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delayed gastric emptying

Aung S Myint, Brandon Rieders, Mohammed Tashkandi, Marie L Borum, Joyce M Koh, Sindu Stephen, David B Doman
Gastroparesis is a complex, debilitating dysmotility disorder with challenging symptom management. A diagnosis of gastroparesis is based on objectively delayed gastric emptying in the absence of mechanical obstruction. Given the limited efficacy of treatment options and serious side effects, significant research continues for therapeutic options for gastroparesis. Promising investigational pharmacologic therapies include relamorelin, prucalopride, and aprepitant. A novel endoscopic therapy is gastric peroral endoscopic pyloromyotomy, which is associated with improved gastric emptying...
November 2018: Gastroenterology & Hepatology
Amy Li, Rupen Shah, Xiaoxia Han, Akshay Sood, Christopher Steffes, David Kwon
BACKGROUND: It is unclear whether placement of operative enteral access (OEA) during pancreaticoduodenectomy (PD) correlates with decreased morbidity. METHODS: A retrospective chart review of patients undergoing PD with and without OEA placement between January 2016 and May 2018 was undertaken. Outcomes included length of stay (LOS), 30- and 90-day readmission, initiation of total parenteral nutrition (TPN), postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), and surgical site infection (SSI)...
November 28, 2018: American Journal of Surgery
Steven B Clayton, Claire M Shin, Alex Ewing, Wojciech Blonski, Joel Richter
BACKGROUND AND AIMS: Idiopathic Esophago-gastric outflow obstruction (EGJOO) is a new clinical entity resulting in delayed esophageal emptying secondary to a poorly relaxing lower esophageal sphincter. Little is known about treatment outcomes of idiopathic EGJOO patients. The aim of this study was to investigate the clinical response of pneumatic dilation (PD) in idiopathic EGJOO patients with a standing barium column and/or with pill arrest on timed barium esophagram (TBE) before and after undergoing PD...
December 10, 2018: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
Lana N Zhang, Jeffrey P Moak, John Desbiens, Sridhar Hanumanthaiah, Robin R Fabian, Lindsay Clarke, Rashmi D Sahay, Anil Darbari
OBJECTIVE: To assess the utility of gastrointestinal (GI) diagnostic studies in the evaluation of patients with orthostatic intolerance. STUDY DESIGN: Medical records of 103 consecutive children/young adults with orthostatic intolerance and gastrointestinal symptoms were reviewed. All patients had undergone antroduodenal manometry in conjunction with the tilt table test, autonomic testing, and upper gastrointestinal endoscopy (EGD). A gastric emptying study (GES) was performed in 81 patients...
October 18, 2018: Journal of Pediatrics
Zoë-Marie Ellis, Hui Shan Grace Tan, Nicolas D Embleton, Per Torp Sangild, Ruurd M van Elburg
BACKGROUND: High feed osmolality (or osmolarity) is often suggested to be linked with adverse gastrointestinal events in preterm infants. AIM: To systematically review the literature on milk feed osmolality and adverse gastrointestinal events in newborn and low birthweight infants and animals. METHODS: MEDLINE, Embase, CAB Abstracts, Current Contents, BIOSIS Previews and SciSearch were searched from inception to May 2018 to identify potentially relevant studies...
December 6, 2018: Archives of Disease in Childhood. Fetal and Neonatal Edition
Jian-Wen Lu, Hong-Fan Ding, Xiao-Ning Wu, Xue-Min Liu, Bo Wang, Zheng Wu, Yi Lv, Xu-Feng Zhang
BACKGROUND: Post-pancreaticoduodenectomy hemorrhage (PPH) is a potentially lethal complication. The objective of this study was to explore the risk factors of PPH, and to evaluate the treatment options. METHODS: Clinical data of 739 consecutive patients undergoing pancreaticoduodenectomy between 2009 and 2017 were collected from a prospectively maintained database. Univariate and multivariate analysis were performed by logistic regression model to evaluate potential risk factors associated with early and late PPH...
December 4, 2018: Journal of Gastroenterology and Hepatology
E Hadzijusufovic, E Tagkalos, H Neumann, B Babic, S Heinrich, H Lang, P P Grimminger
Delayed gastric emptying (DGE) after Ivor-Lewis esophagectomy occurs postoperatively in up to 50% of the patients. This pyloric dysfunction can lead to severe secondary complications postoperatively such as early aspiration, pneumonia or may even have an impact on anastomotic healing and therefore leakage. Early detection of DGE is essential to prevent further complications. The common treatment postoperatively is endoscopic pyloric balloon dilatation (EPBD) after symptoms already occurred. In our work, we analyzed patients who received a preoperative EPBD during the routine restaging endoscopy and compared those patients to a control group to analyze if preoperative EPBD may prevent postoperative DGE and secondary additional complications...
December 1, 2018: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
J Busquets, S Martín, J Fabregat, L Secanella, N Pelaez, E Ramos
BACKGROUND: Delayed gastric emptying (DGE) is the most important cause of an extended hospital stay after pancreatoduodenectomy. Reports suggest that a Roux-en-Y gastroenteric anastomosis may have lower incidence of DGE than a Billroth II reconstruction. The primary aim of this RCT was to compare Billroth II (single loop) and Roux-en-Y (double loop) after pancreatoduodenectomy to determine whether Roux-en-Y reconstruction is associated with a lower incidence of DGE. Secondary endpoints were postoperative complications...
December 3, 2018: British Journal of Surgery
Masaru Ochiai, Tsutomu Nozaki, Masaki Kato, Ken-O Ishihara
As the seed extract from Camellia japonica (CJ) contains saponins, inhibitory effects of pancreatic lipase activity and body fat accumulation are expected. To investigate the anti-obesity effect of CJ seed extract, ICR mice were fed with a high-fat diet that was either supplemented or not with 1% CJ seed extract for 53 days. Including CJ seed extract in the high-fat diets of mice increased fecal fat excretion and decreased the body weight gain and lipid parameters in plasma and in the liver. In addition, lipid-induced hypertriglyceridemia was delayed by a single administration of CJ in ddY mice...
2018: Journal of Oleo Science
Maka S Hedrington, Stephen N Davis
Glucagon-like peptide-1 (GLP-1) receptor agonists are highly potent antihyperglycemic drugs that impose low risk of hypoglycemia and also result in body weight reduction. Currently, all approved members of the class require administration by injection. Areas covered: This manuscript reviews oral semaglutide-an experimental GLP-1 receptor agonist in phase-3 clinical development. Available pharmacological and clinical data of the drug are reviewed, and important end-points described. Expert opinion: Oral peptide delivery has become possible with the discovery of absorption enhancers...
November 30, 2018: Expert Opinion on Pharmacotherapy
Johan Gagnière, Bertrand Le Roy, Julie Veziant, Bruno Pereira, Raja R Narayan, Denis Pezet, Emmanuel Buc, Aurélien Dupré
BACKGROUND: Sympathetic denervation of the antropyloric area combined with relative devascularization from division of the right gastric vessels (RGV) during pancreaticoduodenectomy (PD) could predispose to delayed gastric emptying (DGE). Therefore, some authors advocated for RGV preservation (RGVP), where feasibility and utility for the prevention of post-operative DGE have never been investigated. METHODS: From 2011 to 2014, patients who underwent classic Whipple PD (CWPD, n = 34), standard pylorus-preserving PD (PPPD, n = 44) or PPPD with RGVP (n = 22) were retrospectively analysed...
November 29, 2018: ANZ Journal of Surgery
Tao Zhang, Zhi-Ming Zhao, Yuan-Xing Gao, Wan Yee Lau, Rong Liu
BACKGROUND: Pancreaticoduodenectomy (PD) is one of the most technically difficult abdominal operations. Recent advances have allowed surgeons to attempt PD using minimally invasive surgery techniques. This retrospective study aimed to analyze the learning curve of a single surgeon who had carried out his first 100 robot-assisted laparoscopic pancreaticoduodenectomy (RPD) in a high-volume pancreatic center. METHODS: The data on consecutive patients who underwent RPD for malignant or benign pathologies were prospectively collected and retrospectively analyzed...
November 27, 2018: Surgical Endoscopy
Timothy R Koch, Timothy R Shope, Michael Camilleri
The worldwide rise in the prevalence of obesity supports the need for an increased interaction between ongoing clinical research in the allied fields of gastrointestinal medicine/surgery and diabetes mellitus. There have been a number of clinically-relevant advances in diabetes, obesity, and metabolic syndrome emanating from gastroenterological research. Gastric emptying is a significant factor in the development of upper gastrointestinal symptoms. However, it is not the only mechanism whereby such symptoms occur in patients with diabetes...
November 15, 2018: World Journal of Diabetes
Yanming Zhou, Bin Hu, Kongyuan Wei, Xiaoying Si
BACKGROUND: Delayed gastric emptying (DGE) is one of the most frequent complications following pancreaticoduodenectomy. This meta-analysis aimed to evaluate the impact of Braun enteroenterostomy on DGE following pancreaticoduodenectomy. METHODS: A systematic review of the literature was performed to identify relevant studies. Statistical analysis was carried out using Review Manager software 5.3. RESULTS: Eleven studies involving 1672 patients (1005 in Braun group and 667 in non-Braun group) were included in the meta-analysis...
November 26, 2018: BMC Gastroenterology
Pankaj Kumar Garg, Jyoti Sharma, Ashish Jakhetiya, Nilokali Chishi
Introduction  A postoperative pancreatic fistula (POPF) is a major cause of morbidity and mortality following pancreaticoduodenectomy (PD). A pharmacologic approach using perioperative octreotide, a long-acting somatostatin analog having an inhibitory action on pancreatic exocrine secretion, was proposed to reduce the incidence of the POPF. Despite contradictory results in various randomized controlled trials (RCTs), the prophylactic octreotide has been widely used in the last two decades to reduce the POPF...
October 2018: Surgery Journal
Merel M Tielemans, Gerben A J van Boekel, Teun van Gelder, Eric T Tjwa, Luuk B Hilbrands
Gastrointestinal (GI) discomfort is common after renal transplantation and can be caused by the use of various immunosuppressive drugs. GI symptoms affect the quality of life, lead to an impaired graft survival and an increased mortality. Moreover, diseases and disturbances of the GI tract also affect the pharmacokinetics of immunosuppressive drugs. This review addresses the interaction between immunosuppressive agents and GI disorders. The GI tract is involved in the metabolism of several immunosuppressive drugs...
November 14, 2018: Transplantation Reviews
Frances U Onyimba, John O Clarke
Gastroparesis is an increasing concern and options remain limited. Diagnosis hinges on recognition of delayed gastric emptying in the absence of mechanical obstruction. Nontransit studies evaluating gastric motility serve a complementary role and may help guide therapy. Treatment consists of a combination of lifestyle and dietary medication, medications (antiemetics, prokinetics, neuromodulators, and accommodation-enhancers), alternative and complementary therapy, endoscopic therapy (pyloric-directed therapy, temporary stimulation, jejunostomy, or venting gastrostomy) and surgical therapy (pyloroplasty, gastric electrical stimulation, gastrectomy)...
January 2019: Medical Clinics of North America
Guo-Qiang Zhang, Xiao-Hua Li, Xiao-Jian Ye, Hai-Bin Chen, Nan-Tao Fu, An-Tao Wu, Yong Li
BACKGROUND: The aim of this study was to determine whether internal or external drainage with a pancreatic duct stent is the optimal pancreaticojejunostomy method to prevent pancreatic fistula (PF) after pancreaticoduodenectomy (PD) for subgroups of patients at high risk for PF. MATERIALS AND METHODS: A total of 495 patients who underwent PD were reviewed. Univariate and multivariate analyses were used to identify risk factors for PF after PD. We further compared the incidence of PF and outcomes between the internal and external drainage groups for subgroups of patients at high risk for PF...
December 2018: Journal of Surgical Research
Susanna Every-Palmer, Stephen J Inns, Eve Grant, Pete M Ellis
BACKGROUND: Gastrointestinal hypomotility in people taking clozapine is common, poorly understood and potentially dangerous. It causes distress and sometimes sudden death, with greater associated morbidity than the better known adverse effect of clozapine, agranulocytosis. Neither the mechanism nor prevalence of clozapine-induced gastrointestinal hypomotility is well understood. Previous studies show clozapine impedes colon transit, likely owing to anticholinergic and anti-serotonergic properties...
November 19, 2018: CNS Drugs
Wen-Hao Tang, Xin Shi, Xin Fan, Wei-Dong Chen, Cheng-Zhong You, Helmut Friess
No abstract text is available yet for this article.
June 1, 2018: American Surgeon
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