Upper Gastrointestinal Symptoms In Patients Research Articles

Evaluation of the impact of overlapping upper gastrointestinal symptoms on the clinical characteristics of patients with functional constipation, along with risk factor analysis.

Functional constipation (FC), a common functional gastrointestinal disorder, is usually overlapping with upper gastrointestinal symptoms (UGS). We aimed to explore the clinical characteristics of patients with FC overlapping UGS along with the related risk factors. The differences in the severity of constipation symptoms, psychological state, quality of life (QoL), anorectal motility and perception function, autonomic function, and the effect of biofeedback therapy (BFT) among patients with FC in different groups were analyzed, along with the risk factors of overlapping UGS. Compared with patients with FC alone, those with FC overlapping UGS had higher scores in the Patient Assessment of Constipation Symptoms and Self-Rating Anxiety Scale and lower scores in the Short Form-36 health survey (P < 0.05). Patients with FC overlapping UGS also had lower rectal propulsion, more negative autonomic nervous function, and worse BFT efficacy (P < 0.05). Overlapping UGS, especially overlapping functional dyspepsia, considerably affected the severity of FC. Logistic regression model showed that age, body mass index (BMI), anxiety, exercise, and sleep quality were independent factors influencing overlapping UGS in patients with FC. Overlapping UGS reduces the physical and mental health and the QoL of patients with FC. It also increases the difficulty in the treatment of FC. Patient's age, BMI, anxiety, physicalexercise, and sleep quality might be predictors for FCoverlapping UGS.

Efficacy and safety of itopride SR for upper gastrointestinal symptoms in patients with diabetic gastroparesis: real-world evidence from Pakistan.

Gastroparesis is a serious condition that can be caused by diabetes, surgery or infection, or can be idiopathic. When there is no mechanical obstruction, gastroparesis is characterized by delayed stomach emptying. Itopride, a prokinetic drug, inhibits acetylcholinesterase activity in addition to antagonizing dopamine D2 receptors. This prospective, multicentre study is based on real-world data from 988 patients with a diagnosis of diabetic gastroparesis for index (PAGI-SYM2) evaluation at baseline and week 4 of treatment for upper gastrointestinal disorder symptoms. Upper gastrointestinal symptom severity scores improved significantly after 4 weeks of treatment (p<0.001), with significant improvement across all categories of gastroparesis (very mild (37-58.6%), mild degree (24.6-31.6%), moderate (29.3-7.3%) and severe (8.8-2.6%). Itopride SR (Nogerd SR) in a 150 mg once-daily dose showed promising results in reducing the severity of upper gastrointestinal disorder symptoms associated with diabetic gastroparesis. Both statistical and clinical effectiveness were observed. Moreover, the treatment demonstrated a favourable tolerability profile, with a low incidence of adverse effects.

The Association of Smoking and Coffee Consumption With Occurrence of Upper Gastrointestinal Symptoms in Patients With Active Helicobacter pylori Infection in Jazan City: A Cross-Sectional Study.

Helicobacter pylori(H. pylori) is a severe infection responsible for upper gastrointestinal symptoms (UGISs). Several causes of H. pylori infection include food ingestion and person-to-person transmission. Many lifestyle variables can affect the occurrence of UGISssuch ascoffee consumptionand smoking. To assess the association between smoking and coffee consumption and the occurrence of UGISs in patients with active H. pylori infection in Jazan city in Saudi Arabia. A descriptive cross-sectional research design was used to conduct the study between July 2022 and August 2022 in Jazan, southern Saudi Arabia. Male and female Saudis or non-Saudis ≥ 18 years of age with an active H. pylori infection were included. Participants under 18 years or without active H. pylori infection were excluded. Data were collected from participants using the convenience sampling technique and a structured questionnaire. The first part of the questionnaire evaluated social and demographic factors such as age, sex, place of residence, nationality, and educational level; the second part evaluated smoking and coffee-drinking habits. Furthermore, frequencies and percentages represented categorical variables. A continuous variable was converted to a categorical variable. The relationship between different variables is tested using the Chi-square test. The total number of respondents who completed the questionnaire was 1225, with only 422 having H. pylori entries in this study. There were 290 (68.7%) men and only 132 (31.3%) women among them; the majority were young adults (18-20 years old). More than half of the participants (53%) never smoked, 23% were active smokers, and 23% were former smokers. Around 27.1% smoke five cigarettes a day and 12.6% smoke five to 15 cigarettes a day. Three-hundred(71.1%) of the participants drank coffee. 23.9% indicated that they did not drink coffee. Of those who take coffee, more than half (51.7%) take fewer than three cups daily and 25.6% take approximately three to five cups of coffee per day. Our findings indicate a link between coffee consumption and UGISs (p = 0.00), while smoking did not have a significant relationship with UGISs (p = 0.06). Our research showed that drinking coffee was related to UGISs, but smoking was not found in people with active H. pylori infection. In smokers, UGISs increased substantially, but not significantly. We need real-world research to identify the association between coffee consumption and UGISs. In addition, we need to educate people at risk for UGISs to reduce coffee, smoking, and other risk factors.

Disturbed gastric motility in patients with long-standing diabetes mellitus

Purpose: Gastric dysmotility has been reported in patients with long-standing diabetes mellitus (DM). Some patients with DM are diagnosed as diabetes gastroparesis and have several upper gastrointestinal (GI) symptoms such as appetite loss and abdominal pain. This study aimed to identify the relationship between gastric motility and upper GI symptoms in patients with long-standing DM. Method: This study was conducted among 23 patients with DM and 15 healthy controls. All the patients with DM were receiving insulin treatment and had at least one history of incidence of diabetic nephropathy, retinopathy or neuropathy. Gastric motility was evaluated using electrogastrography (EGG) and gastric emptying using the 13C-acetic acid breath test. The most severe upper gastrointestinal symptoms were assessed in all patients. Results: Compared to healthy controls, patients with long-standing DM showed a significantly lower percentage of normogastria at the postprandial state with a lower power ratio in EGG. Gastric emptying was significantly delayed in patients with DM in the overall analysis. Sixteen patients with DM (69.6%) demonstrated abnormalities in either gastric myoelectrical activity or gastric emptying. Among patients with abnormal EGG or delayed gastric emptying, 12 had some GI symptoms, compared with 3 patients with normal gastric motility. No significant correlation was observed between the gastric emptying parameters and HbA1c values. Conclusion: Patients with long-standing DM showed gastric dysmotility, including impaired gastric myoelectrical activity and delayed gastric emptying. Gastric dysmotility appears to be closely correlated with upper GI symptoms in patients with long-standing DM.

Beyond Metoclopramide for Gastroparesis

Beyond Metoclopramide for Gastroparesis

180-LB: Effects of Proton Pump Inhibitors on Glycemic Control and Risk of Incident Diabetes: A Systematic Review and Meta-analysis

Background and Aims: Whether proton pump inhibitors (PPI) can improve glycemic control is unclear. Also, incident diabetes from PPI use has not been elucidated. We conducted a meta-analysis and systematic review to determine the impact of PPI on glycemic control in individuals with diabetes and the risk of diabetes in those without diabetes. Methods: PubMed, Embase, Scopus, and ClinicalTrials.gov were searched from inception to November 21, 2020. Studies reporting a change of glycemic indices, including glycosylated hemoglobin (HbA1c) or fasting blood glucose (FBG), in individuals with diabetes taking add-on PPI compared to standard therapy were included. Also, studies evaluating risk of incident diabetes in individuals taking PPI were assessed. We performed dual independent review, data extraction, and quality assessment. Weighted mean differences or relative risks were imputed using random-effects models. Results: Seven studies (n = 342) for glycemic control, and five studies (n = 244,439) for risk of incident diabetes were included. Compared to standard therapy, add-on PPI was associated with a significant decrease in HbA1c (WMD = −0.36 %; 95% CI: −0.68 to −0.05; p = 0.025), and FBG (WMD = −10.0 mg/dL; 95% CI: −19.4 to −0.6; p = 0.037). However, PPI use was not significantly associated with the risk of incident diabetes (pooled RR = 1.10; 95% CI: 0.89 to 1.34; p = 0.385). Conclusions: PPI along with standard care improved glycemic indices in individuals with diabetes but did not alter the risk of incident diabetes. The effects of PPI on glycemic control should be considered when treating upper gastrointestinal symptoms in patients with diabetes. Disclosure C. Peng: None. K. Bukhari: None. H. Huang: None. Y. Tu: None. G. Lee: None. H. Chang: None. Y. Huang: None. Y. Fu: None. K. M. Munir: None.

Management of Dyspepsia and Gastroparesis in Patients with Diabetes. A Clinical Point of View in the Year 2021.

Diabetes mellitus is a widespread disease, and represents an important public health burden worldwide. Together with cardiovascular, renal and neurological complications, many patients with diabetes present with gastrointestinal symptoms, which configure the so-called diabetic enteropathy. In this review, we will focus on upper gastrointestinal symptoms in patients with diabetes, with particular attention to dyspepsia and diabetic gastroparesis (DG). These two clinical entities share similar pathogenetic mechanisms, which include autonomic neuropathy, alterations in enteric nervous system and histological abnormalities, such as interstitial cells of Cajal depletion. Moreover, the differential diagnosis may be challenging because of overlapping clinical features. Delayed gastric emptying should be documented to differentiate between DG and dyspepsia and it can be assessed through radioactive or non-radioactive methods. The clinical management of dyspepsia includes a wide range of different approaches, above all Helicobacter pylori test and treat. As regards DG treatment, a central role is played by dietary modification and glucose control and the first-line pharmacological therapy is represented by the use of prokinetics. A minority of patients with DG refractory to medical treatment may require more invasive therapeutic approaches, including supplemental nutrition, gastric electric stimulation, pyloromyotomy and gastrectomy.

Rheumatologic disorders in patients undergoing esophageal manometry: prevalence, symptom characteristics, and manometric findings.

Rheumatologic disorders (RDs) can have gastrointestinal (GI) manifestations. Systemic sclerosis (SSc) patients often have upper GI symptoms from absent esophageal contractility (AC). Upper GI symptom characteristics and high-resolution esophageal manometry with impedance (HREMI) findings of other RDs have not been well studied. We aimed to: (i) determine the prevalence of RD in patients undergoing HREMI and (ii) assess the symptom characteristics and manometric findings of these patients. Patients undergoing HREMI (July 2018 to March 2020) rated their GI symptoms' severity. Healthy volunteers (HVs) also underwent HREMI. Of the 1,003 patients, 90 (9%) had RD (mean age: 55.3 ± 1.4years, 73.3% females), most commonly SSc (n = 27), rheumatoid arthritis (RA, n = 20), and systemic lupus erythematosus (SLE, n = 11). The most severe upper GI symptoms in patients with RD were heartburn, regurgitation, nausea, and dysphagia, with no significant differences in their severities between SSc, RA, and SLE. RD patients had higher upper esophageal sphincter (UES) pressures, lower distal contractile integral (DCI), lower bolus clearance, and more frequent hiatal hernia (HH) on HREMI (all P < 0.05) than HVs. Over half (61.1%) of patients with RD had esophageal motility disorders, most commonly AC (n = 25), ineffective esophageal motility (IEM; n = 18), and esophagogastric junction (EGJ) obstructive disorders (n = 11). Among patients undergoing HREMI, 9% had RD. Upper GI symptom severities did not distinguish different RDs. Patients with RD had higher UES pressures, weaker DCI, lower bolus clearance, and more frequent HH than HVs. Although AC and IEM were most common motility disorders, a considerable minority (12.2%) of our RD patients had EGJ obstructive disorders.

Autonomic function in gastroparesis and chronic unexplained nausea and vomiting: Relationship with etiology, gastric emptying, and symptom severity.

Autonomic dysfunction can be present in patients with idiopathic and diabetic gastroparesis. The role of autonomic dysfunction relating to gastric emptying and upper gastrointestinal symptoms in patients with gastroparesis and chronic unexplained nausea and vomiting (CUNV) remains unclear. The aim of our study is to evaluate autonomic function in patients with gastroparesis and CUNV with respect to etiology, gastric emptying and symptom severity. We studied 242 patients with chronic gastroparetic symptoms recruited at eight centers. All patients had a gastric emptying scintigraphy within 6months of the study. Symptom severity was assessed using the gastroparesis cardinal symptom index. Autonomic function testing was performed at baseline enrollment using the ANX 3.0 autonomic monitoring system which measures heart rate variability and respiratory activity measurements. Low sympathetic response to challenge (Valsalva or standing) was the most common abnormality seen impacting 89% diabetic and 74% idiopathic patients. Diabetics compared to idiopathics, exhibited greater global hypofunction with sympathetic (OR=4.7, 95% CI 2.2-10.3; P<.001) and parasympathetic (OR=7.2, 95% CI 3.4-15.0; P<.001) dysfunction. Patients with delayed gastric emptying were more likely to have paradoxic parasympathetic excessive during sympathetic challenge [(Valsalva or standing) 40% vs. 26%, P=.05]. Patients with more severe symptoms exhibited greater parasympathetic dysfunction compared to those with mild-moderate symptoms: resting sympathovagal balance [LFa/RFa 1.8 (1.0-3.1) vs. 1.2 (0.6-2.3), P=.006)] and standing parasympathetic activity [0.4 (0.1-0.8) vs. 0.6 (0.2-1.7); P=.03]. Autonomic dysfunction was common in patients with gastroparesis and CUNV. Parasympathetic dysfunction was associated with delayed gastric emptying and more severe upper gastrointestinal symptoms. Conversely, sympathetic hypofunction was associated with milder symptoms. Gastroparesis and CUNV may be a manifestation of GI autonomic dysfunction or imbalance, such that sympathetic dysfunction occurs early on in the manifestation of chronic upper GI symptoms, while parasympathetic dysfunction results in more severe symptoms and delayed gastric emptying.

Effects of Promotility Agents on Gastric Emptying and Symptoms: A Systematic Review and Meta-analysis

Studies have reported a lack of association between improvements in gastric emptying (GE) and upper gastrointestinal (UGI) symptoms with promotility drugs. However, GE test methods were suboptimal in some studies. We assessed improvements in GE and UGI symptoms in patients given promotility agents in studies with optimal or moderate test methods (scintigraphy or breath test, solid meal, >2 hours duration) compared to studies with suboptimal GE test methods. With an expert librarian, we completed an extensive search of publications in the Ovid MEDLINE (1946 to present), EMBASE (1988 to January 2018), and EBM Reviews Cochrane Central Register of Controlled Trials, without restrictions on language or year. Two independent reviewers evaluated the following inclusion criteria: randomized, blinded, parallel, or crossover trials of 5HT4 agonists, D2 receptor antagonist, or ghrelin agonists; trials that measured change in GE (T1/2) or composite UGI symptoms; trials of patients with functional dyspepsia and gastroparesis; and trials of GE test methods. Standardized mean differences (units expressed as SD) were used to standardize symptom assessments that were not uniform across studies. Random effects model was used to analyze data and meta-regression was used to evaluate the association between change in GE and UGI symptoms. Of 899 studies considered, 22 studies assessed change in GE; 23 evaluated UGI symptoms; and 14 evaluated GE and UGI symptoms. Promotility agents significantly accelerated GE (T1/2) in all studies (mean reduction in T1/2, 16.3 minutes; 95% confidence interval, -22.1 to -10.6 minutes) and in studies that used optimal GE test methods (mean reduction in T1/2, 23.6 minutes; 95% confidence interval, -32.3 to -14.9 minutes). Promotility agents also significantly reduced UGI symptoms (mean reduction, 0.25 SD; 95% confidence interval, -0.37 to -0.13 SD). Meta-regression found no significant association between change in GE and UGI symptoms. However, when only studies with optimal GE test methods were evaluated, there was a significant positive association between improvement in GE and UGI symptoms (P= .02). In a meta-analysis of published trials, we found promotility agents to significantly accelerate GE (when optimal test methods were used) and to produce significant improvements in UGI symptoms.

Randomized clinical trial: a double-blind, placebo-controlled study to assess the clinical efficacy and safety of alginate-antacid (Gaviscon Double Action) chewable tablets in patients with gastro-oesophageal reflux disease.

The alginate-antacid Gaviscon Double Action (Gaviscon DA) has a combined acid-neutralizing and reflux-suppressing action. Response to treatment in a symptomatic gastro-oesophageal reflux disease (GERD) population has not yet been tested in a large-scale clinical study. The aim of this study was to assess the efficacy and safety of Gaviscon DA compared with matched placebo tablets in the reduction of upper gastrointestinal symptoms in patients with GERD. In this multicentre, randomized, double-blind, placebo-controlled study, adults with GERD symptoms (N=424) received Gaviscon DA or placebo tablets for 7 days. The primary endpoint was a clinically important reduction of at least 1.5 points in the Reflux Disease Questionnaire (RDQ) GERD dimension (combined heartburn/regurgitation) between baseline and the end of the treatment. Secondary endpoints included the change in RDQ score from baseline for individual RDQ dimensions and Overall Treatment Evaluation. A significantly greater proportion of patients treated with Gaviscon DA met the primary endpoint compared with placebo (47.8 vs. 33.2%, respectively, P=0.0031; odds ratio: 1.85, 95% confidence interval: 1.23-2.78). A significant treatment effect was also observed for heartburn, regurgitation and dyspepsia individually. Patients in the Gaviscon DA group rated their overall treatment response greater than patients in the placebo group [mean Overall Treatment Evaluation (SD): 3.2 (3.08) vs. 2.2 (3.34); P<0.001]. No notable differences in the incidence of adverse events were observed between treatments. The alginate-antacid combination, Gaviscon DA, is an effective and well-tolerated treatment to reduce reflux symptoms and associated dyspepsia in symptomatic GERD patients.

Clinical pattern and prevalence of upper gastrointestinal toxicity in patients abusing ketamine.

Evaluations of upper gastrointestinal toxicity from ketamine abuse are uncommon. This study investigated the clinical pattern of upper gastrointestinal symptoms in patients inhaling ketamine. In a cross-sectional study of 611 consecutive patients who were seeking treatment for ketamine uropathy in a tertiary hospital setting between August 2008 and June 2016, their clinical pattern of upper gastrointestinal symptoms was evaluated and compared with a control population of 804 non-users. A total of 168 (27.5%) patients abusing ketamine (mean age 26.3 years, 58.9% female) reported the presence of upper gastrointestinal symptoms. These symptoms were significantly more prevalent in patients inhaling ketamine than in those who were not (27.5% vs 5.2%, P < 0.001). Their mean duration of ketamine abuse before symptom presentation was 5.0 ± 3.1 years. The presenting symptoms included epigastric pain (n = 155, 25.4%), recurrent vomiting (n = 48, 7.9%), anemia (n = 36, 5.9%) and gastrointestinal bleeding (n = 20, 3.3%). Uropathy symptoms were preceded by upper gastrointestinal symptoms for 4.4 ± 3.0 years in 141 (83.9%) patients. Logistic regression showed that elder age (odds ratio [OR] 1.06, P = 0.04), active abuser status (OR 1.60, P = 0.04) and longer duration of ketamine abuse (OR 1.00, P = 0.04) were independent factors associated with upper gastrointestinal toxicity. Although epigastric symptoms are unusual in the young population, upper gastrointestinal toxicity was highly prevalent in those inhaling ketamine. Enquiries about ketamine abuse are recommended when assessing young patients with epigastric symptoms.

Influence of Helicobacter pylori infection on the prevalence and patterns of upper gastrointestinal symptoms in Nigerians with diabetes mellitus.

Infection with Helicobacter pylori infection is widespread in our environment. However, whether this fact has any bearing on the prevalence and pattern of symptoms referable to the upper gastrointestinal (GI) system in our population of diabetes mellitus (DM) patients has not been much studied. We embarked on this study to evaluate if H. pylori infection played any significant role in the prevalence and patterns of upper GI symptoms in type 2 DM patients in Lagos, Nigeria. A case-control design was employed. One hundred consecutive, consenting, and ambulant type 2 DM patients were recruited from the Lagos University Teaching Hospital and 100 age- and sex-matched nondiabetic controls were drawn from medical outpatient clinics of the same hospital. All subjects were investigated for a marker of active infection with H. pylori via stool antigen testing, had anthropometric measurements taken, and completed a structured questionnaire administered to elicit for the presence of various upper GI symptoms over the preceding 3 months prior to the time of the study. The controls were further tested for DM. For analysis, the symptoms were divided into dyspepsia, gastroesophageal reflux (GER), and others. H. pylori infection status was neither significantly associated with dyspepsia in either cases or controls (χ2 [1] = 2.198, P = 0.138) nor significantly associated with the symptomatic suggestion of GER in either cases or controls (χ2 [1] = 3.742, P = 0.053). Moreover, the same held for the other upper GI symptoms in cases or controls (χ2 [1] = 0.157, P = 0.203). H. pylori infection was detected in 18% of DM patients and 13% of controls, but there was no statistical significance in this difference (χ2 [1] = 0.954, P = 0.329). Infection with H. pylori does not appear, from the results of this study, to influence the prevalence and patterns of upper GI symptoms in patients with DM in Nigeria.

Burden of upper gastrointestinal symptoms in patients prescribed dabigatran for stroke prevention.

Background:Dabigatran, a non-vitamin K antagonist oral anticoagulant, has been shown to prevent stroke in patients with non-valvular atrial fibrillation. Nonetheless, studies show that 10%–30% of those prescribed dabigatran experience dyspepsia that may eventually lead to discontinuation of therapy and loss of clinical benefit.Aim:To evaluate the gastrointestinal tolerability of dabigatran utilizing a validated questionnaire, as well as determining subsequent non-compliance and drug discontinuation.Method:This is an observational study. All patients were assessed by a validated questionnaire, Hong Kong dyspepsia index, prior to drug prescription and again 4 weeks later.Results:In this study, 115 patients with non-valvular atrial fibrillation (mean age: 74.6 ± 11.4 years; mean CHA2DS2-VASc score was 3.39 ± 1.59) were prescribed dabigatran. At baseline, the mean Hong Kong dyspepsia index was 12.9 ± 1.6 and nine patients had significant dyspepsia (Hong Kong dyspepsia index ⩾ 16). After 4 weeks, the mean Hong Kong dyspepsia index was similar at 12.6 ± 1.9 (p = 0.23). There was no change in Hong Kong dyspepsia index after initiation of dabigatran in 59 (51.3%) patients, and improvement in 37 (32.2%). Only 19 (16.5%) patients had worsening of Hong Kong dyspepsia index, and among these 19 patients, only 1 patient (0.9%) discontinued dabigatran due to significant dyspepsia.Conclusion:Worsening of dyspepsia with dabigatran 110 mg twice daily was uncommon with correct drug administration and clear instructions provided. Systematic assessment of dyspeptic symptoms using a validated questionnaire (i.e. Hong Kong dyspepsia index) before and after treatment initiation allows a more objective comparison of dyspeptic symptoms.

Su1436 Central Versus Peripheral Sites of Action of New Ghrelin Agonists on Gastrointestinal Prokinetic Activity

Background: Gastric dysmotility including delayed gastric emptying and decrease the electrical activity of the stomach is common in patients with long-standing diabetes mellitus (DM). These DM patients, some of them are diagnosed as diabetic gastroparesis, have several upper gastrointestinal (GI) symptoms such as nausea, vomiting, bloating and abdominal pain. However, the relationship between gastric dysmotility and GI symptoms has not been investigated well. Aim: The aim of this study was to identify the relationship between gastric motility measures and upper GI symptoms in patients with long-standing DM. Methods: We enrolled 22 long-standing DM patients (13 females, 9 males; aged 33-80 years) with more than 10 years duration of DM, and 15 matched healthy controls (9 females, 6 males; aged 26-74 years). All DM patients were receiving insulin treatment, and had at least one history of diabetic neuropathy, retinopathy or nephropathy. Gastric motility was evaluated with cutaneous recorded electrogastrography (EGG) and gastric emptying of a semi-solid meal, using 13C-octanoic acid breath testing. Upper GI symptoms were quantified in all patients by questionnaire. Results: Compared with the healthy controls, the DM patients showed a significant lower percentage of normogastria (2to 4 cpm slow wave) in both fasting and postprandial state with a lower power ratio (postprandial peak power / fasting peak power) in EGG. Both half-emptying time and lag time in 13C-acetic acid breath testing were higher in DM patients than in healthy controls, indicating that gastric emptying was significantly delayed in the former in overall analysis. Fifteen patients demonstrated abnormalities of either gastric myoelectric activity or gastric emptying (group A), and 7 had normal gastric motor function (group B). Sixteen of 22 (72.7%) patients had some kind of upper GI symptoms. The number of patients who had some GI symptoms was 13 in group A versus 3 in group B. No significant correlation was observed between gastric emptying parameters and HbA1C values. Conclusion: The patients with long-standing DM showed gastric dysmotility, including impaired gastric myoelectrical activity and delayed gastric emptying. Gastric dysmotility appear to be an important factor in the generation of upper GI symptoms in patients with long-standing DM. The relationship between gastric motility and upper gastrointestinal symptoms

Su1435 The Role of Insulin and IGF-I Signaling Passway in Renovation of Interstitial Cells of Cajal Promoted by Gastric Electrical Stimulation in Streptozotocin-Induced Diabetic Rats

Background: Gastric dysmotility including delayed gastric emptying and decrease the electrical activity of the stomach is common in patients with long-standing diabetes mellitus (DM). These DM patients, some of them are diagnosed as diabetic gastroparesis, have several upper gastrointestinal (GI) symptoms such as nausea, vomiting, bloating and abdominal pain. However, the relationship between gastric dysmotility and GI symptoms has not been investigated well. Aim: The aim of this study was to identify the relationship between gastric motility measures and upper GI symptoms in patients with long-standing DM. Methods: We enrolled 22 long-standing DM patients (13 females, 9 males; aged 33-80 years) with more than 10 years duration of DM, and 15 matched healthy controls (9 females, 6 males; aged 26-74 years). All DM patients were receiving insulin treatment, and had at least one history of diabetic neuropathy, retinopathy or nephropathy. Gastric motility was evaluated with cutaneous recorded electrogastrography (EGG) and gastric emptying of a semi-solid meal, using 13C-octanoic acid breath testing. Upper GI symptoms were quantified in all patients by questionnaire. Results: Compared with the healthy controls, the DM patients showed a significant lower percentage of normogastria (2to 4 cpm slow wave) in both fasting and postprandial state with a lower power ratio (postprandial peak power / fasting peak power) in EGG. Both half-emptying time and lag time in 13C-acetic acid breath testing were higher in DM patients than in healthy controls, indicating that gastric emptying was significantly delayed in the former in overall analysis. Fifteen patients demonstrated abnormalities of either gastric myoelectric activity or gastric emptying (group A), and 7 had normal gastric motor function (group B). Sixteen of 22 (72.7%) patients had some kind of upper GI symptoms. The number of patients who had some GI symptoms was 13 in group A versus 3 in group B. No significant correlation was observed between gastric emptying parameters and HbA1C values. Conclusion: The patients with long-standing DM showed gastric dysmotility, including impaired gastric myoelectrical activity and delayed gastric emptying. Gastric dysmotility appear to be an important factor in the generation of upper GI symptoms in patients with long-standing DM. The relationship between gastric motility and upper gastrointestinal symptoms

Su1434 Gastric Dysmotility and Its Relationship to Upper Gastrointestinal Symptoms in Patients With Long-Standing Diabetes Mellitus

Su1434 Gastric Dysmotility and Its Relationship to Upper Gastrointestinal Symptoms in Patients With Long-Standing Diabetes Mellitus

More severe upper gastrointestinal symptoms associated with non-erosive reflux disease than with erosive gastroesophageal reflux disease during maintenance proton pump inhibitor therapy.

During maintenance proton pump inhibitor (PPI) therapy, patients with gastroesophageal reflux disease (GERD) sometimes complain of upper gastrointestinal symptoms. To evaluate upper gastrointestinal symptoms in patients on maintenance PPI therapy for erosive GERD or non-erosive reflux disease (NERD) without endoscopic mucosal breaks by using a new questionnaire. At Gunma University Hospital over a 12-month period during 2011-2012, we enrolled 30 consecutive patients with erosive GERD and 46 patients with NERD. All patients had been on maintenance PPI therapy for more than 1year. We used the modified frequency scale for the symptoms of GERD (mFSSG) questionnaire to assess upper gastrointestinal symptoms. We also asked patients about their satisfaction with maintenance therapy and whether they wished to change their current PPI. The NERD patients had significantly higher symptom scores than the erosive GERD patients. There was no difference in the treatment satisfaction rate between patients with erosive GERD and NERD, but more patients with NERD wanted to change their PPI therapy. There was no difference in the mFSSG score between NERD patients who wished to change their current PPI therapy and those who were satisfied with it. During maintenance PPI therapy, upper gastrointestinal symptoms were more severe in NERD patients than in patients with erosive GERD. NERD patients often wished to change their PPI therapy, but this was not dependent on the severity of their upper GI symptoms.

A Small Particle Size Diet Reduces Upper Gastrointestinal Symptoms in Patients With Diabetic Gastroparesis: A Randomized Controlled Trial

Gastroparesis is a well-known complication to diabetes mellitus (DM). Dietary advice is considered to be of importance to reduce gastrointestinal (GI) symptoms in patients with diabetic gastroparesis, but no randomized controlled trials exist. Our aim was to compare GI symptoms in insulin treated DM subjects with gastroparesis eating a diet with small particle size ("intervention diet") with the recommended diet for DM ("control diet"). 56 subjects with insulin treated DM and gastroparesis were randomized to the intervention diet or the control diet. The patients received dietary advice by a dietitian at 7 occasions during 20 weeks. GI symptom severity, nutrient intake and glycemic control were measured before and after the intervention. A significantly greater reduction of the severity of the key gastroparetic symptoms-nausea/vomiting (P=0.01), postprandial fullness (P=0.02) and bloating (P=0.006)-were seen in patients who received the intervention diet compared with the control diet, and this was also true for regurgitation/heartburn (P=0.02), but not for abdominal pain. Anxiety was reduced after the intervention diet, but not after the control diet, whereas no effect on depression or quality of life was noted in any of the groups. A higher fat intake in the intervention group was noted, but otherwise no differences in body weight, HbA1c or nutrient intake were seen. A small particle diet improves the key symptoms of gastroparesis in patients with diabetes mellitus. (ClinicalTrials.gov NCT01557296).

The Ghrelin Agonist RM-131 Accelerates Gastric Emptying of Solids and Reduces Symptoms in Patients With Type 1 Diabetes Mellitus

RM-131, a synthetic ghrelin agonist, greatly accelerates gastric emptying of solids in patients with type 2 diabetes and delayed gastric emptying (DGE). We investigated the safety and effects of a single dose of RM-131 on gastric emptying and upper gastrointestinal (GI) symptoms in patients with type 1 diabetes and previously documented DGE. In a double-blind cross-over study, 10 patients with type 1 diabetes (age, 45.7 ± 4.4 y; body mass index, 24.1 ± 1.1 kg/m(2)) and previously documented DGE were assigned in random order to receive a single dose of RM-131 (100 μg, subcutaneously) or placebo. Thirty minutes later, they ate a radiolabeled solid-liquid meal containing EggBeaters (ConAgra Foods, Omaha, NE), and then underwent 4 hours of gastric emptying and 6 hours of colonic filling analyses by scintigraphy. Upper GI symptoms were assessed using a daily diary, gastroparesis cardinal symptom index (total GCSI-DD) and a combination of nausea, vomiting, fullness, and pain (NVFP) scores (each rated on a 0-5 scale). At screening, participants' mean level of hemoglobin A1c was 9.1% ± 0.5%; their total GCSI-DD score was 1.66 ± 0.38 (median, 1.71), and their total NVFP score was 1.73 ± 0.39 (median, 1.9). The t1/2 of solid gastric emptying was 84.9 ± 31.6 minutes when subjects were given RM-131 and 118.7 ± 26.7 when they were given a placebo. The median difference (Δ)was 33.9 minutes (interquartile range [IQR] -12, -49), or -54.7% (IQR, -21%,-110%). RM-131 decreased gastric retention of solids at 1 hour (P = .005) and 2 hours (P = .019). Numeric differences in t1/2 for gastric emptying of liquids, solid gastric emptying lag time, and colonic filling at 6 hours were not significant. Total GCSI-DD scores were 0.79 on placebo (IQR, 0.75, 2.08) and 0.17 on RM-131 (IQR, 0.00, 0.67; P = .026); NVFP scores were lower on RM-131 (P = .041). There were no significant adverse effects. RM-131 significantly accelerates gastric emptying of solids and reduces upper GI symptoms in patients with type 1 diabetes and documented DGE.