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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diabetic gastroparesis is defined as delayed gastric emptying without mechanical obstruction in the setting of diabetes. Symptoms range from mild bloating to severe vomiting episodes and can result in frequent hospitalizations and poor quality of life. It is suspected that diabetic gastroparesis is underdiagnosed due to its similar presentation to other conditions such as gastroesophageal reflux disease. The pathogenesis of diabetic gastroparesis remains unclear, but proposed mechanisms include vagal dysfunction, hyperglycemia, interstitial cells of Cajal network disturbances, loss of neural nitric oxide synthase expression in the myenteric plexus, and oxidative stress. Current management for diabetic gastroparesis focuses on dietary and lifestyle changes as well as improved glycemic control. Limited options for medical therapies are available that include prokinetic and antiemetic medications. Metoclopramide is the only FDA-approved medication for the treatment of gastroparesis. Metoclopramide improves symptoms of gastroparesis although extended treatment presents challenges such as decreased efficacy over time and increased risks for adverse events. We summarize the current knowledge of the pathophysiology of diabetic gastroparesis and review current and investigational treatments for diabetes gastroparesis.
J Diabetes Complications 2020 Sep 06
PMID:Diabetic gastroparesis: An overview of pathogenesis, clinical presentation and novel therapies, with a focus on ghrelin receptor agonists. 3294 98

BACKGROUND The aims of this study were to summarize the clinical characteristics and risk factors for bezoars and to analyze the effectiveness and safety of the endoscopic treatment of bezoars. MATERIAL AND METHODS From January 2015 to February 2020, 75 of the 23 950 patients who underwent gastroscopic examination in our medical center were diagnosed with bezoars. Clinical and treatment information for these patients was collected retrospectively and analyzed. RESULTS The detection rate of bezoars was 0.31%. Risk factors included the time of year (autumn and winter seasons), alcohol consumption, hypertension, diabetes, and residing in the Mentougou district, which is rich in hawthorn and persimmon. Abdominal pain (90.7%) and bloating (80.0%) were common clinical symptoms of bezoars, while gastric mucosa erosion (90.7%) and gastric ulcers (60%) were common manifestations on endoscopic examination. Six patients with bezoars were successfully discharged after drug treatment. The success rate for bezoars treated by gastroscopic lithotripsy was 94.2% (65/69 patients). The factors affecting the therapeutic effect of bezoars include patient age (P=0.025) and bezoar size (P=0.042). Patients with bezoars larger than 9 cm were significantly more likely to have intestinal obstructions than were patients with bezoars smaller than 9 cm (P<0.001). CONCLUSIONS Bezoars mainly occur in elderly patients with diseases such as gastrointestinal dyspraxia and diabetes, and are most common in hawthorn and persimmon producing areas. Endoscopic treatment is safe and effective for bezoars in general, but intestinal obstruction should be considered for bezoars larger than 9 cm.
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PMID:Clinical Features, Risk Factors, and Endoscopic Treatment of Bezoars: A Retrospective Analysis from a Single Center in Northern China. 3302 45

Mr. Editor: We present a patient underwent cryoballoon ablation for symptomatic atrial fibrillation with gastroparesis five days later. It was solved with conservative measures such as prokinetics. A 72-year-old woman with history of symptomatic paroxysmal atrial fibrillation treated with edoxaban. Pulmonary vein isolation, using a cryoballoon catheter, was performed. 5 days later she started with upper abdominal pain, bloating and vomiting. Computed tomography (CT) revealed marked gastric dilatation without any gastric or intestinal obstruction. Treatment with intravenous erythromycin was prescribed for 3 days and subsequently with oral cinitapride with good evolution. 10 days later, the disappearance of the findings with a stomach of normal dimensions without delay of gastric emptying is confirmed by esophagogastroduodenal transit. DISCUSSION Gastroparesis is an alteration characterized by a delayed gastric emptying in the absence of mechanical obstruction. It is usually manifested with postprandial fullness, belching and vomiting. The most frequent causes are: idiopathic, diabetes, Parkinson's, pharmacological and post-surgical (1). Cases of gastroparesis induced by ablation of the pulmonary veins have recently been described, which damages the periesophageal vagal plexus leading to gastric hypomotility (2,3). It is a rare but probably underdiagnosed complication because most patients remain asymptomatic. Additionally, the ablation with cryoballoon seems to increase the possibility of this collateral damage comparing to radiofrequency (2). Other risk factors associated to are: a small atrium, lower mean temperatures in the pulmonary vein and multiple applications (4). Radiology exams (radiography an CT scan) are normally enough to diagnose this entity. The diagnosis is made by radiography and CT. Although they are not able to quantify the delay of the gastric emptying they can appreciate the gastric dilatation and discard other causes. Confirmation by scintigraphy is not usually needed. In the cases described, the treatment used is prokinetic agents. Endoscopic treatment is saved for more severe patients (3). The new techniques of pulmonary ablation have increased the cases of symptomatic gastroparesis so it is important to recognize this trigger factor (2).
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PMID:GASTROPARESIS SECONDARY TO PULMONARY VEIN CRYOABLATION: A FACTOR TO CONSIDER. 3322 75


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