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  • Wiley  (8)
  • Farrugia, Gianrico  (8)
  • Kuo, Braden  (8)
  • 1
    Online Resource
    Online Resource
    Characteristics and outcomes of patients with gastroparesis using enteral and/or exclusive parenteral nutrition
    Wiley ; 2023
    In:  Journal of Parenteral and Enteral Nutrition Vol. 47, No. 4 ( 2023-05), p. 541-549
    Details
    In: Journal of Parenteral and Enteral Nutrition, Wiley, Vol. 47, No. 4 ( 2023-05), p. 541-549
    Abstract: Patients with gastroparesis (Gp) may need enteral nutrition (EN) or exclusive parenteral nutrition (PN). Among patients with Gp, we aimed to (1) identify the frequency of EN and exclusive PN use and (2) explore characteristics of patients using EN and/or exclusive PN compared with those using oral nutrition (ON), including changes over 48 weeks. Methods Patients with Gp underwent history and physical examination, gastric emptying scintigraphy, water load satiety testing (WLST), and questionnaires assessing gastrointestinal symptoms and quality of life (QOL). Patients were observed 48 weeks. Results Of 971 patients with Gp (idiopathic, 579; diabetic, 336; post–Nissen fundoplication, 51), 939 (96.7%) were using ON only, 14 (1.4%) using exclusive PN, and 18 (1.9%) using EN. Compared with patients receiving ON, patients receiving exclusive PN and/or EN were younger, had lower body mass index, and had greater symptom severity. Patients receiving exclusive PN and/or EN had lower physical QOL but not mental QOL or Gp‐related QOL scores. Patients receiving exclusive PN and/or EN ingested less water during WLST but did not have worse gastric emptying. Of those who had been receiving exclusive PN and/or EN, 50% and 25%, respectively, resumed ON at 48‐week follow‐up. Conclusions This study describes patients with Gp requiring exclusive PN and/or EN for nutrition support, who represent a small (3.3%) but important subset of patients with Gp. Unique clinical and physiological parameters are associated with this subset and provide insight into the use of nutrition support in Gp.
    Type of Medium: Online Resource
    ISSN: 0148-6071 , 1941-2444
    URL: Issue
    URL: Article
    DOI: 10.1002/jpen.v47.4
    DOI: 10.1002/jpen.2493
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2170060-6
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  • 2
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    Autonomic function in gastroparesis and chronic unexplained nausea and vomiting: Relationship with etiology, gastric emptying, and symptom severity
    Wiley ; 2020
    In:  Neurogastroenterology & Motility Vol. 32, No. 8 ( 2020-08)
    Details
    In: Neurogastroenterology & Motility, Wiley, Vol. 32, No. 8 ( 2020-08)
    Abstract: 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. Methods We studied 242 patients with chronic gastroparetic symptoms recruited at eight centers. All patients had a gastric emptying scintigraphy within 6 months 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. Key Results 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] . Conclusions 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. Inferences 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.
    Type of Medium: Online Resource
    ISSN: 1350-1925 , 1365-2982
    URL: Issue
    URL: Article
    DOI: 10.1111/nmo.v32.8
    DOI: 10.1111/nmo.13810
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2008278-2
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  • 3
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    Online Resource
    Body weight in patients with idiopathic gastroparesis
    Wiley ; 2021
    In:  Neurogastroenterology & Motility Vol. 33, No. 2 ( 2021-02)
    Details
    In: Neurogastroenterology & Motility, Wiley, Vol. 33, No. 2 ( 2021-02)
    Abstract: The classic clinical picture of gastroparesis is a symptomatic patient losing weight. In addition, a number of patients with delayed gastric emptying are obese and/or gaining weight. Our aim was to investigate the factors impacting body weight in patients with idiopathic gastroparesis. Methods In patients with idiopathic gastroparesis, detailed history and weight were acquired at enrollment and after 48 weeks. Questionnaires assessed symptoms, food intake, physical activity, and quality of life. Patients underwent laboratory testing, gastric emptying scintigraphy, and water load testing. Results Of 138 patients with idiopathic gastroparesis, 10% were underweight (BMI  〈  18.5), 39% were normal weight (BMI 18.5‐25), 20% were overweight with BMI 25 to 30 kg/m 2 , and 29% were obese with BMI  〉  30 kg/m 2 . Body weight at enrollment was positively associated with oral caloric consumption ( P   〈  .001), following a gastroparesis diet ( P  = .04), nutrition consultation ( P  = .001), upper abdominal pain ( P  = .01); and negatively associated with energy expenditure ( P  = .05), alcohol use ( P  = .003) and severity of bloating ( P   〈  .001). When followed over 48 weeks, 53% patients stayed stable (within 5% of baseline weight), 30% gained, and 17% lost weight. Weight gain over 48 weeks was positively associated with oral caloric consumption ( P  = .003) and constipation severity ( P  = .005) at enrollment, and negatively associated with lower abdominal pain severity ( P  = .007) at enrollment, and associated with improvement in inability to finish meal score ( P   〈  .001) at 48 weeks. Conclusions In this series of patients with idiopathic gastroparesis, 10% were underweight whereas 29% were obese. Over 48 weeks, 30% of patients increased their body weight ≥ 5%. Diet, activity, and symptoms are important factors associated with body weight in patients with idiopathic gastroparesis.
    Type of Medium: Online Resource
    ISSN: 1350-1925 , 1365-2982
    URL: Issue
    URL: Article
    DOI: 10.1111/nmo.v33.2
    DOI: 10.1111/nmo.13974
    Language: English
    Publisher: Wiley
    Publication Date: 2021
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  • 4
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    Online Resource
    Buspirone for early satiety and symptoms of gastroparesis: A multi‐centre, randomised, placebo‐controlled, double‐masked trial ( BESST )
    Wiley ; 2023
    In:  Alimentary Pharmacology & Therapeutics Vol. 57, No. 11 ( 2023-06), p. 1272-1289
    Details
    In: Alimentary Pharmacology & Therapeutics, Wiley, Vol. 57, No. 11 ( 2023-06), p. 1272-1289
    Abstract: Patients with gastroparesis and related disorders have symptoms including early satiety, postprandial fullness and bloating. Buspirone, a 5‐HT 1 receptor agonist, may improve fundic accommodation. Aim To determine if buspirone treatment improves early satiety and postprandial fullness in patients with symptoms of gastroparesis. Methods This 4‐week multi‐centre clinical trial randomised patients with symptoms of gastroparesis and moderate‐to‐severe symptoms of fullness (Gastroparesis Cardinal Symptom Index [GCSI] early satiety/postprandial fullness subscore [ES/PPF] ) to buspirone (10 mg orally) or placebo three times per day. The primary outcome was a change in the ES/PPF from baseline to 4 weeks. The primary analysis was per protocol intention‐to‐treat ANCOVA of between‐group baseline vs. 4‐week differences (DoD) in ES/PPF adjusted for baseline ES/PPF. Results are reported using both nominal and Bonferroni (BF) p values. Results and conclusions Ninety‐six patients (47 buspirone, 49 placeboes; 92% female, 50% delayed gastric emptying, 39% diabetic) were enrolled. There was no between‐groups difference in the 4‐week ES/PPF primary outcome: −1.16 ± 1.25 (SD) on buspirone vs −1.03 ± 1.29 (SD) on placebo (mean DoD: −0.11 [95% CI: −0.68, 0.45]; p  = 0.69). Buspirone performed better than placebo in patients with severe‐to‐very severe bloating at baseline compared to patients with none to moderate: (ES/PPF DoD = −0.65 vs. 1.58, p TX*GROUP  = 0.003; p BF  = 0.07). Among individual GCSI symptoms, only bloating appeared to improve with buspirone vs. placebo. Conclusions Patients with moderate‐to‐severe early satiety/postprandial fullness and other symptoms of gastroparesis did not benefit from buspirone treatment to improve the ES/PPF primary outcome compared with placebo. There was a suggestion of the benefit of buspirone in patients with more severe bloating. Trial Registration: ClinicalTrials.gov NCT0358714285.
    Type of Medium: Online Resource
    ISSN: 0269-2813 , 1365-2036
    URL: Issue
    URL: Article
    DOI: 10.1111/apt.v57.11
    DOI: 10.1111/apt.17479
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2003094-0
    SSG: 15,3
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  • 5
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    Online Resource
    A pilot genome‐wide association study meta‐analysis of gastroparesis
    Wiley ; 2023
    In:  United European Gastroenterology Journal
    Details
    In: United European Gastroenterology Journal, Wiley
    Abstract: Gastroparesis (GP) is characterized by delayed gastric emptying in the absence of mechanical obstruction. Objective Genetic predisposition may play a role; however, investigation at the genome‐wide level has not been performed. Methods We carried out a genome‐wide association study (GWAS) meta‐analysis on (i) 478 GP patients from the National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Clinical Research Consortium (GpCRC) compared to 9931 population‐based controls from the University of Michigan Health and Retirement Study; and (ii) 402 GP cases compared to 48,340 non‐gastroparesis controls from the Michigan Genomics Initiative. Associations for 5,811,784 high‐quality SNPs were tested on a total of 880 GP patients and 58,271 controls, using logistic mixed models adjusted for age, sex, and principal components. Gene mapping was obtained based on genomic position and expression quantitative trait loci, and a gene‐set network enrichment analysis was performed. Genetic associations with clinical data were tested in GpCRC patients. Protein expression of selected candidate genes was determined in full thickness gastric biopsies from GpCRC patients and controls. Results While no SNP associations were detected at strict significance ( p  ≤ 5 × 10 −8 ), nine independent genomic loci were associated at suggestive significance ( p  ≤ 1 × 10 −5 ), with the strongest signal (rs9273363, odds ratio = 1.4, p  = 1 × 10 −7 ) mapped to the human leukocyte antigen region. Computational annotation of suggestive risk loci identified 14 protein‐coding candidate genes. Gene‐set network enrichment analysis revealed pathways potentially involved in immune and motor dysregulation ( p FDR ≤ 0.05). The GP risk allele rs6984536A (Peroxidasin‐Like; PXDNL ) was associated with increased abdominal pain severity scores (Beta = 0.13, p  = 0.03). Gastric muscularis expression of PXDNL also positively correlated with abdominal pain in GP patients ( r  = 0.8, p  = 0.02). Dickkopf WNT Signaling Pathway Inhibitor 1 showed decreased expression in diabetic GP patients ( p  = 0.005 vs. controls). Conclusion We report preliminary GWAS findings for GP, which highlight candidate genes and pathways related to immune and sensory‐motor dysregulation. Larger studies are needed to validate and expand these findings in independent datasets.
    Type of Medium: Online Resource
    ISSN: 2050-6406 , 2050-6414
    URL: Article
    DOI: 10.1002/ueg2.12453
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2728585-6
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  • 6
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    Factors that contribute to the impairment of quality of life in gastroparesis
    Wiley ; 2021
    In:  Neurogastroenterology & Motility Vol. 33, No. 8 ( 2021-08)
    Details
    In: Neurogastroenterology & Motility, Wiley, Vol. 33, No. 8 ( 2021-08)
    Abstract: Multiple measures show poor quality of life present in gastroparesis. Several areas impacted on reduced quality of life: (1) Symptoms of nausea, vomiting, and abdominal pain, as well as IBS; (2) Etiology and acute onset and progressively worsening symptoms; (3) Comorbidities and psychological factors such as anxiety and depression; (4) Patient related factors such as smoking. Targeting the modifiable factors may improve patient outcomes in gastroparesis.
    Type of Medium: Online Resource
    ISSN: 1350-1925 , 1365-2982
    URL: Issue
    URL: Article
    DOI: 10.1111/nmo.v33.8
    DOI: 10.1111/nmo.14087
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2008278-2
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  • 7
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    Prevalence and clinical correlates of antinuclear antibody in patients with gastroparesis
    Wiley ; 2022
    In:  Neurogastroenterology & Motility Vol. 34, No. 5 ( 2022-05)
    Details
    In: Neurogastroenterology & Motility, Wiley, Vol. 34, No. 5 ( 2022-05)
    Abstract: Autoimmunity may play a role in the pathogenesis of gastroparesis in a subset of patients. Antinuclear antibody (ANA) testing is often used to screen for autoimmune disorders. Aims 1) Determine prevalence of a positive ANA in patients with gastroparesis; 2) Describe characteristics of idiopathic gastroparesis patients with positive ANA. Methods Patients were assessed with gastric emptying scintigraphy (GES), symptom assessment via Patient Assessment of Upper GI Symptoms [PAGI‐SYM], and blood tests—ANA, erythrocyte sedimentation rate (ESR), C‐reactive protein (CRP). Results Positive ANA was seen in 148 of 893 (17%) patients with gastroparesis, being similar in idiopathic (16% of 536 patients), T1DM (16% of 162), T2DM (18% of 147), and postfundoplication (19% of 48 patients) gastroparesis. Among 536 patients with idiopathic gastroparesis, ANA titer 1:40–1:80 was seen in 33 (6%) patients, 1:160–1:320 in 36 (7%) patients, and ≥1:640 in 17 (3%) patients. Increasing ANA titer was associated with female gender ( p  = 0.05), Hispanic ethnicity ( p  = 0.02), comorbid rheumatoid arthritis ( p  = 0.02), systemic sclerosis ( p  = 0.004), and elevated ESR ( p  = 0.007). ANA positivity was associated with lower total GCSI ( p  = 0.007) and lower nausea/vomiting subscale ( p  = 0.0005), but not related to gastric emptying. Conclusions The prevalence of a positive ANA in patients with gastroparesis was high at ~17% and did not differ significantly based on etiology. In idiopathic patients, ANA positivity was associated with rheumatoid arthritis, systemic sclerosis, and elevated ESR. ANA‐positive gastroparesis represents a subset who often have other autoimmune symptoms or disorders, but less severe nausea and vomiting.
    Type of Medium: Online Resource
    ISSN: 1350-1925 , 1365-2982
    URL: Issue
    URL: Article
    DOI: 10.1111/nmo.v34.5
    DOI: 10.1111/nmo.14270
    Language: English
    Publisher: Wiley
    Publication Date: 2022
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  • 8
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    Effectiveness of gastric electrical stimulation in gastroparesis: Results from a large prospectively collected database of national gastroparesis registries
    Wiley ; 2019
    In:  Neurogastroenterology & Motility Vol. 31, No. 12 ( 2019-12)
    Details
    In: Neurogastroenterology & Motility, Wiley, Vol. 31, No. 12 ( 2019-12)
    Abstract: Gastric electrical stimulation (GES) for treating gastroparesis symptoms is controversial. Methods We studied 319 idiopathic or diabetic gastroparesis symptom patients from the Gastroparesis Clinical Research Consortium (GpCRC) observational studies: 238 without GES and 81 with GES. We assessed the effects of GES using change in GCSI total score and nausea/vomiting subscales between baseline and 48 weeks. We used propensity score methods to control for imbalances in patient characteristics between comparison groups. Key Results GES patients were clinically worse (40% severe vs. 18% for non‐GES; P   〈  .001); worse PAGI‐QOL (2.2. vs. 2.6; P  = .003); and worse GCSI total scores (3.5 vs. 2.8; P   〈  .001). We observed improvements in 48‐week GCSI total scores for GES vs. non‐GES: improvement by ≥ 1‐point (RR = 1.63; 95% CI = (1.14, 2.33); P  = .01) and change from enrollment (difference = −0.5 (−0.8, −0.3); P   〈  .001). When adjusting for patient characteristics, symptom scores were smaller and not statistically significant: improvement by ≥ 1‐point (RR = 1.29 (0.88, 1.90); P  = .20) and change from the enrollment (difference = −0.3 (−0.6, 0.0); P  = .07). Of the individual items, the nausea improved by ≥ 1 point (RR = 1.31 (1.03, 1.67); P  = .04). Patients with GCSI score ≥ 3.0 tended to improve more than those with score 〈 3.0. (Adjusted P = 0.02). Conclusions and Inferences This multicenter study of gastroparesis patients found significant improvements in gastroparesis symptoms among GES patients. Accounting for imbalances in patient characteristics, only nausea remained significant. Patients with greater symptoms at baseline improved more after GES. A much larger sample of patients is needed to fully evaluate symptomatic responses and to identify patients likely to respond to GES.
    Type of Medium: Online Resource
    ISSN: 1350-1925 , 1365-2982
    URL: Issue
    URL: Article
    DOI: 10.1111/nmo.v31.12
    DOI: 10.1111/nmo.13714
    Language: English
    Publisher: Wiley
    Publication Date: 2019
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