Granisetron transdermal system improves refractory nausea and vomiting in gastroparesis.

BACKGROUND: Symptoms of gastroparesis include nausea and vomiting, which can markedly diminish quality of life. Nausea and vomiting can also make treatment with oral antiemetics problematic. AIM: Our aim was to determine whether treatment-resistant nausea and vomiting in patients with gastroparesis improve after granisetron transdermal patch (GTP) therapy. METHODS: In an open-label pilot study, patients with gastroparesis and symptoms of nausea and vomiting refractory to conventional treatment were treated with GTP. After 2 weeks, patients were asked to assess their therapeutic response using the Clinical Patient Grading Assessment Scale (CPGAS; +7 = completely better; 0 = no change; -7 = very considerably worse). Responders were defined as CPGAS score >0, non-responders as ≤0. RESULTS: Patients (n = 36) were treated with GTP. Of these 36 patients, one patient discontinued treatment due to the GTP not adhering to the skin. Of the remaining 35 patients, 18 improved, 15 remained the same, and two worsened. The average CPGAS score was +1.8 ± 0.4 (SEM) (P < 0.05 vs 0). Of the 18 patients with improvement, the average CPGAS score was +3.7 ± 0.3 (SEM), corresponding to "somewhat" to "moderately better" improvement in nausea/vomiting. Side effects occurred in nine patients: four developed constipation, three patients had skin rash, and two reported headaches. CONCLUSIONS: GTP was moderately effective in reducing refractory symptoms of nausea and/or vomiting from gastroparesis in 50% of patients. Mild side effects were reported by 25% of patients. GTP may be an effective treatment for nausea and vomiting in gastroparesis, and further study is warranted.

Anti-hypertensive therapy and risk factors associated with hypotension during colonoscopy under conscious sedation.

BACKGROUND AND AIMS: Pre-operative use of select anti-hypertensive therapy has been associated with peri-operative hypotension in the surgical setting. Our aim was to determine the effect of anti-hypertensive medications on blood pressure (BP) and procedural outcomes in gastrointestinal endoscopy. METHODS: Our study was a prospective, cross-sectional survey of outpatients undergoing colonoscopy with conscious sedation. We enrolled patients with hypertension that took anti-hypertensive medications within 24 hours of the procedure and patients without hypertension that were not on BP-lowering agents. We recorded mean BP prior to, during, and after the procedure. RESULTS: 626 patients (338 males; mean age 56.0 +/- 10.4 years) were enrolled, and 158 patients were on anti-hypertensive therapy. There were 57 patients who developed hypotension, defined as systolic BP <90 mmHg and/or diastolic BP <60 mmHg, during the colonoscopy. Taking a BP medication, regardless of class, was not associated with an increased risk of procedural hypotension (all p >0.05). Age, body mass index, gender, duration, fentanyl dose, midazolam dose, and co-morbidities (asthma, chronic obstructive pulmonary disease, congestive heart failure, coronary artery disease) were also not associated (all p >0.05). Instead, a lower pre-procedure systolic BP (OR=0.97, 95% CI=0.95-0.99; p=0.004) and diastolic BP (OR=0.95, 95% CI=0.92-0.97; p<0.001) were identified as the only risk factors. CONCLUSION: Patients should continue their anti-hypertensive therapy leading up to endoscopy. A lower pre-procedure BP is the main risk factor for procedural hypotension in patients undergoing colonoscopy with conscious sedation. Future studies should explore other factors, such as bowel preparation, that can affect pre-procedure BP.