Gastrointestinal Dysmotility Symptoms Research Articles

Safety of prolonged use of metoclopramide and domperidone as treatment for chronic gastrointestinal dysmotility disorders in patients with systemic sclerosis

BackgroundMetoclopramide and domperidone are prokinetic agents commonly used to treat gastrointestinal dysmotility disorders. This study aimed to evaluate the safety and associated side effects of prolonged-use metoclopramide and domperidone as treatment for chronic gastrointestinal dysmotility disorders in patients with systemic sclerosis (SSc). MethodsA quantitative observational survey was conducted by interview questionnaire in rheumatology outpatients at a tertiary teaching hospital in Riyadh, Saudi Arabia. The study included all patients aged 25–80 years diagnosed with SSc. All patients were on metoclopramide or domperidone for the treatment of chronic gastrointestinal dysmotility symptoms over at least 12 weeks. ResultsEighteen eligible patients were included. Most study participants were diagnosed with SSc complicated by interstitial lung disease (n = 13; 72.2 %). The most frequently reported side effect that occurred while taking prokinetic drugs was shortness of breath (n = 12; 66.7 %). None of the participants reported experiencing depression, galactorrhea, or syncope. CNS side effects were reported in 5.6 %. There were no differences in side effects based on the type and dosage of prokinetic drug used. ConclusionsUse of metoclopramide and domperidone for the treatment of chronic gastrointestinal dysmotility in SSc patients for 12 weeks or longer was not associated with any troublesome side effects. Further studies with more participants are needed to confirm our findings.

Imaging Review of Gastrointestinal Motility Disorders.

The motor function of the gastrointestinal tract relies on the enteric nervous system, which includes neurons spanning from the esophagus to the internal anal sphincter. Disorders of gastrointestinal motility arise as a result of disease within the affected portion of the enteric nervous system and may be caused by a wide array of underlying diseases. The etiology of motility disorders may be primary or due to secondary causes related to infection or inflammation, congenital abnormalities, metabolic disturbances, systemic illness, or medication-related side effects. The symptoms of gastrointestinal dysmotility tend to be nonspecific and may cause diagnostic difficulty. Therefore, evaluation of motility disorders requires a combination of clinical, radiologic, and endoscopic or manometric testing. Radiologic studies including fluoroscopy, CT, MRI, and nuclear scintigraphy allow exclusion of alternative pathologic conditions and serve as adjuncts to endoscopy and manometry to determine the appropriate diagnosis. Additionally, radiologist understanding of clinical evaluation of motility disorders is necessary for guiding referring clinicians and appropriately imaging patients. New developments and advances in imaging techniques have allowed improved assessment and diagnosis of motility disorders, which will continue to improve patient treatment options. Online supplemental material is available for this article. ©RSNA, 2022.

What Is Wrong With This Wireless Motility Capsule?

CASE REPORT A 37-year-old woman was evaluated for suspected gastroparesis with nausea, heartburn, and constipation. She reported bowel movements every 2 weeks (Bristol Stool Scale Type I–III) with excessive straining. She was taking pantoprazole, famotidine, promethazine, and bisacodyl. Her history included esophageal stricture requiring dilation 3 years previously. She reported intermittent dysphagia for solids. A wireless motility capsule (WMC) study was performed for the evaluation of gastrointestinal motility disorder. The WMC profile is presented (Figure 1). The horizontal axis shows the time scale, and the vertical axis shows pressure (red), pH (green), and temperature (blue). The pH was 5–7 with occasional decreases to 2.0 coinciding with drinks/meals, indicating esophageal capsule retention. Ten hours later, the patient vomited and expelled the capsule, confirmed by a temperature decline. A week later, an upper endoscopy confirmed distal esophageal stricture with mucosal changes of esophagitis (Figure 1). Pantoprazole was increased to twice daily, and repeat esophagogastroduodenoscopy in 8 weeks was recommended (Figure 2).Figure 1.: Wireless motility capsule profile of the patients. The horizontal axis shows the time scale, and the vertical axis shows pressure (red), pH (green), and temperature (blue). The pH was 5–7 with occasional decreases to 2.0 coinciding with drinks/meals, indicating esophageal capsule retention. Ten hours later, the patient vomited and expelled the capsule, confirmed by a temperature decline.Figure 2.: Upper endoscopy 1 week after wireless motility capsule testing confirming distal esophageal stricture with mucosal changes of esophagitis.The WMC study is contraindicated in patients with dysphagia, stricture, or bowel obstruction. Capsule retention, although rare (0.33%), can occur, especially if the contraindications for this test are not carefully ruled out before ordering the test.1 The test was incorrectly requested for the patient presented here, but fortunately, the patient vomited the capsule. In patients with dysphagia, stricture, or bowel obstruction, gastrointestinal dysmotility symptoms should be evaluated using alternative tests, such as scintigraphy. Although WMC is significant advance and clinically useful for the diagnosis of gastrointestinal motility disorders, the manufacturer's recommendations and precautions should be followed carefully to prevent potentially serious complications.2 DISCLOSURES Author contributions: L. Mosley wrote the manuscript. A. Jehangir edited the manuscript. S. Sridhar, A. Sharma, and S.S.C. Rao revised the manuscript for intellectual content. S.S.C. Rao is the article guarantor. All authors approve the final version of the manuscript. Financial disclosure: None to report. Previous presentation: This case was presented at the American College of Gastroenterology Annual Scientific Meeting; October 22–27, 2021; Las Vegas, Nevada. Informed consent was obtained for this case report.

Hymecromone Administration in Real Clinical Practice: Results of the Prospective Multicentre Observational Study in the Republic of Kazakhstan

Introduction. This multicentre prospective non-interventional observational study was conducted to obtain additional data about Odeston efficacy and safety in routine clinical practice. The objectives of the study included collection of clinical characteristics of patients, evaluation of Odeston effects in treatment of biliary pain and changes in the gallbladder emptying, evaluation of compliance to therapy, and treatment effect satisfaction.Materials and methods. The study was conducted from July 2020 to April 2021 at the premises of 60 study sites in 4 cities of the Republic of Kazakhstan. Patients having indications for Odeston administration according to the patient leaflet were enrolled. The study included 2 patient visits and an intermediate telephone contact. A visual analogue scale and RAPID questionnaire were used to characterise biliary pain; severity of associated symptoms, bowel habit and a quality of life according the SF-12 were also assessed. A rate of a ≥50 % reduction in symptom severity was used as a primary efficacy criterion; a rate of a ≥10 improvement in the SF-12 quality of life score was used as a secondary efficacy criterion. Compliance to treatment was evaluated using a number of days on Odeston. Treatment satisfaction was assessed using 5 grades.Results. 877 patients, 68.2 % of females and 31.8 % of males, were included in the study; the mean age was 46.0 ± 14.9 years. Primary functional biliary disorder was diagnosed in 65.3 % of patients, chronic non-calculous cholecystitis — 51.4 %, uncomplicated gallbladder disease — in 8.9 %, biliary sludge — 38.4 %, sphincter of Oddi functional disorder — 5.3 % of patients. A dose of Odeston was prescribed at the discretion of the physician. Group A patients received 600 mg (n = 89), group B received 1200 mg of Odeston a day (n = 788). In group B, an incidence of pronounced pain interference with daily living activities was higher. In both groups, the mean VAS scores were reduced to 1 point on treatment, a primary efficacy criterion was achieved in 77.3 % of patients in group A and in 79.8 % of patients in group B, р < 0.05. In both groups, a reduction in the incidence of constipation and diarrhea (р < 0,001) and an increase in the mean scores of physical and mental functioning were noted (р < 0.001, though a secondary efficacy criterion was not achieved (a ≥10 change in the SF-12 score). A prevalence of ultrasonographic sings of biliary sludge was reduced, and an increased gallbladder emptying was observed (p < 0.001). 77.4 % of patients in a total group of patients reported about drug administration for 21 days. A number of patients who were completely satisfied with treatment was higher in group B (p = 0.027).Conclusions. It was found that biliary pain interfered with daily living activities and commonly accompanied by other symptoms of gastrointestinal dysmotility. Odeston effectively reduces the severity of biliary pain, corrects dyspeptic disorders and normalizes stool pattern in patients with functional and organic diseases of the biliary system. Treatment satisfaction was higher with a dose of 1200 mg a day, particularly in more pronounced interference of pain with daily living activities.

Role of Gastric Emptying in Symptoms of Gastroparesis

The symptoms of gastroparesis, such as nausea, vomiting, postprandial fullness, early satiety and abdominal pain, frequently impair the quality of life of the affected individuals. The diagnosis of gastroparesis is made after structural etiologies are ruled out and an assessment of gastric function shows delayed gastric emptying. The role of the delay in gastric emptying in the pathogenesis of symptoms of gastroparesis has been debated, with some studies suggesting an association between delayed gastric emptying and the upper gastrointestinal symptoms, while others do not. The recent literature supports the importance of using reliable methods to assess gastric emptying, as delay in gastric emptying measured on a reliable test (4-h scintigraphy or breath test) is associated with the severity of upper gastrointestinal symptoms. In addition to measuring total gastric emptying, evaluation of regional gastric retention in the proximal and distal stomach and whole gut transit to assess small intestinal and colonic transit may provide additional useful information in patients with more generalized symptoms of gastrointestinal dysmotility.

Autosomal dominant optic atrophy and cataract "plus" phenotype including axonal neuropathy.

ObjectiveTo characterize the phenotype in individuals with OPA3-related autosomal dominant optic atrophy and cataract (ADOAC) and peripheral neuropathy (PN).MethodsTwo probands with multiple affected relatives and one sporadic case were referred for evaluation of a PN. Their phenotype was determined by clinical ± neurophysiological assessment. Neuropathologic examination of sural nerve and skeletal muscle, and ultrastructural analysis of mitochondria in fibroblasts were performed in one case. Exome sequencing was performed in the probands.ResultsThe main clinical features in one family (n = 7 affected individuals) and one sporadic case were early-onset cataracts (n = 7), symptoms of gastrointestinal dysmotility (n = 8), and possible/confirmed PN (n = 7). Impaired vision was an early-onset feature in another family (n = 4 affected individuals), in which 3 members had symptoms of gastrointestinal dysmotility and 2 developed PN and cataracts. The less common features among all individuals included symptoms/signs of autonomic dysfunction (n = 3), hearing loss (n = 3), and recurrent pancreatitis (n = 1). In 5 individuals, the neuropathy was axonal and clinically asymptomatic (n = 1), sensory-predominant (n = 2), or motor and sensory (n = 2). In one patient, nerve biopsy revealed a loss of large and small myelinated fibers. In fibroblasts, mitochondria were frequently enlarged with slightly fragmented cristae. The exome sequencing identified OPA3 variants in all probands: a novel variant (c.23T>C) and the known mutation (c.313C>G) in OPA3.ConclusionsA syndromic form of ADOAC (ADOAC+), in which axonal neuropathy may be a major feature, is described. OPA3 mutations should be included in the differential diagnosis of complex inherited PN, even in the absence of clinically apparent optic atrophy.

Pyridostigmine for the treatment of gastrointestinal symptoms in systemic sclerosis

Symptoms of gastrointestinal dysmotility are common among patients with systemic sclerosis (SSc), and the management of severe cases is often limited by a relative lack of effective interventions. The objective of this case series was to review our experience with pyridostigmine as a treatment for patients with SSc and symptomatic gastrointestinal disease. This study evaluated rates of symptom improvement, side effects, medication adherence, and dose ranges for SSc patients prescribed pyridostigmine for refractory gastrointestinal symptoms over a 10-year period at a quaternary referral center. Patients were defined as responders if they remained on pyridostigmine for at least 4 weeks and clinical benefit was documented by the recorded response of the patient or by the treating physician RESULTS: Of 31 patients treated with pyridostigmine for at least 4 weeks, 51.6% reported symptomatic improvement. Constipation was the most commonly improved symptom based on prevalence prior to therapy (noted by 6/20 patients suffering with constipation). Fifteen of 31 patients reported adverse effects, most commonly diarrhea. Throughout the duration of follow-up (median 126 days, range: 28-506 days), pyridostigmine was continued by 81.3% of patients who reported symptomatic benefit and 58.1% of patients overall. Pyridostigmine holds promise for the treatment of various gastrointestinal symptoms in SSc patients, particularly in patients with refractory constipation. Though side effects may limit its use, most patients who experienced benefit chose to continue therapy.

Gonadotropin-Releasing Hormone and Its Role in the Enteric Nervous System.

Gonadotropin-releasing hormone (GnRH), follicle-stimulating hormone, and luteinizing hormone orchestrate the reproduction cycle and regulate the sex steroid secretion from the gonads. In mammals, GnRH1 is secreted as a hormone from the hypothalamus, whereas both GnRH1 and GnRH2 are present as neurotransmitters/peptides in various tissues, where the peptides exert many different effects. mRNA coding for GnRH1 and GnRH2 have been described in the human gastrointestinal tract, and GnRH has been found in both submucosal and myenteric neurons. mRNA coding for GnRH and the fully expressed peptide have been found in rat enteric neurons by some researchers but not by others. mRNA coding for GnRH receptors, but not the fully expressed receptor, has been found in one rat study. GnRH influences gastrointestinal motility and secretion. GnRH analogs are clinically used in the treatment of sex hormone-dependent diseases, i.e., endometriosis and malignancies, and as pretreatment for in vitro fertilization. Reduced numbers of enteric neurons and IgM antibodies against GnRH and progonadoliberin-2 (precursor of GnRH2) have been observed after such treatment, with the clinical picture of gastrointestinal dysmotility. Similarly, a rat model of enteric neurodegeneration has been developed after administration of the GnRH analog buserelin. Serum IgM antibodies against GnRH1, progonadoliberin-2, and GnRH receptors have been described in patients with signs and symptoms of gastrointestinal dysmotility and/or autonomic dysfunction, such as irritable bowel syndrome, enteric dysmotility, diabetes mellitus, and primary Sjögren’s syndrome. Thus, apart from regulation of reproduction and sex hormone secretion, GnRH also constitutes a part of enteric nervous system (ENS) and its functions during physiological and pathological conditions. This review aimed to describe the role of GnRH in the ENS.

Impact of Wireless Motility Capsule Testing on Management Strategies and Symptomatic Improvement in Diabetic Patients with Gastrointestinal Dysmotility

Introduction: Wireless Motility Capsule (WMC) is used for the assessment of diabetic (DM) patients with suspected gastrointestinal (GI) dysmotility. However, the impact of WMC findings on the clinical management and subsequent symptomatic improvement is not clearly understood. Our aim was to assess the change in therapy and resulting change in symptoms based on WMC testing in DM patients with suspected GI dysmotility. Methods: Retrospective chart review of all DM patients who had WMC testing at our institution from 2010 to 2015 was performed. Only patients for whom follow-up information was available regarding medication changes and response to treatment were included. Patients with a previous history of gut surgery, inflammatory bowel disease or gut cancer were excluded. Results of WMC testing were classified as isolated vs. multiregional dysmotility. The presenting symptoms, change in treatment after WMC testing and symptom response were noted. Chi-square test for independence was used to compare the extent of involvement on WMC testing in those who responded to therapy. Results: A total of 47 patients were included. Mean age was 46 ± 14 years with 77% being females. The prevalence of presenting symptoms is illustrated in figure 1. Nausea and/or vomiting was the most commonly reported symptom (96%), followed by abdominal pain (74%), constipation (72%), bloating (53%) and diarrhea (32%). Treatment prescribed included: Ondansetron/Promethazine (N=27), Erythromycin (N=20), Metoclopramide (N=26), Domperidone (N=14), Linaclotide (N=14), Polyethylene glycol (N=13), Lubiprostone (N=7) and Mirtazapine (N=4). WMC testing was abnormal in 37 (79%) patients. Among those, treatment changes as a result of WMC testing were made in 25 patients (66%). Overall, 27 (57%) patients reported improvement in at least one symptom (Figure 2). In those patients, the extent of involvement on WMC testing was not significantly different, with 52% having an isolated dysmotility and 48% having multiregional involvement (p=0.9) Response to treatment was highest for Linaclotide (64%) and lowest for Metoclopramide (19%). Response to the rest of the medications is presented in figure 3.Figure 1Figure 2Figure 3Conclusion: WMC testing leads to changes in management in 66% of DM patients with symptoms of GI dysmotility. Symptom improvement was noted in 57% of patients. Isolated vs multiregional pattern of underlying GI dysmotility does not seem to impact symptom improvement. Multiple treatment options are available with varying symptom response.

Bariatric Surgery in Obese Patients With Type 1 Diabetes.

There is a paucity of data on the impact of bariatric surgery in type 1 diabetes (T1D). The aim of this review was to quantify the overall effects of bariatric surgery in obese patients with T1D. We searched PubMed, Scopus, ISI Web of Knowledge, and Google Scholar from their inception to December 2015 to identify all relevant studies of bariatric surgery in adult obese patients with T1D. The review included 17 studies with 107 individuals, including 10 case series and 7 case reports. Overall, the dominant procedure was gastric bypass (n = 70; 65%). All studies reported a significant reduction in excess weight. A significant reduction in weight-adjusted daily insulin requirements was shown in all case series except one. Pooled mean ± SD of pre- and postoperative glycated hemoglobin (HbA1c) for the entire cohort with available data (n = 96) was 8.4 ± 1.3% and 7.9 ± 1.1%, respectively (P = 0.01). In addition to common postoperative complications, profound glycemic changes (diabetic ketoacidosis and hypoglycemia) and gastrointestinal dysmotility symptoms (prolonged ileus and acute gastric remnant dilation) have been reported. No surgical mortality was reported. Bariatric surgery leads to significant weight loss in severely obese patients with T1D and results in a significant improvement in insulin requirements and glycemic status. The favorable metabolic effects of bariatric surgery may facilitate medical management of and cardiovascular risk reduction in T1D in the setting of severe obesity. Diabetic ketoacidosis and hypoglycemia are potentially serious complications. Short-term results of bariatric surgery in patients with T1D are encouraging, but larger and longer-term studies are needed.

Tu1458 Chronic Pain and Gastrointestinal Dysmotility Symptoms Exist Independent of Each Other in the Post-Operative Period Following Total Pancreatectomy With Islet Transplantation (TP-IAT)

Tu1458 Chronic Pain and Gastrointestinal Dysmotility Symptoms Exist Independent of Each Other in the Post-Operative Period Following Total Pancreatectomy With Islet Transplantation (TP-IAT)

Japanese apricot improves symptoms of gastrointestinal dysmotility associated with gastroesophageal reflux disease.

To investigate the effects of Japanese apricot (JA) consumption on gastroesophageal reflux disease (GERD)-related symptoms. Participants included individuals living in Minabe-cho, a well-known JA-growing region, who received specific medical check-ups by the local community health service in 2010. GERD-related symptoms were examined in 1303 Japanese individuals using a validated questionnaire, the Frequency Scale for Symptoms of GERD (FSSG), which consists of 7 questions associated with acid reflux symptoms and 5 questions asking about gastrointestinal dysmotility symptoms. Each question was answered using a 4-point scale, with higher scores indicating more severe GERD-related symptoms. Subjects were divided into two groups according to their intake of dried and pickled JA: daily intake (≥ 1 JA daily) (392 subjects) and none or occasional intake (< 1 JA daily) (911 subjects). FSSG scores were compared between subjects who consumed JA daily and those who did not. Next, subjects were stratified by age, gender and Helicobacter pylori (H. pylori) status for subanalyses. Those who ate JA daily were significantly older than those who did not (60.6 ± 10.5 years vs 56.0 ± 11.0 years, P < 0.001). Total FSSG scores were significantly lower in subjects with daily JA intake than in those with none or only occasional intake (2.13 ± 3.14 vs 2.70 ± 3.82, P = 0.005). In particular, subjects who consumed JA daily showed significantly improved FSSG dysmotility scores compared with subjects who did not (1.05 ± 1.58 vs 1.46 ± 2.11, P < 0.001). In contrast, the FSSG reflux score did not differ between subjects with and without daily intake of JA (1.08 ± 1.90 vs 1.24 ± 2.11, P = 0.177). Subanalysis indicated that improvement in dysmotility by JA intake was specifically observed in non-elderly (1.24 ± 1.68 vs 1.62 ± 2.22, P = 0.005) and H. pylori-negative subjects (0.99 ± 1.58 vs 1.57 ± 2.06, P < 0.001). GERD patients (total FSSG score ≥ 8) were less frequently observed among subjects with daily intake of JA as compared to those without daily intake of JA (6.1% vs 9.7%, P = 0.040). Daily JA intake may improve digestive dysmotility symptoms, resulting in relief of GERD symptoms. The effect is more obvious in non-elderly and H. pylori-negative subjects.

Immunotherapy trial as diagnostic test in evaluating patients with presumed autoimmune gastrointestinal dysmotility.

Chronic gastrointestinal dysmotility greatly impacts the quality of life. Treatment options are limited and generally symptomatic. Neural autoimmunity is an under-recognized etiology. We evaluated immunotherapy as an aid to diagnosing autoimmune gastrointestinal dysmotility (AGID). Twenty-three subjects evaluated at the Mayo Clinic for suspected AGID (August 2006-February 2014) fulfilled the following criteria: (1) prominent symptoms of gastrointestinal dysmotility with abnormalities on scintigraphy-manometry; (2) serological evidence or personal/family history of autoimmune disease; (3) treated by immunotherapy on a trial basis, 6-12 weeks (intravenous immune globulin, 16; or methylprednisolone, 5; or both, 2). Response was defined subjectively (symptomatic improvement) and objectively (gastrointestinal scintigraphy/manometry studies). Symptoms at presentation: constipation, 18/23; nausea or vomiting, 18/23; weight loss, 17/23; bloating, 13/23; and early satiety, 4/23. Thirteen patients had personal/family history of autoimmunity. Sixteen had neural autoantibodies and 19 had extra-intestinal autonomic testing abnormalities. Cancer was detected in three patients. Preimmunotherapy scintigraphy revealed slowed transit (19/21 evaluated; gastric, 11; small bowel, 12; colonic, 11); manometry studies were abnormal in 7/8. Postimmunotherapy, 17 (74%) had improvement (both symptomatic and scintigraphic, five; symptomatic alone, eight; scintigraphic alone, four). Nine responders re-evaluated had scintigraphic evidence of improvement. The majority of responders who were re-evaluated had improvement in autonomic testing (six of seven) or manometry (two of two). This proof of principle study illustrates the importance of considering an autoimmune basis for idiopathic gastrointestinal dysmotility and supports the utility of a diagnostic trial of immunotherapy.

Identifying Eating Disorder Risk Factors in Those with Dysmotility Symptoms

Purpose: Eating disorders (ED) are strongly associated with disturbing gastrointestinal sensitivity and motor physiology. Consequently, patients with EDs develop functional gastrointestinal disorders (FGIDs). The purpose of our study is to determine if patients with dysmotility symptoms have an underlying ED, if there is a specific motility disorder that is common and identify ED risk factors that should be screened for in patients with FGIDs. Methods: We performed a prospective study of patients referred to our motility lab with a variety of upper and lower gastrointestinal dysmotility symptoms. Patients were included if they had any of the following studies: esophageal manometry, anal manometry, impedance pH study, or SmartPill. Enrolled patients were screened for an underlying ED with a self-reporting questionnaire that contained ED risk factors as well as three validated diagnostic scales: 1) Eating Attitude Test (EAT); 2) DSM-IV Criteria for Anorexia Nervosa (AN) and Bulimia Nervosa (BN); 3) Eating Disorder Diagnostic Scale (EDDS) for AN, BN, and Binge Eating Disorder (BED). Significant findings were defined as the following: Eat Score ≥19, ≥3 of 4 AN DSM-IV criteria for females, ≥2 of 3 AN DSM-IV criteria for males, ≥5 of 6 BN DSM-IV criteria, ≥3 of 4 AN EDDS criteria for females, ≥2 of 3 AN EDDS criteria for males, ≥2 of 3 BN EDDS criteria, and ≥5 of 6 BED EDDS criteria. Results: One hundred patients were enrolled. Mean age was 48.4±13.7 years, 80 (80%) were female, and 47 (47%) were non-Hispanic white. Eleven (11%) were found to have a previously undiagnosed eating disorder. Of these 11 patients, 9 (81.8%) were female with a mean age of 50.5±12.5 years and 6 (54.5%) were non-Hispanic white. No difference was noted in the demographics of the two groups. ED patients were significantly more likely to report a previous or current attempt of dieting (90.9% vs. 38.2%; p=0.001) as well as compensatory behaviors (diet pill, laxatives, diuretics, self-induced vomiting, fasting; 73% vs. 13.4%; p=0.0001). Parental stress was also noted to be more common in ED patients (81.8% vs. 41.5%; p=0.02). In addition, a college education (81.8% vs. 39.3%; p=0.01) and abuse (55% vs. 22.5%; p=0.03) was significantly more frequent in the ED group. On average, ED patients were evaluated by two gastroenterologists in the outpatient setting. Discussion of neither an eating disorder nor its associated risk factors was elicited. Conclusion: Eleven (11%) of patients presenting for motility testing were found to have an ED. ED patients had a significantly increased prevalence of the following risk factors: dieting, abuse, parental stress, college education, and compensatory behaviors. These risk factors become important to ascertain in patients with dysmotility symptoms as it may indicate an underlying ED and alter the management strategy.

Irritable Bowel Syndrome and Other Functional Gastrointestinal Disorders

Irritable bowel syndrome is one of several highly prevalent functional gastrointestinal disorders (FGID) displaying symptoms of gastrointestinal dysmotility and visceral hypersensitivity. Substantial overlap of symptoms and comorbidities occur not only between irritable bowel syndrome and other FGID but also with gastrointestinal disorders that are not related to motility (eg, celiac disease and lactose intolerance) and to somatic conditions (eg, fibromyalgia and chronic fatigue syndrome). Pathogenic mechanisms common among FGIDs may include alternations in intestinal and colonic microflora. Evidence is also emerging of an interplay between gut immune cells/activity and alternations in motility, secretion, and sensation. The role of cytokine activity and inflammation is important in this regard. As recommended by Rome III, diagnostic testing should be guided by the patient's age, primary symptom characteristics, and other clinical and laboratory features. The high prevalence of coexisting conditions suggests the need to routinely assess patients for related disorders. Treatment should be based on an individualized evaluation, explanation, and reassurance.

Anorectal Motility and Sensation Abnormalities and Its Correlation with Anorectal Symptoms in Patients with Systemic Sclerosis: A Preliminary Study

Gastrointestinal (GI) hypomotility and symptoms are common in Scleroderma (SSc) patients yet so far uncorrelated. Eight SSc patients and matched controls were queried about their GI dysmotility symptoms and quality of life (QoL) and underwent anorectal motility and sensory tests. Specific scoring systems were developed for anorectal symptoms and anorectal dysmotility. We found that (1) the SSc patients showed low QoL and marked overall GI symptoms. The most common anorectal symptom was incomplete bowel movement (50%). (2) Compared to normal controls, SSc patients showed impaired anorectal pressures, sensations, and rectal compliance (P ≤ .01 for each). (3) The anorectal motility/sensation abnormality score was robustly correlated with the total anorectal symptom score (r s = .78, P = .02). In conclusion, scleroderma patients have impaired anorectal motor and sensory functions, and the abnormality score of these anorectal functions is correlated with the total anorectal symptoms score. These scoring systems may assist clinicians in predicting dysmotility based on patient symptoms.

Delayed gastric emptying and enteric nervous system dysfunction in the rotenone model of Parkinson's disease

Gastrointestinal (GI) dysfunction is the most common non-motor symptom of Parkinson's disease (PD). Symptoms of GI dysmotility in PD include early satiety and weight loss from delayed gastric emptying and constipation from impaired colonic transit. Understanding the pathophysiology and treatment of these symptoms in PD patients has been hampered by the lack of investigation into GI symptoms and pathology in PD animal models. We report that the parkinsonian neurotoxin and mitochondrial complex I inhibitor rotenone causes delayed gastric emptying and enteric neuronal dysfunction when administered chronically to rats in the absence of major motor dysfunction or CNS pathology. When examined 22–28 days after initiation of rotenone infusion by osmotic minipump (3 mg/kg/day), 45% of rotenone-treated rats had a profound delay in gastric emptying. Electrophysiological recording of neurally-mediated muscle contraction in isolated colon from rotenone-treated animals confirmed an enteric inhibitory defect associated with rotenone treatment. Rotenone also induced a transient decrease in stool frequency that was associated with weight loss and decreased food and water intake. Pathologically, no alterations in enteric neuron numbers or morphology were apparent in rotenone-treated animals. These results suggest that enteric inhibitory neurons may be particularly vulnerable to the effects of mitochondrial inhibition by parkinsonian neurotoxins and provide evidence that parkinsonian gastrointestinal abnormalities can be modeled in rodents.

Patient Characteristics Irritable Bowel Syndrome with Constipation (IBS-C)

Background: Abdominal pain/discomfort, bloating and constipation are gastrointestinal (GI) dysmotility and sensory symptoms related to irritable bowel syndrome (IBS). Dysmotility symptoms are associated with impaired quality of life (QoL) and increased health care utilization. LOGIC is an ongoing, prospective, observational study designed to evaluate the treatment patterns and health outcomes of patients with IBS symptoms in Canada Methods: 1,553 patients with IBS-type symptoms were enrolled from 147 community and specialist physician sites across Canada. Clinical data and patient-reported outcomes (PROs) were collected at baseline; PROs are completed at Months 1, 3, 6, 9 and 12. QoL and patient’s health state were assessed using IBS-QOL and EQ-5D questionnaires, and work productivity by using the WPAI:IBS. Resource utilization included number and type of physician visits, procedures and treatments Results: Baseline data were obtained from 1,553 patients, of whom 1,321 (85%) were women. Patients had a mean age of 46 years and mean disorder duration of 11 years (1 month‐69 years). Self-reported bowel patterns were predominantly constipation (39%) and alternating (37%). The mean overall IBS-QOL (mean score on 0‐100 scale) was 66; food avoidance (52) and health worry (59) were the most serious concerns, followed by body image (61), dysphoria (67) and interference with activity (67). The WPAI:IBS indicated a 6% loss of work time, with approximately 34% impairment in overall work productivity and 37% impairment in daily activities. In the preceding month, patients had on average 0.76 consultations with a family doctor and 0.07 specialist visits. More than two-thirds reported a history of undergoing a medical procedure, the most common being abdominal ultrasound (51%), barium X-ray (45%), and colonoscopy (35%). The most common prescription (Rx) medications reported at baseline included tegaserod (26%) and pinaverium bromide (9%). Within the previous 4 weeks, fiber (30%), laxatives (28%) and analgesics (39%) were the most commonly reported non-Rx medications Conclusions: These baseline data are consistent with previous findings showing significant use of medications and healthcare resources with concomitant low QoL in patients with GI dysmotility symptoms. This study will follow patients for 1 year, providing insights into the assessment, treatment and outcomes of IBS symptoms in Canada l The multiple symptoms of IBS negatively affect many aspects of patients’ lives, such as sleep, travel, diet, intimacy and leisure activities 2,5‐8 l The QoL of IBS patients is substantially diminished compared with the general population and also patients who have other episodic, chronic disorders such as gastroesophageal reflux disease, migraine or asthma 9,10

Symptom overlap and comorbidity of irritable bowel syndrome with other conditions

Irritable bowel syndrome (IBS) is one of several highly prevalent, multi-symptom gastrointestinal motility disorders that have a wide clinical spectrum and are associated with symptoms of gastrointestinal dysmotility and visceral hypersensitivity. Symptom overlap and comorbidity between IBS and other gastrointestinal motility disorders (eg, chronic constipation, functional dyspepsia, gastroesophageal reflux disease), with gastrointestinal disorders that are not related to motility (eg, celiac disease, lactose intolerance), and with somatic conditions (eg, fibromyalgia, chronic fatigue syndrome), are frequent. The clinical associations and pathophysiologic links between IBS and these disorders continue to be explored. This review discusses overlapping symptoms and comorbidity of IBS with select gastrointestinal and non-gastrointestinal disorders and attempts to identify commonalities among these conditions.