Drug delivery of zinc to Barrett's metaplasia by oral administration to Barrett's esophagus patients.

BACKGROUND: Delivery of a pharmacologically effective drug dosage to a target tissue is critical. Barrett's epithelia are a unique challenge for drug delivery of orally administered zinc due to rapid transit down the esophageal lumen, incomplete absorptive differentiation of these epithelia, and the use of proton-pump inhibitor drugs abrogating intestinal uptake of supplemental zinc. METHODS: Barrett's esophagus patients were administered oral zinc gluconate (26 mg zinc twice daily) for 14 days prior to biopsy procurement. Barrett's biopsies were analyzed for total zinc content by atomic absorption spectroscopy and by western immunoblot for cellular proteins known to be regulated by zinc. RESULTS: Cellular levels of both the Znt-1 transport protein and the alpha isoform of PKC were over 50% lower in the zinc treatment group. CONCLUSION: Oral zinc administration can result in effective delivery of zinc to Barrett's epithelia with resulting effects on intracellular signal transduction.

Fatigue: a prevalent symptom in gastroparesis.

BACKGROUND: Fatigue is seen in many medical conditions. Patients with gastroparesis may complain of fatigue. AIM: The aim of this work is to first assess the prevalence and severity of fatigue in patients with gastroparesis, and secondly to correlate fatigue with symptoms, quality of life, and factors that may contribute to fatigue. METHODS: One hundred and fifty-six patients with gastroparesis filled out questionnaires including the fatigue assessment instrument (FAI), patient assessment of upper gastrointestinal symptom severity index, patient assessment of upper gastrointestinal disorders-quality of life and hospital anxiety, and depression scale to evaluate for fatigue, symptoms, quality of life, and depression. Gastric emptying test and laboratory studies for hemoglobin, glycosylated hemoglobin, thyroid function (TSH), and inflammatory markers (CRP and ESR) were obtained. RESULTS: Fatigue was reported by 93 % of patients. The mean total FAI score was 3.71 ± 0.2, with 51 % of patients having a score above 4, indicating severe fatigue. There were moderate correlations between fatigue and many symptoms of gastroparesis: upper abdominal discomfort (r = 0.446), upper abdominal pain (r = 0.422), loss of appetite (r = 0.329), bloating (r = 0.297), and abdominal distention (r = 0.265). Fatigue in patients using metoclopramide (3.5 ± 0.4) was similar to patients using domperidone (3.7 ± 0.5) or neither medicine (3.8 ± 0.3). Fatigue severity correlated with a decreased quality of life (r = -0.694, p < 0.001), increased depression (r = 0.339, p = 0.009), lower anxiety (r = -0.441, p < 0.001), and lower hemoglobin levels (r = -0.258, p = 0.005), but not to glycosylated hemoglobin, ESR, CRP, TSH, or gastric emptying. CONCLUSIONS: Fatigue is an important significant symptom in patients with gastroparesis with a high prevalence and severity. Fatigue is correlated with many symptoms of gastroparesis, low hemoglobin, depression, inflammation, decreased quality of life, but not to severity of delayed gastric emptying or to medication use.

Abdominal pain is a frequent symptom of gastroparesis.

BACKGROUND & AIMS: Although the most commonly recognized symptoms of gastroparesis (GP) are nausea and vomiting, patients also report abdominal pain. We aimed to define the prevalence, severity, and quality of abdominal pain in GP and to correlate abdominal pain with gastric emptying (GE) and quality of life. METHODS: Patients presumed to have GP underwent 4-hour GE scintigraphy and upper endoscopy examinations and completed the following: patient assessments of gastrointestinal symptoms (Patient Assessment of Upper Gastrointestinal Symptom Severity Index), abdominal pain questionnaires (Short-Form of the McGill Pain Questionnaire), and quality-of-life questionnaires. RESULTS: The study group consisted of 68 patients (58 female; 10 male) with delayed GE (18 diabetic gastroparesis [DG] and 50 idiopathic gastroparesis [IG]). Abdominal pain was present in 90% of patients (89% DG, 90% IG) and nausea was present in 96% (100% DG, 94% IG). Abdominal pain was epigastric in 43% and umbilical in 13%. Pain occurred daily in 43% and was constant in 38%. Pain often was induced by eating (72%), was nocturnal (74%), and interfered with sleep (66%). Severity ranking of symptoms based on the Patient Assessment of Upper Gastrointestinal Symptom Severity Index was as follows: abdominal fullness (3.8 +/- 0.2), bloating (3.6 +/- 0.2), nausea (3.6 +/- 0.2), upper abdominal discomfort (3.3 +/- 0.2), upper abdominal pain (3.0 +/- 0.2), and vomiting (2.2 +/- 0.2). Abdominal pain severity did not correlate with GE, but had moderate correlation with quality of life. CONCLUSIONS: Abdominal pain is a frequent symptom in patients with GP, comparable with nausea and vomiting. Abdominal pain correlates with impaired quality of life but not with GE.