Electrophysiologic, morphologic, and serologic features of chronic unexplained nausea and vomiting: lessons learned from 121 consecutive patients.

BACKGROUND: Despite substantive morbidity, unexplained nausea and vomiting has not been evaluated in a systematic manner via surgically obtained biopsies and direct electrophysiology of the gut, and this information has not been correlated with serologic information. We investigated consecutive patients with unexplained and refractory chronic nausea and vomiting to define the presence of morphologic, physiologic, and/or serologic abnormalities. METHODS: In all, 101 of 121 consecutive patients who experienced chronic nausea and vomiting of unknown etiology evaluated in 1 tertiary referral center over a 10-year period were profiled qualitatively by full-thickness small bowel biopsies with hematoxylin and eosin (H&E) and Smith's Silver stains, quantitatively by intraoperative gastric electrophysiology, and semiquantitatively, when it became available, by serum autoimmune Western blot analysis. RESULTS: Overall, 79 of 101 patients had abnormal full-thickness biopsy (70 neuropathies and 9 myopathies) and frequent serum autoimmune abnormalities (mean score = 13.2, normal < 3.0). In addition, 96 of 101 patients had abnormal frequency and/or uncoupling on gastric electrophysiology. Patients with small-intestinal myopathy showed a diversity of diagnoses; some patients with neuropathy had abdominal pain that correlated with autoimmune scores on Western blot. CONCLUSION: Patients with refractory and unexplained nausea and vomiting have a high incidence of both small bowel morphologic abnormalities (primarily neuropathies) and gastric electrophysiologic abnormalities, which are associated commonly with serologic autoimmune activation. Similar histomorphologic, physiologic, and serologic measures should be considered in the diagnostic evaluation of any patient with refractory or unexplained nausea and vomiting.

An open-label trial of L-glucose as a colon-cleansing agent before colonoscopy.

BACKGROUND: The high volume and poor palatability of standard colon cleansers remain obstacles to colonoscopy for many patients. Significant electrolyte disturbances and fluid balance alterations may occur with available agents. L-glucose, the stereoisomer of D-glucose, has laxative effects that make it potentially useful as a colon-cleansing agent. This study evaluated the safety and efficacy of L-glucose as a bowel cleanser before colonoscopy. METHODS: Thirty healthy individuals (age range 34-70 years) scheduled to undergo outpatient colonoscopy were given 24 g of L-glucose in 8 ounces of water to cleanse the colon. Nonblinded endoscopists rated the quality of the preparation based on established criteria. Laboratory studies were monitored before and after administration of the L-glucose and on the day after colonoscopy; adverse clinical events were also monitored. RESULTS: L-glucose administration resulted in excellent or good preparations in 80% (24/30) of the patients and fair or poor preparations in 20%. Average water consumption was 48 ounces. No adverse event occurred, and no significant laboratory test abnormalities were identified. CONCLUSIONS: Eighty percent of patients who prepared for colonoscopy by ingestion of L-glucose had good or excellent preparations. The L-glucose preparation was palatable, and its efficacy and safety appear equivalent to currently available colon-cleansing agents.