المؤلفون: Kais, Amr, Al-Haddad, Mohammad

مصطلحات موضوعية: GPOEM, Gastroparesis, Botox, Intrapyloric Botulinum Toxin, Gastric Per Oral Endoscopic Myotomy, Gastric Botox, Endoscopy, Myotomy, Gastroenterology

الوصف: BACKGROUND While G-POEM remains an effective and exciting treatment for GP patients, predictors of clinical success remain poorly characterized. Botox injection of the pylorus prior to committing to G POEM can help differentiate those who might have a favorable clinical response to this procedure in patients with GP. METHODS To evaluate the utility of Botox injection prior to G-POEM, 124 patients with clinically diagnosed GP who underwent a GPOEM were assessed in this retrospective cohort study. All G-POEM procedures were conducted at a single center and were completed between February 2018 and May 2023. Patients who had received intrapyloric Botox injection (n=79) had QoL and clinical success rates compared to patients who received other treatment options (n=45). Results were assessed at 1-, 3-, 6-, 12-, 24-, 36-, 48-months post G-POEM. RESULTS When assessing symptom severity, the difference between the change in GCSI values for Botox patients and patients receiving other prior therapy was statistically significant at 6 months post GPOEM; +1.27 for Botox patients vs +0.55 for other treatments (p-value of 0.03). At this 6-month checkpoint, 64% of the Botox group achieved clinical success compared to 37.5% for the other treatment group. When comparing QoL, intrapyloric Botox injection has statistically significant improvements in SF-36 total score at 1, 3-, 6-, 12-, and 36-months post G-POEM, while patients receiving other treatments had no statistically significant improvements in their SF-36 total scores. CONCLUSION We hypothesize that clinical improvement on pre GPOEM Botox selects patients with a higher component of pyloric spasm who end up responding more favorably to GPOEM. IMPLICATIONS Intrapyloric Botox injection is technically feasible in almost all patients with GP and does not require special expertise, training, or equipment; therefore, this should be strongly considered prior to referring a patient for G-POEM.

وصف الملف: application/pdf; application/vnd.openxmlformats-officedocument.presentationml.presentation

العلاقة: Kais A, Al-Haddad M. Using Botulinum Toxin for the Treatment of Gastroparesis (GP) Post Gastric Peroral Endoscopic Myotomy (GPOEM) Knowledge and Intent to Use among IUPUI Students. Poster presented at: Indiana University Medical Student Program for Research and Scholarship (IMPRS) Research Symposium; July 27-28, 2023; Indianapolis, IN.; https://hdl.handle.net/1805/35806Test

الإتاحة: https://hdl.handle.net/1805/35806Test

المؤلفون: Whitmore, Emily, Sneed, Skye, Strunk, Anneliese

المصدر: ExoticsCon in-Person Conference Proceedings; 2022, p187-188, 2p

مصطلحات موضوعية: GASTROPARESIS, IBUPROFEN, FERRET, GASTRIC bypass, MENTAL depression

مستخلص: Ibuprofen ingestion is known to cause significant toxicity in a wide range of species with reported clinical signs of gastrointestinal upset, abdominal pain, lethargy or depression, pale gums, collapse, and sudden death. A 6-month-old male neutered ferret presented on emergency for potential ibuprofen exposure. The exposure was suspected to have occurred 2 days prior to presentation. On examination, the patient was dehydrated, hypothermic, and painful on abdominal palpation. Bloodwork showed increased total solids and BUN, likely indicating dehydration, and an inverted Ca:P ratio. The patient was started on intravenous fluids, gastric protectants, antibiotics, and analgesics. After no clinical improvement in abdominal comfort, mentation, or hydration after 12 hours, radiographs were taken showing severe gastric distention with fluid and gas. Further discussion with the owner revealed a large part of the plastic bag holding ibuprofen was also missing, and concern was raised for potential foreign body obstructive process. After discussion of anesthetic risks and overall poor to grave prognosis, an exploratory gastrotomy was performed that revealed liquid contents with no obvious gastric outflow obstruction. Excellent intestinal peristalsis was observed intra-operatively; however, very few gastric contractions were observed. Repeated serum chemistry showed resolving BUN and TS with improvement in hydration status and correction of the Ca:P ratio. A culture of a peritoneal swab obtained during the first procedure showed Enterococcus and E. coli organisms susceptible to current antibiotics The patient was fed a mixture of barium and liquid diet postoperatively with subsequent radiographs showing no movement of barium past the stomach for more than 8 hours. Fluoroscopic studies were performed twice daily for the remainder of the 3 days in the hospital, which showed appropriate intestinal peristalsis but absent gastric contractions. An anesthetized attempt to pass an orogastric tube was unsuccessful, suspected due to significant lower esophageal sphincter tone. The patient's mentation and abdominal discomfort did not improve, scant melanotic stools were produced, and hematemesis occurred on examination during the third day. Due to concern for prolonged retention of gastric contents, and ulceration a gastrojejunostomy tube was surgically placed to allow for nutritional support via a CRI of liquid diet on the third day of hospitalization. Continued therapy with sucralfate, famotidine, omeprazole, cisapride, and alternating metoclopramide and lidocaine CRI's were administered through the fourth day. On the morning of the fifth day of hospitalization, the patient's PCV dropped to 13% and the stomach was markedly distended on imaging. Another attempt to pass an orogastric tube under anesthesia was again unsuccessful. Approximately 40 hours after the gastrojejunostomy tube was placed, the patient was found unresponsive and CPR was unsuccessful. A necropsy was performed, showing hemorrhagic liquid gastric contents. Histopathology showed ulcerative gastroenterocolitis, interstitial pneumonia, and splenic lymphoma. Trichrome stain indicated gastric fibrosis. Development of clinical signs consistent with NSAID toxicity was highly suggestive of ibuprofen toxicity; however, exposure was never definitively determined. A gastrojejunostomy tube was useful to provide nutritional support to a patient experiencing gastroparesis. The description of this surgical approach may be useful to provide support to similar critically ill pets. [ABSTRACT FROM AUTHOR]

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المؤلفون: Sangnes, Dag A

المصدر: Diabetesforum. 29(4):20

المساهمون: Bozkurt, A, Deniz, M, Yegen, BC

مصطلحات موضوعية: cephalosporins, gastric emptying, cholecystokinin (CCK), CCK-A receptors, capsaicin, STIMULATE CHOLECYSTOKININ SECRETION, PANCREATIC ENZYME SECRETION, TRYPSIN-INHIBITOR, DIABETIC GASTROPARESIS, FEEDBACK-REGULATION, SENSORY NEURONS, MONITOR PEPTIDE, BINDING-SITES, STC-1 CELLS, ERYTHROMYCIN

الوصف: 1 Studies in vitro suggest that cephalosporin antibiotics release the gut hormone cholecystokinin. Cholecystokinin is known to inhibit gastric emptying. Here we examine the effects of cefaclor on gastric emptying and intestinal motility. 2 Male Sprague-Dawley rats were fitted with gastric cannulas. Following a 3-week recovery, the rate of gastric emptying of saline, peptone (4.5%) or cefaclor was determined after instillation into the gastric cannula, while intestinal transit was measured by using the propagation of arabic gum + charcoal mixture given intraduodenally. 3 Gastric emptying of saline was significantly delayed by the addition of cefaclor (3, 10, 30 or 100 mM). The CCK-A antagonist SR-27897B (1 mg kg(-1), i.p.) reversed the delay induced by 10 mM cefaclor, whereas the CCK-B antagonist CI-988 (1 mg kg(-1), i.p.) had no significant effect. In capsaicin-treated rats, 10 mM cefaclor emptied more rapidly than in vehicle-treated animals. 4 Thirty-minute intestinal transit was increased at 30 and 100 mM of cefaclor, while the gastric acid secretion following cefaclor instillation was no different than the group which received saline. 5 The cephalosporin antibiotic cefaclor appears to be a potent stimulant of CCK release from gut endocrine cells, resembling the effects of peptone. Cefaclor delays gastric emptying via capsaicin-sensitive afferent pathways, which involve CCK-A receptor interaction.

العلاقة: BRITISH JOURNAL OF PHARMACOLOGY; https://hdl.handle.net/11424/263565Test; WOS:000089716100003

الإتاحة: https://doi.org/10.1038/sj.bjp.0703585Test
https://hdl.handle.net/11424/263565Test