Acute effect of clonidine on gastric emptying in patients with diabetic gastropathy and controls.

BACKGROUND: The treatments available for diabetic gastropathy are frequently ineffective. Clinical observations suggest that clonidine, an a-2 adrenergic agonist, may improve diabetic gastropathy symptoms. AIMS: To establish whether a single oral dose of clonidine alters the gastric emptying of a solid meal in 10 patients with diabetic gastropathy and their matched controls. A secondary goal was to compare two methods of analysis of the data from gastric emptying studies. METHODS: Clonidine, 0.3 mg, or a matched placebo were administered orally in a double-blind fashion. RESULTS: Only three of the 10 patients showed an increased gastric residual volume. Gastric emptying rates were comparable in patients and controls. Clonidine had no significant effect on gastric emptying in the controls but increased t1/2 values in the patient group. This effect just reached statistical significance only when calculated by the power exponential method (P=0.05 but not by the linear component model. CONCLUSIONS: Delayed gastric emptying is not an invariable characteristic of symptomatic diabetic gastropathy. Clonidine, given as a single dose of 0.3 mg orally, has no gastric prokinetic effects. It may act on gastric afferent innervation or, more likely, at a central site to reduce nausea and vomiting. The analysis of gastric emptying data by the power exponential and the two linear component methods yields equivalent results.

Antibiotic-induced iatrogenic hemobilia.

A classical triad of clinical signs defines hemobilia: GI bleeding, right upper quadrant abdominal pain, and jaundice. Although there are a number of causes, it is largely described in conjunction with blunt or penetrating liver trauma and as an iatrogenic complication of therapeutic hepatobiliary interventions. We present a case of antibiotic-induced vitamin K deficiency that resulted in hemobilia complicating acalculous cholecystitis.

Effect of push enteroscopy on transfusion requirements and quality of life in patients with unexplained gastrointestinal bleeding.

AIM: The aim of our study was to determine whether push enteroscopy altered transfusion requirements or quality of life in patients with unexplained gastrointestinal bleeding. METHODS: Twenty-nine patients with gastrointestinal bleeding unexplained by upper endoscopy and colonoscopy or persistent despite appropriate therapy after these procedures, underwent enteroscopy. Transfusion records in the year preceding and after the procedure were obtained from blood bank records and from telephone interviews every 6 months. RESULTS: Of 29 patients, 20 had received a transfusion (mean 8 +/- 3 units per patient) in the year preceding enteroscopy. In the year after the enteroscopy, 11 patients required transfusion (p = 0.034), and the mean transfusion requirement fell to 4 +/- 2 units, (p = 0.007). Angiodysplasia, the most frequent lesion found at enteroscopy (13 patients, 45%) were treated by endoscopic cautery. These patients had received an average of 13 +/- 6 units of packed cells per patient in the year preceding the procedure. In the year after enteroscopy, there was a significant reduction in transfusions (6 +/- 3 units per patient; p = 0.021). Of the 13 patients, 4 (31%) no longer required transfusions. Median functional status improved from 60 to 90 (p = 0.005). CONCLUSIONS: Enteroscopy alters the outcome of some patients with obscure gastrointestinal bleeding by reducing or eliminating bleeding and improving functional status.

Enteroscopy. Outcomes.

Outcomes studies are important to determine the role of enteroscopy in the management of patients with obscure gastrointestinal bleeding. This article discusses the current available data and identifies areas for further research.