Gastric Dysmotility Research Articles

A Three-way Attack on the Gastrointestinal System- COVID-19, Ehler-Danlos Syndrome, and Anorexia Nervosa Leading to Severe Gastroparesis in a Young Female

A 28-year-old female with a past medical history of Major Depressive Disorder, Generalized Anxiety Disorder, Anorexia Nervosa, Chronic Pain Syndrome, and Gastro-esophageal Reflux presented to our clinic for establishing care in November 2022 with severe gastric dysmotility ever since contracting COVID-19 virus in December 2021. The patient’s symptoms were refractory to Erythromycin and metoclopramide therapy. A GI motility study in February 2022 showed delayed gastric emptying based on which the patient was diagnosed with Post COVID Gastroparesis. Based on an extensive clinical review of the patient’s past medical and surgical history, the patient was found to have cumulative symptoms of GERD, joint instability, abdominal hernia and chronic neuropathic pain, raising the suspicion of Ehler-Danlos syndrome- Hypermobility type. Given the failure of treatment with prokinetic agents and over 60 pounds of weight loss the patient underwent Percutaneous Endoscopic Gastrostomy-Jejunostomy in August 2022, the patient was started on Organic Tube Feeding Formula. To this date, the patient is using the PEG-J for feeding and remains nil per oral. Multiple trials of reintroducing oral feeding have been attempted but the patient still is unable to tolerate oral feeds completely and continues to complain of early satiety, nausea, and vomiting on reintroducing feeds.

Antibiotic duration and gastric dysmotility in preterm neonates.

Prolonged antibiotic use after birth is associated with neonatal feeding intolerance and functional gastrointestinal disorders (FGIDs). A gastric dysrhythmia (tachygastria) with frequencies >4-9 cycles per minute, measured by electrogastrography (EGG), is associated with FGIDs. The relationship between prolonged antibiotic use and % time spent in tachygastria is unknown in preterm infants. We aimed to compare weekly changes in % tachygastria between preterm infants receiving long (>48 h) versus short (≤48 h) courses of antibiotics for early onset sepsis evaluation (initiated at <3 days of life). This was a longitudinal, prospective cohort study of 88 preterm infants (<34 weeks' gestation) with weekly EGG recordings from the first week of life until 40 weeks' post-menstrual age, discharge, or death. We calculated % of EGG recording time in tachygastria and determined the mean across weekly sessions. A mixed effects model assessed variance in % tachygastria between the short- and long-antibiotic exposure groups across all weeks. Baseline characteristics were similar between the two groups. There was no difference in % tachygastria between short and long antibiotic exposure groups across nine postnatal weeks (p = 0.08). Early, prolonged antibiotic exposure among preterm infants may not lead to significant gastric dysrhythmia. Future studies including larger sample sizes and a "no antibiotic" exposure arm are essential in elucidating this potential relationship.

Strategies for protecting lung health after spinal cord injury and gastric reflux

Spinal cord injuries have a significant and far-reaching impact, affecting more than 300,000 people in the United States alone. Among these injuries, cervical-level injuries are the most common, accounting for approximately 60% of all spinal cord injuries. Pulmonary complications, specifically aspiration-related pneumonia, rank as the primary cause of death in individuals with these injuries. Notably, those with cervical spinal cord injuries have an elevated risk of experiencing acute lung injury and acute respiratory distress syndrome. Moreover, spinal cord injuries, regardless of their location, often lead to gastric dysmotility, a condition frequently linked with gastroesophageal reflux disease. This research aims to untangle the intricate relationship between these interconnected health issues and their collective impact on pulmonary function. Here we tested the hypotheses 1) that cervical spinal cord injury increases the susceptibility for developing acute lung injury associated with gastric juice aspiration and 2) that TRPV4 inhibitors will mitigate gastric fluid/SCI-induced lung injury. These studies employed a rat model of spinal cord injury, C2 hemisection (C2Hx). This model mimics the reduced inspiratory tidal volume observed in individuals with cervical spinal cord injuries and has more recently been shown to recapitulate certain aspects of lung injury associated with spinal cord injuries. Additionally, to produce the effects of gastric reflux, gastric juices were introduced into the trachea in a subset of animals following spinal cord injury. Furthermore, TRPV4 inhibitors were administered to assess their potential to mitigate lung damage after spinal injury, gastric juice instillation or at both times. Preliminary data suggest that C2Hx and low levels of gastric juice increase inflammatory markers in the lung and circulation above even high levels of gastric instillation. Further, preliminary data supports the hypothesis that TRVP4 inhibition may protect the lung. The outcomes of these investigations will provide valuable insights into how spinal cord injuries might predispose individuals to lung injury. Additionally, they will evaluate the effcacy of a promising therapeutic approach using TRPV4 inhibitors to restore lung barrier function, potentially reversing this susceptibility. R21NS121966-01. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Gastric dysrhythmias in patients with early systemic sclerosis: a cross-sectional study.

Gastric involvement in patients with early systemic sclerosis (SSc) has not been previously investigated. We aim to evaluate the association of gastric dysrhythmias with gastrointestinal (GI) symptoms and nailfold video capillaroscopy (NVC). Cross-sectional study. Patients with early SSc, completed the UCLA GIT 2.0 questionnaire, performed an NVC, and a surface Electrogastrography (EGG). Descriptive statistics was used for demographic and clinical characteristics and Fisher and Kendall Tau tests were used for association analysis. 75 patients were screened, 30 patients were consecutively enrolled, 29 performed the EGG and 1 patient had a non-interpretable NVC. 29/30 were female with a mean age of 48.7 years (25-72). The mean disease duration from the first non-RP symptom was 22.6 +/-10.8 months and most of the patients had limited disease (76.6%). Total GIT 2.0 score symptoms were moderate-severe in 63% of the participants and 28/29 had an abnormal EGG. Bradygastria was the most common pattern present in 70% of the participants. NVC patterns: 17% early, 34% active, 28% scleroderma-like, 14% non-specific, and 2 patients had a normal NVC. There was no association between severe GI symptoms or NVC patterns and severely abnormal EGG, but the presence of bradygastria was associated with severe impairment in the social functioning area (p 0.018). Gastric dysmotility is common in early SSc and there is a lack of correlation between GI symptoms and NVC scleroderma patterns. EGG is a sensitive, cheap, and non-invasive exam, that may be an alternative to early diagnosis of GI involvement.

The role of hypothalamic Orexin-A in stress-induced gastric dysmotility: An agonistic interplay with corticotropin releasing factor.

Central Orexin-A (OXA) modulates gastrointestinal (GI) functions and stress response. This study aimed to investigate whether OXA and CRF interact at hypothalamic level. Solid gastric emptying (GE), fecal output (FO), plasma corticosterone (CORT), and postprandial antro-pyloric motility were assessed in rats that underwent acute restraint stress (ARS) and pretreated with central OX1R and/or CRF receptor antagonists SB-334867 and alpha-helical CRF9,41 . Microdialysis was performed to assess ARS-induced release of OXA and CRF in PVN and LHA, respectively. Immunofluorescence labeling was performed to detect the stress-induced changes in OXA and to assess the hypothalamic distribution of OX1R and CRF1/2 receptors. ARS-induced c-Fos immunoreactivity was evaluated in PVN and LHA of rats received OX1R and CRF receptor antagonists. ARS delayed GE by disturbing the coordination of antro-pyloric contractions while stimulating FO and CORT secretion. ARS-induced alterations in GE, FO, plasma CORT, and antro-pyloric motility were attenuated by OX1R and/or CRF receptor antagonists, however, these changes were completely restored in rats received both antagonists. ARS stimulated release of OXA and CRF which were significantly attenuated by α-CRF9,41 and SB-334867, respectively. The OX1R was detected in CRF-immunoreactive cells, whereas dense expression of CRF2 receptor but not CRF1 was observed in LHA. ARS remarkably increased OXA immunoreactivity in LHA. ARS-induced c-Fos expression in LHA and PVN was abolished by α-CRF9,41 and SB-334867, respectively. Our findings suggest a reciprocal contribution of OXA and CRF which seems to be involved in the mediation of stress-induced alterations in neuroendocrine and GI motor functions.

OGC P33 Comparison of the post-operative outcomes of surgical and chemical interventions on the gastric pylorus during oesophagectomy: A systematic review and meta-analysis

Abstract Background Oesophagectomy can lead to gastric dysmotility and pyloric dysfunction, causing delayed gastric emptying (DGE). DGE is associated with significant postoperative morbidity, namely aspiration pneumonia and anastomotic leak. Surgical drainage and botox injections (BI) on pylorus were described to combat DGE. Pyloric interventions however can increase risk of bile reflux, oesophagitis, dumping syndrome and pyloric leaks. Current literature showed equivocal short- and long-term outcomes of pyloric drainage procedures, with no consensus on the necessity of such procedures. We aim to evaluate the latest literature, comparing effects of different pylorus surgical drainage methods, BI and watch-and-wait approach on the pylorus during oesophagectomy Methods The OVID database was searched systematically. Articles were screened with the Rayyan software. Inclusion Criteria of articles are as follows: • RCT and comparative cohort studies (retrospective and prospective) which included any drainage methods, performed at the same time as oesophagectomy • Oesophagectomy for benign or malignant conditions • Studies of adult human subjects ≥ age of 18 years old • Studies published in English language • Studies published within the last 25 years Primary outcomes evaluated were DGE and pulmonary complication rates. A traditional pairwise meta-analysis was performed with Revman 5.4, utilizing a random effects model for analysis of the pooled outcome measures. Results Data of 3925 patients from 27 publications evaluating up to ten pyloric interventions were analyzed. Most studies were retrospective in nature (24 studies). Due to heterogeneity of reported outcomes, pooled meta-analyses were only performed on limited studies. Pooled analyses showed pyloric interventions reduced DGE rates in 19 studies and pulmonary complications in 11 studies. Relative risks (95% CI; p value) were 0.95 (0.7,1.29; p=0.74) and 0.88 (0.72,1.08; p=0.22), respectively.Figure 1:Forrest plot comparing DGE rates of Pyloric Interventions vs No Intervention Figure 2:Forrest plot comparing rates of Pulmonary Morbidity of Pyloric Interventions vs No Intervention Conclusions Our systematic review and meta-analysis did not observe statistically significant and conclusive evidence favouring pyloric drainage procedures to none. High quality comparative studies and inconsistent scrutinization of post operative outcomes were lacking. Prospectively designed RCT or propensity matched cohort studies comparing surgical pyloric drainage, BI and no intervention should be conducted to produce standardized comparison. We suggest analyzing post operative outcomes by measuring data which could be objectively recorded (DGE utilizing the latest definition, pulmonary morbidity, anastomotic leak, biliary reflux rates, radiographic or endoscopic findings etc.) combined with subjective measurement of patient symptoms, where a patient-centred questionnaire could be performed.

Gastric Alimetry® Test Interpretation in Gastroduodenal Disorders: Review and Recommendations.

Chronic gastroduodenal symptoms are prevalent worldwide, and there is a need for new diagnostic and treatment approaches. Several overlapping processes may contribute to these symptoms, including gastric dysmotility, hypersensitivity, gut-brain axis disorders, gastric outflow resistance, and duodenal inflammation. Gastric Alimetry® (Alimetry, New Zealand) is a non-invasive test for evaluating gastric function that combines body surface gastric mapping (high-resolution electrophysiology) with validated symptom profiling. Together, these complementary data streams enable important new clinical insights into gastric disorders and their symptom correlations, with emerging therapeutic implications. A comprehensive database has been established, currently comprising > 2000 Gastric Alimetry tests, including both controls and patients with various gastroduodenal disorders. From studies employing this database, this paper presents a systematic methodology for Gastric Alimetry test interpretation, together with an extensive supporting literature review. Reporting is grouped into four sections: Test Quality, Spectral Analysis, Symptoms, and Conclusions. This review compiles, assesses, and evaluates each of these aspects of test assessment, with discussion of relevant evidence, example cases, limitations, and areas for future work. The resultant interpretation methodology is recommended for use in clinical practice and research to assist clinicians in their use of Gastric Alimetry as a diagnostic aid and is expected to continue to evolve with further development.

Intravenous Immunoglobulin Therapy for Autoimmune Dysautonomia in children: A Case Series (P10-5.013)

<h3>Objective:</h3> To assess the efficacy of intravenous immunoglobulin (IVIG) therapy in Autoimmune Dysautonomia <h3>Background:</h3> IVIG has been successfully used in the past for pain management and Autoimmune Gastric Dysmotility Disorder (AGID) of adult patients with suspected autoimmune etiology. However, the literature on efficacy of IVIG in children is scarce. <h3>Design/Methods:</h3> A retrospective review of AGID patients treated with IVIG was conducted. All symptoms were reviewed. <h3>Results:</h3> Patient 1 was positive for IgM TS-HDS Ab. Patients 2 and 3 were positive for Neuronal Acetylcholine Receptor Ganglionic (alpha-3) Ab. Patients 1 and 2 had Small Fiber Neuropathy diagnosis. Age at diagnosis of patients 1, 2, and 3 were 14, 17.25, and 16.5 years, respectively. Duration of treatment for patient 3 was 6 months, and 1 year for patients 1 and 2. Post treatment, patient 1 did not require venting of J tube; though still dependent on Total Parenteral Nutrition (TPN). Patient 1 is no longer dependent on enemas, as distal colonic and antroduodenal contractions have normalized. Esophageal dysmotility remains unchanged. Abdominal pain and distention, Postural Orthostatic Tachycardia Syndrome (POTS), and neuropathic pain improved. Patient 2 presented with intractable vomiting and POTS. She was dependent on Nasogastric tube (NG) feedings due to vomiting and was on cyproheptadine, erythromycin, bethanechol, amitriptyline, and prucalopride. Post treatment, vomiting resolved and all but prucalopride were discontinued. Colonic motility has not been re-assessed, however constipation, abdominal distention, and pain resolved. Polyethylene glycol and Bisacodyl were discontinued. Likewise, her POTS resolved. Patient 3 had hyperadrenergic POTS, persistent vomiting, and constipation, suffering a 4 kg weight loss. Following treatment, her vomiting and constipation improved, regaining 3.5 kg. Activity levels and orthostatic dizziness improved, and midodrine and fludrocortisone were discontinued. <h3>Conclusions:</h3> IVIG is an effective treatment for autoimmune dysautonomia in patients with positive IgM TS-HDS Ab and N-AchR Ganglionic (alpha-3) Ab. <b>Disclosure:</b> Mr. Bolufer has nothing to disclose. Dr. Prakash has nothing to disclose.

Optimizing nutrition IN pediatric intestinal pseudo-obstruction syndrome.

Pediatric intestinal pseudo-obstruction (PIPO) encompasses a variety of rare, heterogeneous, and disabling disorders that severely affect gastrointestinal motility and are associated with high morbidity and mortality. PIPO management is complex and focuses on maintaining an optimal nutritional status, improving gut function, relieving symptoms, and treating complications. Nutritional issues prevail, and PIPO patients often experience severe undernutrition and faltering growth. Thus, nutritional management plays a pivotal role for achieving the most favorable clinical outcomes. The calorie and nutrient intake of each patient needs to be tailored to age, extent and severity of gut involvement and nutritional needs to support an optimal nutritional status. After defining the extent and severity of gut dysmotility, an experienced team should perform a careful nutritional assessment. An oral diet should always be encouraged and might include bite and dissolve solids, liquid diet or simple oral stimulation. If oral caloric intake is inadequate, liquid gastric feeds should provide the subsequent step. In the presence of severe gastric dysmotility, continuous post-pyloric feeding represents a viable option. In the most severe cases, parenteral nutrition (PN) is required to meet appropriate nutritional requirements. Pediatric data on this topic are scarce and mainly extrapolated from adult studies. In this review, we discuss current evidence and knowledge regarding nutritional options, implications of the use of different feed types, including a blended diet, and the use of PN. Moreover, based on our experience and the evidence from the literature, we propose a flow chart to guide the nutritional management of PIPO patients.

The role of mosapride and levosulpiride in gut function and glycemic control in diabetic rats

Background and study aimsGastroparesis is a well-known consequence of long-standing diabetes that presents with gastric dysmotility in the absence of gastric outlet obstruction. This study aimed to evaluate the therapeutic effects of mosapride and levosulpiride on improving gastric emptying in type 2 diabetes mellitus (T2DM) while regulating glycemic levels. Material and methodsRats were divided into the normal control, untreated diabetic, metformin-treated (100 mg/kg/day), mosapride-treated (3 mg/kg/day), levosulpiride-treated (5 mg/kg/day), metformin (100 mg/kg/day) + mosapride (3 mg/kg/day)-treated, and metformin (100 mg/kg/day) + levosulpiride (5 mg/kg/day)-treated diabetic groups. T2DM was induced by a streptozotocin–nicotinamide model. Fourweeks from diabetes onset, the treatment was started orally daily for 2 weeks. Serum glucose, insulin, and glucagon-like peptide 1 (GLP-1) levels were measured. Gastric motility study was performed using isolated rat fundus and pylorus strip preparations. Moreover, the intestinal transit rate was measured. ResultsMosapride and levosulpiride administration showed a significant decrease in serum glucose levels with improvement of gastric motility and intestinal transit rate. Mosapride showed a significant increase in serum insulin and GLP-1 levels. Metformin with mosapride and levosulpiride co-administration showed better glycemic control and gastric emptying than either drug administered alone. ConclusionMosapride and levosulpiride showed comparable prokinetic effects. Metformin administration with mosapride and levosulpiride showed better glycemic control and prokinetic effects. Mosapride provided better glycemic control than levosulpiride. Metformin + mosapride combination provided superior glycemic control and prokinetic effects.

Diagnostic Methods for Evaluation of Gastric Motility-A Mini Review.

Gastric motility abnormalities are common in patients with disorders of gut-brain interaction, such as functional dyspepsia and gastroparesis. Accurate assessment of the gastric motility in these common disorders can help understand the underlying pathophysiology and guide effective treatment. A variety of clinically applicable diagnostic methods have been developed to objectively evaluate the presence of gastric dysmotility, including tests of gastric accommodation, antroduodenal motility, gastric emptying, and gastric myoelectrical activity. The aim of this mini review is to summarize the advances in clinically available diagnostic methods for evaluation of gastric motility and describe the advantages and disadvantages of each test.

A central amygdala input to the dorsal vagal complex controls gastric motility in mice under restraint stress.

Background/aims: Psychological and physiological stress can cause gastrointestinal motility disorders. Acupuncture has a benign regulatory effect on gastrointestinal motility. However, the mechanisms underlying these processes remain unclear. Methods: Herein, we established a gastric motility disorder (GMD) model in the context of restraint stress (RS) and irregular feeding. The activity of emotional center-central amygdala (CeA) GABAergic neurons and gastrointestinal center-dorsal vagal complex (DVC) neurons were recorded by electrophysiology. Virus tracing and patch clamp analysis of the anatomical and functional connection between the CeAGABA → dorsal vagal complex pathways were performed. Optogenetics inhibiting or activating CeAGABA neurons or the CeAGABA → dorsal vagal complex pathway were used to detect changes in gastric function. Results: We found that restraint stress induced delayed gastric emptying and decreased gastric motility and food intake. Simultaneously, restraint stress activated CeA GABAergic neurons, inhibiting dorsal vagal complex neurons, with electroacupuncture (EA) reversing this phenomenon. In addition, we identified an inhibitory pathway in which CeA GABAergic neurons project into the dorsal vagal complex. Furthermore, the use of optogenetic approaches inhibited CeAGABA neurons and the CeAGABA → dorsal vagal complex pathway in gastric motility disorder mice, which enhanced gastric movement and gastric emptying, whereas activation of the CeAGABA and CeAGABA → dorsal vagal complex pathway mimicked the symptoms of weakened gastric movement and delayed gastric emptying in naïve mice. Conclusion: Our findings indicate that the CeAGABA → dorsal vagal complex pathway may be involved in regulating gastric dysmotility under restraint stress conditions, and partially reveals the mechanism of electroacupuncture.

Fourier Phase Analysis of Dynamic Antral Contraction Scintigraphy: New Software, Reference Values, and Comparisons to Conventional Gastric Emptying.

Dynamic antral contraction scintigraphy (DACS) has been used to evaluate for gastric dysmotility by measuring antral contraction frequency and ejection fraction (EF). Fourier phase image analysis has the potential to assess gastric antral contractions for dyssynchrony as has been used for analyzing nuclear cardiology ventriculography (multigated acquisition studies) for cardiac dyssynchrony. The aims of this study were to determine whether Fourier phase analysis helps to characterize antral motility physiology, whether Fourier phase analysis correlates with conventional gastric emptying scintigraphy (GES), and which DACS parameters may aid in diagnosing gastric dysmotility, particularly delayed gastric emptying (GE). Methods: DACS and GES of healthy volunteers (n = 22) were compared with patients (n = 99) with symptoms of gastroparesis. New DACS Fourier phase analysis software was developed. Results: GE was delayed (n = 53) or normal (n = 46) in patients. There was a linear correlation between the time for the stomach to empty 50% of the meal and the percentage total proximal and distal in-phase antral pixels at 30 min (r = 0.37, P = 0.0001) and 60 min (r = 0.26, P = 0.007). In healthy volunteers, the mean proximal-to-distal ratio of in-phase antral pixels increased from 1.67 (30 min) to 2.65 (120 min) (P = 0.035), and EF increased from 23% (30 min) to 32% (120 min) (P = 0.022). Multivariable regressions of percentage total proximal and distal in-phase antral pixels (30 min) and EF (60 min) were the best predictors of abnormal GE (adjusted odds ratio, 3.30 [95% CI, 1.21-9.00] and 2.97 [95% CI, 1.08-8.21], respectively). Conclusion: This study used Fourier phase analysis to analyze DACS in healthy volunteers and patients with symptoms of gastroparesis. In addition to establishing reference values, new physiologic information on antral motility was obtained. In healthy volunteers, there was an increasing proximal-to-distal ratio of in-phase antral pixels and antral EF over time after meal ingestion. The percentage total proximal and distal in-phase antral pixels at both 30 and 60 min correlated well with GE values for the time for the stomach to empty 50% of the meal. For symptomatic patients, the percentage total proximal and distal in-phase antral pixels at 30 min and the EF at 60 min after meal ingestion correlated with delayed GE on conventional GES. Thus, Fourier phase analysis of DACS appears to have potential to further aid in diagnosing gastric dysmotility in GES.

Oxaliplatin-Induced Damage to the Gastric Innervation: Role in Nausea and Vomiting.

Nausea and vomiting are common gastrointestinal side effects of oxaliplatin chemotherapy used for the treatment of colorectal cancer. However, the mechanism underlying oxaliplatin-induced nausea and vomiting is unknown. The stomach is involved in the emetic reflex but no study investigated the effects of oxaliplatin treatment on the stomach. In this study, the in vivo effects of oxaliplatin treatment on eating behaviour, stomach content, intrinsic gastric neuronal population, extrinsic innervation to the stomach, levels of mucosal serotonin (5-hydroxytryptamine, 5-HT), and parasympathetic vagal efferent nerve activity were analysed. Chronic systemic oxaliplatin treatment in mice resulted in pica, indicated by increased kaolin consumption and a reduction in body weight. Oxaliplatin treatment significantly increased the stomach weight and content. The total number of myenteric and nitric oxide synthase-immunoreactive neurons as well as the density of sympathetic, parasympathetic, and sensory fibres in the stomach were decreased significantly with oxaliplatin treatment. Oxaliplatin treatment significantly increased the levels in mucosal 5-HT and the number of enterochromaffin-like cells. Chronic oxaliplatin treatment also caused a significant increase in the vagal efferent nerve activity. The findings of this study indicate that oxaliplatin exposure has adverse effects on multiple components of gastric innervation, which could be responsible for pica and gastric dysmotility.

Gastric dysmotility and gastrointestinal symptoms in myalgic encephalomyelitis/chronic fatigue syndrome

Background Gastrointestinal symptoms are common in ME/CFS, but there is a knowledge gap in the literature concerning gastrointestinal motility features and detailed symptom description. Objective In this study, we aimed to characterize gastric motility and gastric symptoms in response to a liquid meal. Methods We included 20 patients with ME/CFS with abdominal complaints who were recruited to a double-blind randomized placebo-controlled trial of Rituximab. The patients of this sub study were examined with an ultrasound drink test, and gastrointestinal symptoms were evaluated using the Rome III questionnaire and Irritable Bowel Syndrome Symptom Severity Scale (IBS-SSS) questionnaire. Results We found that patients commonly reported fullness/bloating (75%), abdominal pain (45%) and nausea (35%). Ultrasound measurements revealed lower proximal measurements of the stomach after a meal (p < 0.01) and larger fasting antral area (p = 0.019) compared to healthy controls. The patients had a stronger symptomatic response to the liquid meal compared to healthy controls regarding epigastric pain, discomfort and nausea (p < 0.05). Ninety percent of the patients reported bowel movement frequencies within the normal range but scored high on bowel habit dissatisfaction and life disruption. Conclusion The patients presented with fullness/bloating, nausea and epigastric pain, showed signs of impaired gastric accommodation and visceral hypersensitivity, showing that the gastrointestinal symptoms of ME/CFS patients are similar to functional dyspepsia. Key summary Gastrointestinal symptoms are common in ME/CFS, but there is a knowledge gap in the literature concerning gastrointestinal motility features and detailed symptom description. • In this study, patients with ME/CFS had signs of impaired gastric accommodation after a liquid meal. • Out of 20 patients, 15 patients reported fullness/bloating, 9 reported abdominal pain, and 7 reported nausea. The patients showed signs of visceral hypersensitivity on a drink test. • Our findings suggest that patients with ME/CFS share many similarities with patients with Functional Dyspepsia. The findings were not typical for Irritable Bowel Syndrome.

Gastrointestinal factors associated with risk of bronchiectasis in children.

To evaluate gastrointestinal (GI) risk factors for bronchiectasis in children. We hypothesized that upper GI tract dysmotility would be associated with increased risk of bronchiectasis. Subjects in this retrospective cohort study included those evaluated for persistent pulmonary symptoms in the Aerodigestive Center at Boston Children's Hospital who underwent chest computed tomography (CT) between 2002 and 2019. To determine gastrointestinal predictors of bronchiectasis, baseline characteristics, comorbidities, enteral tube status, medications received, gastroesophageal reflux burden, adequacy of swallow function, esophageal dysmotility, gastric dysmotility, and neutrophil count on bronchoalveolar lavage (BAL) were compared between patients with and without bronchiectasis. Proportions were compared with Fisher's exact test and binary logistic regression with stepwise selection was used for multivariate analysis. ROC analyses were utilized to compare BAL neutrophils and bronchiectasis. Of 192 subjects, 24% were found to have evidence of bronchiectasis on chest CT at age 7.9 ± 0.5 years. Enteral tubes (OR 5.77, 95% CI 2.25-14.83, p < 0.001) and increased BAL neutrophil count (OR 5.79, 95% CI 1.87-17.94, p = 0.002) were associated with increased risk while neurologic comorbidities were associated with decreased risk (OR 0.24, 95% CI 0.09-0.66, p = 0.006). Gastroesophageal reflux was not found to be a significant risk factor. Neutrophil counts >10% had 72% sensitivity and 60% specificity for identifying bronchiectasis. Enteral tubes were associated with significantly increased risk of bronchiectasis but gastroesophageal reflux was not. Providers should consider obtaining chest CT to evaluate for bronchiectasis in children found to have unexplained elevated BAL neutrophil count.

Priorities in choosing prokinetic for patients with functional dyspepsia: Focus on itopride

Functional dyspepsia is a widespread disease with many symptoms that reduce the patient's quality of life. The effectiveness of prokinetics, including in combination with proton pump inhibitors, has a high level of scientific evidence in the treatment of functional dyspepsia. The effectiveness of itopride hydrochloride is determined by a dual mechanism of action: antagonism to D 2-dopamine receptors and inhibition of acetylcholinesterase. The drug exceeds of metoclopramide and domperidone in safety in relation to cardiac and neurological disorders. Itopride hydrochloride is not expected to have pharmacokinetic interactions with other drugs metabolized by the CYP3A4 system. In addition to functional dyspepsia, itopride hydrochloride is indicated in the treatment of chronic gastritis, gastrointestinal symptoms associated with gastric dysmotility or delayed gastric emptying, such as bloating, rapid satiety, a feeling of fullness in the stomach after eating, pain or discomfort in the epigastric region, loss of appetite, heartburn, nausea and vomiting. The pharmacoeconomic analysis shows an advantage of Itopride-SZ in comparing of the direct cost of it with the original and several generic drugs. In this way, it allows recommend Itopride-SZ as an affordable drug for various cohorts of patients.

Zhizhu Kuanzhong, a traditional Chinese medicine, alleviates gastric hypersensitivity and motor dysfunction on a rat model of functional dyspepsia.

Ethnopharmacological relevance: Zhizhu Kuanzhong (ZZKZ) is a traditional Chinese medicine modified from classic formula Zhizhu decoction in "Synopsis of Golden Chamber" (Han Dynasty in the 3rd century) and the Zhizhu pill in "Differentiation on Endogenous" in Jin Dynasty (1,115-1,234). ZZKZ contains four botanical drugs, including Citrus × Aurantium L [Rutaceae; Aurantii Fructus Immaturus], Atractylodes Macrocephala Koidz. [Compositae; Rhizoma Atractylodis Macrocephalae], Bupleurum Chinense DC [Apiaceae; Radix Bupleuri Chinensis], and Crataegus Pinnatifida Bunge [Rosaceae; Fructus Crataegi Pinnatifidae], which have been widely used in clinical therapy for functional dyspepsia (FD). Aim of the study: This study aimed to evaluate the pharmacological effects and mechanisms of action of ZZKZ on gastric hypersensitivity and motor dysfunction in a rat model of FD. Materials and methods: FD was induced in Sprague-Dawley rats by neonatal gastric irritation with 0.1% iodoacetamide. The FD rats were treated with ZZKZ (0.5g/kg, 1.0g/kg, or 1.5g/kg respectively) by gavage for 7days, while domperidone (3mg/kg) acted as treatment control. Body weight gain, food intake, gastric emptying, and intestinal propulsion were also measured. Ex vivo gastric smooth muscle activity recordings and greater splanchnic afferent (GSN) firing recordings were employed to evaluate gastric motility and sensation. Particularly, the role of 5-HT in the action of ZZKZ in improving gastric dysmotility and hypersensitivity was explored. Results: ZZKZ promoted weight gain, food intake, gastric emptying, and intestinal propulsion in FD rats. ZZKZ promoted spontaneous and ACh-induced contractions of gastric smooth muscle strips in FD rats, alleviated spontaneous activity, and chemical (acid perfusion) and mechanical (intragastric distension) stimulated GSN firing in FD rats. ZZKZ ameliorated gastric smooth muscle contraction and GSN firing induced by 5-HT in FD rats. ZZKZ stimulated the release of serum 5-HT, with reduced 5-HT3 receptor and increased 5-HT4 receptor mRNA expression in the guts of FD rats. Conclusion: This study demonstrated that ZZKZ improves FD-related gastric hypersensitivity and motor dysfunction and should be an effective compound for relieving FD symptoms. The gastric 5-HT system with lower 5-HT3 activity and increased 5-HT4 distribution is involved in the mechanisms of ZZKZ underlying the treatment of FD.

Migraine and Gastroparesis.

Migraine is a chronic and disabling disease affecting a significant proportion of the world's population. There is evidence that gastroparesis, a gastrointestinal (GI) dysmotility disorder in which transit of gastric contents is delayed, can occur in the setting of migraine. This article aims to review recent literature on overlap in the pathophysiology and clinical manifestations of migraine and gastroparesis and highlight management considerations when these disorders coexist. There has been increasing recognition of the importance of the connection between the GI tract and the brain, and mounting evidence for the overlap in the pathophysiology of migraine and gastroparesis specifically. There exists a complex interplay between the central, autonomic, and enteric nervous systems. Studies show that gastroparesis may be present during and between acute migraine attacks necessitating modification of management to optimize outcomes. Gastric dysmotility in the setting of migraine can impact absorption of oral migraine medications and alternate formulations should be considered for some patients. Noninvasive vagus nerve stimulation has been FDA cleared for migraine treatment and is also being studied in gastroparesis. Dysfunction of the autonomic nervous system is a significant feature in the pathophysiology of gut motility and migraine, making treatments that modulate the vagus nerve attractive for future research.

Assessment of Gastric Dysmotility Using Standardized Tc-99m Sulfur Colloid-Labeled Rice Cakes in Diabetic Patients.

Diabetes mellitus is a common lifestyle disease where patients suffer from gastric dysmotility, which is usually underdiagnosed. The aim of this study was to evaluate the utility of Tc-99m sulfur colloid-labeled meal gastric emptying scintigraphy in Type 2 diabetic patients. A total of 43 patients and 30 controls, satisfying the inclusion criteria from March 2019 to August 2020, were included. Serial planar images were acquired in both anterior and posterior projections for an iso-time of 1 min at 1 min, 60 min (1 h), 120 min (2 h), and 240 min (4 h) after consumption of Tc-99m SC-labeled idly (rice cakes). The gastric emptying was considered delayed if there was <10% emptying at 1 h, <70% emptying at 2 h, and <94% emptying at 4 h. The mean T1/2 was similar among cases (44.11 ± 10.52 min) and controls (49.56 ± 13.44 min, P = 0.056) while the mean gastric emptying at 1 h was slower in cases compared to controls, P = < 0.01. Two cases (4.6%) had delayed gastric emptying while none of the controls had delayed gastric emptying. T1/2 showed no association with duration of diabetes or HbA1c levels (P = 0.76, 0.45) and a weak correlation with fasting blood sugar (FBS) on the day of scan (R value = 0.18). In comparison to controls, diabetic patients had faster gastric emptying with no association with duration of diabetes or HbA1c levels and a weak correlation with FBS on the day of scan.