Utility of Three Prognostic Risk Scores in Predicting Outcomes in Elderly Non-Malignant Patients after Percutaneous Gastrostomy.

BACKGROUND/OBJECTIVES: Percutaneous endoscopic gastrostomy is a method of providing enteral feeding to patients who cannot take adequate oral nutrition. The aims of this study were to determine the performance of malnutrition and mortality scoring systems for predicting short and long-term mortality in elderly patients who had undergone gastrostomy procedure due to non-malignant conditions. DESIGN: Retrospective cohort study. SETTING: University hospital in Turkey. PARTICIPANTS: 155 individuals aged 65 and older principally hospitalized for non-malignant diseases and require percutaneous endoscopic gastrostomy. MEASUREMENTS: "Geriatric Nutritional Risk Index", "Malnutrition Universal Screening Tool" (MUST) and "Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity" (P-POSSUM) scores were calculated. The ability of these scores to predict mortality was determined. RESULTS: The mean survival period was 9.59±6.0 months and mortality rate was 80.6%. The performance of "Geriatric Nutritional Risk Index" was superior to MUST and P-POSSUM in predicting long-term survival of gastrostomy patients; 94.1% of patients were alive with a cut-off value of 90 for "Geriatric Nutritional Risk Index" (sensitivity: 92% CI 85.9-95.6 and specificity: 90% CI 74.3-96.5). Survival analysis showed that patients (n=7) with a "Geriatric Nutritional Risk Index" score of > 98 before the gastrostomy had the longest survival time, while patients (n=102) with a "Geriatric Nutritional Risk Index" score of < 82 had the worst outcome. CONCLUSIONS: A scoring system such as "Geriatric Nutritional Risk Index" should be considered as a risk scoring system for predicting early and late mortality at gastrostomy and also assist in making decisions such as timing of gastrostomy procedure.

The association between gastroesophageal flap valve function and gastroesophageal reflux symptoms.

BACKGROUND AND STUDY AIMS: Upper gastrointestinal endoscopic examination is usually the first step in the evaluation of patients with suspected gastroesopageal reflux disease. The primary aim of this study was to investigate the association between gastroesophageal flap valve function (GEFV) and gastroesophapgeal reflux symptoms in patients undergoing routine upper endoscopy. Patients and methods: 1507 patients were included into the study and the GEFV graded I to IV as follows: Hill I-II: normal GEFV, and Hill III-IV: abnormal GEFV. RESULTS: Patients in abnormal GEFV group had a higher incidence of reflux symptoms compared to normal GEFV group (53.4% vs 47.4% for heartburn p=0.03 and 53.2% vs 42.4% for regurgitation, p<0.01). In abnormal GEFV patients, esophagitis was more common compared to those with normal GEFV (32.6% vs 11.1%, p<0.01). Presence of heartburn and regurgitation (n =556) correlated with Hill III-IV grades (n = 184/556), (sensitivity: 33%, p = 0.003). In contrast, 24.6% (157/638) of patients without reflux symptoms were in abnormal GEFV group. In patients undergoing endoscopy because of reflux symptoms, Grade III-IV valve was detected more commonly in patients with reflux symptoms compared to patients without reflux symptoms (p = 0.01). CONCLUSIONS: Patients with abnormal valves (Hill grades III and IV) but without reflux symptoms, esophagitis and hiatal hernia should be evaluated individually by means of the presence of gastroesophageal reflux disease which means that GEFV is not a good indicator of reflux disease.

Clinical trial: insulin-sensitizing agents may reduce consequences of insulin resistance in individuals with non-alcoholic steatohepatitis.

BACKGROUND: Currently, although only a few therapies normalize the liver test abnormalities with/without improving the liver histology, no pharmacologic therapy has proved to be effective for the treatment of non-alcoholic steatohepatitis. AIM: To investigate the role of insulin sensitizers in the treatment of individuals with non-alcoholic steatohepatitis (NASH). METHODS: A total of 74 individuals with NASH (male/female, 44/30; mean age, 47.2 +/- 9.0 years) were enrolled. Participants were divided into two distinct groups: group 1 (n = 25) participants were administered a conventional diet and exercise programme while those in group 2 (n = 49) were administered the diet and exercise programme plus insulin sensitizers. RESULTS: With respect to baseline metabolic, biochemical and histological parameters, no significant differences were observed between the two groups (P > 0.05). Insulin sensitizers significantly improved metabolic parameters (homeostasis model assessment-insulin resistance score, P < 0.05), serum aminotransferase levels [aspartate aminotransferase (AST): 45.9 +/- 24.2 to 33.3 +/- 17.7 IU/L, P < 0.01; alanine aminotransferase (ALT): 78.2 +/- 46.3 to 47.3 +/- 34.5 IU/L, P < 0.001] and histological features (median non-alcoholic fatty liver disease activity score: 5.0-3.0, P = 0.01), while diet and exercise improved serum aminotransferase levels (AST: 39.3 +/- 11.1 to 30.0 +/- 8.6 IU/L, P < 0.01; ALT: 66.9 +/- 28.9 to 42.0 +/- 16.2 IU/L, P < 0.001) at the end of the 48 weeks when compared to baseline. Insulin sensitizers improved the high-sensitivity C-reactive protein levels (P < 0.01). No serious adverse effects of insulin sensitizers were observed. CONCLUSION: Insulin sensitizers can lead to improvement in metabolic, biochemical and histological abnormalities of NASH as a result of improved insulin sensitivity.

The diagnostic value of on-site cytopathological evaluation and cell block preparation in fine-needle aspiration cytology of liver masses.

OBJECTIVE: The aims of this study were to evaluate the typing accuracy of conventional smear (CS), cell block (CB) preparations and combined use of both procedures (CS + CB) for the diagnosis of hepatic malignancies and to determine whether immediate on-site cytopathological evaluation improves the diagnostic yield of liver fine-needle aspiration cytology (FNAC). METHODS: Ultrasound-guided FNABs were performed on 323 consecutive cases with liver masses between December 2002 and December 2004. Histologically and/or clinically correlated 167 cases were included in the study. Preliminary FNAB results, results of CS, CB, and combined use of CS and CB were compared regarding diagnostic sensitivity, specificity, and accuracy for the diagnosis of malignancy. Subtyping accuracies of different methods were also compared. RESULTS: The sensitivity of on-site cytopathological examination and CS were both 92.8%. The sensitivity of CS + CB was slightly better than that of CB (93.5% versus 84.8%). Specificity of all procedures was achieved 100%. Diagnostic accuracy of on-site cytopathological evaluation, CS, CB, and CS + CB were 93.9%, 93.9%, 87.2%, and 94.5%, respectively. A specific subtype diagnosis of malignant tumours could be rendered accurately on the basis of preliminary diagnosis in 71%, CS in 75.4%, CB in 78.3% and combined approach in 92% of cases. In terms of typing accuracy, 87.5% of HCCs, 93.2% of adenocarcinomas, 92.3% of neuroendocrine carcinomas, 100% of lymphomas and 100% of other malignant tumours were correctly subclassified in the final cytopathological diagnosis. The agreement between preliminary diagnosis and final cytopathological diagnosis was 77.2%. CONCLUSION: With use of on-site cytopathological evaluation and combined use of CS and CB, the diagnostic accuracy of liver tumours approaches 100% and also significantly improve diagnostic and subtyping accuracy of liver malignancies.

Behçet's disease-like presentation of bullous pyoderma gangrenosum associated with Crohn's disease.

A 47-year-old woman presented with a 2-month history of generalized arthralgia and a 10-day history of oral aphthous ulcers. After hospitalization, papulopustular lesions and perianal ulcerations developed. Pathergy test was positive and ophthalmological examination was normal. The presence of oral aphthous ulcers, genital ulcerations, papulopustular lesions and arthralgia, and the positive pathergy test suggested the diagnosis of Behçet's disease (BD). In a few days, positive pathergy reactions and papulopustular lesions evolved into bullous lesions, which were diagnosed dermatopathologically as pyoderma gangrenosum. Two days after the presentation of papulopustular lesions, the patient experienced diarrhoea accompanied by bloody stools and mucus. Histopathological examination of biopsy specimens showed no vasculitis but revealed findings suggestive of Crohn's disease. The patient responded well to treatment with systemic steroids and 5-aminosalicylic acid. Our case demonstrates that the differential diagnosis of BD and inflammatory bowel disease may be perplexing and that these two diseases may be closely related.

Evaluation of the effect of transplant-related factors and tissue injury on donor-derived hepatocyte and gastrointestinal epithelial cell repopulation following hematopoietic cell transplantation.

The aim of this study was to detect donor-derived hepatocytes and gastrointestinal epithelial cells in recipients of sex-mismatched allogeneic hematopoietic cell transplants, and to assess the effect of tissue injury on the extent of the repopulation. A total of 29 paraffin-embedded biopsy samples were reviewed. Double labeling by immunohistochemistry and fluorescence in situ hybridization was performed. Eighty-nine percent of sex-mismatched samples with histologic evidence of injury demonstrated the presence of donor-derived hepatocytes and gastrointestinal epithelial cells (mean 2.4%). None of the hepatocytes and gastrointestinal epithelial cells in samples obtained from female recipients with female donors showed a Y chromosome signal. The proportion of donor-derived hepatocyte and gastrointestinal epithelial cells in samples with severe graft-versus-host disease was greater than that of samples with mild/moderate graft-versus-host disease (P = 0.09). No relationship between the source of stem cells and the population rate was detected (P > 0.05). We conclude that some recipient hepatocytes and gastrointestinal tract epithelial cells are replaced by donor-derived cells during tissue injury. The severity of tissue injury seems to influence on the extent of this repopulation.

Lamivudine prophylaxis for prevention of chemotherapy-induced hepatitis B virus reactivation in hepatitis B virus carriers with malignancies.

Although hepatitis B virus (HBV) reactivation in HBV carriers undergoing immunosuppressive therapy is clearly documented, the role of antiviral prophylaxis in such individuals is still controversial. The aim of this study was to determine the efficacy of lamivudine prophylaxis in HBV carriers with haemato/oncological malignancies, who receive chemotherapy. Eighteen HBV carriers with malignancy, who were candidates for chemotherapy, were enrolled. Eight subjects (three with leukaemia, four with lymphoma and one with multiple myeloma) were enrolled for prophylactic lamivudine therapy. The remaining 10 patients (six with leukaemia, three with lymphoma and one with breast cancer) were not treated with lamivudine and were used as a control. Lamivudine was administered beginning on the same day as the chemotherapy and was maintained for a year after chemotherapy was discontinued. No HBV-related mortality was observed in either group. In the lamivudine-treated group, none of the subjects had clinical, biochemical or serological evidence of HBV reactivation during the time they were receiving chemotherapy and after their chemotherapy was discontinued. In contrast, five of the 10 HBV carriers not receiving lamivudine therapy experienced a reactivation of HBV infection. This reactivation of HBV was observed during the chemotherapy in four with one individual experiencing a HBV activation 12 months after chemotherapy was discontinued. No lamivudine-related major adverse effects were observed. Hence prophylactic lamivudine treatment in HBV carriers with haemato/oncological malignancy receiving chemotherapy prevents chemotherapy-induced HBV reactivation.

Distal oesophageal pH measurement in children during general anaesthesia using the laryngeal mask airway, tracheal tube and face mask.

BACKGROUND: Distal oesophageal pH was measured during controlled ventilation in children with the laryngeal mask airway (LMATM), tracheal tube (TT) and face mask (FM). METHODS: Fifty-six children scheduled for inguinal surgery with a standardized general anaesthetic technique were randomly allocated to receive LMA (n=21), TT (n=18) or FM (n=19). A 14 Fr pH probe was placed into the distal oesophagus and pH values were measured over 1 min at 2-min intervals during the first 20 min of anaesthesia. RESULTS: The median values of pH were 4.4 (3.5-5.5), 4.2 (3.3-4.9), 4.1 (3.2-5.1), 4.1 (3.3-5.0), 4.0 (3.3-4.9), 4.0 (3.4-5.1); 4.2 (3.3-5.1), 4.2 (3.6-5.0), 4.2 (3.5-5.0), 4.2 (3.5-5.2), 4.2 (3.5-5.0), 4.1 (3.5-5.0) and 4.2 (3.6-5.0), 4.2 (3.8-5.8), 4.1 (2.8-5.2), 4.2 (3.3-5.1), 4.2 (3.4-5.1), 4.3 (3.4-5.1) for LMA, TT and FM groups, respectively. CONCLUSION: There was no difference in the median pH values, within and between the groups (P > 0.05). We conclude that there is no difference in gastro-oesophageal reflux, when using a LMA, TT or FM during controlled ventilation in anaesthetized children.

A new percutaneous approach for the treatment of hydatid cysts of the liver.

OBJECTIVES: The aims of this study were to investigate the efficacy of a new percutaneous treatment modality of hydatid disease of the liver and to present the results of long term follow-up. METHODS: Eighty-seven patients (55 female, mean age 43.5 yr) with 98 hydatid cysts (73 type I, 15 type II, and 10 type III) in the liver underwent percutaneous treatment. All patients were examined by ultrasonography and some of them were examined by CT. They were all positive by indirect hemagglutination test. Sonographic guidance was used in all patients. The procedure included the puncture and free drainage of the cyst fluid. After free drainage was stopped, absolute alcohol and polidocanol 1% were used as sclerosing agents. The patients were followed-up with periodic ultrasonographic examinations. RESULTS: The mean follow-up time was 33 months. The mean diameter of the cysts decreased from 77.0+/-2.7 mm to 63.0+/-2.5 mm (p < 0.001). The entire cyst cavity filled with a solid echo pattern in 32 cysts, two-thirds of the cyst cavity showed a pseudotumor echo pattern in 34 cysts, and one-third of the cyst cavity showed a pseudotumor pattern in 23 cysts, whereas no pseudotumor appearence was observed in eight cysts. Apart from an anaphylactoid reaction observed in one patient, no major complication occurred during the follow-up period. CONCLUSIONS: Long term results indicate that this new percutaneous treatment modality of the hydatid disease of the liver is an effective and safe method without causing major complications. Percutaneous treatment of hydatid cysts of the liver offers good results and should be the first choice, especially for patients who are contraindicated to surgery.

Gastric myoelectrical activity in patients with Parkinson's disease: evidence of a primary gastric abnormality.

Parkinson's disease patients may experience various gastrointestinal symptoms; however, the exact pathophysiology of these symptoms is not fully understood. Therefore, the aim of this study was to investigate the pattern of gastric myoelectrical activity in patients with Parkinson's disease. Eleven patients with Parkinson's disease and 10 healthy subjects participated in the study. Patients were stratified as "receiving dopaminergic therapy" (N = 5) and "off therapy" (N = 6). Gastric myoelectrical activity was measured by means of surface electrogastrography (EGG) for 30 min before and for 90 min after a standardized meal. The dominant frequency, postprandial EGG power change, and the percentage of normal 2-4 cycles/min (cpm) slow-wave activity in the three groups were calculated and compared. The mean postprandial EGG power increase in the untreated patients was smaller than in the treated patients (-3.11 +/- 1.01 and 1.17 +/- 1.96 dB; P = 0.072). Moreover, both of these values were significantly decreased when compared to the control group (untreated vs control: -3.11 +/- 1.01 vs 8.01 +/- 1.86 dB; P = 0.04 and treated vs control: 1.17 +/- 1.96 vs 8.01 +/- 1.86 dB; P = 0.02). The percentage of normal 2-4 cpm slow waves in untreated patients was not different from the treated patients (82.6 +/- 6.6% vs 75.8 +/- 13.6%, P = NS) or from the control group (88.2 +/- 5.4%, P = NS). The dominant frequency after the meal was similar to that in the fasting state both in the untreated (3.3 +/- 0.1 vs 3.2 +/- 0.2 cpm; P = NS) and treated patients (3.2 +/- 0.1 vs 3.1 +/- 0.1 cpm, P = NS), whereas the dominant frequency significantly increased postprandially in the control group (2.88 +/- 0.12 vs 3.05 +/- 0.16; P < 0.05). Abnormalities in gastric myoelectrical activity in untreated Parkinson's disease patients reflect direct involvement of the gastrointestinal tract by the primary disease process. EGG can be regarded as a useful diagnostic tool in evaluating gastrointestinal involvement in neurodegenerative diseases.

Gastric myoelectrical activity, gastric emptying, and correlations with symptoms and fasting blood glucose levels in diabetic patients.

BACKGROUND: The aims of this study were to determine the electrogastrogram (EGG) changes and gastric emptying rates in diabetic patients and to investigate the correlation between upper gastrointestinal symptoms, fasting blood glucose, and gastric myoelectrical abnormalities. METHODS: Fourteen patients with long-standing type 1 diabetes mellitus and dyspepsia symptoms participated in the study. EGG recordings were obtained 30 minutes before and during a 2-hour radionuclide gastric emptying test for a solid meal. Fasting blood glucose was determined immediately before the gastric emptying study. Symptoms of nausea, vomiting, early satiety, abdominal bloating, and pain were rated from 0 to 3. RESULTS: Nine patients (64%) had delayed gastric emptying with 84.6 +/- 4.5% retention at 2 hours. Seven patients (50%) had abnormal EGG findings. The postprandial power change in the EGG of the patients with delayed gastric emptying (-0.48 +/- 0.16 dB) was decreased compared with patients with normal gastric emptying (4.7 +/- 2.6 dB) (P = 0.079). In patients with abnormal EGGs, the mean symptom score was significantly higher than patients with normal EGGs (2.42 +/- 0.13 versus 2.0 +/- 0.16; P < 0.05). Compared with normal gastric emptying patients, patients with delayed gastric emptying had higher but not significantly different symptom scores (2.31 +/- 0.11 versus 2.08 +/- 0.30; P = 0.225). There was no significant difference in fasting glucose levels in delayed (252 +/- 61.2 mg/dl) versus normal (378 +/- 82 mg/dl) gastric emptying or abnormal (288 +/- 86.4 mg/dl) EGGs versus patients with normal (304 +/- 57.6 mg/dl) EGGs. CONCLUSIONS: Overall, 78% (11 of 14) of patients with diabetes had either gastric motility or myoelectrical abnormalities. Patients with abnormal EGGs had more severe symptom scores. In diabetic patients with symptoms of gastropathy, an EGG may provide an important screening test for diagnosing abnormal gastric motility.

Delta-9-tetrahydrocannabinol delays the gastric emptying of solid food in humans: a double-blind, randomized study.

BACKGROUND: Delta-9-tetrahydrocannabinol (THC), the active constituent of marijuana, is an effective agent in the prevention of chemotherapy-induced nausea and vomiting. AIM: To determine the effect of THC on gastric emptying of a radiolabelled solid food in humans. METHODS: Thirteen healthy volunteers underwent gastric emptying studies after receiving THC and placebo in a randomized double-blind fashion on 2 separate days. THC, at a dose of 10 mg/m2 of body surface area, or placebo were administered. RESULTS: Gastric emptying after THC was slower than placebo in all subjects. Mean percentage of isotope remaining in the stomach was significantly greater than after placebo from 30 min (85.5 +/- 4.3% vs. 94.2 +/- 1. 4% placebo and THC, respectively, P < 0.05) to 120 min (45.6 +/- 7. 2% vs. 73.9 +/- 7.1% placebo and THC, respectively, P < 0.001) after the test meal. No correlation was found between plasma THC levels and the delay in gastric emptying. CONCLUSIONS: THC at a dose used for preventing chemotherapy-induced nausea and vomiting significantly delays gastric emptying of solid food in humans. Therefore, the anti-emetic property of THC may be mediated through the central nervous system.

Prevalence of impaired gastric emptying of solids in systemic sclerosis: diagnostic and therapeutic implications.

The aims of this study were to evaluate the gastric emptying of solids in patients with progressive systemic sclerosis, correlate the esophageal motility abnormalities with their gastric emptying status, delineate the symptoms suggestive of abnormal gastric emptying, and assess the effect of metoclopramide in patients with abnormally slow gastric emptying. Twenty patients underwent esophageal motility evaluation and gastric emptying studies with a radiolabeled solid meal. Gastric emptying was also measured in 13 healthy volunteers. Four patients in whom esophageal motility was normal also had an accompanying normal rate of gastric emptying. In 16 patients with abnormal esophageal motility, mean gastric emptying was significantly delayed as compared with that in normal subjects (67.4% vs 49.8% retention of isotope at 2 hours, P < .05). Ten patients had absolute criteria for slow gastric emptying (>+2 SD). However, only postprandial bloating and early satiety were symptoms that accurately predicted slow radionuclide emptying. In four of these patients in whom gastric emptying was slow, 10 mg intramuscular metoclopramide significantly (P < .05 vs baseline) accelerated the gastric emptying of the same test meal. We conclude that (1) gastric emptying of solids was delayed in approximately two thirds of patients with abnormal esophageal motility, whereas it was normal in patients with normal esophageal motor function; (2) metoclopramide significantly accelerated this slow gastric emptying; and (3) delayed gastric emptying contributes to the severity of the gastroesophageal reflux frequently present in patients with progressive systemic sclerosis, and promotility agents offer a valuable therapeutic approach.

Demography, clinical characteristics, psychological and abuse profiles, treatment, and long-term follow-up of patients with gastroparesis.

Patients with gastroparesis frequently present challenging clinical, diagnostic, and therapeutic problems. Data from 146 gastroparesis patients seen over six years were analyzed. Patients were evaluated at the time of initial diagnosis and at the most recent follow-up in terms of gastric emptying and gastrointestinal symptomatology. The psychological status and physical and sexual abuse history in female idiopathic gastroparesis patients were ascertained and an association between those factors and gastrointestinal symptomatology was sought. Eighty-two percent of patients were females (mean age: 45 years old). The mean age for onset of gastroparesis was 33.7 years. The etiologies in 146 patients are: 36% idiopathic, 29% diabetic, 13% postgastric surgery, 7.5% Parkinson's disease, 4.8% collagen vascular disorders, 4.1% intestinal pseudoobstruction, and 6% miscellaneous causes. Subgroups were identified within the idiopathic group: 12 patients (23%) had a presentation consistent with a viral etiology, 48% had very prominent abdominal pain. Other subgroups were gastroesophageal reflux disease and nonulcer dyspepsia (19%), depression (23%), and onset of symptoms immediately after cholecystectomy (8%). Sixty-two percent of women with idiopathic gastroparesis reported a history of physical or sexual abuse, and physical abuse was significantly associated with abdominal pain, somatization, depression, and lifetime surgeries. At the end of the follow-up period, 74% required continuous prokinetic therapy, 22% were able to stop prokinetics, 5% had undergone gastrectomy, 6.2% went onto gastric electrical stimulation (pacing), and 7% had died. At some point 21% had required nutrition support with a feeding jejunostomy tube or periods of parenteral nutrition. A good response to pharmacological agents can be expected in the viral and dyspeptic subgroups of idiopathics, Parkinson's disease, and the majority of diabetics, whereas a poorer outcome to prokinetics can be expected in postgastrectomy patients, those with connective tissue disease, a subgroup of diabetics, and the subset of idiopathic gastroparesis dominated by abdominal pain and history of physical and sexual abuse. Appreciation of the different etiologies and psychological status of the patients may help predict response to prokinetic therapy.

Effect of octreotide on gastric and small bowel motility in patients with gastroparesis.

BACKGROUND: Octreotide has been shown to have effects on gastric and small bowel motility with implications for its role in treating patients with upper gastrointestinal dysmotility syndromes. Our aim was to investigate the effect of octreotide on antral and small bowel motility in patients with gastroparesis. METHODS: Upper gastrointestinal manometry was carried out continuously for a period of 30 h in 11 patients with gastroparesis. The spontaneous migrating motor complex (MMC) in the fasting state and octreotide-induced MMCs were characterized and compared with regard to site of origin, duration of phase III, amplitude of phase III and propagation velocity of the MMC along the gut. The 2-h postprandial motility index was compared after a control meal as well as after a 100 microg octreotide administration. RESULTS: In all 11 gastroparetic patients, octreotide induced a phase III-like activity front within minutes after administration and this primarily originated in the small bowel (86% of activity fronts compared with 32% of fronts originating in the small bowel prior to octreotide administration (P < 0.004)). Gastric initiation of these activity fronts dramatically decreased after octreotide administration, occurring in 68% of activity fronts prior to octreotide administration and 14% of occasions after octreotide injection (P < 0.05). The postprandial antral motility index was markedly reduced after octreotide administration (11.33 +/- 0.39 vs. 7.96 +/- 0.76, P < 0.0003) and octreotide re-established a motility pattern during the postprandial period that was similar to that normally seen in the interdigestive state. The octreotide-induced phase III activity fronts appeared at a higher frequency and had a higher propagative velocity compared to the spontaneous phase III fronts in the fasting state (9.27 +/- 0.82 vs. 5.56 +/- 0.81 cm/min, P < 0.05). CONCLUSIONS: We conclude that octreotide's marked inhibitory effect on antral contractility may serve to worsen clinical symptoms in patients with gastroparesis and therefore this agent should not be given in the periprandial period. Those gastroparetic patients with associated small bowel dysmotility and diarrhoea from bacterial overgrowth may benefit from the nocturnal administration of octreotide because of its stimulatory effect of phase III MMC activity as well as its known inhibitory effect on small bowel secretions.

Effect of chronic oral domperidone therapy on gastrointestinal symptoms and gastric emptying in patients with Parkinson's disease.

This study investigated whether domperidone could improve gastrointestinal symptoms in patients with Parkinson's disease who were receiving levodopa therapy. A total of 11 patients were studied. Following a baseline gastric emptying test, patients were treated with a starting dose of domperidone 20 mg p.o. q.i.d. A follow-up gastric emptying test was repeated at least 4 months after starting domperidone therapy. At the beginning and at each 3-month follow-up visit, symptoms of nausea, vomiting, anorexia, abdominal bloating, heartburn, regurgitation, dysphagia, and constipation were evaluated and scored on a scale of 0-3. The overall mean follow-up period was 3 years. Compared with their baseline evaluation, patients experienced a significant improvement in all symptoms (p < 0.05) except dysphagia and constipation. Gastric emptying of an isotope-labeled solid meal was significantly faster, with a baseline result of 60.2 +/- 6.4% retention of isotope 2 h after the meal compared with 37.0 +/- 2.2% retention during domperidone therapy (p < 0.05). Patients' global assessment of Parkinson's disease remained stable or improved. Serum prolactin was elevated in all patients after domperidone therapy (p < 0.05). Domperidone therapy significantly reduces upper gastrointestinal symptoms and accelerates gastric emptying of a solid meal, but does not interfere with response to antiparkinsonism treatment.

Gastric myoelectrical activity, gastric emptying and correlations with dyspepsia symptoms in patients with gastroesophageal reflux.

BACKGROUND: Delayed gastric emptying is a mechanism that contributes to the pathogenesis of gastroesophageal reflux. Electrogastrogram changes, gastric emptying rates, and Helicobacter pylori status were investigated, and a correlation was sought with dyspepsia symptoms in gastroesophageal reflux disease patients. METHODS: Fifty patients (27 females; mean age 43) with gastroesophageal reflux were studied. Electrogastrographic recordings were obtained 30 minutes before and simultaneously with a 2-hour radionuclide gastric-emptying test using an isotope-labeled solid meal. Symptoms of nausea, abdominal bloating, abdominal pain, and early satiety were graded from 0 to 5. RESULTS: Thirty-six percent of patients had delayed gastric eliminating. Thirty-eight percent (19/50) patients had abnormal electrogastrograms, and 11 of these 19 also had delayed gastric emptying. There was a significant difference in the electrogastrographic parameter of postprandial power change in patients with delayed versus normal gastric emptying (0.20 +/- 0.8 dB vs 3.17 +/- 0.8 dB, p < 0.05). In patients with an abnormal electrogastrogram, the mean symptom score was significantly higher than in patients with a normal electrogastrogram (2.18 +/- 0.26 vs 1.35 +/- 0.16, p < 0.05). Twenty-one percent (7/33) of patients were positive (+) for Helicobacter pylori overall, but this did not seem to affect electrogastrogram and gastric emptying findings. CONCLUSIONS: Fifty-two percent of gastroesophageal reflux disease patients have gastric motor or myoelectrical abnormalities that contribute to the pathogenesis of this entity and also help explain the high prevalence of dyspepsia in the clinical presentation of gastroesophageal reflux disease.

The effect of intravenous vasopressin on gastric myoelectrical activity in human subjects.

UNLABELLED: Vasopressin's role in the sensation of nausea is incompletely understood. In this study, our goals were to investigate whether high intravenous vasopressin levels in normal subjects would induce nausea and vomiting and to determine the electrogastrographic (EGG) pattern which would develop at these concentrations. METHODS: EGG recordings were made on five fasting healthy subjects (three females, mean age: 27 years). Vasopressin was infused (0.15 or 0.3 U kg-1 h-1) for 1 h after a 30-min baseline recording. Serum vasopressin levels were measured every 15 min. Symptoms of nausea, cramping, retching, vomiting and bloating were graded from 0 to 5 (0 = none, 5 = most severe). Normal saline at the same rate was then infused for 1 h, with recording of symptoms and measuring blood levels of vasopressin as done previously. RESULTS: EGG data showed a 43% reduction in the percentage of normal slow waves (96-53%) at a vasopressin rate of 0.3 U kg-1 h-1. A 29% reduction (88-59%) occurred at 0.15 U kg-1 h-1. The EGG dominant frequency decreased by 0.8 cpm (3.07-2.25) for the high dose, while only 0.2 cpm reduction (2.9-2.7) occurred at the lower dose. Bradygastria (< 2.4 cpm) rather than tachygastria (> 3.7 cpm) was the predominant abnormality with the high dose. Symptoms of nausea correlated with the infusion of vasopressin and significantly increased with the higher dose. CONCLUSIONS: (i) At supraphysiological vasopressin levels, nausea was present in 80% of subjects but there was no retching or vomiting, (ii) bradygastria was the predominant dysrhythmia at these high vasopressin concentrations, (iii) increasing vasopressin levels correlated symptomatically with increases in nausea.

The rumination syndrome: clinical and manometric profile, therapy, and long-term outcome.

The aims of this study were to investigate the diagnostic studies necessary to identify rumination syndrome and the long-term therapeutic outcomes of patients with rumination syndrome. Sixteen patients with rumination were evaluated between 1989 and 1995. Esophageal motility, gastric emptying, upper gastrointestinal motility, and electrogastrography of all patients were reviewed; follow-up information about their current status was available from 10 of the 16 patients. Duration of symptoms was 77.2 months and the mean age was 28.5 years at the time of diagnosis. Esophageal and upper gastrointestinal motility, gastric emptying, and electrogastrographic studies were all normal. Mean lower esophageal pressure was 12.7 mm Hg and three of the 16 patients had a decreased pressure of less than 6 mm Hg. Ten patients were followed for a mean duration of 31.2 months. Five of 10 patients used biofeedback and relaxation techniques and reported subjective improvement. Our results indicate that rumination syndrome is often confused with a gastric motility disorder and diagnosis is possible if one is aware of this condition. Although there is not a definitive management protocol for this condition, reassurance and education of the patient and the family are crucial first steps followed by behavioral and relaxation programs.