Stimulation électrique gastrique chez 11 patients souffrant de gastroparésie réfractaire au traitement médical

ROUEN-BU Médecine-Pharmacie (765402102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Editorial: on the road towards treatment of gastroparesis—accelerating but do we get closer?

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Pyloric distensibility in health and disease.

Until recently, gastric motility measurements in Humans were mostly limited to accommodation (using barostat or 3-dimensional imaging studies of gastric volume) and gastric emptying tests, the latter being the only one performed in routine clinical care. Accurate and easy to use techniques were lacking to assess pyloric function in health and disease. Recently, pyloric distensibility has been developed and validated to assess pyloric opening. Several studies confirmed that pyloric distensibility was decreased in gastroparesis and correlated with gastric emptying as well as gastroparesis symptoms. In addition, pyloric distensibility may predict outcome of endoscopic techniques targeting the pylorus, namely intra-pyloric botulinum toxin injection and gastric per-oral pyloromyotomy. Pyloric distensibility appears therefore to be a promising and useful new tool in the workup of gastroparesis patients

Gastric Electrical Stimulation: Role and Clinical Impact on Chronic Nausea and Vomiting

International audienceGastric electrical stimulation (GES) is currently used as an alternative treatment for medically refractory gastroparesis. GES has been initially developed to accelerate gastric motility, in order to relieve the symptoms of the patients. Subsequent studies, unfortunately, failed to demonstrate the acceleration of gastric emptying using high-frequency stimulation – low energy stimulation although the technique has shown a clinical impact with a reduction of nausea and vomiting for patients with gastroparesis. The present review details the clinical efficacy of GES in gastroparesis as well as its putative mechanisms of action

Botulinum toxin: endoscopic treatment in fecal incontinence after ileoanal anastomosis

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Gastroparesis in Parkinson Disease: Pathophysiology, and Clinical Management

International audiencePatients with Parkinson disease (PD) experience a range of non-motor symptoms, including gastrointestinal symptoms. These symptoms can be present in the prodromal phase of the disease. Recent advances in pathophysiology reveal that α-synuclein aggregates that form Lewy bodies and neurites, the hallmark of PD, are present in the enteric nervous system and may precede motor symptoms. Gastroparesis is one of the gastrointestinal involvements of PD and is characterized by delayed gastric emptying of solid food in the absence of mechanical obstruction. Gastroparesis has been reported in nearly 45% of PD. The cardinal symptoms include early satiety, postprandial fullness, nausea, and vomiting. The diagnosis requires an appropriate test to confirm delayed gastric emptying, such as gastric scintigraphy, or breath test. Gastroparesis can lead to malnutrition and impairment of quality of life. Moreover, it might interfere with the absorption of antiparkinsonian drugs. The treatment includes dietary modifications, and pharmacologic agents both to accelerate gastric emptying and relieve symptoms. Alternative treatments have been recently developed in the management of gastroparesis, and their use in patients with PD will be reported in this review

Modulation peptidergique au cours de la stimulation électrique gastrique

La stimulation électrique gastrique est une nouvelle thérapie améliorant les symptômes des patients gastroparétiques sans modifier la vidange gastrique. Dans ce travail, nous avons d abord démontré que l efficacité clinique de cette technique est indépendante de la vidange gastrique. Puis nous avons mis en évidence chez le rat que cette thérapie pouvait moduler l activité des neurones à corticotropin-releasing factor hypothalamiques, et ce de manière indépendante de la voie vagale. La modulation du système nerveux central par la stimulation électrique gastrique peut recruter soit les afférences spinales, soit être secondaire à la libération des peptides gastriques dans la circulation. Parmi ceux-ci, la ghréline ainsi que les urocortines sont potentiellement impliquées, compte-tenu de leurs effets sur la motricité digestive et la prise alimentaire. A l inverse, l obestatine, codée par le gène de la ghréline, n est probablement pas mise en jeu compte tenu de son absence d effets sur ces paramètres.Gastric electrical stimulation is a new therapy to relief symptoms of gastroparetic patients without affecting gastric emptying. In the present work, we first evidence that clinical improvement during this therapy was unrelated to gastric emptying. We next demonstrated in rats that gastric electrical stimulation could modulate hypothalamic corticotropin-releasing factor producing neurons, the later being vagal-independent. Then, this technique is likely to modulate central nervous system either by recruiting spinal afferent or though the release of gastric peptides in the bloodstream. Among them, ghrelin and urocortins are susceptible to explain such effect since they display significant effects on gastric motility and food intake. On the other hand, obestatin, encoded by the ghrelin gene, ihas no effect on feeding and digestive and does not represent a good candidate.ROUEN-BU Sciences (764512102) / SudocROUEN-BU Sciences Madrillet (765752101) / SudocSudocFranceF

Gastric electrical stimulation is safe during pregnancy and delivery: Results from a French cohort

Abstract Background Gastric electrical stimulation (GES) is an effective therapy in medically refractory chronic nausea and vomiting. GES is assumed to be a contraindication for pregnancy. We examined the safety of GES during pregnancy and its clinical impact on vomiting symptoms. Methods A retrospective study was performed in two tertiary centers including all female patients of childbearing age implanted with GES. Patients without pregnancy while on GES were asked about their desire and concerns about pregnancy. Patients who were pregnant while on GES therapy were interviewed about the course of the pregnancy and labor, as well as the health of the children. Key Results Among 91 patients implanted at childbearing age, 54 patients without pregnancy answered the questionnaire. Nine patients (16.7%) reported a desire for pregnancy and five patients (7.4%) reported worries about the safety of GES during pregnancy. Sixteen pregnancies were reported in 10 patients. All pregnancies ended in a live birth with premature birth in 12 pregnancies (75.0%). No health concern was currently noted in these children. No severe GES‐related complications occurred during pregnancy with only pain at the implantation site reported during 3 pregnancies (18.8%). The severity and frequency of nausea and vomiting significantly increased during the first trimester ( p = 0.04 and p = 0.005, respectively) and decreased after the delivery, becoming lower than before the pregnancy ( p = 0.044 and p = 0.011, respectively). Conclusion & Inferences Patients are concerned regarding pregnancy while being treated with GES. No serious maternal or fetal complications related to GES were noted in our cohort

Fructose and irritable bowel syndrome

International audienceIrritable bowel syndrome (IBS) is a chronic disorder characterised by recurrent abdominal pain or discomfort and transit disturbances with heterogeneous pathophysiological mechanisms. The link between food and gastrointestinal (GI) symptoms is often reported by patients with IBS and the role of fructose has recently been highlighted. Fructose malabsorption can easily be assessed by hydrogen and/or methane breath test in response to 25 g fructose; and its prevalence is about 22 % in patients with IBS. The mechanism of fructose-related symptoms is incompletely understood. Osmotic load, fermentation and visceral hypersensitivity are likely to participate in GI symptoms in the IBS population and may be triggered or worsened by fructose. A low-fructose diet could be integrated in the overall treatment strategy, but its role and implication in the improvement of IBS symptoms should be evaluated. In the present review, we discuss fructose malabsorption in adult patients with IBS and the interest of a low-fructose diet in order to underline the important role of fructose in IBS