Amol Sharma

Prevalence and risk factors for gastroesophageal reflux disease in an impoverished minority population.

SUMMARY BACKGROUND AND AIMS An epidemiological link between an increased body mass index and complaints of typical heartburn symptoms has been identified. It appears that increasing waist circumference, rather than overall weight is most important. Studies to date have not included minority, impoverished communities. Our aim was to determine the impact of obesity on the prevalence of reflux disease in an impoverished community while controlling for known confounders. METHODS DESIGN Cross-sectional survey delivered by in-home interviews, convenience sampling, and targeted mailing. Data queried include demographics, medical history, lifestyle habits, and symptoms of reflux disease. Height, weight, hip and waist circumference measured in participating subjects. PARTICIPANTS 503 subjects living in the zip code immediately surrounding Temple University Hospital. Included only adults living in the hospitals zip code for at least 3 years. RESULTS The highest quartile of waist circumference (≥42 in.) demonstrated a strong association with GERD (AOR = 2.15; 95% CI 1.18-3.90). Smoking increased the odds by 1.72 (95% CI 1.13-2.62). There was no relationship between body mass index, waist-hip ratio, or diet and reflux classification. CONCLUSIONS Increasing waist circumference, but not overall body mass index or waist-hip ratio, and smoking are risk factors for prevalent GERD. No association between reflux disease and lifestyle choices such as coffee drinking and fast food dining were found. LIMITATIONS Potential for recall bias and disease misclassification. Possible methodological errors in self-measurement of waist and hip circumference.

Constipation in Parkinson’s Disease: a Nuisance or Nuanced Answer to the Pathophysiological Puzzle?

Purpose of ReviewChronic constipation is a common, nonmotor, and prodromal symptom in Parkinson’s disease (PD). Its underlying neuropathology may provide pathophysiological insight into PD. Here, we critically review what is currently known about the neuroanatomical and brain-gut interactions, and the origin and progression of Lewy pathology (LP) at three levels—brain/brainstem, spinal cord, and enteric nervous system.Recent FindingsMany recent studies have illustrated the challenges of examining LP in tissues obtained from colon biopsies of PD patients. Large-scale epidemiological studies have not confirmed the widely accepted Braakpostula.SummaryIn this review, we propose an alternative origin and route of spread of LP in PD. We describe novel, noninvasive neurophysiological testing that could advance the understanding of LP and complex bidirectional brain-pelvic floor neural pathways in PD—a true disease model of a neurogastrointestinal disorder. This review may provide the impetus for future studies investigating gut and brain interaction and constipation in PD.

Pathology of Gastroparesis

While symptoms of gastroparesis are defined, the pathogenesis of this condition is poorly understood. Furthermore, gastric emptying scintigraphy, the gold standard for diagnostic testing, does not correlate with symptom severity. Some patients with the classic constellation of symptoms for gastroparesis have normal or near-normal gastric emptying patterns. Uncertainty of underlying pathophysiology underscores the struggle to develop effective therapies. The inability of the stomach to effectively empty its solid and liquid contents into the duodenum in the absence of a mechanical obstruction defines gastroparesis. Gastric emptying is dependent on well-coordinated efforts by multiple components in the gastric wall. Different cells, structures, and mechanisms are hypothesized to be responsible for gastroparesis. Currently, however there is a lack of histopathologic evidence to substantiate most of these hypotheses.