Jennifer Eversmann

A Novel Classification Scheme for Gastroparesis Based on Predominant-Symptom Presentation

Aim Symptoms of gastroparesis are very diverse. Classifying patients by predominant symptom may improve management strategy. Goal To validate a new symptom-predominant classification for gastroparesis using symptom severity and quality-of-life measures. Study Subjects with gastroparesis for >2 months were prospectively enrolled. A physician classified each subject into one of the following: vomiting-predominant, dyspepsia-predominant, or regurgitation-predominant gastroparesis. Subjects also classified themselves independently from the physician. Each subject completed a Patient Assessment of Gastrointestinal Disorders–Symptom Severity Index (PAGI-SYM) and SF-12v2 Health-Related Quality-Of-Life survey. Receiver operating characteristic curves were constructed with sensitivity and specificity of each PAGI-SYM subscale to differentiate subjects into symptom-predominant subgroups. Area under the curve (AUC) was used to compare the receiver operating characteristic curves. Analysis of variance, Cohens kappa (κ) statistic, student t test, and Pearson correlation (r) were used. Results One hundred subjects (87 females, mean 48 y) were enrolled. There was a 78% concordance between physician and subjects classification of gastroparesis with substantial correlation (κ=0.64). PAGI-SYM nausea/vomiting subscale (AUC=0.79) and PAGI-SYM heartburn/regurgitation subscale (AUC=0.73) were the best in differentiating subjects into vomiting-predominant and regurgitation-predominant gastroparesis, respectively. No subscale was adequate to differentiate dyspepsia-predominant gastroparesis. SF-12v2 total scores significantly correlated with worsening of the total PAGI-SYM scores (r=–0.339 to –0.600, all P<0.001). Conclusions There was a substantial agreement between physician and patient using a symptom-predominant gastroparesis classification. Results suggest that a predominant-symptom classification is a valid means to categorize subjects with vomiting-predominant and regurgitation-predominant gastroparesis. Patients with dyspepsia and delayed gastric emptying need further research.

Pharmacokinetic profile of immediate-release omeprazole in patients with gastro-oesophageal reflux associated with gastroparesis

Aliment Pharmacol Ther 31, 516–522

Effects on Segmental GI Transit and Physiologic Parameters by Lubiprostone in Patients With Chronic Idiopathic Constipation

baseline characteristics were similar between TGD 300 mg/d (n = 23), TGD 900 mg/d (n = 22), and placebo (n = 19) groups, including hemoglobin A1c (HbA1c), blood insulin, body mass index (BMI), triglyceride, low-density lipoprotein cholesterol (LDL-C), high-molecularweight (HMW) adiponectin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and diastolic blood pressure. At 12 weeks, TGD 300 mg/d and TGD 900 mg/d significantly (p < 0.05 and p < 0.01) reduced HbA1c (0.1% and 0.21%) and insulin concentration (2.8 and 3.6 μU/mL), respectively, versus placebo. TGD 300 mg/d and TGD 900 mg/d also significantly (p < 0.01 and p < 0.05, respectively) reduced LDL-C (9 and 7 mg/dL, respectively). TGD 900 mg/d significantly reduced triglyceride by 21 mg/dL (p < 0.05) and diastolic blood pressure by 8 mmHg (p < 0.01). Placebo was associated with a significant (p < 0.05) increase from baseline in BMI, ALT, and AST (0.17 kg/m2, 3, and 2 U/L, respectively), whereas TGD was not. TGD 300 mg/d significantly (p < 0.05) increased HMW adiponectin by 0.6 mg/mL. Adverse events did not differ significantly between the groups. From T-RFLP analysis, the clusters to which saccharometabolism improvement effect by TGD was invalid existed. Conclusions: Intake of transglucosidase for 12 weeks in subjects with T2DM resulted in lowering of HbA1c and blood insulin level, and improvements in metabolic and cardiovascular risk factors.

Delayed Colonic Transit is Associated With a Decrease of the Normal Predominant Bacteria in the Colon Microbiota

Introduction/Aims: Post-infectious irritable bowel syndrome (PI-IBS) may develop in 4% to 30% of affected patients following bacterial gastroenteritis (GE), but limited information is available on outcome of viral GE. During summer 2009 a massive outbreak of viral GE associated with contamination of municipal drinking water (Norovirus and Enterovirus) occurred in San Felice del Benaco (Lake Garda, Italy) [1]. In order to investigate the natural history of a community outbreak of viral GE and to assess the incidence of functional gastrointestinal disorders and PI-IBS, we carried out a prospective population-based cohort study with control group. Methods: Baseline questionnaires were administered to the resident community within one month of the outbreak. Follow-up questionnaires of the Italian version of Gastrointestinal Symptom Rating Scale (GSRS, a 15 item survey scored according to a 7-point Likert scale) were mailed to all patients responding to baseline questionnaire at 3 and 6 months and to a cohort of unaffected controls, living in the same geographical area, at 6 months after the outbreak. GSRS itemwere grouped into five dimensions: abdominal pain, reflux, indigestion, diarrhea and constipation. At month 12 all patients and controls were interviewed by an health assistant in order to verify Rome III criteria of IBS. T-test and χ2 or fishers exact test were used as appropriate. Results: Baseline questionnaires were returned by 348 patients: mean age ± SD 45 ± 22 years, 53% female. At outbreak nausea (scored ≥4), vomiting and diarrhea lasting 2-3 days or more were reported by 66%, 60% and 77% of patients, respectively. Fifty percent reported fever and 19% referred weight loss (mean 3 Kg). Follow-up surveys were returned at month 6 by 185 patients and 168 controls: mean of GSRS score for each dimension is reported in the figure. At month 12 we identified 40 patients with a new diagnosis of IBS (Rome III criteria), in comparison with 3 subjects in the control cohort (p<0.0001; OR 11.40, 3.44-37.82, 95%CI). The 40 cases of PI-IBS, according to the subclassification of IBS by predominant stool pattern [2], were subtyped as follow: 4 IBS with constipation, 7 IBS with diarrhea, 16 with mixed IBS and 13 with unsubtyped IBS. Conclusion: Our study provides evidence that mixed Norovirus and Enterovirus GE may lead to post-infectious gastrointestinal disordes which persist for at least 12 month after infection. PI-IBS following viral infections develops in a substantial proportion of patients (22%) similar to that reported after bacterial GE. References: 1) Scarcella et al. Eurosurveillance 2009 2) Longstreth et al, Gastroenterology 2006.