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Query: UMLS:C1291077 (bloating)
 1,674 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The pathophysiology, diagnosis, and treatment of diabetic gastroparesis are reviewed, and the mechanisms of action, pharmacokinetics, clinical efficacy, adverse effects, and dosage of metoclopramide, domperidone, and cisapride are described. Diabetic gastroparesis is a state of delayed gastric emptying that reportedly affects 20-30% of diabetic patients. Symptoms include nausea, early satiety, postprandial bloating and fullness, and vomiting. Diabetic gastroparesis has been managed most successfully with drugs that stimulate gastric emptying. Of the three agents studied--metoclopramide, domperidone, and cisapride--only metoclopramide is commercially available in the United States. The clinical efficacy of metoclopramide, domperidone, and cisapride has been well documented in several placebo-controlled trials. Metoclopramide effectively decreases mean gastric emptying time, although tolerance to this stimulation of gastric emptying may develop with long-term therapy. However, symptomatic relief persists with long-term therapy because of metoclopramide's antiemetic properties. Domperidone, which has also been shown to stimulate gastric motility and to possess antiemetic properties, improves symptoms in patients suffering from diabetic gastroparesis. Cisapride appears to have continued beneficial effects on gastric motility with long-term therapy. All three agents have favorable adverse-effect profiles. Although metoclopramide is currently the first-line agent for the management of gastroparesis, domperidone and cisapride both possess properties that may make them useful alternatives in patients who are unresponsive to or cannot tolerate metoclopramide therapy.
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PMID:Use of metoclopramide, domperidone, and cisapride in the management of diabetic gastroparesis. 219 Jul 45

This study investigated whether domperidone could improve gastrointestinal symptoms in patients with Parkinson's disease who were receiving levodopa therapy. A total of 11 patients were studied. Following a baseline gastric emptying test, patients were treated with a starting dose of domperidone 20 mg p.o. q.i.d. A follow-up gastric emptying test was repeated at least 4 months after starting domperidone therapy. At the beginning and at each 3-month follow-up visit, symptoms of nausea, vomiting, anorexia, abdominal bloating, heartburn, regurgitation, dysphagia, and constipation were evaluated and scored on a scale of 0-3. The overall mean follow-up period was 3 years. Compared with their baseline evaluation, patients experienced a significant improvement in all symptoms (p < 0.05) except dysphagia and constipation. Gastric emptying of an isotope-labeled solid meal was significantly faster, with a baseline result of 60.2 +/- 6.4% retention of isotope 2 h after the meal compared with 37.0 +/- 2.2% retention during domperidone therapy (p < 0.05). Patients' global assessment of Parkinson's disease remained stable or improved. Serum prolactin was elevated in all patients after domperidone therapy (p < 0.05). Domperidone therapy significantly reduces upper gastrointestinal symptoms and accelerates gastric emptying of a solid meal, but does not interfere with response to antiparkinsonism treatment.
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PMID:Effect of chronic oral domperidone therapy on gastrointestinal symptoms and gastric emptying in patients with Parkinson's disease. 939 20

Functional dyspepsia includes one or more of four cardinal symptoms: postprandial fullness, early satiety, pain or burning in the epigastrum. According to the Rome III diagnostic criteria for functional dyspepsia, these symptoms must be present for the last 3 months with symptom onset at least 6 months prior to diagnosis. Functional dyspepsia is not the result of an underlying structural abnormality, but rather the consequence of multiple pathophysiological mechanisms such as abnormal gastric motility, gastric and duodenal hypersensitivity to acid, Helicobacter pylori infection. Dyspeptic patients over 50 or those with alarm symptoms should be investigated to detect any structural abnormality such as cancer, peptic ulcer or esophagitis. After structural abnormalities and gastroesophageal reflux disease are excluded the management of functional dyspepsia consists of either a test and treat approach (non invasive detection of Helicobacter pylori infection followed by eradication therapy) or empirical therapy. Although endoscopy was traditionally reserved for those patients without symptom relief after 6-8 weeks of therapy, the significant percentage of patients with functional dyspepsia with symptom breakthrough or relapse after antisecretory or prokinetic therapy discontinuation makes an initial endoscopic study a logical choice. Therapy with proton pump inhibitors yields results especially in those patients with regurgitation and epigastric burning sensation, while prokinetic agents with no extrapyramidal side effects (such as Domperidone and Itopride) alleviate satiation, bloating and nausea by accelerating gastric emptying. Second-line drugs with encouraging results in clinical trials which can be used in functional dyspepsia are low-dose tricyclic antidepressants as well as selective serotonine reuptake inhibitors.
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PMID:Functional dyspepsia: a pragmatic approach. 2118 Feb 36