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1.
Front Endocrinol (Lausanne) ; 15: 1379398, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38957444

RESUMO

Background: Diabetic gastroparesis is a common complication in patient with diabetes. Dietary intervention has been widely used in the treatment of diabetic gastroparesis. The aim of this study is to evaluate the role of diet in the treatment of diabetic gastroparesis. Methods: This systematic review was conducted a comprehensive search of randomized controlled trials using dietary interventions for the treatment of diabetic gastroparesis up to 9 November 2023. The primary outcomes were gastric emptying time and clinical effect, while fasting blood glucose, 2-hour postprandial blood glucose and glycosylated hemoglobin were secondary outcomes. Data analysis was performed using RevMan 5.4 software, and publication bias test was performed using Stata 15.1 software. Results: A total of 15 randomized controlled trials involving 1106 participants were included in this review. The results showed that patients with diabetic gastroparesis benefit from dietary interventions (whether personalized dietary care alone or personalized dietary care+routine dietary care). Compared with routine dietary care, personalized dietary care and personalized dietary care+routine dietary care can shorten the gastric emptying time, improve clinical efficacy, and reduce the level of fasting blood glucose, 2-hour postprandial blood glucose and glycosylated hemoglobin. Conclusions: Limited evidence suggests that dietary intervention can promote gastric emptying and stabilize blood glucose control in patients with diabetic gastroparesis. Dietary intervention has unique potential in the treatment of diabetic gastroparesis, and more high-quality randomized controlled trials are needed to further validate our research results. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023481621.


Assuntos
Gastroparesia , Humanos , Gastroparesia/dietoterapia , Gastroparesia/terapia , Gastroparesia/etiologia , Esvaziamento Gástrico , Glicemia/metabolismo , Complicações do Diabetes/dietoterapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Diabetes Mellitus/dietoterapia
2.
A A Pract ; 18(7): e01824, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-39023194

RESUMO

Gastric ultrasound estimates stomach contents in perioperative patients. A 10-year-old boy with abdominal rhabdomyosarcoma, who received abdominal radiation, developed gastroparesis and was scheduled for endoscopic gastrointestinal pyloric dilation. Point-of-care gastric ultrasound revealed gastric antral cross-sectional area of 6.5 cm2 (estimated gastric content ~30 mL). However, dynamic right-to-left ultrasound revealed more hypoechoic material in the fundus of the stomach. On induction ~125 mL of stomach contents was suctioned. Antral measurements may not accurately predict the stomach contents in the setting of a stiff/fixed antrum. Scanning from antrum to fundus determined contents more accurately, especially with a prior history of abdominal radiation.


Assuntos
Sistemas Automatizados de Assistência Junto ao Leito , Antro Pilórico , Ultrassonografia , Humanos , Masculino , Criança , Antro Pilórico/diagnóstico por imagem , Rabdomiossarcoma/diagnóstico por imagem , Gastroparesia/diagnóstico por imagem , Estômago/diagnóstico por imagem , Conteúdo Gastrointestinal/diagnóstico por imagem , Neoplasias Abdominais/diagnóstico por imagem
3.
World J Gastroenterol ; 30(22): 2852-2865, 2024 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-38947292

RESUMO

Diabetes, commonly known for its metabolic effects, also critically affects the enteric nervous system (ENS), which is essential in regulating gastrointestinal (GI) motility, secretion, and absorption. The development of diabetes-induced enteric neuropathy can lead to various GI dysfunctions, such as gastroparesis and irregular bowel habits, primarily due to disruptions in the function of neuronal and glial cells within the ENS, as well as oxidative stress and inflammation. This editorial explores the pathophysiological mechanisms underlying the development of enteric neuropathy in diabetic patients. Additionally, it discusses the latest advances in diagnostic approaches, emphasizing the need for early detection and intervention to mitigate GI complications in diabetic individuals. The editorial also reviews current and emerging therapeutic strategies, focusing on pharmacological treatments, dietary management, and potential neuromodulatory interventions. Ultimately, this editorial highlights the necessity of a multidisciplinary approach in managing enteric neuropathy in diabetes, aiming to enhance patient quality of life and address a frequently overlooked complication of this widespread disease.


Assuntos
Neuropatias Diabéticas , Sistema Nervoso Entérico , Motilidade Gastrointestinal , Humanos , Neuropatias Diabéticas/etiologia , Neuropatias Diabéticas/terapia , Neuropatias Diabéticas/diagnóstico , Neuropatias Diabéticas/fisiopatologia , Sistema Nervoso Entérico/fisiopatologia , Gastroenteropatias/fisiopatologia , Gastroenteropatias/terapia , Gastroenteropatias/diagnóstico , Gastroenteropatias/etiologia , Trato Gastrointestinal/inervação , Trato Gastrointestinal/fisiopatologia , Gastroparesia/terapia , Gastroparesia/fisiopatologia , Gastroparesia/diagnóstico , Gastroparesia/etiologia , Estresse Oxidativo , Qualidade de Vida
4.
J Psychosom Res ; 183: 111834, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38896986

RESUMO

OBJECTIVE: To determine the prevalence and associations between anxiety/depression, and gastrointestinal (GI) symptoms across gastroparesis and functional dyspepsia. METHODS: Twenty adult studies were identified through systematic searches of three databases (PubMed, CINAHL and PsycINFO) in September 2023. Meta-analysis was performed to estimate the pooled prevalence rates of anxiety and depression across gastroparesis and functional dyspepsia, and to determine whether the associations of anxiety/depression and gastrointestinal (GI) symptoms differ in gastroparesis versus functional dyspepsia. RESULTS: The overall pooled prevalence rate for anxiety was similar (χ2(1) = 2.45, p = .12) in gastroparesis (49%) and functional dyspepsia (29%). The overall pooled prevalence rate for depression in gastroparesis (39%), and functional dyspepsia (32%) was also similar (χ2(1) = 0.81, p = .37). No significant relationship between anxiety and GI symptoms (r = 0.11) or depression and GI symptoms (r = 0.16) was found in gastroparesis, whilst significant, though weak, positive relationships between anxiety and GI symptoms (r = 0.30) and depression and GI symptoms (r = 0.32) were found in functional dyspepsia. The association between GI symptoms and anxiety, but not depression, across gastroparesis and functional dyspepsia was found to be significant (χ2(1) = 5.22, p = .02). CONCLUSION: Contributing to ongoing debate as to whether gastroparesis and functional dyspepsia are interchangeable syndromes, this review found that anxiety and depression prevalence was similar in both conditions. Psychological assessment and the utilisation of effective and holistic care in both conditions is therefore warranted.


Assuntos
Ansiedade , Depressão , Dispepsia , Gastroparesia , Humanos , Gastroparesia/epidemiologia , Gastroparesia/psicologia , Dispepsia/epidemiologia , Dispepsia/psicologia , Prevalência , Depressão/epidemiologia , Ansiedade/epidemiologia , Gastroenteropatias/epidemiologia , Gastroenteropatias/psicologia
5.
Cleve Clin J Med ; 91(6): 373-383, 2024 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-38830702

RESUMO

Gastroparesis is a heterogeneous motility disorder characterized by nausea, vomiting, and postprandial fullness. Its diagnosis requires objective documentation of delayed gastric emptying of solid food and exclusion of mechanical obstruction. Its epidemiology is unclear, and the main causes are diabetes mellitus and idiopathic disease. Cardinal symptoms often co-occur. Management involves nutritional assessment, dietary changes, drug evaluation, glycemic control (for patients with diabetes mellitus), and symptom relief. In this review, we explore challenges nongastroenterologists may encounter and how they can use current recommendations to manage patients with gastroparesis.


Assuntos
Gastroparesia , Gastroparesia/diagnóstico , Gastroparesia/etiologia , Gastroparesia/terapia , Gastroparesia/fisiopatologia , Humanos , Esvaziamento Gástrico/fisiologia
6.
Neurogastroenterol Motil ; 36(8): e14843, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38873849

RESUMO

BACKGROUND: Low-intensity pulsed ultrasound (LIPUS) combined with acupoint can promote gastric motility of diabetic rats. The switch of gastric smooth muscle cell (GSMCs) phenotype was related to the diabetes-induced gastric dysfunction, but the mechanism is not clearly elucidated. This study was aimed at exploring the underlying mechanism of LIPUS stimulation application in diabetic gastroparesis rats. METHODS: In this study, Sprague-Dawley male rats were divided into three groups: control group (CON), diabetic gastroparesis group (DGP), and LIPUS-treated group (LIPUS). LIPUS irradiation was performed bilaterally at ST36 for 20 min per day for 4 weeks. The gastric emptying rate was measured by ultrasound examination. Contraction ability of GSMCs was assessed by muscle strip experiment. The expression of related proteins or mRNAs including α-SMA, SM22α, MHC, RhoA, Rock2, p-MYPT1, MYPT1, p-MLC, MLC, MALAT1, miR-449a, and DLL1 was detected by different methods such as western blotting, RT-qPCR, immunohistochemistry, and immunofluorescence staining, as appropriate. KEY RESULTS: (a) LIPUS stimulation at ST36 could improve the gastric motility dysfunction of diabetic rats. (b) LIPUS increased RhoA, Rock2, p-MYPT1, and p-MLC expression level. (c) MALAT1 and DLL1 contents were decreased, but the level of miR-449a was increased in the LIPUS group. CONCLUSIONS & INFERENCES: LIPUS may affect the contractile marker expression of gastric smooth muscle through the RhoA/Rock and MALAT1/miR-449a/DLL1 pathway to ameliorate DGP.


Assuntos
Pontos de Acupuntura , Diabetes Mellitus Experimental , MicroRNAs , Contração Muscular , Músculo Liso , RNA Longo não Codificante , Ratos Sprague-Dawley , Transdução de Sinais , Animais , Masculino , Ratos , MicroRNAs/metabolismo , MicroRNAs/genética , Músculo Liso/metabolismo , RNA Longo não Codificante/metabolismo , RNA Longo não Codificante/genética , Diabetes Mellitus Experimental/metabolismo , Quinases Associadas a rho/metabolismo , Quinases Associadas a rho/genética , Gastroparesia/metabolismo , Gastroparesia/terapia , Ondas Ultrassônicas , Proteína rhoA de Ligação ao GTP/metabolismo , Proteínas de Membrana/metabolismo , Proteínas de Membrana/genética , Estômago , Esvaziamento Gástrico/fisiologia , Terapia por Ultrassom/métodos , Miócitos de Músculo Liso/metabolismo , Proteínas rho de Ligação ao GTP
9.
J Gastrointest Surg ; 28(7): 1083-1088, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38705370

RESUMO

BACKGROUND: This study aimed to examine the rate of delayed emptying and other 90-day postoperative complications after total, subtotal, and distal gastrectomies for gastric adenocarcinoma in a population-based setting. METHODS: This study included all patients who underwent total, subtotal, or distal gastrectomy for gastric cancer in Finland in 2005-2016, with follow-up until December 31, 2019. Logistic regression provided the odds ratios with 95% CIs of 90-day mortality. The results were adjusted for age, sex, year of surgery, comorbidities, pathologic stage, and neoadjuvant therapy. RESULTS: A total of 2058 patients underwent total (n = 1227), subtotal (n = 450), or distal (n = 381) gastrectomy. In the total, subtotal, and distal gastrectomy groups, the rates of 90-day delayed emptying were 1.7%, 1.3%, and 2.1% in the whole cohort and 1.6%, 1.8%, and 3.5% in the subgroup analysis of R0 resections, respectively. The resection type was not associated with the risk of delayed emptying. Subtotal gastrectomy was associated with a lower risk of major complications and reoperations, whereas distal gastrectomy was associated with a lower risk of anastomotic complications. CONCLUSION: The extent of resection did not affect delayed emptying, whereas fewer postoperative complications were observed after subtotal or distal gastrectomy than after total gastrectomy.


Assuntos
Adenocarcinoma , Gastrectomia , Complicações Pós-Operatórias , Neoplasias Gástricas , Humanos , Neoplasias Gástricas/cirurgia , Neoplasias Gástricas/patologia , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Finlândia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Adenocarcinoma/cirurgia , Adenocarcinoma/patologia , Reoperação/estatística & dados numéricos , Gastroparesia/etiologia , Gastroparesia/epidemiologia , Esvaziamento Gástrico
10.
Neurogastroenterol Motil ; 36(8): e14821, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38798079

RESUMO

BACKGROUND: The association between upper gastrointestinal symptoms and delayed gastric emptying (GE) shows conflicting results. This study aimed to assess whether the symptoms of the Gastroparesis Cardinal Symptom Index (GCSI) and/or the scores were associated with the result of GE tests and whether they could predict delayed GE. METHODS: Patients referred for suspected gastroparesis (GP) were included in a prospective database. Demographical data, medical history, and symptoms of the GCSI score were collected for each patient. A GE scintigraphy was then performed with a 4-hour recording. Delayed GE was defined as a retention rate ≥ 10% at 4 h. RESULTS: Among 243 patients included in this study, 110 patients (45%) had delayed GE. The mean age (49.9 vs. 41.3 years; p < 0.001) and weight loss (9.4 kg vs. 5.6 kg; p = 0.025) were significantly higher in patients with delayed GE. Patients with diabetes or a history of surgery had a higher prevalence of delayed GE (60% and 78%, respectively) than patients without comorbidity (17%; p < 0.001). The GCSI score was higher in patients with delayed GE (3.06 vs. 2.80; p = 0.045), but no threshold was clinically relevant to discriminate between patients with normal and delayed GE. Only vomiting severity was significantly higher in patients with delayed GE (2.19 vs. 1.57; p = 0.01). CONCLUSION: GE testing should be considered when there are symptoms such as a higher weight loss, comorbidities (diabetes, and history of surgery associated with GP), and the presence of vomiting. Other symptoms and the GCSI score are not useful in predicting delayed GE.


Assuntos
Esvaziamento Gástrico , Gastroparesia , Humanos , Gastroparesia/fisiopatologia , Gastroparesia/diagnóstico , Masculino , Feminino , Esvaziamento Gástrico/fisiologia , Pessoa de Meia-Idade , Adulto , Índice de Gravidade de Doença , Estudos Prospectivos , Idoso , Cintilografia
11.
Neurogastroenterol Motil ; 36(8): e14819, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38816956

RESUMO

BACKGROUND: Absent "organic" disease, dyspeptic symptoms may arise from abnormal gastric sensation, accommodation, motility or emptying (GE). Extensive gastric sensorimotor evaluation is rarely undertaken because testing is prolonged, invasive, poorly tolerated or unavailable. AIMS: To investigate whether gastric antral motor function, evaluated with scintigraphy, predicts GE. To explore whether motor testing with symptom recording predicts day-to-day symptoms in patients with dyspepsia. METHODS: GE was determined using a scintigraphic solid-meal protocol (296 kcal, 35% fat). Antral motility was estimated from 10 min of scintigraphic time-activity curves acquired 40 min after meal consumption. An antral motility index (MI) was derived from contraction amplitude and frequency. Intra-gastric distribution of the meal on scintograms at 1 h (IGD1) was determined. Meal-induced symptoms were evaluated by questionnaire. Patients completed the Gastroparesis Cardinal Symptom Index Daily Diary (GCSI-DD) for 14 days. RESULTS: Twelve healthy participants and 23 prospectively recruited patients completed the study. Nine patients had delayed, and 2 had rapid, GE. In univariate analysis MI explained 42% of GE half-time. In multivariate analysis MI and GE half-time explained 25% of the variance in meal-induced symptoms. While scintigraphic evaluation of gastric motor function with symptom recording explained 80% of the variance in the GCSI-DD, meal-induced symptoms were the only significant predictor. However, among patients with delayed GE, MI, GE half-time, IGD1, and meal-induced symptoms all significantly predicted GCSI-DD. CONCLUSIONS: Antral motility predicts GE. In exploratory analyses, only meal-induced symptoms predicted daily symptoms among patients with dyspepsia. However, motor function also predicted symptoms in patients with delayed GE.


Assuntos
Dispepsia , Esvaziamento Gástrico , Cintilografia , Humanos , Dispepsia/diagnóstico por imagem , Dispepsia/fisiopatologia , Feminino , Masculino , Adulto , Esvaziamento Gástrico/fisiologia , Pessoa de Meia-Idade , Cintilografia/métodos , Estudos Prospectivos , Motilidade Gastrointestinal/fisiologia , Gastroparesia/diagnóstico por imagem , Gastroparesia/fisiopatologia , Gastroparesia/diagnóstico , Adulto Jovem
12.
Rev Med Suisse ; 20(876): 1080-1082, 2024 May 29.
Artigo em Francês | MEDLINE | ID: mdl-38812340

RESUMO

Gastroparesis is a rare and late microvascular complication, but a significant one of diabetes. Defined by a slowing of gastric emptying, this condition manifests with nonspecific gastrointestinal symptoms, including nausea, vomiting, abdominal pain, postprandial fullness, and early satiety. Faced with such a clinical presentation, it is often challenging to diagnose gastroparesis. In this article, we discuss the diagnostic procedures, as well as therapeutic approaches and management of the disease.


La gastroparésie est une complication microvasculaire rare et tardive, mais conséquente, du diabète. Définie par un ralentissement de la vidange gastrique, cette pathologie se présente sous la forme de symptômes gastro-intestinaux aspécifiques incluant des nausées, des vomissements, des douleurs abdominales, une sensation de réplétion postprandiale et une satiété précoce. Face à une présentation clinique de ce type, il est souvent difficile de poser le diagnostic de gastroparésie. Dans cet article, nous évoquons donc les examens complémentaires permettant de poser le diagnostic, ainsi que les propositions thérapeutiques et la prise en charge de la maladie.


Assuntos
Diabetes Mellitus Tipo 1 , Gastroparesia , Humanos , Gastroparesia/diagnóstico , Gastroparesia/terapia , Gastroparesia/etiologia , Gastroparesia/fisiopatologia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/diagnóstico , Esvaziamento Gástrico/fisiologia
13.
Rev Gastroenterol Peru ; 44(1): 71-74, 2024.
Artigo em Espanhol | MEDLINE | ID: mdl-38734915

RESUMO

Initially developed as medications for diabetes mellitus, GLP-1 agonists have gained much popularity in the treatment of obesity and weight loss. The present case describes a 69-year-old woman with a history of peptic ulcer and use of NSAIDs, who presented with abdominal pain and oral intolerance refractory to conventional management, for which an upper digestive endoscopy was performed, diagnosing severe gastroparesis. Asking more about the story, revealed surreptitious use of semaglutide. She continued with supportive therapy and the symptoms resolved spontaneously. The present case report aims to warn of the potential risks of the use of GLP-1 analogues in the context of endoscopy with sedation.


Assuntos
Gastroparesia , Receptor do Peptídeo Semelhante ao Glucagon 1 , Peptídeos Semelhantes ao Glucagon , Redução de Peso , Humanos , Idoso , Feminino , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Peptídeos Semelhantes ao Glucagon/uso terapêutico , Peptídeos Semelhantes ao Glucagon/análogos & derivados , Peptídeos Semelhantes ao Glucagon/efeitos adversos , Redução de Peso/efeitos dos fármacos , Gastroparesia/tratamento farmacológico , Índice de Gravidade de Doença , Agonistas do Receptor do Peptídeo 1 Semelhante ao Glucagon
14.
BMC Surg ; 24(1): 145, 2024 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-38734631

RESUMO

BACKGROUND: Delayed gastric emptying (DGE) commonly occurs after pancreaticoduodenectomy (PD). Risk factors for DGE have been reported in open PD but are rarely reported in laparoscopic PD (LPD). This study was designed to evaluate the perioperative risk factors for DGE and secondary DGE after LPD in a single center. METHODS: This retrospective cohort study included patients who underwent LPD between October 2014 and April 2023. Demographic data, preoperative, intraoperative, and postoperative data were collected. The risk factors for DGE and secondary DGE were analyzed. RESULTS: A total of 827 consecutive patients underwent LPD. One hundred and forty-two patients (17.2%) developed DGE of any type. Sixty-five patients (7.9%) had type A, 62 (7.5%) had type B, and the remaining 15 (1.8%) had type C DGE. Preoperative biliary drainage (p = 0.032), blood loss (p = 0.014), and 90-day any major complication with Dindo-Clavien score ≥ III (p < 0.001) were independent significant risk factors for DGE. Seventy-six (53.5%) patients were diagnosed with primary DGE, whereas 66 (46.5%) patients had DGE secondary to concomitant complications. Higher body mass index, soft pancreatic texture, and perioperative transfusion were independent risk factors for secondary DGE. Hospital stay and drainage tube removal time were significantly longer in the DGE and secondary DGE groups. CONCLUSION: Identifying patients at an increased risk of DGE and secondary DGE can be used to intervene earlier, avoid potential risk factors, and make more informed clinical decisions to shorten the duration of perioperative management.


Assuntos
Esvaziamento Gástrico , Laparoscopia , Pancreaticoduodenectomia , Complicações Pós-Operatórias , Humanos , Pancreaticoduodenectomia/efeitos adversos , Masculino , Feminino , Estudos Retrospectivos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Idoso , Fatores de Risco , Esvaziamento Gástrico/fisiologia , Gastroparesia/etiologia , Gastroparesia/epidemiologia , Adulto
15.
J Med Case Rep ; 18(1): 248, 2024 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-38750592

RESUMO

BACKGROUND: Gastroparesis is a condition that affects the motility of the gastrointestinal (GI) tract, causing a delay in the emptying process and leading to nausea, vomiting, bloating, and upper abdominal pain. Motility treatment along with symptom management can be done using antiemetics or prokinetics. This study highlights the diagnostic and therapeutic challenges of gastroparesis and suggests a potential link between facial trauma and symptom remission, indicating the need for further investigation. CASE PRESENTATION: A 46-year-old Hispanic man with hypertension, type 2 diabetes (T2D), and hyperlipidemia on amlodipine 10 mg, lisinopril 5 mg, empagliflozin 25 mg, and insulin glargine presented with a diabetic foot ulcer with probable osteomyelitis. During hospitalization, the patient developed severe nausea and vomiting. The gastroenterology team advised continuing antiemetic medicine and trying very small sips of clear liquids. However, the patient didn't improve. Therefore, the gastroenterology team was contacted again. They advised having stomach emptying tests to rule out gastroparesis as the source of emesis. In addition, they recommended continuing metoclopramide, and starting erythromycin due to inadequate improvement. Studies found a 748-min stomach emptying time. Normal is 45-90 min. An uneventful upper GI scope was done. Severe gastroparesis was verified, and the gastroenterology team advised a percutaneous jejunostomy or gastric pacemaker for gastroparesis. Unfortunately, the patient suffered a mechanical fall resulting in facial trauma. After the fall, the patient's nausea eased, and emesis stopped. He passed an oral liquids trial after discontinuation of erythromycin and metoclopramide. CONCLUSION: This case exemplifies the difficulties in diagnosing and treating gastroparesis. An interesting correlation between parasympathetic surges and recovery in gastroparesis may be suggested by the surprising remission of symptoms following face injuries.


Assuntos
Traumatismos Faciais , Gastroparesia , Humanos , Gastroparesia/tratamento farmacológico , Gastroparesia/fisiopatologia , Gastroparesia/etiologia , Masculino , Pessoa de Meia-Idade , Traumatismos Faciais/complicações , Náusea/etiologia , Náusea/tratamento farmacológico , Vômito/tratamento farmacológico , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Antieméticos/uso terapêutico , Esvaziamento Gástrico/efeitos dos fármacos , Resultado do Tratamento
16.
Cell Stress Chaperones ; 29(3): 440-455, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38653383

RESUMO

This study aimed to investigate the changes in oxidative stress, adenosine monophosphate-activated protein kinase (AMPK), connexin43 (Cx43), nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) expression, and extracellular matrix (ECM) in the gastric smooth muscle tissues of rats with diabetic gastroparesis (DGP) and high glucose-cultured gastric smooth muscle cells, determine the existence of oxidative stress-AMPK-Cx43-NLRP3 pathway under high glucose condition, and the involvement of this pathway in ECM remodeling in DGP rats. The results showed that with increasing duration of diabetes, oxidation stress levels gradually increased, the AMPK activity decreased first and then increased, NLRP3, CX43 expression, and membrane/cytoplasm ratio of Cx43 expression were increased in the gastric smooth muscle tissues of diabetic rats. Changes in ECM of gastric smooth muscle cells were observed in DGP rats. The DGP group showed higher collagen type I content, increased expression of Caspase-1, transforming growth factor-beta 3 (TGF-ß3), and matrix metalloproteinase-2 (MMP-2), decreased tissue inhibitor of metalloproteinase-1 (TIMP-1) expression, and higher interleukin-1 beta content when compared with the control group. For gastric smooth muscle cells cultured under higher glucose, the MMP-2 and TGF-ß3 expression was decreased, TGF-ß1 and TIMP-1 expression was increased, the interleukin-1 beta content was decreased in cells after inhibition of NLRP3 expression; the NLRP3 and Caspase-1 expression was decreased, and adenosine triphosphate content was lower after inhibition of Cx43; the expression of NLRP3, Caspase-1, P2X7, and the membrane/cytoplasm ratio of CX43 expression was decreased in cells after inhibition of AMPK and oxidative stress, the phospho-AMPK expression was also decreased after suppressing oxidative stress. Our findings suggest that high glucose induced the activation of the AMPK-Cx43-NLRP3 pathway through oxidative stress, and this pathway was involved in the ECM remodeling of gastric smooth muscles in DGP rats by regulating the biological functions of TGF-ß3, TGF-ß1, MMP-2, and TIMP-1.


Assuntos
Proteínas Quinases Ativadas por AMP , Conexina 43 , Diabetes Mellitus Experimental , Matriz Extracelular , Gastroparesia , Miócitos de Músculo Liso , Proteína 3 que Contém Domínio de Pirina da Família NLR , Estresse Oxidativo , Transdução de Sinais , Animais , Masculino , Ratos , Proteínas Quinases Ativadas por AMP/metabolismo , Conexina 43/metabolismo , Diabetes Mellitus Experimental/metabolismo , Diabetes Mellitus Experimental/complicações , Diabetes Mellitus Experimental/patologia , Matriz Extracelular/metabolismo , Gastroparesia/metabolismo , Gastroparesia/patologia , Glucose/metabolismo , Miócitos de Músculo Liso/metabolismo , Miócitos de Músculo Liso/patologia , Proteína 3 que Contém Domínio de Pirina da Família NLR/metabolismo , Ratos Sprague-Dawley , Estômago/patologia
17.
Expert Opin Pharmacother ; 25(5): 541-549, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38629943

RESUMO

INTRODUCTION: Gastroparesis is a chronic disorder characterized by decreased gastric emptying and presents with nausea, vomiting, and abdominal pain which impacts patients' quality of life greatly. The treatment modalities available for gastroparesis have been expanding over the past 2 decades. Currently, there are multiple options available for gastroparesis, albeit with only one FDA-approved medication until June 2021. AREAS COVERED: We review the different treatments available for gastroparesis and discuss the recently FDA-approved intranasal formulation of metoclopramide. This nasal spray guarantees metoclopramide absorption within 15 min of application bypassing first pass metabolism in the liver and overcoming the limitations of the oral formulation not passing into the small intestine for absorption because of a gastroparetic stomach or a patient unable to take the oral metoclopramide because of nausea and vomiting. EXPERT OPINION: We now find ourselves in an oasis after spending many years in a 'desert' regarding pharmacologic therapies available for gastroparesis. The expansion of the research involving dopamine receptor antagonists and delving into alternative mechanisms of alleviating gastroparesis symptoms has been crucial in the landscape of gastroparesis. This is especially true as our knowledge of gastroparesis has proven that simply improving gastric emptying does not necessarily translate to clinical improvement.


Assuntos
Esvaziamento Gástrico , Gastroparesia , Qualidade de Vida , Humanos , Administração Intranasal , Antagonistas de Dopamina/uso terapêutico , Esvaziamento Gástrico/efeitos dos fármacos , Fármacos Gastrointestinais/uso terapêutico , Fármacos Gastrointestinais/farmacologia , Fármacos Gastrointestinais/administração & dosagem , Gastroparesia/tratamento farmacológico , Gastroparesia/fisiopatologia , Metoclopramida/uso terapêutico
19.
Dig Dis Sci ; 69(5): 1722-1730, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38594432

RESUMO

INTRODUCTION: Patients with gastroparesis (Gp) have symptoms with or without a cyclic pattern. This retrospective study evaluates differences in cyclic vs. non-cyclic symptoms of Gp by analyzing mucosal electrogastrogram (mEG), familial dysautonomias, and response to gastric stimulation. METHODS: 37 patients with drug refractory Gp, 7 male and 30 female, with a mean age of 41.4 years, were studied. 18 had diabetes mellitus, 25 had cyclic (Cyc), and 12 had a non-cyclic (NoCyc) pattern of symptoms. Patients underwent temporary mucosal gastric stimulator (tGES) placement, which was done as a trial before permanent stimulator (GES) placement. Electrogastrogram (EGG) by mucosal (mEG) measures, including frequency, amplitude, and frequency-amplitude ratio (FAR), were pre- and post-tGES. Patients' history of personal and familial dysautonomias, quality of life, and symptom scores were recorded. Baseline vs. follow-ups were compared by paired t tests and McNemar's tests. T tests contrasted symptom scores, gastric emptying tests (GET), and mEG measures, while chi-squared tests deciphered comorbidity differences between two groups and univariate and multivariate analyses. RESULTS: There were significantly more patients with diabetes in the Cyc group vs. the NoCyc group. Using a 1 point in symptom outcome, 18 patients did not improve and 19 did improve with tGES. Using univariable analysis, with the cyclic pattern as a predictor, patients exhibiting a cyclic pattern had an odds ratio of 0.22 (95% CI 0.05-0.81, p = 0.054) for achieving an improvement of at least one unit in vomiting at follow-up from baseline. The mucosal electrogastrogram frequency to amplitude ratio (FAR) for the "not Improved" group was 19.6 [3.5, 33.6], whereas, for the "Improved" group, it was 54.3 [25.6, 72.5] with a p-value of 0.049. For multivariate logistic regression, accounting for sex and age squared, patients exhibiting a cyclic pattern had an adjusted odds ratio (OR) of 0.16 (95% CI 0.03-0.81, p = 0.027) for achieving an improvement of at least one unit in vomiting at follow-up from baseline. The two groups had no significant differences in the personal or inherited history of investigated familial patterns. CONCLUSION: This study shows differences in Gp patients with Cyc vs. NoCyc symptoms in several areas. Larger studies are needed to elicit further differences between the two groups about cycles of symptoms, EGG, findings, familial patterns, and response to mucosal GES.


Assuntos
Terapia por Estimulação Elétrica , Esvaziamento Gástrico , Gastroparesia , Humanos , Gastroparesia/terapia , Gastroparesia/fisiopatologia , Gastroparesia/diagnóstico , Feminino , Masculino , Adulto , Estudos Retrospectivos , Pessoa de Meia-Idade , Esvaziamento Gástrico/fisiologia , Terapia por Estimulação Elétrica/métodos , Resultado do Tratamento
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