrica. Durante un periodo de 14 meses se realizaron 167 procedimientos para colocar sondas transpilóricas, en pacientes internados en terapia intensiva...

Diabetic gastroparesis.

Our understanding of gastric motility disorder--diabetic gastroparesis has advanced in the last ten to fifteen years, but the published data regarding pathogenesis are confusing and show conflicting results. The pathogenesis is sometimes linked with hyperglycemia, autonomic neuropathy, gastrointestinal hormone or myogenic mechanism. Antral hypomotility is often associated with hyperglycemia which is often accompanied by reduction in duodenal waves. Varying level of motilin, a gastrokinetic hormone has been reported. However none of the mechanism could explain the exact pathogenesis. The relationship of this mortality disorder with clinical symptoms is not always established, however nausea and vomiting lasting for days or weeks are the prominent symptoms. Other symptoms are post-prandial fullness, early satiety, bloating, belching, and vague abdominal discomfort. In a few cases, it may be the cause of poor nutrition, uncontrolled diabetes and recurrent ketoacidosis. Last one or two decades have seen some advancement in the investigational procedures like scintigraphy, radio-opaque markers, breath test, electrogastrography and MRI. Which can lead to a proper diagnosis. Such objective assessment is all the more important as nearly half of the patients do not have any symptom. Symptomatic improvement of gastroparetic patients should be the aim and in asymptomatic patients, treatment is often not recommended. Some dietary advice and prokinetic agents like metoclopramide, cisapride etc. are often prescribed but much needs to be further known as management is not always uniformly rewarding.

Assessment of gastroparesis in patients with liver cirrhosis

This study was done on 30 patients with established liver cirrhosis compared with 10 healthy age and sex matched individuals. To assess gastroparesis in those individuals, half gastric emptying time was measured ultrasonographically. It was significantly longer in patients than the controls. It also correlated to the severity of liver affection as it was significantly longer in Child-Pugh grade C cirrhotics than Child-Pugh grades A and B cirrhotics. Also, there was a significant longer 1/2 gastric emptying time in patients with ascites, esophageal varices or hepatic encephalopathy. Furthermore, cirrhotic patients with shrunken liver had significantly longer 1/2 gastric emptying time than those with average sized or enlarged liver. The 1/2 gastric emptying time was also correlated with dyspeptic symptoms

Gastroparesis diabeticorum: a clinical study in sudanese patients

Gastroparesis diabeticorum is a distressing and little mentioned gastrointestinal complication among our diabetic patients. The objective of this study was to confirm the occurrence of this syndrome and to identify its clinical features and impact on glycemic control of diabetes mellitus. The authors set a special clinic in Medani, Sudan, to receive the diabetic patients complaining of chronic [more than two weeks] symptoms related to the upper gastrointestinal tract. The criteria of diagnosis of gastroparesis diabeticorum were: symptoms [nausea, vomiting, epigastric discomfort and feeling of fullness for long periods after meals] in patients with diabetic autonomic neuropathy, and confirmatory findings of gastric stasis in the barium studies. The similar conditions were excluded. Fasting blood glucose was measured to assess the glycemic control of diabetes. Eight patients were identified, of a wide range of age group [27 - 64 years], longstanding diabetes [8 - 26 years] and poor glycemic control [fasting blood glucose > 8 mmol / L in 7 out of 8 patients]. More than one diabetic complication was recorded in each patient. We established the occurrence of gastroparesis diabeticorum as one of the manifestations of diabetic autonomic neuropathy among our patients. It should be thought of as one of the etiological factors of the upper gastroenteropathies, like peptic ulcer and giardiasis, in Sudanese diabetic patients

Gastroparesia: recentes avanços no diagnóstico e tratamento / Gastroparesis: recent advances in diagnosis and treatment

Sem motilidade gastrointestinal normal nao há digestao nem absorçao adequadas dos nutrientes ingeridos. Mais atentos à possibilidade diagnóstica de gastroparesia, os médicos recorrem atualmente, com mais freqüência, às técnicas que permitem quantificar o ritmo de progressao do conteúdo gástrico e dispoem, hoje em dia, de medicamentos procinéticos eficazes no alívio sintomático e mesmo na normalizaçao comprovada do ritmo mioelétrico de percentual significativo de pacientes com dismotilidade gastrointestinal. Alguns conceitos básicos da fisiologia gástrica sao destacados, no sentido de melhor compreender os distúrbios motores e com mais facilidade tentar estabelecer um diagnóstico etiológico e instituir o tratamento adequado. Nesta revisao bibliográfica, sao abordados os mais recentes progressos relacionados com o estudo do retarde do esvaziamento gástrico.