Allergy to Prolene Sutures in a Dural Graft for Chiari Decompression

Allergy to Prolene suture is exceedingly rare with only 5 cases reported in the literature. There have been no such cases associated with neurosurgical procedures. Diagnosis is nearly always delayed in spite of persistent symptomatology. A 27-year-old girl with suspected Ehlers-Danlos, connective tissue disorder, underwent posterior fossa decompression for Chiari Type 1 malformation. One year later, the patient presented with urticarial rash from the neck to chest. Cerebrospinal fluid and blood testing, magnetic resonance imaging, and intraoperative exploration did not suggest allergic reaction. Eventually skin testing proved specific Prolene allergy. After suture material was removed, the patient no longer complained of pruritus or rash. This single case highlights the important entity of allergic reaction to suture material, namely, Prolene, which can present in a delayed basis. Symptomatology can be vague but has typical allergic characteristics. Multidisciplinary approach is helpful with confirmatory skin testing as a vital part of the workup

Is Gastroparesis Found More Frequently in Patients with Cystic Fibrosis? A Systematic Review

Cystic fibrosis (CF) is associated with different gastrointestinal motility disturbances and syndromes. We aim to assess gastric emptying in patients with CF compared to healthy controls by a systematic review of existing literature. Medical databases and abstracts from major gastroenterology and CF meetings were reviewed. Emptying times in CF patients were compared with healthy controls using random effects models. Subgroup analysis stratified results by age and diagnostic modality. Nineteen studies from 7 countries included 574 subjects (359 CF patients and 215 controls). Using pooled analysis frequency of gastroparesis was high (38%, 95% CI 30–45%) but results were highly dependent on the diagnostic modality. Delayed gastric emptying is more common in CF compared to general population. Scintigraphy identified rapid gastric emptying in a subgroup of CF patients, but this finding disappeared with adequate pancreatic enzyme replacement and after other diagnostic modalities were included

Early Disruption of the Microbiome Leading to Decreased Antioxidant Capacity and Epigenetic Changes: Implications for the Rise in Autism

Currently, 1 out of every 59 children in the United States is diagnosed with autism. While initial research to find the possible causes for autism were mostly focused on the genome, more recent studies indicate a significant role for epigenetic regulation of gene expression and the microbiome. In this review article, we examine the connections between early disruption of the developing microbiome and gastrointestinal tract function, with particular regard to susceptibility to autism. The biological mechanisms that accompany individuals with autism are reviewed in this manuscript including immune system dysregulation, inflammation, oxidative stress, metabolic and methylation abnormalities as well as gastrointestinal distress. We propose that these autism-associated biological mechanisms may be caused and/or sustained by dysbiosis, an alteration to the composition of resident commensal communities relative to the community found in healthy individuals and its redox and epigenetic consequences, changes that in part can be due to early use and over-use of antibiotics across generations. Further studies are warranted to clarify the contribution of oxidative stress and gut microbiome in the pathophysiology of autism. A better understanding of the microbiome and gastrointestinal tract in relation to autism will provide promising new opportunities to develop novel treatment modalities

An update on current pharmacotherapy options for dyspepsia

Introduction: Functional dyspepsia (FD) is a highly prevalent and challenging disorder which impacts patients' quality of life and poses a considerable socioeconomic burden. Given the vagueness of the definition of FD based on the current Rome III criteria's expert opinion, the diagnosis of FD continues to be one of exclusion. Despite efforts to better define what constitutes FD, validity of such diagnostic criteria remains controversial given the lack of a distinct pathophysiologic mechanism. Areas covered: New insights into the pathophysiology of FD have expanded our treatment options for the syndrome. This review will discuss the current pharmacologic treatments of FD with particular focus on the more robust randomized controlled trials to date. Expert opinion: Recently, the understanding of the pathophysiology of FD has evolved with novel hypothesis such as sensorimotor abnormalities of the stomach or duodenum, genetic polypmorphisms, psychological comorbidities, food sensitivities and allergies, and immune dysregulation found to be possibly responsible for its pathogenesis. Despite the expanding knowledge about the likely multifactorial pathophysiology of FD, its treatment remains a challenge

Current developments for the diagnosis and treatment of irritable bowel syndrome

Current treatment options for the chronic gastrointestinal disorder irritable bowel syndrome (IBS) have long been limited to symptomatic treatments due to lack of pathophysiologic understanding of the syndrome. Within the past 10 years, however, a number of new pharmacological targets have been identified that may aid in the treatment of irritable bowel syndrome. Although only a limited number of new drug entities have entered the market in the past years, many new potential pharmacophores are evolving. Among them, several drugs are in the pipeline that target cholecystokinin or corticotropin-releasing factor receptors, serve as inhibitors for specific tryptophan hydroxylase iso-enzymes, modulate chloride secretion, influence immune responses via monoclonal antibodies or ATP-mediated pathways, and even normalize the gastrointestinal microflora via supplementation with probiotics. While new treatments that act via chloride secretion and immune modulation present with favorable outcomes in clinical trials, other novel therapies require further evaluation. This review is intended to provide a synopsis of current and emerging pharmacotherapies for IBS

Treatment of pain symptoms in irritable bowel syndrome patients

Irritable bowel syndrome represents a common gastrointestinal disorder that significantly impacts patients' lives. It is defined by Rome II criteria and characterized by abdominal pain and bloating associated with changes in bowel habit. Visceral hypersensitivity is currently considered a biological marker for the disease. Current therapeutic treatments include the use of fiber supplements, antidiarrheal agents, laxatives, antispasmodics, tricyclic antidepressants and serotonergic agents. Through a proper understanding of the diagnostic criteria, pathophysiology and treatment options, this disorder can be treated effectively in many patients

The treatment of gastroparesis, constipation and small intestinal bacterial overgrowth syndrome in patients with Parkinson's disease

Introduction: Parkinson's disease (PD) affects the nerves of the entire gastrointestinal (GI) tract and may result in profound gastrointestinal (GI) dysfunction leading to poor patient outcomes. Common GI disturbances in patients with PD include gastroparesis (GP), constipation and small intestinal bacterial overgrowth syndrome (SIBO). In particular, GP is difficult to treat due to the limited options available and precautions, contraindications and adverse effects associated with the approved treatments. Moreover, some commonly used medications can worsen pre-existing PD. Areas covered: Our review will focus on treatment options for GP and SIBO with motilin agonists, dopamine receptor antagonists, Ghrelin agonists muscarinic agonists, 5-HT 4 receptor agonists, antibiotics, probiotics and herbal formulation such as iberogast. Constipation occurs in the majority of patients with PD and fortunately many treatments are now available. Our review is based on original papers or reviews selected from PUBMED search and Cochrane reviews. Expert opinion: Motility disorders of the GI tract are found frequently in patients with PD and treating the underlying GI disorders caused by PD with various prokinetics and laxatives is paramount in achieving improvements in patient's motor function. Various prokinetics and laxatives are now available to provide some relief of the GI morbidity caused by PD leading even to better absorption of even the PD treatments

Comparison of the Effect of Azithromycin Versus Erythromycin on Antroduodenal Pressure Profiles of Patients with Chronic Functional Gastrointestinal Pain and Gastroparesis

Current pharmacologic treatments for gastroparesis have been disappointing due to the limited options available. Erythromycin ethylsuccinate is a potent prokinetic agent that stimulates gastric emptying. Recently, erythromycin has been linked to the occurrences of sudden cardiac death due to QT prolongation. Azithromycin is similar to erythromycin in structure but does not have significant drug–drug interactions as seen with erythromycin.This study aims to determine whether azithromycin stimulates antral activity in patients with chronic gastrointestinal pain and refractory gastroparesis.Small bowel manometric data on 30 patients undergoing clinical evaluation for chronic digestive problems or documented refractory gastroparesis were reviewed. Antral activity was measured after infusion of erythromycin 250 mg intravenous and azithromycin (500 or 250 mg intravenous) given at different intervals during the small bowel manometry. The parameters measured included the total duration of effect, mean amplitude of antral contractions, duration of the highest antral contraction phase, number of cycles per minute, and the motility index. Comparison of erythromycin and azithromycin at similar doses showed a similar positive effect on antral activity. However, comparison of erythromycin and azithromycin at the higher dose of 500 mg showed that the mean amplitude, duration of antral activity, and motility index were significantly increased with azithromycin (P < 0.05). Azithromycin stimulates antral activity similar to erythromycin and moreover has a longer duration of effect. However, unlike erythromycin, azithromycin does not have significant drug–drug interactions and may be a potential new medication for the treatment of gastroparesis and gastrointestinal dysmotility