Highlights
- •We identified a subset of patients with functional obstructive gastroparesis.
- •These patients had normal 3 cpm gastric myoelectrical activity and normal endoscopy.
- •33 patients had at least one pyloric Botox injection or pyloric balloon dilation.
- •Overall, 78% of the 33 patients reported improvement in gastroparesis symptoms.
- •Average weight gain was 1.54 lb from baseline to final treatment (p < 0.04).
Abstract
Gastroparesis (GP) is associated with loss of interstitial cells of Cajal (ICCs) and
gastric dysrhythmias such as tachygastria. We hypothesized that a subset of patients
with GP, normal 3 cycles per minute (cpm) gastric myoelectrical activity (GMA), and normal upper endoscopy
may respond to pyloric therapies.
Aims
To determine the effect of botulinum toxin A (btA) injection or balloon dilation (BD)
of the pylorus on symptoms and body weight in patients with GP and 3 cpm GMA.
Methods
Patients were identified who had GP, normal 3 cpm GMA, and normal endoscopy that excluded mechanical obstruction of the pylorus.
Electrogastrograms (EGG) with water load tests (WLT) were recorded to determine GMA.
Gastric emptying was measured with 4 h scintigraphy. Each patient underwent up to three pyloric treatments with btA or
BD.
Results
Thirty-three patients (29 women) with an average age of 42 years were studied. Seventy-nine percent had idiopathic GP and 21% had diabetic GP.
The average percent meal retained at 4 h was 42% and each EGG test showed normal 3 cpm GMA. Nausea was the major symptom in 76% of patients. Complete or partial symptom
response occurred in 75%, 72%, and 88% of patients after the first, second, or third
endoscopic pyloric treatment, respectively. Overall, 78% of the 33 patients reported
improvement in symptoms and average weight gain was 1.54 lb from baseline to final treatment (p < 0.04).
Conclusion
Pyloric therapies appear to be effective treatments in symptomatic patients with GP
and 3 cpm GMA and controlled trials are warranted.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Autonomic Neuroscience: Basic and ClinicalAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Stern R.M. Koch K.L. Andrews P.L. Nausea: Mechanisms and Treatment. Oxford Press, New York2011
- Influence of intra-pyloric botulinum toxin injection on gastric emptying and meal related symptoms in gastroparesis patients.Aliment. Pharmacol. Ther. 2006; 24: 661-667
- Clinical trial: a randomized-controlled crossover study of intrapyloric injection of botulinum toxin in gastroparesis.Aliment. Pharmacol. Ther. 2007; 26: 1251-1258
- Endoscopic pyloric injection of botulinum toxin A for the treatment of refractory gastroparesis.Gastrointest. Endosc. 2005; 61: 833-839
- Gastric myoelectrical activity in patients with gastric outlet obstruction and idiopathic gastroparesis.Am. J. Gastroenterol. 1998; 93: 1803-1809
- Adenocarcinoma of the pancreas invading the duodenum and presenting as idiopathic gastroparesis with nausea and vomiting.Am. J. Gastroenterol. Case Rep. 2016; (in press)
- Mapping and modeling gastrointestinal bioelectricity: from engineering bench to bedside.Physiology. 2013; 28: 310-317
- Comparison of metoclopramide and erythromycin in the treatment of diabetic gastroparesis.Diabetes Care. 1993; 16: 1511-1514
- Gastroduodenal motility disturbances in man.Scand. J. Gastroenterol. 1985; 109: 59-68
- Botulinum toxin A for the treatment of delayed gastric emptying.Am. J. Gastroenterol. 2008; 103: 416-423
- Clinical-histological associations in gastroparesis: results from the Gastroparesis Clinical Research Consortium.Neurogastroenterol. Motil. 2012; 24 (531-e249. PMCID: PMC3353102)
- Extending gastric emptying scintigraphy from two to four hours detects more patients with gastroparesis.Dig. Dis. Sci. 2001; 46: 24-29
- Attenuation of isolated pyloric pressure waves in gastroparesis in response to botulinum toxin injection: a case report.Gastrointest. Endosc. 2002; 56: 770-772
- Laparoscopic and endoscopic pyloroplasty for gastroparesis results in sustained symptom improvement.J. Gastrointest. Surg. 2011; 15: 1513-1519
- Electrogastrography for evaluation of patients with suspected gastroparesis.in: Parkman H. McCallum R. Gastroparesis: Pathophysiology, Presentation, Diagnosis and Treatment. Springer, New York, NY2011: 153-161
- Handbook of Electrogastrography.Oxford University Press, 2004
- Reproducibility of gastric myoelectrical activity and water load test in patients with dysmotility-like dyspepsia symptoms and in control subjects.J. Clin. Gastroenterol. 2000; 31: 125-129
- Botulinum toxin for the treatment of gastroparesis: a preliminary report.Am. J. Gastroenterol. 2002; 97: 1548-1552
- The treatment of diabetic gastroparesis with botulinum toxin injection of the pylorus.Diabetes Care. 2004; 27: 2341-2347
- Association of the status of interstitial cells of Cajal and electrogastrogram parameters, gastric emptying, and symptoms in patients with gastroparesis.Neurogastroenterol. Motil. 2010; 22: 56-61
- Gastric electrical stimulation with Enterra improves symptoms from diabetic gastroparesis in a prospective study.Clin. Gastroenterol. Hepatol. 2010; 8: 947-954
- Treatment of idiopathic gastroparesis with injection of botulinum toxin into the pyloric sphincter muscle.Am. J. Gastroenterol. 2002; 97: 1653-1660
- Abnormal initiation and conduction of slow wave activity in gastroparesis, defined by high-resolution electrical mapping.Gastroenterology. 2012; 143: 589-598
- Metoclopramide therapy in fifty-five patients with delayed gastric emptying.Am. J. Gastroenterol. 1980; 74: 231-236
- Development and validation of a patient-assessed gastroparesis symptom severity measure: the Gastroparesis Cardinal Symptom Index.Aliment. Pharmacol. Ther. 2003; 18: 141-150
- Prokinetic agents.Gastroenterol. Clin. N. Am. 1992; 21: 567-596
- Nausea: a review of pathophysiology and therapeutics.Ther. Adv. Gastroenterol. 2016; 9: 98-112
- Metoclopramide to treat gastroparesis due to diabetes mellitus: a double-blind, controlled trial.Ann. Intern. Med. 1982; 96: 444-446
- Evaluation of pylorus with concurrent intraluminal pressure and EndoFLIP in patients with nausea and vomiting.Neurogastroenterol. Motil. 2016; (Epub 2016 Jan 27)
- Assessment of gastric emptying using a low fat meal: establishment of international control values.Am. J. Gastroenterol. 2000; 95: 1456-1462
Article info
Publication history
Published online: July 15, 2016
Accepted:
July 15,
2016
Received in revised form:
July 14,
2016
Received:
April 25,
2016
Identification
Copyright
© 2016 Elsevier B.V. All rights reserved.
