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Aldali JA, Asseri MK, Almufarrij HA, Alromih AM, Alajlan AM, Alrashed KA, ALghadeer AI, Almutawa BI, Alshalani A. Prevalence of Gastroparesis and the Impact of Metformin in Diabetic Patients: A Cross-Sectional Study in Riyadh, Saudi Arabia. Gastroenterol Res Pract 2024; 2024:3713569. [PMID: 39664090 PMCID: PMC11634406 DOI: 10.1155/grp/3713569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 10/08/2024] [Accepted: 11/08/2024] [Indexed: 12/13/2024] Open
Abstract
Background: The prevalence of gastroparesis in individuals with diabetes mellitus varies significantly across different studies. This study is aimed at estimating the prevalence of gastroparesis among diabetic patients in Riyadh, Saudi Arabia, and evaluating the association between metformin use and clinical manifestations of gastroparesis. Methods: This cross-sectional study employed an online survey distributed via Google Forms, targeting patients at a diabetes clinic. The survey comprised three sections, including the Gastroparesis Cardinal Symptom Index (GCSI). Eligible participants were those diagnosed with either type 1 or type 2 diabetes mellitus and aged 18 or older. Results: The study included 385 participants, with the majority diagnosed with type 2 diabetes (55.6%) for over 10 years (59.5%). A significant proportion had poorly controlled blood glucose levels (56.6%) and were taking metformin (50.9%). Among gastrointestinal (GI) symptoms, "stomach fullness" was reported most frequently (53.2%), whereas "vomiting" was reported least often (17.9%). GCSI scores did not differ significantly between type 1 and type 2 diabetes patients (p = 0.88). However, patients with diabetes durations of less than 3 years, those with durations of 5-7 years controlled blood glucose levels, and those on metformin exhibited higher GCSI scores (p = 0.20, p = 0.02, and p = 0.10, respectively). Conclusion: This study identified some commonalities as well as differences in the prevalence and symptomatology of gastroparesis among diabetic patients. We observed no significant variation in GCSI scores between type 1 and type 2 diabetes. Nevertheless, higher GCSI scores were associated with shorter diabetes durations, controlled blood glucose levels, and metformin use. However, due to the small sample size and reliance on self-reported data, one should interpret the study's findings with caution.
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Affiliation(s)
- Jehad A. Aldali
- Department of Pathology, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 13317, Saudi Arabia
| | - Mushabbab K. Asseri
- Department of Endocrine & Diabetes, Prince Sultan Medical Military City, Riyadh 11159, Saudi Arabia
| | - Haneen A. Almufarrij
- Medical School, College of Medicine, King Saud Bin Abdul Aziz University for Health Sciences (KSAU-HS), Riyadh 11481, Saudi Arabia
| | - Aroob M. Alromih
- Medical School, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 13317, Saudi Arabia
| | - Albandari M. Alajlan
- Medical School, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 13317, Saudi Arabia
| | - Khawlah A. Alrashed
- Medical School, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 13317, Saudi Arabia
| | - Atheer I. ALghadeer
- Medical School, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 13317, Saudi Arabia
| | - Bushra I. Almutawa
- Medical School, College of Medicine, King Saud Bin Abdul Aziz University for Health Sciences (KSAU-HS), Riyadh 11481, Saudi Arabia
| | - Abdulrahman Alshalani
- Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Szczupak M, Jankowska M, Jankowski B, Wierzchowska J, Kobak J, Szczupak P, Kosydar-Bochenek J, Krupa-Nurcek S. Prokinetic effect of erythromycin in the management of gastroparesis in critically ill patients-our experience and literature review. Front Med (Lausanne) 2024; 11:1440992. [PMID: 39314225 PMCID: PMC11416996 DOI: 10.3389/fmed.2024.1440992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 08/26/2024] [Indexed: 09/25/2024] Open
Abstract
Introduction Gastroparesis is a disorder characterized by impaired gastric emptying and the accumulation of food in the intestines without any clear mechanical cause. Gastroparesis in critical care patients is a prevalent issue in the intensive care unit. The disruption of normal gastrointestinal motility in critically ill patients is linked to a significant risk of intolerance to enteral feeding, colonization of the gastrointestinal tract with pathogenic bacterial strains, increased permeability of the intestinal wall, translocation of the intestinal microbiota, leading to progressive malnutrition, and potential development of bacterial infection. Materials and methods The literature was reviewed to assess the benefits and risks associated with the use of this medication. Aim The aim of the study was to treat the symptoms of gastroparesis and stimulate gastrointestinal motility. Consequently, the aim was to reduce the amount of backed-up food content in the stomach, accelerate gastrointestinal motility, and return to intestinal feeding. Results Gastroparesis is a frequent issue among patients in the intensive care unit. Critical illness can lead to gastrointestinal motility disorders, causing slowed gastric emptying. This increases the risk of problems such as intolerance to enteral feeding, regurgitation, and aspiration of gastrointestinal contents into the respiratory tract, as well as colonization of the gastrointestinal tract by pathogens. Over time, impaired intestinal absorption can result in malnutrition, necessitating the initiation of parenteral nutrition. Conclusion After analysis of the literature and published scientific reports, as well as considering their own research, it is evident that erythromycin, as a prokinetic drug, effectively enhances gastrointestinal motility. This contributes to stimulating gastric emptying in critically ill patients with gastroparesis who are hospitalized in an intensive care unit. The use of erythromycin in combination with metoclopramide and/or itopride hydrochloride allows for a synergistic effect, leading to the quickest possible return to enteral feeding.
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Affiliation(s)
- Mateusz Szczupak
- Department of Anesthesiology and Intensive Care, Copernicus Hospital, Gdansk, Poland
| | - Magdalena Jankowska
- Department of Anesthesiology and Intensive Care, Copernicus Hospital, Gdansk, Poland
| | - Bartłomiej Jankowski
- Department of Anesthesiology and Intensive Care, Copernicus Hospital, Gdansk, Poland
| | - Jolanta Wierzchowska
- Department of Anesthesiology and Intensive Care, Copernicus Hospital, Gdansk, Poland
| | - Jacek Kobak
- Department of Otolaryngology, Medical University of Gdansk, Gdansk, Poland
| | - Paweł Szczupak
- Department of Electrical Engineering and Computer Science, Rzeszow University of Technology, Rzeszow, Poland
| | - Justyna Kosydar-Bochenek
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszow, Rzeszow, Poland
| | - Sabina Krupa-Nurcek
- Department of Surgery, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland
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Uppaluri S, Jain MA, Ali H, Shingala J, Amin D, Ajwani T, Fatima I, Patel N, Kaka N, Sethi Y, Kapoor N. Pathogenesis and management of diabetic gastroparesis: An updated clinically oriented review. Diabetes Metab Syndr 2024; 18:102994. [PMID: 38579489 DOI: 10.1016/j.dsx.2024.102994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/25/2024] [Accepted: 03/20/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND AND AIMS Diabetic gastroparesis (DGp) is a common and preventable complication of uncontrolled diabetes mellitus (D.M.) and significantly affects the Quality of Life of patients. Diagnosis and management present as a clinical challenge due to the disease's complexity and limited effective therapeutic options. This review aims to comprehensively outline the pathogenesis, diagnosis, and management of diabetic gastroparesis, evaluating evolving approaches to guide clinicians and provide future recommendations. METHODS A literature review was conducted on scholarly databases of PubMed, Google Scholar, Scopus and Web of Science encompassing published articles, gray literature and relevant clinical guidelines. Data were synthesized and analyzed to provide a comprehensive overview of diabetic gastroparesis, focusing on pathogenesis, diagnosis, and management. RESULTS The review intricately explores the pathogenesis contributing to diabetic gastroparesis, emphasizing autonomic neuropathy, oxidative stress, inflammation, hormonal dysregulation, microbiota alterations, and gastrointestinal neuropathy. Primary management strategies are underscored, including lifestyle modifications, symptom relief, and glycemic control. The discussion encompasses pharmacological and surgical options, highlighting the importance of a multidisciplinary approach involving various healthcare professionals for comprehensive patient care. CONCLUSION This review offers a thorough understanding of pathogenesis, diagnosis, and management of diabetic gastroparesis, underlining evolving approaches for clinicians. A multidisciplinary approach is crucial to address both the physical and mental health aspects of diabetes and its complications.
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Affiliation(s)
- Srikar Uppaluri
- Kamineni Academy of Medical Sciences and Research Center, Hyderabad, India; PearResearch, Dehradun, India.
| | - Manisha Ashok Jain
- PearResearch, Dehradun, India; Shri Bhausaheb Hire Govt. Medical College, Dhule, Maharashtra, India.
| | - Hira Ali
- PearResearch, Dehradun, India; Chifeng University Medical College, China.
| | - Jay Shingala
- PearResearch, Dehradun, India; B.J. Medical College, Ahmedabad, India.
| | - Dhruti Amin
- PearResearch, Dehradun, India; GMERS Medical College and Hospital, Gotri, Vadodara, India.
| | - Trisha Ajwani
- PearResearch, Dehradun, India; Baroda Medical College, Gujarat, India.
| | - Irum Fatima
- PearResearch, Dehradun, India; Osmania Medical College, Hyderabad, India.
| | - Neil Patel
- PearResearch, Dehradun, India; GMERS Medical College, Himmatnagar, Gujarat, India.
| | - Nirja Kaka
- PearResearch, Dehradun, India; GMERS Medical College, Himmatnagar, Gujarat, India.
| | - Yashendra Sethi
- PearResearch, Dehradun, India; Government Doon Medical College, Dehradun, India.
| | - Nitin Kapoor
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India.
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Ramzan A, Memon GF, Shaikh AA, Khoso MM, Meher T, Ghafoor A, Shehzad NA, Ahmed S, Nawaz Z, Rehan M, Saeed T, Taj W, Abbass S, Khan R, Ehsan H, Alam A, Manzoor B, Khan MN, Yahya KM, Mukhtiar F, Javed MA, Sheikh MU, Janjua D, Jabeen S, Zafar J, Khokhar RH, Nazar M, Maheshwary N, Khan MA. Efficacy and safety of itopride SR for upper gastrointestinal symptoms in patients with diabetic gastroparesis: real-world evidence from Pakistan. Drugs Context 2023; 12:2023-6-4. [PMID: 38148829 PMCID: PMC10751102 DOI: 10.7573/dic.2023-6-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/04/2023] [Indexed: 12/28/2023] Open
Abstract
Background Gastroparesis is a serious condition that can be caused by diabetes, surgery or infection, or can be idiopathic. When there is no mechanical obstruction, gastroparesis is characterized by delayed stomach emptying. Itopride, a prokinetic drug, inhibits acetylcholinesterase activity in addition to antagonizing dopamine D2 receptors. Methods This prospective, multicentre study is based on real-world data from 988 patients with a diagnosis of diabetic gastroparesis for index (PAGI-SYM2) evaluation at baseline and week 4 of treatment for upper gastrointestinal disorder symptoms. Results Upper gastrointestinal symptom severity scores improved significantly after 4 weeks of treatment (p<0.001), with significant improvement across all categories of gastroparesis (very mild (37-58.6%), mild degree (24.6-31.6%), moderate (29.3-7.3%) and severe (8.8-2.6%). Conclusion Itopride SR (Nogerd SR) in a 150 mg once-daily dose showed promising results in reducing the severity of upper gastrointestinal disorder symptoms associated with diabetic gastroparesis. Both statistical and clinical effectiveness were observed. Moreover, the treatment demonstrated a favourable tolerability profile, with a low incidence of adverse effects.
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Affiliation(s)
- Adil Ramzan
- Department of Medicine, Karachi Medical and Dental College/Abbasi Hospital, Karachi,
Pakistan
| | | | | | | | - Tariq Meher
- Hayatabad Medical Complex, Peshawar,
Pakistan
| | | | | | | | | | - Muhammad Rehan
- Civil Hospital, Karachi,
Pakistan
- Kutiyana Memon Hospital, Karachi,
Pakistan
| | - Tariq Saeed
- Hamdard University Hospital, Karachi,
Pakistan
| | - Waqar Taj
- Baloch Medical Center, Turbat,
Pakistan
| | | | - Ramiz Khan
- Qazi Hussain Ahmed Medical Complex MTI, Nowshera,
Pakistan
| | | | | | - Bilal Manzoor
- Dr. Abdul Majeed Memorial Clinic, Peshawar,
Pakistan
| | | | | | - Farhan Mukhtiar
- Diabetes/Endocrinology Unit, DHQ Hospital, Charsadda,
Pakistan
| | - Muhammad Asif Javed
- Social Security MNCH Hospital, Faislabad,
Pakistan
- Health Care Clinic, Shahkot,
Pakistan
| | | | - Danish Janjua
- Sakhi Shahbaz Clinic for Diabetic Foot, Sahiwal,
Pakistan
| | | | - Junaid Zafar
- Jinnah Medical Complex, Dera Ghazi Khan,
Pakistan
| | - Riaz Hussain Khokhar
- People’s University of Medical and Health Sciences for Women, Nawabshah,
Pakistan
| | | | | | - Muhammad Athar Khan
- Department of Community Medicine, Liaquat College of Medicine & Dentistry, Karachi,
Pakistan
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Koury M, Tantum J, Savard C, Donohue J. A Case of Wernicke’s Encephalopathy Due to Idiopathic Gastroparesis: A Rare Cause of Encephalopathy in a Young Woman. Cureus 2022; 14:e25653. [PMID: 35784977 PMCID: PMC9249061 DOI: 10.7759/cureus.25653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2022] [Indexed: 11/05/2022] Open
Abstract
Wernicke’s encephalopathy (WE) is a rare, life-threatening neurological disease due to thiamine deficiency. It is most commonly associated with chronic alcoholism but is also associated with disorders of malabsorption and malnutrition. We present a case of a young female with idiopathic gastroparesis who developed Wernicke’s encephalopathy due to poor oral intake and malnutrition as a result of gastroparesis. This case exemplifies that Wernicke’s encephalopathy should be on the differential in patients who present with encephalopathy with a history of gastroparesis.
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Affiliation(s)
- Clipper F. Young
- Primary Care Department, Touro University California College of Osteopathic Medicine, Vallejo, CA
| | - Marianne Moussa
- Graduate, Touro University California College of Pharmacy, Vallejo, CA
| | - Jay H. Shubrook
- Primary Care Department, Touro University California College of Osteopathic Medicine, Vallejo, CA
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Bi YZ, Le YP, Li J, Fang X, Zuo S, Kong LB. Effectiveness and safety of Helicobacter pylori eradication in treating diabetic gastroparesis patients with Helicobacter pylori infection: Meta-analysis. Shijie Huaren Xiaohua Zazhi 2016; 24:487-492. [DOI: 10.11569/wcjd.v24.i3.487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the effectiveness and safety of Helicobacter pylori (H. pylori) eradication in treating diabetic gastroparesis (DGP) patients with H. pylori infection.
METHODS: Online databases (PubMed, EMbase, Cochrane Library, Wangfang, CNKI and CBMdice) were searched for randomized controlled trials investigating therapeutic effects of H. pylori eradication vs conventional treatment. Outcomes were analyzed with RevMan 5.3.
RESULTS: Six randomized controlled trials containing 508 patients were included. The results of meta-analysis showed that H. pylori eradication was superior to conventional treatment for DGP patients in clinical effects (RR = 1.33, 95%CI: 1.21-1.47, P < 0.00001). The incidence of adverse events was similar between the two therapies (P = 0.39).
CONCLUSION: Compared with the conventional treatment, H. pylori eradication has more significant clinical effects and comparable incidence of adverse events.
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Liu H, Yu B, Zhang M, Liu K, Wang FC, Gao XY. Treatment of Diabetic Gastroparesis by Complementary and Alternative Medicines. MEDICINES (BASEL, SWITZERLAND) 2015; 2:212-219. [PMID: 28930208 PMCID: PMC5456216 DOI: 10.3390/medicines2030212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 07/08/2015] [Accepted: 07/29/2015] [Indexed: 12/13/2022]
Abstract
Gastroparesis is a common gastrointestinal complication in diabetes, induced by hyperglycemia and characterized by delayed gastric emptying and upper abdominal symptoms, such asnausea, vomiting, early satiety, bloating and epigastric pain. Diabetic gastroparesis (DGP) affects life quality and glycemic control, and is a challenge to treat in both Western and Eastern medicine. Routine treatment in Western medicine includes gastric emptying promoted by prokinetic agents, gastric pacemaking, or surgery combined with lifetime hormono-therapy, all of which have unavoidable side effects and limitations, and are very expensive. Complementary and alternative medical treatments like acupuncture, moxibustion, and massage are becoming more and more attractive because of their effectiveness, fewer side effects, and reliable safety. This article aims to introduce representative methods of complementary and alternative medicine to treat DGP, which were searched in English through Pubmed and in Chinese through CNKI (China Knowledge Resource Integrated Database). Several lines of evidence demonstrated the effects of single or combined complementary alternative therapies on DGP outcomes; however, the mechanisms were rarely investigated. Randomized controlled trials are undoubtedly required in future studies.
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Affiliation(s)
- Hao Liu
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, 16 Nanxiaojie, Dongzhimennei, Beijing 100700, China.
- School of Acupuncture and Tuina-massage, Changchun University of Traditional Chinese Medicine, Changchun 130117, China.
| | - Bo Yu
- School of Acupuncture and Tuina-massage, Changchun University of Traditional Chinese Medicine, Changchun 130117, China.
| | - Meng Zhang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, 16 Nanxiaojie, Dongzhimennei, Beijing 100700, China.
- School of Acupuncture and Tuina-massage, Changchun University of Traditional Chinese Medicine, Changchun 130117, China.
| | - Kun Liu
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, 16 Nanxiaojie, Dongzhimennei, Beijing 100700, China.
| | - Fu-Chun Wang
- School of Acupuncture and Tuina-massage, Changchun University of Traditional Chinese Medicine, Changchun 130117, China.
| | - Xin-Yan Gao
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, 16 Nanxiaojie, Dongzhimennei, Beijing 100700, China.
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Tian JX, Zhao JB, Li M, Li JL, Cao Y, Gregersen H, Tong XL. Distribution of advanced glycation end products and their receptor in the stomach of diabetic rats. Shijie Huaren Xiaohua Zazhi 2015; 23:2714-2721. [DOI: 10.11569/wcjd.v23.i17.2714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To observe the distribution of advanced glycation end products (AGEs) and their receptor (RAGE) in the stomach of diabetic rats.
METHODS: Diabetes mellitus (DM) and control (CON) rats were reared for eight weeks. Fasting plasma glucose (FPG), glycated serum protein (GSP) and gastric layer thickness were measured. The expression of AGEs and RAGE was detected by immunohistochemical staining.
RESULTS: The thickness of the mucosa (781.47 μm ± 137.82 μm vs 709.85 μm ± 169.41 μm) and submucosa (233.39 μm ± 134.05 μm vs 109.32 μm ± 44.43 μm) increased significantly in the DM group compared with the CON group (P < 0.05). The expression of AGEs and RAGE in the mucosa (5.66 ± 1.90 vs 2.25 ± 0.52, 2.79 ± 0.54 vs 1.70 ± 0.30) and muscle (37.37 ± 7.38 vs 24.32 ± 4.02, 4.26 ± 0.80 vs 3.59 ± 0.37) layers of the stomach was significantly higher in the DM group than in the CON group (P < 0.05).
CONCLUSION: The expression of AGEs and RAGE is up-regulated in the stomach of diabetic rats. The increased levels of AGE and RAGE in gastric tissue may contribute to diabetic gastrointestinal dysfunction.
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Qiu X, Lin M, Zhang Y. Trimebutine maleate combined with domperidone for treatment of diabetic gastroparesis. Shijie Huaren Xiaohua Zazhi 2014; 22:4478-4481. [DOI: 10.11569/wcjd.v22.i29.4478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the clinical effects of trimebutine maleate combined with domperidone in the treatment of diabetic gastroparesis (DGP).
METHODS: Eighty-six patients with DGP were randomly divided into either an experiment group or a control group. The experiment group was treated with trimebutine maleate combined with domperidone, and the control group was treated with domperidone alone. The clinical effects, gastric emptying half-time (GET1/2), adverse reactions, and relapse were compared for the two groups.
RESULTS: The total effective rate for the experiment group was significantly higher than that for the control group (93.02% vs 74.42%, P < 0.05). The GET1/2 post-treatment for the two groups was significantly lower than that prior-treatment (124.49 min ± 23.05 min vs 225.62 min ± 21.88 min, 199.46 min ± 23.49 min vs 222.62 min ± 19.08 min, P < 0.05). There was no significant difference in the rate of adverse reactions for the two groups (0.00% vs 4.65%, P > 0.05). The rate of relapse at 2 mo for the experiment group was lower than that for the control group (13.95% vs 51.16%, P < 0.05).
CONCLUSION: Trimebutine maleate combined with domperidone can improve clinical symptoms and GET1/2 in patients with DGP.
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Tian JX, Li M, Liao JQ, Liu WK, Tong XL. Xiangshaliujunzi Decoction for the treatment of diabetic gastroparesis: A systematic review. World J Gastroenterol 2014; 20:561-568. [PMID: 24574726 PMCID: PMC3923032 DOI: 10.3748/wjg.v20.i2.561] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 09/01/2013] [Accepted: 11/13/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the current clinical evidence of the effectiveness of Xiangshaliujunzi Decoction (XSLJZD) for the treatment of diabetic gastroparesis (DGP).
METHODS: Randomized controlled trials (RCTs) were retrieved from seven major electronic databases including Medline, the Cochrane Library, Embase, Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure, Chinese Scientific Journal Database (VIP), and Wanfang Databases, using search dates from the beginning of the databases to May 2013. No language limitations were applied. We included RCTs that used XSLJZD or a modified XSLJZD compared with a control group for the treatment of DGP. The control groups included conventional treatment (Western medicinal treatment), placebo, and no treatment (blank), but not acupuncture. The main outcome index was clinical effectiveness, which was based on the gastric emptying test and variations in the gastrointestinal (GI) symptoms between the treatment and control groups after intervention. Data extraction, analysis, and quality assessment were conducted according to the Cochrane Handbook for Systematic Review of Interventions, Version 5.1.0.
RESULTS: Ten RCTs involving 867 patients (441 in the experimental groups, and 426 in the control groups) were identified, and the overall methodological quality was evaluated as generally low. In the treatment groups, all 10 trials used herbs alone as the treatment, whereas all control groups used prokinetic medicine. The period of intervention ranged from 2 to 8 wk. Three classes were used to evaluate treatment efficacy: significant effective, effective, and ineffective, and all trials used the clinical effective rate (based on the gastric emptying test and changes in GI symptoms) to evaluate efficacy. The data showed that the effects of XSLJZD for the treatment of DGP were superior to the control group (n = 867, RR =1.33, 95%CI: 1.24-1.42, Z = 8.11, P < 0.00001). Two trials recorded adverse events, and one trial reported follow-up.
CONCLUSION: XSLJZD could restore the gastric emptying rate and improve symptoms. However, the evidence remains weak due to the poor methodological quality of the included studies.
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Harrison NS, Williams PA, Walker MR, Nikitini Y, Helling TS, Abell TL, Lahr CJ. Evaluation and treatment of gastric stimulator failure in patients with gastroparesis. Surg Innov 2013; 21:244-9. [PMID: 24056201 DOI: 10.1177/1553350613503735] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This study evaluates treatment of gastroparesis patients refractory to gastric electrical stimulation (GES) therapy with surgical replacement of the entire GES system. SUMMARY BACKGROUND DATA Some patients who have symptomatic improvement with GES later develop recurrent symptoms. Some patients improve by simply altering pulse parameter settings. Others continue to have symptoms with maximized pulse parameters. For these patients, we have shown that surgical implantation of a new device and leads at a different gastric location will improve symptoms of gastroparesis. METHODS This study evaluates 15 patients with recurrent symptoms after initial GES therapy who subsequently received a second GES system. Positive response to GES replacement therapy is evaluated by symptoms scores for vomiting, nausea, epigastric pain, early satiety, and bloating using a modified Likert score system, 0 to 4. RESULTS Total symptom scores improved for 12 of 15 patients with GES replacement surgery. Total score for the replacement group decreased from 17.3 ± 1.6 to 13.6 ± 3.7 with a difference of 3.6 (P value = .017). This score is compared with that of the control group with a preoperative symptom score of 15.8 ± 3.6 and postoperative score of 12.3 ± 3.5 with a difference of 3.5 (P value = .011). The control group showed a 20.3% decrease in mean total symptoms score, whereas the study group showed a 22.5% decrease in mean with an absolute reduction of 2.2. CONCLUSION Reimplantation of a GES at a new gastric location should be considered a viable option for patients who have initially failed GES therapy for gastroparesis.
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Affiliation(s)
| | | | - Micah R Walker
- University of Mississippi Medical Center, Jackson, MS, USA
| | - Yana Nikitini
- University of Mississippi Medical Center, Jackson, MS, USA
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Chinese herbal medicine banxiaxiexin decoction treating diabetic gastroparesis: a systematic review of randomized controlled trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:749495. [PMID: 23935681 PMCID: PMC3725710 DOI: 10.1155/2013/749495] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 05/19/2013] [Accepted: 05/20/2013] [Indexed: 12/27/2022]
Abstract
Objective. To assess the current clinical evidence of Banxiaxiexin decoction for diabetic gastroparesis (DGP). Methods. Electronic databases were searched until December 2012. No language limitations were applied. We included RCTs using Banxiaxiexin decoction/modified Banxiaxiexin decoction for DGP. No restriction for the control group except acupuncture. Applying clinical effective rate as the main outcome index. Data extraction, analyses and quality assessment were conducted according to the Cochrane review standards. Results. 16 RCTs involving 1302 patients were finally identified, and the methodological quality was evaluated as generally low. The data showed that the effect of Banxiaxiexin decoction (BXXD) for DGP was superior to the control group (n = 1302, RR 1.23, 95% CI 1.17 to 1.29, Z = 8.04, P < 0.00001). Only one trial recorded adverse events, no obvious adverse event occurred. Conclusions. Banxiaxiexin decoction could regain the gastric emptying rate and improve diabetic gastrointestinal symptoms. However, the methodological quality of included studies is low, and long term efficacy and safety are still uncertain, which indicates that the findings above should be read with caution. Thereby, well-designed, large-scale, and high-quality randomized controlled clinical trials with scientific rigor are warranted for stronger evidence in future research.
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Alagiakrishnan K, Frankel M. Silent acute gastric dilatation due to Salmonella infection in a diabetic elderly. Age Ageing 2011; 40:759-60. [PMID: 21893501 DOI: 10.1093/ageing/afr120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Acute gastric dilatation is a potentially life-threatening entity that has been reported in patients with some acute infections like pneumonia and staphylococcal bacteremia. We describe a case of acute gastric dilatation presenting atypically in a 65-year-old diabetic with Salmonella diarrhoea. By the fourth day of hospital admission the patient's abdomen was distended in the absence of pain, nausea or vomiting. An abdominal radiograph showed marked gastric dilatation with no evidence of obstruction or ileus. With nasogastric tube insertion and initiation of intravenous antibiotics, the stomach was back to normal size. It is likely that Salmonella infection was the major cause of acute gastric dilatation in this patient.
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