Multidisciplinary behavioral therapy reduces rumination.

BACKGROUND: Behavioral therapy has proved effective as rumination therapy. Our objective was to treat rumination patients using multidisciplinary behavioral therapy aimed at reducing ≥2 of the rumination score. METHODS: All patients fulfilled Rome IV criteria for rumination and were referred to speech therapy for psychoeducation, diaphragmatic breathing exercises and guided eating, physiotherapy for exercises to relax the thoracic and abdominal muscles, and consultation with the psychologist and the dietitian. Symptoms, depression, anxiety, health-related quality of life (HRQoL), and functional capacity were evaluated by questionnaires (Rome IV, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), 15D, and World Health Organization Disability Assessment Schedule (WHODAS) 2.0) at baseline and at 6-month control. Esophageal manometry was performed at 6-month control. KEY RESULTS: The study enrolled 11 patients (19-64 years, 10 female). Rumination score: 6.5 (5-8) at baseline, 4.0 (3-5) at the 6-month control, p = 0.005. BDI/8 (6-13), BAI/15 (8-29) at baseline; BDI/7 (4-8), BAI/15 (7-27) at the 6-month control, NS. 15D score: 0.800 at baseline, 0.845 at the 6-month control, NS. WHODAS 2.0 score: 15 (7-33) at baseline, 11 (7-26) at the 6-month control, NS. Rumination could be evoked in manometry in six of nine (67%) patients at 6-month control. CONCLUSIONS AND INFERENCES: Behavioral multidisciplinary therapy significantly reduces the self-assessed frequency of rumination. These patients have more depression, anxiety and a lower HRQoL compared to the normal population.

Upper abdominal symptoms in patients with Type 1 diabetes: unrelated to impairment in gastric emptying caused by autonomic neuropathy.

AIMS: Diabetic gastroparesis is a common condition occurring in some 30-50% of patients with long-term diabetes. Some studies have found a relationship between autonomic neuropathy and diabetic gastroparesis. In addition to autonomic neuropathy, acute changes in plasma glucose concentration can also affect gastric emptying. The objective was to examine the relationship between autonomic nerve function, glucose concentration, gastric emptying, and upper abdominal symptoms in Type 1 diabetic patients. METHODS: Gastric emptying of solids and liquids was measured with scintigraphy in 27 patients with longstanding Type 1 diabetes with upper abdominal symptoms. Autonomic nerve function was examined by standardized cardiovascular tests, and plasma glucose concentrations were measured during scintigraphy. Severity of abdominal symptoms and quality of life were explored by validated questionnaires. RESULTS: Seven patients (26%) had delayed gastric emptying of solids and three (11%) of liquids. Mean gastric half-emptying time of solids was 128 +/- 116 min and of liquids 42 +/- 30 min. Of the 26 patients undergoing tests, 16 (62%) had autonomic nerve dysfunction. Autonomic neuropathy score (1.6 +/- 1.7) correlated positively with the gastric emptying rate of solids (P = 0.006), a rate unrelated to symptom scores or plasma glucose concentrations during scintigraphy. Quality of life in patients with abdominal symptoms was lower than in the normal Finnish population. CONCLUSIONS: Impaired gastric emptying of solids in patients with Type 1 diabetes is related to autonomic neuropathy, but not to actual glycaemic control. The upper abdominal symptoms observed in these patients cannot be explained, however, by impaired gastric emptying.

Outcomes of High-Frequency Gastric Electric Stimulation for the Treatment of Severe, Medically Refractory Gastroparesis in Finland.

BACKGROUND AND AIMS: Severe, medically uncontrollable gastroparesis is a rare entity, which can be treated using a high-frequency gastric electric stimulator implanted surgically. Previous follow-ups have proven positive outcomes with gastric electric stimulator in patients with gastroparesis. The aim of this study was to evaluate the efficacy and safety of gastric electric stimulator in patients, in whom gastroparesis could not be controlled by conservative means in our country. MATERIALS AND METHODS: This is a retrospective multi-center cohort comprising all patients who had been implanted gastric electric stimulator for severe, medically refractory gastroparesis during 2007-2015 in Finland. RESULTS: Fourteen patients underwent implantation of gastric electrical stimulator without any postoperative complications. Laparoscopic approach was used in 13 patients (93%). Prior implantation, all patients needed frequent hospitalization for parenteral feeding, 13 had severe nausea, 11 had severe vomiting, 10 had notable weight loss, and 6 had frequent abdominal pain. After operation, none of the patients required parenteral feeding, 11 patients (79%) gained median of 5.1 kg in weight (P < 0.01), and symptoms were relieved markedly in 8 and partially in 3 patients (79%). Of partial responders, two continued to experience occasional vomiting and one mild nausea. Five patients needed medication for gastroparesis after the operation. One patient did not get any relief of symptoms, but gained 6 kg in weight. No major late complications occurred. CONCLUSION: Gastric electrical stimulator seems to improve the nutritional status and give clear relief of the symptoms of severe, medically uncontrollable gastroparesis. Given the low number of operations, gastric electrical stimulator seems to be underused in Finland.

Effect of peritoneal dialysis on gastric myoelectrical activity in patients with chronic renal failure.

Impaired gastric myoelectrical activity has been reported in patients with chronic renal failure (CRF). The effect of peritoneal dialysis on this function has not previously been described. The aim here was to investigate the effect of peritoneal dialysis on gastric myoelectrical activity. Gastric myoelectrical activity was recorded by electrogastrography (EGG) in 23 patients with CRF (18 with dyspepsia) during peritoneal dialysis and with the peritoneal cavity empty of dialysis fluid (14 patients), and in 20 healthy controls. Two 30-min EGG recordings before and after a solid test meal were analyzed using spectral analysis methods. No significant difference in the percentage of normal 2- to 4-cpm slow waves was found in patients on peritoneal dialysis compared to those with the peritoneal cavity empty of dialysis fluid or to controls (in fasting state 83 +/- 3%, 80 +/- 5% and 89 +/- 4%, in fed state 91 +/- 3%, 86 +/- 4% and 83 +/- 4%, respectively). It was found that the power ratio (change in power of normal slow waves in fed state) was significantly higher in the 14 patients on peritoneal dialysis compared to the same patients with the peritoneal cavity empty of dialysis fluid (27.2 +/- 10.7 vs 8.6 +/- 4.8, P < 0.05). There was no significant difference in the power ratio between patients with the peritoneal cavity empty of dialysis fluid and controls (8.6 +/- 4.8 vs 7.5 +/- 2.2). The subgroup of patients with no dyspepsia had a significantly higher power ratio compared to those with dyspepsia both on dialysis and with the peritoneal cavity empty of dialysis fluid (39.4 +/- 13.7 vs 12.4 +/- 5.2 and 29.2 +/- 21.5 vs 2.8 +/- 0.4 respectively, P < 0.05). In conclusion, there was no significant difference in gastric myoelectrical activity between patients with the peritoneal cavity empty of dialysis fluid and controls. Dialysis fluid in the peritoneal cavity seems to enforce the gastric myoelectrical signal.