Functional Dyspepsia and Gastroparesis: One Disease or Two?

Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
The American Journal of Gastroenterology (Impact Factor: 9.21). 11/2012; 107(11):1615-20. DOI: 10.1038/ajg.2012.104
Source: PubMed
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    ABSTRACT: Gastroparesis is characterized by delayed gastric emptying and symptoms thereof in the absence of gastric outlet obstruction. Most studies on the epidemiology of gastroparesis have been conducted in selected case series rather than in the population at large. In the only community-based study of gastroparesis in diabetes mellitus (DM), the average cumulative incidence of symptoms and delayed gastric emptying over 10 years was higher in type 1 DM (5%) than in type 2 DM (1%) and controls (1%). In the United States, the incidence of hospitalizations related to gastroparesis increased substantially between 1995 and 2004, and particularly after 2000. Copyright © 2015 Elsevier Inc. All rights reserved.
    Gastroenterology Clinics of North America 03/2015; 44(1):9-19. DOI:10.1016/j.gtc.2014.11.002 · 1.92 Impact Factor
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    ABSTRACT: No medication is approved for the treatment of functional dyspepsia (FD). The risks that patients would be willing to take to cure their FD symptoms are unknown. FD patients (Rome III criteria) were mailed a questionnaire that assessed demographics, medication use, and prior medication adverse events. Scales to measure FD severity, quality of life, anxiety, depression, impulsiveness, and risk-taking behavior were included. A standard gamble (SG) evaluated willingness to take risks associated with a theoretical FD medication. Data were analyzed using simple descriptive statistics. One hundred and fourteen responses were analyzed (54.5% response rate). The mean age of the patients was 49.2 years; 84% were women and 96% were white. The mean duration of symptoms was 8.2 years (range 1-38 years). The most bothersome symptom was upper abdominal discomfort (25%), followed by upper abdominal pain (22%) and bloating (15%). Forty percent of respondents rated their FD symptoms as moderate and 31% as mild. Forty-six percent reported a side effect from a prescription medication used to treat FD. When asked about a hypothetical medication that could cure their FD symptoms, 49% of respondents reported that they would accept a mean 12.7% risk of sudden death for a 99% chance of cure. This prospective study suggests that FD patients are surprisingly willing to take significant risks with a hypothetical medication to cure their symptoms. To counsel patients effectively and assist in the development of informed, preference-based decisions regarding medication therapy, physicians need to elicit and understand FD patients' risk adversity.
    01/2015; 6(1):e69. DOI:10.1038/ctg.2014.18
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    ABSTRACT: Transcutaneous intraluminal impedance measurement (TIIM) is a new method to cutaneously measure gastric contractions by assessing the attenuation dynamics of a small oscillating voltage emitted by a battery-powered ingestible capsule retained in the stomach. In the present study, we investigated whether TIIM can reliably assess gastric motility in acute canine models. Methods. Eight mongrel dogs were randomly divided into 2 groups: half received an active TIIM pill and half received an identically sized sham capsule. After 24-hour fasting and transoral administration of the pill (active or sham), two force transducers (FT) were sutured onto the antral serosa at laparotomy. After closure, three standard cutaneous electrodes were placed on the abdomen, registering the transluminally emitted voltage. Thirty-minute baseline recordings were followed by pharmacological induction of gastric contractions using neostigmine IV and another 30-minute recording. Normalized one-minute baseline and post-neostigmine gastric motility indices (GMIs) were calculated and Pearson correlation coefficients (PCCs) between cutaneous and FT GMIs were obtained. Statistically significant GMI PCCs were seen in both baseline and post-neostigmine states. There were no significant GMI PCCs in the sham capsule test. Further chronic animal studies of this novel long-term gastric motility measurement technique are needed before testing it on humans.
    Gastroenterology Research and Practice 11/2014; 2014:1-9. DOI:10.1155/2014/691532 · 1.50 Impact Factor