Safety of prolonged use of metoclopramide and domperidone as treatment for chronic gastrointestinal dysmotility disorders in patients with systemic sclerosis.

Background: Metoclopramide and domperidone are prokinetic agents commonly used to treat gastrointestinal dysmotility disorders. This study aimed to evaluate the safety and associated side effects of prolonged-use metoclopramide and domperidone as treatment for chronic gastrointestinal dysmotility disorders in patients with systemic sclerosis (SSc). Methods: A quantitative observational survey was conducted by interview questionnaire in rheumatology outpatients at a tertiary teaching hospital in Riyadh, Saudi Arabia. The study included all patients aged 25-80 years diagnosed with SSc. All patients were on metoclopramide or domperidone for the treatment of chronic gastrointestinal dysmotility symptoms over at least 12 weeks. Results: Eighteen eligible patients were included. Most study participants were diagnosed with SSc complicated by interstitial lung disease (n = 13; 72.2 %). The most frequently reported side effect that occurred while taking prokinetic drugs was shortness of breath (n = 12; 66.7 %). None of the participants reported experiencing depression, galactorrhea, or syncope. CNS side effects were reported in 5.6 %. There were no differences in side effects based on the type and dosage of prokinetic drug used. Conclusions: Use of metoclopramide and domperidone for the treatment of chronic gastrointestinal dysmotility in SSc patients for 12 weeks or longer was not associated with any troublesome side effects. Further studies with more participants are needed to confirm our findings.

The potential role of the sodium iodide symporter gene polymorphism in the development of differentiated thyroid cancer.

The sodium iodide symporter (NIS) (solute carrier family 5; SLC5A), mediates the active transport of iodine anion (I(-)) into thyroid follicular cells to facilitate thyroid hormone biosynthesis. Considering its fundamental role in thyroid function, our objective in this study is to explore its potential involvement in the pathogenesis of differentiated thyroid cancer (DTC). Following a preliminary sequencing of the gene in a representative sample of the general population, five variants, (1) rs45602038, (2) rs4808708, (3) rs4808709, (4) rs7250346 and (5) rs12327843, were selected for a larger population-based association study consisting of 507 cases and 597 controls, of which only the rs45602038_TT [Odds ratio (95% confidence interval)=1.90 (1.26-2.88); p=0.002] was associated with disease following adjustment for other confounders using the multivariate analysis. Furthermore, a 5-mer haplotype CGAGT constructed from the five studied SNPs conferred a significant risk (χ(2)=10.98; p=0.0009) for DTC. This association trickled down through shorter derivatives, with the 4-mer haplotype CGAG (χ(2)=13.25; p=0.0003) displaying the most significant association and the 3-mer GAG (χ(2)=11.80; p=0.0006) being equally strongly linked to the disease. Comparison of the flanking derivatives of the primary 5-mer haplotype also indicated that the 3-mer CGA (χ(2)=4.04; p=0.045) constructed from SNP block 1-3 was a lot weaker than that of the AGT (χ(2)=6.73; p=0.0095) constructed from the blocks 3-5 from the other end of the gene. Put together, these data implicate the three nucleotide changes at the rs4808708, rs4808709 and rs7250346 loci (blocks 2-4) as the core for this relationship.

Diagnostic value of recombinant human thyrotropin-stimulated ¹²³I whole-body scintigraphy in the follow-up of patients with differentiated thyroid cancer.

PURPOSE: Published data on recombinant human thyrotropin- (rhTSH-) stimulated iodine-123 (¹²³I) diagnostic whole-body scintigraphy (DxWBS) in differentiated thyroid cancer (DTC) surveillance after initial treatment are limited. We sought to evaluate this modality's diagnostic value in this setting. MATERIALS AND METHODS: We retrospectively compared rhTSH-stimulated ¹²³I DxWBS results with DTC status concurrently determined by stimulated serum thyroglobulin (Tg) measurement, neck ultrasonography, and other imaging studies. Disease was considered present based on stimulated Tg level ≥1 µg/L without interfering Tg autoantibodies with or without positive imaging or biopsy-proven DTC. We also compared scan positivity and disease detection rates of rhTSH-stimulated DxWBS scans obtained with ¹²³I with those acquired with iodine-131 (¹³¹I) during the same period. The sample comprised 105 consecutive totally thyroidectomized patients undergoing rhTSH-aided DxWBS with I-123 (n = 67) or with ¹³¹I (n = 38) for diagnostic follow-up. rhTSH, 0.9 mg/d, was injected intramuscularly on 2 consecutive days. Oral diagnostic activities of 5 to 10 mCi (185-370 MBq) ¹²³I or 3 mCi (111 MBq) ¹³¹I were given on the third day. DxWBS was performed 24 hours (¹²³I) or 48 to 72 hours (¹³¹I) later. RESULTS: rhTSH-aided ¹²³I DxWBS scans showed 35.3% sensitivity, 98.0% specificity, 85.7% positive predictive value, and 81.6% negative predictive value. rhTSH-stimulated ¹²³I and ¹³¹I DxWBS did not differ in scan positivity (10.4% vs. 13.2%, P = 0.75) or disease detection rates (35.3% vs. 27.8%, P = 1.00). CONCLUSIONS: In DTC, rhTSH-aided ¹²³I DxWBS achieves comparable results in diagnostic follow-up with those of rhTSH-aided ¹³¹I DxWBS. Future studies should address the preablation setting and scan activity and timing.