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BACKGROUND: This study compared the effects of ondansetron and placebo in patients with diabetes mellitus and symptoms of dyspepsia (diabetic gastroenteropathy [DGE]). METHODS: We performed a randomized, double-blinded, placebo-controlled study of ondansetron tablets (8 mg) three times daily for 4 weeks in DGE patients. Symptoms were assessed with the Gastroparesis Cardinal Symptom Index daily diaries. Gastric emptying (GE) of solids (scintigraphy) and duodenal lipid infusions (300 kcal over 2 h) were each assessed twice, with placebo and ondansetron. Drug effects on GE, symptoms during the GE study and during lipid infusion, and daily symptoms were analyzed. KEY RESULTS: Of 41 patients, 37 completed both GE studies and one completed 1; 31 completed both lipid infusions and four only placebo; and all 35 randomized patients completed 4 weeks of treatment. Compared to placebo, ondansetron reduced the severity of fullness (p = 0.02) and belching (p = 0.049) during lipid infusion but did not affect GE T1/2. Both ondansetron and placebo improved daily symptoms versus the baseline period (p < 0.05), but the differences were not significant. In the analysis of covariance of daily symptoms during the treatment period, the interaction term between treatment and the acute effect of ondansetron on symptoms during lipid challenge was significant (p = .024). CONCLUSIONS & INFERENCES: Ondansetron significantly reduced fullness during enteral lipid infusion in patients with DGE. Overall, ondansetron did not improve daily symptoms versus placebo. But patients in whom ondansetron improved symptoms during enteral lipid challenge were perhaps more likely to experience symptom relief during daily treatment.
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Vaciamiento Gástrico , Ondansetrón , Humanos , Ondansetrón/administración & dosificación , Ondansetrón/uso terapéutico , Masculino , Femenino , Método Doble Ciego , Vaciamiento Gástrico/efectos de los fármacos , Persona de Mediana Edad , Adulto , Gastroparesia/tratamiento farmacológico , Dispepsia/tratamiento farmacológico , Anciano , Complicaciones de la Diabetes/tratamiento farmacológico , Lípidos/sangre , Resultado del Tratamiento , Antieméticos/administración & dosificación , Antieméticos/uso terapéuticoRESUMEN
BACKGROUND: TikTok is one of the fastest growing social media platforms. Irritable bowel syndrome (IBS) has recently become a trending topic of interest among TikTok users. AIM: To better understand the quality and accuracy of information presented in the most popular IBS-relevant videos on TikTok. METHODS: We reviewed videos with the tag 'IBS'. We excluded those not relevant to IBS or lasting <10 s or >10 min. Baseline characteristics about the videos were collected. Two independent reviewers assessed each video using DISCERN and Patient Education Materials and Assessment Tool (PEMAT) tools, two validated instruments to assess the quality of patient education materials. RESULTS: Of 100 videos, 33% were uploaded by participants with a defined medical background. The median DISCERN score of videos uploaded by participants with a medical background was 2.43 (2.00-3.10); from participants with a non-medical background, it was 1.37 (1.23-1.70) (p < 0.01). The median PEMAT Understandability scores of videos uploaded by participants with or without a medical background were 92.86 (86.61-95.00) and 80.95 (75.76-89.58), respectively (p < 0.01). The median PEMAT Actionability scores of videos uploaded by participants with or without a medical background were 100.00 (66.67-100.00) and 0.00, respectively (0.00-45.83; p < 0.01). CONCLUSION: Videos posted by medical professionals are easier to understand and to act on, and are more reliable and unbiased, and more likely to recommend shared decision making about treatment.
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Síndrome del Colon Irritable , Educación del Paciente como Asunto , Medios de Comunicación Sociales , Grabación en Video , Humanos , Educación del Paciente como Asunto/métodos , FemeninoRESUMEN
BACKGROUND: Although diabetic gastroenteropathy (DGE) is associated with small intestinal bacterial overgrowth (SIBO), most studies have evaluated SIBO with a hydrogen breath test, which may be affected by altered transit in DGE. The risk factors for the consequences of SIBO in DGE are poorly understood. We aimed to evaluate the prevalence of, risk factors for, and gastrointestinal symptoms associated with SIBO in patients with DGE. METHODS: In 75 patients with DGE and dyspepsia, we tested for SIBO (≥105 colony forming units /mL of aerobic and/or anaerobic bacteria in a duodenal aspirate) and assessed gastric emptying (GE) of solids, symptoms during a GE study and during an enteral lipid challenge (300 kcal/2 h), and daily symptoms with a Gastroparesis Cardinal Symptom Index diary for 2 weeks. Symptoms and GE were compared in patients with versus without SIBO. KEY RESULTS: Of 75 patients, 34 (45%) had SIBO, which was not associated with the use of proton pump inhibitors, daily symptoms, GE, or symptoms during a GE study. During enteral lipid challenge, severe nausea (p = 0.006), fullness (p = 0.02) and bloating (p = 0.009) were each associated with SIBO. Twenty patients (59%) with versus 13 (32%) without SIBO had at least one severe symptom during the lipid challenge (p = 0.006). CONCLUSIONS & INFERENCES: Among patients with DGE 45% had SIBO, which was associated with symptoms during enteral lipid challenge but not with delayed GE, symptoms during a GE study, or daily symptoms. Perhaps bacterial products and even fatty acids are recognized by and activate mast cells that drive the increased lipid sensitivity in SIBO.
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Intestino Delgado , Humanos , Femenino , Masculino , Persona de Mediana Edad , Intestino Delgado/microbiología , Adulto , Anciano , Vaciamiento Gástrico/fisiología , Enfermedades Gastrointestinales/microbiología , Enfermedades Gastrointestinales/epidemiología , Síndrome del Asa Ciega/epidemiología , Síndrome del Asa Ciega/diagnóstico , Síndrome del Asa Ciega/complicaciones , Complicaciones de la Diabetes/microbiología , Pruebas Respiratorias , Factores de RiesgoRESUMEN
OBJECTIVE: To review mindfulness-based interventions (MBIs) tested in randomized controlled trials (RCT) across the cancer continuum. DATA SOURCE: Articles identified in PubMed, CINAHL, Web of Science, PsycINFO, and Embase. STUDY INCLUSION AND EXCLUSION CRITERIA: Two independent reviewers screened articles for: (1) topic relevance; (2) RCT study design; (3) mindfulness activity; (4) text availability; (5) country (United States); and (6) mindfulness as the primary intervention component. DATA EXTRACTION: Twenty-eight RCTs met the inclusion criteria. Data was extracted on the following variables: publication year, population, study arms, cancer site, stage of cancer continuum, participant demographic characteristics, mindfulness definition, mindfulness measures, mindfulness delivery, and behavioral theory. DATA SYNTHESIS: We used descriptive statistics and preliminary content analysis to characterize the data and identify emerging themes. RESULTS: A definition of mindfulness was reported in 46% of studies and 43% measured mindfulness. Almost all MBIs were tested in survivorship (50%) or treatment (46%) stages of the cancer continuum. Breast cancer was the focus of 73% of cancer-site specific studies, and most participants were non-Hispanic white females. CONCLUSION: The scoping review identified 5 themes: (1) inconsistency in defining mindfulness; (2) differences in measuring mindfulness; (3) underrepresentation of racial/ethnic minorities; (4) underrepresentation of males and cancer sites other than breast; and (5) the lack of behavioral theory in the design, implementation, and evaluation of the MBI.
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Neoplasias de la Mama , Atención Plena , Envío de Mensajes de Texto , Masculino , Femenino , Humanos , Estados Unidos , Proyectos de InvestigaciónRESUMEN
BACKGROUND: Diarrhea and rectal urgency are risk factors for fecal incontinence (FI). The effectiveness of bowel modifiers for improving FI is unclear. METHODS: In this double-blind, parallel-group, randomized trial, women with urge FI were randomly assigned in a 1:1 ratio to a combination of oral clonidine (0.1 mg twice daily) with colesevelam (1875 mg twice daily) or two inert tablets for 4 weeks. The primary outcome was a ≥50% decrease in number of weekly FI episodes. KEY RESULTS: Fifty-six participants were randomly assigned to clonidine-colesevelam (n = 24) or placebo (n = 32); 51 (91%) completed 4 weeks of treatment. At baseline, participants had a mean (SD) of 7.5 (8.2) FI episodes weekly. The primary outcome was met for 13 of 24 participants (54%) treated with clonidine-colesevelam versus 17 of 32 (53%) treated with placebo (p = 0.85). The Bristol stool form score decreased significantly, reflecting more formed stools with clonidine-colesevelam treatment (mean [SD], 4.5 [1.5] to 3.2 [1.5]; p = 0.02) but not with placebo (4.2 [1.9] to 4.1 [1.9]; p = 0.47). The proportion of FI episodes for semiformed stools decreased significantly from a mean (SD) of 76% (8%) to 61% (10%) in the clonidine-colesevelam group (p = 0.007) but not the placebo group (61% [8%] to 67% [8%]; p = 0.76). However, these treatment effects did not differ significantly between groups. Overall, clonidine-colesevelam was well tolerated. CONCLUSIONS AND INFERENCES: Compared with placebo, clonidine-colesevelam did not significantly improve FI despite being associated with more formed stools and fewer FI episodes for semiformed stools.
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Clonidina , Incontinencia Fecal , Humanos , Femenino , Clonidina/uso terapéutico , Incontinencia Fecal/tratamiento farmacológico , Incontinencia Fecal/complicaciones , Clorhidrato de Colesevelam/uso terapéutico , Diarrea/etiología , Intestinos , Método Doble CiegoRESUMEN
PURPOSE: Colorectal cancer (CRC) screening is recommended for average-risk adults, yet many adults are not up-to-date with screening. One recommended CRC screening approach is the annual completion of a fecal immunochemical test (FIT). However, usually, fewer than half of mailed FIT tests are returned. METHODS: To address barriers to FIT return, a video brochure was developed providing targeted CRC screening information and step-by-step FIT instructions as a component in a mailed FIT program. This pilot study occurred in 2021-2022 and partnered with a federally qualified health center in Appalachian Ohio to send a FIT to patients who were 50-64 years old, of average risk, and not up-to-date on CRC screening. Patients were randomly assigned to 1 of 3 groups that differed on materials sent with the FIT: usual care (manufacturer's instructions), a video brochure (video instructions, disposable gloves, disposable stool collection device), or an audio brochure (audio instructions, disposable gloves, disposable stool collection device). FINDINGS: Overall, 16 of 94 patients (17%) returned the FIT, and return was higher among those sent the video brochure (28%) compared to the other 2 groups (OR: 3.1; 95% CI: 1.02, 9.2; P = .046). Two patients had positive tests and were referred for colonoscopy. Patients sent the video brochure reported the content was important, relevant, and made them think about completing the FIT. CONCLUSIONS: Using a video brochure to provide understandable information in a mailed FIT kit is a promising strategy to improve CRC screening outreach programs in rural regions.
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Neoplasias Colorrectales , Detección Precoz del Cáncer , Adulto , Humanos , Persona de Mediana Edad , Folletos , Proyectos Piloto , Tamizaje Masivo , Neoplasias Colorrectales/diagnóstico , Sangre OcultaRESUMEN
Sarcina species (spp.) infections in humans are relatively rare; however, reported cases have recently increased. We have presented the case of a 56-year-old female with diabetes who presented with bloating, dysphagia, and substantial weight loss, ultimately diagnosed with reactive gastritis secondary to Sarcina spp. infection. Administration of antibiotics and a proton pump inhibitor led to symptom alleviation and weight gain. This case underscores the significance of considering Sarcina spp. infection in patients experiencing unexplained weight loss and nonspecific gastrointestinal symptoms, highlighting the importance of promptly identifying and managing these infections to prevent potentially life-threatening complications that are becoming more prevalent in literature.
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Tactile corpuscle-like bodies (TCLBs) are specialized mechanoreceptors found in the dermal papilla of glabrous skin. They are normally not found in the gastrointestinal (GI) mucosa. There has been an increase in incidental detection in the GI mucosa due to the widespread use of colonoscopy procedures. However, TCLB's clinical implications in the GI tract remain unknown. We present a case of a 74-year-old man who was noted to have TCLBs in the rectosigmoid mucosa following resection for iatrogenic perforation. The TCLBs were spindle-shaped, positive for S-100, and negative for CD68. We review the literature on TCLBs in the GI tract and discuss their potential function in the GI mucosa.
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BACKGROUND: The relationship between cardiovascular and gastrointestinal (ie, plasma pancreatic polypeptide [PP] response to modified sham feeding [MSF]) indices of vagal function is unclear. Hyperglycemia inhibits PP secretion via vagally mediated mechanisms. Our aims were to (a) compare the PP response, (b) its relationship with glycemia, and (c) the relationship between PP response to MSF, gastric emptying (GE) of solids, and symptoms during GE study in healthy controls, patients with diabetic gastroenteropathy (DM), and non-ulcer dyspepsia (NUD). METHODS: In 24 healthy controls, 40 DM, and 40 NUD patients, we measured plasma PP concentrations during MSF, cardiovagal functions, GE, and symptoms during a GE study. KEY RESULTS: Baseline PP concentrations were higher in DM than in controls and NUD (P = .01), and in type 2 than in type 1 DM patients (P < .01). The PP increment during MSF was normal (≥20 pg/mL) in 70% of controls, 54% of DM, and 47% of NUD patients. Overall, the PP response and cardiovagal tests were concordant (P = .01). Among patients with a reduced PP increment with MSF, 7/10 of T1DM and 1/7 of T2DM patients had moderate or severe cardiovagal dysfunctions (P < .05). The PP response to MSF was not associated with GE. CONCLUSIONS & INFERENCES: Up to 30% of healthy controls have a reduced PP increment during MSF, limiting the utility of this test to detect vagal injury. The PP response is more useful when it is normal than abnormal. A reduced PP response is more likely to be associated with cardiovagal dysfunctions in T1DM than in T2DM.
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Complicaciones de la Diabetes/diagnóstico , Dispepsia/diagnóstico , Enfermedades Gastrointestinales/diagnóstico , Polipéptido Pancreático/sangre , Precursores de Proteínas/sangre , Enfermedades del Nervio Vago/diagnóstico , Adulto , Complicaciones de la Diabetes/sangre , Dispepsia/sangre , Ingestión de Alimentos/fisiología , Femenino , Enfermedades Gastrointestinales/sangre , Enfermedades Gastrointestinales/etiología , Humanos , Masculino , Placebos , Enfermedades del Nervio Vago/etiologíaRESUMEN
BACKGROUND: Non-ulcer dyspepsia (NUD) is a heterogeneous disorder, which is characterized by upper gastrointestinal symptoms and sensorimotor disturbances, including abnormal gastric emptying (GE) and increased intestinal chemosensitivity, and associated with greater plasma glucagon-like peptide-1 (GLP-1) levels during duodenal lipid infusion. However, the relationship(s) between these disturbances and daily symptoms in NUD is variable. We hypothesize that abnormal GE and symptoms during a GE study and during duodenal lipid infusion are associated with the severity of daily symptoms and that GLP-1 mediates symptoms during duodenal lipid infusion in NUD. METHODS: Gastric emptying of solids, symptoms during the GE study and duodenal lipid infusion, and daily gastrointestinal symptoms (2 week diary) were measured in 24 healthy controls and 40 NUD patients. During duodenal lipid infusion, participants received the GLP-1 antagonist exendin 9-39 or placebo. KEY RESULTS: In controls and patients, GE of solids was normal in 75% and 75%, delayed in 8% and 12.5%, or rapid in 17% and 12.5%, respectively. No controls but 26 patients (65%) had severe symptoms during the GE study. During lipid infusion, gastrointestinal symptoms were greater (P = .001) in patients and not affected by exendin. Symptoms during GE study and lipid infusion accounted for respectively 62% and 37% of variance in daily symptom severity. CONCLUSIONS: In NUD, symptoms during a GE study and to a lesser extent during lipid infusion explain the variance in daily symptoms. Intestinal chemosensitivity is not reduced by GLP-1 antagonist. Assessment of symptoms during a GE study may provide a useful biomarker for NUD in research and clinical practice.
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Técnicas de Diagnóstico del Sistema Digestivo , Duodeno , Dispepsia/fisiopatología , Vaciamiento Gástrico/fisiología , Tránsito Gastrointestinal/fisiología , Lípidos/administración & dosificación , Dolor Abdominal/fisiopatología , Adulto , Ansiedad , Estudios de Casos y Controles , Depresión , Método Doble Ciego , Dispepsia/tratamiento farmacológico , Femenino , Pirosis/fisiopatología , Humanos , Intubación Gastrointestinal , Masculino , Náusea/fisiopatología , Fragmentos de Péptidos/farmacología , Cintigrafía , Distribución Aleatoria , Respuesta de Saciedad , Índice de Severidad de la Enfermedad , Vómitos/fisiopatologíaRESUMEN
BACKGROUND: High-resolution manometry (HRM) is used to measure rectoanal pressures in defecatory disorders and fecal incontinence. This study sought to define normal values for rectoanal HRM, ascertain the effects of age and BMI on rectoanal pressures, and compare pressures in asymptomatic women with normal and prolonged balloon expulsion time (BET). METHODS: High-resolution manometry pressures and BET were measured in 163 asymptomatic healthy participants. Women (96) and men (47) with normal BET were used to estimate normal values and the effects of age/BMI on pressures using a Medtronic 4.2-mm-diameter rectoanal catheter. KEY RESULTS: Age is associated with lower resting pressure, higher rectal pressure during evacuation, and a higher rectoanal gradient during evacuation in women and men. In women, the BET is also inversely correlated with age while the BMI is correlated with a higher threshold volume for discomfort and a longer BET. The anal squeeze pressure increment, squeeze duration, and HPZ length are higher in men than women. The rectoanal gradient during evacuation is also lower (ie, more negative) in asymptomatic women with an abnormal than a normal BET. CONCLUSIONS & INFERENCES: These findings provide an expanded database of normal values for anorectal HRM in men and women. Age and sex affect anal resting and squeeze pressures, respectively; rectal pressure during evacuation is also higher in older people. Less than 15% of asymptomatic people have BET >60 seconds, which is associated with manometry features of impaired evacuation.
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Canal Anal/fisiología , Manometría/métodos , Trastornos del Suelo Pélvico/fisiopatología , Recto/fisiología , Adulto , Femenino , Voluntarios Sanos , Humanos , Masculino , Persona de Mediana Edad , Valores de ReferenciaRESUMEN
BACKGROUND: Our aim is to explain the lack of clarity in the ways in which anxiety and depression, which are common in defecatory disorders (DD), may contribute to the disorder. In this study, we evaluate the effects of mental stress and relaxation on anal pressures and the mechanisms thereof. METHODS: In 38 healthy women and 36 DD patients, rectoanal pressures were assessed at rest and during mental stressors (ie, word-color conflict [Stroop] and mental arithmetic tests) and mental relaxation, before and after randomization to placebo or the adrenergic α1 -antagonist alfuzosin. KEY RESULTS: During the baseline Stroop test, the anal pressure increased by 6 ± 13 mm Hg (mean ± SD, P = 0.004) in healthy women and 9 ± 10 mm Hg (P = 0.0001) in constipated women. During mental arithmetic, the anal pressure increased in healthy (4 ± 8 mm Hg, P = 0.002) and constipated women (5 ± 9 mm Hg, P = 0.004). After relaxation, anal pressure declined (P = 0.0004) by 3 ± 4 mm Hg in DD patients but not in controls. Alfuzosin reduced (P = 0.0001) anal resting pressure (by 31 ± 19 mm Hg) vs placebo (16 ± 18 mm Hg). However, during the postdrug Stroop test, anal pressure increased (P = 0.0001) in participants who received alfuzosin but not placebo. CONCLUSIONS & INFERENCES: In healthy controls and DD patients, mental stressors likely increased anal pressure by contracting the internal anal sphincter; relaxation reduced anal pressure in DD patients. Alfuzosin reduced anal resting pressure but did not block the Stroop-mediated contractile response, which suggests that this response is not entirely mediated by adrenergic α1 receptors.
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Antagonistas de Receptores Adrenérgicos alfa 1/farmacología , Defecación/fisiología , Distrés Psicológico , Quinazolinas/farmacología , Relajación/psicología , Adulto , Canal Anal/fisiología , Defecación/efectos de los fármacos , Método Doble Ciego , Femenino , Humanos , Manometría , Persona de Mediana Edad , Enfermedades del Recto/fisiopatología , Enfermedades del Recto/psicología , Test de StroopRESUMEN
PURPOSE OF REVIEW: To review recently published data on factors that predict the risk of progression of Barrett's esophagus (BE) to high grade dysplasia (HGD) or esophageal adenocarcinoma (EAC). RECENT FINDINGS: Computer models have been developed that could help predict the risk of progression with greater accuracy. The progression of BE score (PIB) is one such model based on clinical and endoscopic features, while a second uses automated image analysis of formalin-fixed and paraffin-embedded tissues looking for morphologic features and immunostaining patterns for molecular markers. Panels of genes such as those regulated by Myc and hypermethylated genes have been recently described. EAC remains a cancer with a poor 5-year survival of less than 20%. Screening for BE, the only known precursor of EAC is recommended only in high-risk individuals. Clinical, endoscopic, and molecular predictors of progression have been identified but require validation. These tools could in turn help focus screening and surveillance efforts to reduce mortality from EAC.
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BACKGROUND & AIMS: Some patients with defecatory disorders (DD) have high anal pressures that may impede rectal evacuation. Alpha-1 adrenoreceptors mediate as much as 50% of anal resting pressure in humans. We performed a randomized, placebo-controlled study of the effects of alfuzosin, an alpha1-adrenergic receptor antagonist, on anal pressures alone in healthy women and also on bowel symptoms in women with DD. METHODS: In a double-blind study performed from March 2013 through March 2017, anal pressures were evaluated before and after 36 women with DD (constipation for at least 1 year) and 36 healthy women (controls) were randomly assigned (1:1) to groups given oral alfuzosin (2.5 mg immediate release) or placebo. Thereafter, patients were randomly assigned (1:1) to groups given oral alfuzosin (10 mg extended release) or placebo each day for 2 weeks. Participants kept daily diaries of bowel symptoms for 2 weeks before (baseline) and during administration of the test articles (treatment). Weekly questionnaires recorded the overall severity of constipation symptoms, bloating, abdominal pain, nausea, and vomiting; overall satisfaction with treatment of constipation was evaluated at weeks 2 and 4. The primary endpoint was the change in the number of spontaneous (SBMs) and complete SBMs (CSBMs) between the treatment and baseline periods. We evaluated relationships between stool form, passage, and complete evacuation. RESULTS: Alfuzosin reduced anal resting pressure by 32 ± 3 mm Hg versus 16 ± 3 mm Hg for placebo (P = .0001) and anal pressure during evacuation by 26 ± 3 mm Hg versus 16 ± 3 mm Hg for placebo, (P = .03). However, alfuzosin did not significantly increase the rectoanal gradient, SBMs or CSBMs compared with placebo. Both formulations of alfuzosin were well tolerated. Hard stools and the ease of passage during defecation accounted for 72% and 76% of the variance in the satisfaction after defecation, respectively, during baseline and treatment periods. CONCLUSIONS: In a randomized trial, alfuzosin reduced anal pressure at rest and during simulated evacuation in healthy and constipated women, compared with placebo, but did not improve bowel symptoms in constipated women. This could be because the drug does not improve stool form or dyssynergia, which also contribute to DD. ClinicalTrials.gov number, NCT 01834729.
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Canal Anal/fisiopatología , Estreñimiento/tratamiento farmacológico , Defecación/fisiología , Hábitos , Quinazolinas/uso terapéutico , Antagonistas de Receptores Adrenérgicos alfa 1/uso terapéutico , Adulto , Estreñimiento/fisiopatología , Defecación/efectos de los fármacos , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Masculino , Manometría , Persona de Mediana Edad , Presión , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
CONTEXT: Delayed gastric emptying (GE) is common but often asymptomatic in diabetes. The relationship between symptoms, glycemia, and neurohormonal functions, including glucagonlike peptide 1 (GLP-1), are unclear. OBJECTIVES: To assess whether GE disturbances, symptoms during a GE study, and symptoms during enteral lipid infusion explain daily symptoms and whether GLP-1 mediates symptoms during enteral lipid infusion. DESIGN: In this randomized controlled trial, GE, enteral lipid infusion, gastrointestinal (GI) symptoms during these assessments, autonomic functions, glycosylated hemoglobin (HbA1c), and daily GI symptoms (2-week Gastroparesis Cardinal Symptom Index diary) were evaluated. During enteral lipid infusion, participants received the GLP-1 antagonist exendin 9-39 or placebo. SETTING: Single tertiary referral center. PARTICIPANTS: 24 healthy controls and 40 patients with diabetic gastroenteropathy. MAIN OUTCOME MEASURES: GE, symptoms during enteral lipid infusion, and the effect of exendin 9-39 on the latter. RESULTS: In patients, GE was normal (55%), delayed (33%), or rapid (12%). During lipid infusion, GI symptoms tended to be greater (P = 0.06) in patients with diabetes mellitus (DM) than controls; exendin 9-39 did not affect symptoms. The HbA1c was inversely correlated with the mean symptom score during the GE study (r = -0.46, P = 0.003) and lipid infusion (r = -0.47, P < 0.01). GE and symptoms during GE study accounted for 40% and 32%, respectively, of the variance in daily symptom severity and quality of life. CONCLUSIONS: In DM gastroenteropathy, GE and symptoms during a GE study explain daily symptoms. Symptoms during enteral lipid infusion were borderline increased but not reduced by a GLP-1 antagonist.
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Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Vaciamiento Gástrico/fisiología , Enfermedades Gastrointestinales/fisiopatología , Péptido 1 Similar al Glucagón/antagonistas & inhibidores , Fragmentos de Péptidos/administración & dosificación , Administración Oral , Adulto , Enfermedades Asintomáticas/terapia , Glucemia/análisis , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/metabolismo , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/metabolismo , Emulsiones , Femenino , Vaciamiento Gástrico/efectos de los fármacos , Enfermedades Gastrointestinales/diagnóstico , Enfermedades Gastrointestinales/tratamiento farmacológico , Enfermedades Gastrointestinales/etiología , Hemoglobina Glucada/análisis , Humanos , Lípidos/administración & dosificación , Masculino , Persona de Mediana Edad , Calidad de Vida , Resultado del TratamientoAsunto(s)
Estreñimiento , Electroacupuntura , Enfermedad Crónica , Defecación , Humanos , Resultado del TratamientoRESUMEN
Although abdominal pain is a symptom of several structural gastrointestinal disorders (eg, peptic ulcer disease), this comprehensive review will focus on the 4 most common nonstructural, or functional, disorders associated with abdominal pain: functional dyspepsia, constipation-predominant and diarrhea-predominant irritable bowel syndrome, and functional abdominal pain syndrome. Together, these conditions affect approximately 1 in 4 people in the United States. They are associated with comorbid conditions (eg, fibromyalgia and depression), impaired quality of life, and increased health care utilization. Symptoms are explained by disordered gastrointestinal motility and sensation, which are implicated in various peripheral (eg, postinfectious inflammation and luminal irritants) and/or central (eg, stress and anxiety) factors. These disorders are defined and can generally be diagnosed by symptoms alone. Often prompted by alarm features, selected testing is useful to exclude structural disease. Identifying the specific diagnosis (eg, differentiating between functional abdominal pain and irritable bowel syndrome) and establishing an effective patient-physician relationship are the cornerstones of therapy. Many patients with mild symptoms can be effectively managed with limited tests, sensible dietary modifications, and over-the-counter medications tailored to symptoms. If these measures are not sufficient, pharmacotherapy should be considered for bowel symptoms (constipation or diarrhea) and/or abdominal pain; opioids should not be used. Behavioral and psychological approaches (eg, cognitive behavioral therapy) can be helpful, particularly in patients with chronic abdominal pain who require a multidisciplinary pain management program without opioids.
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Dolor Abdominal/etiología , Dispepsia/complicaciones , Síndrome del Colon Irritable/complicaciones , Dolor Abdominal/terapia , Analgésicos Opioides/efectos adversos , Comorbilidad , Estreñimiento/complicaciones , Estreñimiento/etiología , Estreñimiento/terapia , Diagnóstico Diferencial , Diarrea/complicaciones , Diarrea/etiología , Diarrea/terapia , Dieta/efectos adversos , Dieta/normas , Dispepsia/etiología , Dispepsia/terapia , Femenino , Enfermedades Gastrointestinales/complicaciones , Enfermedades Gastrointestinales/etiología , Enfermedades Gastrointestinales/terapia , Humanos , Síndrome del Colon Irritable/terapia , Masculino , Dolor Musculoesquelético , Obesidad , Educación del Paciente como Asunto , Relaciones Médico-Paciente , Distribución por Sexo , Estrés Psicológico/complicacionesRESUMEN
Superior vena cava (SVC) syndrome is not an uncommon occurrence in patients with malignancy and it is often described as a medical emergency. In majority of the cases, SVC syndrome occurs due to mechanical obstruction of the SVC by extraluminal compression with primary intrathoracic malignancies. However, intraluminal obstruction due to thrombosis can also produce symptoms and signs of SVC syndrome. Clot-related SVC obstruction is mostly associated with indwelling central venous catheter and pacemaker leads, although such thrombosis can occur spontaneously in a background of a hypercoagulable state, e.g., malignancy. Here, an unusual case of sudden onset SVC syndrome has been reported, which on initial radiologic evaluation was found to have a lung nodule without any significant mediastinal mass or adenopathy compressing SVC. Subsequent investigation with Doppler ultrasonography of the neck showed thrombosis in the right internal jugular, right subclavian and right brachiocephalic vein, which was responsible for SVC syndrome. Histopathological evaluation of lung nodule confirmed presence of an adenocarcinoma. Therefore, venous thromboembolism as a paraneoplastic syndrome should be kept in mind while evaluating a case of SVC obstruction in a cancer patient. Management of the underlying disease is of prime importance in such cases and anticoagulation is the mainstay of therapy. Ability to identify paraneoplastic syndrome may have a significant effect on clinical outcome, ranging from early diagnosis to improved quality of life of the patient.
RESUMEN
Desmoplasia in human pancreatic cancer (PC) promotes cancer progression and hinders effective drug delivery. The objectives of this study were to characterize a homologous orthotopic model of PC in Syrian golden hamster and investigate the effect of anti-fibrotic (pirfenidone), antioxidant (N-acetyl cysteine, NAC) and anti-addiction (disulfiram, DSF) drugs on desmoplasia and tumor growth in this model. The HapT1 PC cells when implanted orthotopically into hamsters formed tumors with morphological, cellular and molecular similarities to human PC. Protein profiling of activated hamster pancreatic stellate cells (ha-PSCs) revealed expression of proteins involved in fibrosis, cancer cells growth and metastasis. Pirfenidone, suppressed growth of HapT1 cells and the desmoplastic response in vivo; these effects were enhanced by co-administration of NAC. Disulfiram alone or in combination with copper (Cu) was toxic to HapT1 cells and PSCs in vitro; but co-administration of DSF and Cu accelerated growth of HapT1 cells in vivo. Moreover, DSF had no effect on tumor-associated desmoplasia. Overall, this study identifies HapT1-derived orthotopic tumors as a useful model to study desmoplasia and tumor-directed therapeutics in PC. Pirfenidone in combination with NAC could be a novel combination therapy for PC and warrants investigation in human subjects.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/farmacología , Neoplasias Pancreáticas/tratamiento farmacológico , Células Estrelladas Pancreáticas/efectos de los fármacos , Ensayos Antitumor por Modelo de Xenoinjerto/métodos , Acetilcisteína/administración & dosificación , Animales , Línea Celular Tumoral , Disulfiram/administración & dosificación , Fibrosis/prevención & control , Cobayas , Humanos , Páncreas/efectos de los fármacos , Páncreas/patología , Piridonas/administración & dosificación , RatasRESUMEN
Leukemoid reaction is defined as leucocytosis >50,000/µL. When it occurs in association with a malignancy, and infection or leukemia has been ruled out, it is termed as paraneoplastic leukemoid reaction. A patient presented with fatigue, generalized weakness, and abdominal distension and was incidentally noted to have a white blood cell count of 139,000/µL. Leukemia was ruled out by peripheral smear and flow cytometry. Computed tomography-guided biopsy of thickened omentum revealed poorly differentiated metastatic carcinoma. He died 3 days after admission with a peak white blood cell count of 180,000/µL. Previous reports and pathophysiology of paraneoplastic leukemoid reaction are reviewed.