RESUMO

GOAL: The goal of this study was to determine the relationship of reflux with gastroparesis (Gp), looking both at symptoms and objective testing. BACKGROUND: Gp patients often experience gastroesophageal reflux symptoms. How the severity of reflux correlates with the severity of Gp is not known. STUDY: Patients referred to our academic center with symptoms of Gp completed the Patient Assessment of Upper Gastrointestinal Symptoms, Hospital Anxiety and Depression Scale, and Patient Health Questionnaire (PHQ)-15. They underwent 4-hour gastric emptying scintigraphy; and, if indicated, high-resolution esophageal manometry and esophageal pH impedance (EpHI). RESULTS: Of 755 patients from July 2013 to May 2018, 432 had Gp with Gastroparesis Cardinal Symptom Index (GCSI) total score of 3.2±0.1 (mean±SEM) and heartburn/regurgitation subscore of 2.0±0.1. A fourth (27.1%) of all Gp patients had moderate to very severe heartburn/regurgitation symptoms. Heartburn/regurgitation subscore had strong correlation with GSCI total score (r=0.56, P<0.01), and weak correlation with 4-hour gastric retention (r=0.11, P=0.02). In total, 103 Gp patients underwent EpHI monitoring; time esophageal pH<4 had no correlation with heartburn/regurgitation subscore. Less than half (41.7%) of the patients undergoing EpHI had gastroesophageal reflux disease by EpHI. Gp patients with gastroesophageal reflux disease had more severe 4-hour gastric retention, and more frequently had decreased lower esophageal sphincter resting pressure and esophageal motility disorders. Heartburn/regurgitation subscore had moderate correlation with somatic symptoms, and weak correlations with anxiety and depression. CONCLUSIONS: The severity of reflux symptoms in Gp has strong correlation with GCSI total score, weak correlation with gastric retention, and no correlation with esophageal pH monitoring.

Assuntos

Refluxo Gastroesofágico , Gastroparesia , Monitoramento do pH Esofágico , Esvaziamento Gástrico , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico , Gastroparesia/diagnóstico , Gastroparesia/etiologia , Azia/diagnóstico , Azia/etiologia , Humanos , Manometria

RESUMO

OBJECTIVE: To outline the use and utility of gastric electric stimulation (GES) as a therapeutic intervention for gastroparesis. METHODS: Review of the literature. RESULTS: Gastroparesis is characterized by delayed gastric emptying, with symptoms of nausea, vomiting, early satiety, postprandial fullness, and abdominal pain. Some patients with gastroparesis do not respond to medical intervention, and for these patients surgical intervention may be warranted. GES utilizes high-frequency gastric neurostimulation to facilitate gastric emptying and reduce symptoms of gastroparesis. It is indicated for patients with idiopathic and diabetic gastroparesis who have nausea and vomiting as their primary symptoms and who have not responded to medical therapy. GES has also been used in postsurgical and pediatric gastroparesis patients. Optimizing the outcome of this surgical treatment through proper patient selection and meticulous surgical technique is essential as there are inherent risks to the procedure. Nonblinded studies of GES for medically refractory gastroparesis have demonstrated therapeutic symptomatic benefit, whereas randomized controlled trials have not. New interventions such as pyloromyotomy and pyloroplasty are reasonable alternatives or addendums to GES. CONCLUSION: GES may be considered among the therapies available for treating patients with refractory symptoms of gastroparesis. More studies, specifically those comparing GES, pyloromyotomy, GES combined with pyloromyotomy, and placebo, are needed to help guide therapy selection for refractory gastroparesis.

RESUMO

Cholestatic pattern on the hepatic panel is common and can be caused by a broad array of etiologies. Although rare, with a prevalence as low as 0.06%, it is imperative to keep Mirizzi syndrome in the differential diagnosis when evaluating cholestasis. Due to the nonspecific presentation and inconsistent radiologic features, a high index of suspicion is needed to diagnose Mirizzi Syndrome. We present an unusual case of a 51-year-old man with worsening cholestatic laboratory tests and a normal ultrasound and abdominal computerized tomography. A technetium99m mebrofenin hepatobiliary acid scan suggested the diagnosis of Mirizzi syndrome that was later confirmed during an open cholecystectomy.

RESUMO

The adverse effects of mycophenolate mofetil on the colon are well known. However, isolated small intestinal involvement resulting in diarrhea and severe weight loss is infrequently reported in the literature. We present the case of a 45-year-old woman on mycophenolate mofetil following renal transplant, who presented with abdominal pain and weight loss. An esophagogastroduodenoscopy and colonoscopy with biopsies were normal. A small bowel capsule study revealed extensive enteropathy of jejunum and ileum that was confirmed on a push enteroscopy with biopsies. Her symptoms completely resolved after being switched to enteric-coated mycophenolic acid.