Gastroparesis refers to abnormal gastric motility characterized by delayed gastric emptying in the absence of mechanical obstruction. The most common etiologies include diabetes, post-surgical and idiopathic. The most...Gastroparesis refers to abnormal gastric motility characterized by delayed gastric emptying in the absence of mechanical obstruction. The most common etiologies include diabetes, post-surgical and idiopathic. The most common symptoms are nausea, vomiting and epigastric pain. Gastroparesis is estimated to affect 4% of the population and symptomatology may range from little effect on daily activity to severe disability and frequent hospitalizations. The gold standard of diagnosis is solid meal gastric scintigraphy. Treatment is multimodal and includes dietary modification, prokinetic and anti-emetic medications, and surgical interventions. New advances in drug therapy, and gastric electrical stimulation techniques have been introduced and might provide new hope to patients with refractory gastroparesis. In this comprehensive review, we discuss gastroparesis with emphasis on the latest developments; from the perspective of the practicing clinician.展开更多
Functional dyspepsia(FD)and gastroparesis are two common functional gastrointestinal diseases,affecting millions of people in both China and around the world.However,treatment options are limited and difficult due to ...Functional dyspepsia(FD)and gastroparesis are two common functional gastrointestinal diseases,affecting millions of people in both China and around the world.However,treatment options are limited and difficult due to multiple factors involved in their pathophysiologies.Therefore it is critically important to assess and understand pathophysiologies of these diseases before a treatment is given.In this minireview we provide updates on recent development in the pathophysiologies and treatments of FD and gastroparesis.In addition to common abnormalities in gastric accommodation,antral hypomotility and visceral hypersensitivity,FD has recently been reported to display a number of impairment in duodenal functions,such as low-grade inflammation and increased permeability.For gastroparesis,macrophages have recently been reported to play an important role in its pathophysiology.A brief overview on the assessment of pathophysiologies of FD and gastroparesis is also provided;pros and cons of clinically available methodologies as well as emerging methods are discussed.Finally,available treatment options for FD and gastroparesis are presented in this minireview,including authors′opinions on the advantages and disadvantages of each therapy.Potential novel therapies for FD and gastroparesis,especially those associated with Traditional Chinese Medicine,are also introduced and discussed.展开更多
Early involvement of gut is observed in Parkinson’s disease (PD) and symptoms such as constipation may precede motor symptoms. α-Synuclein pathology is extensively evident in the gut and appear...Early involvement of gut is observed in Parkinson’s disease (PD) and symptoms such as constipation may precede motor symptoms. α-Synuclein pathology is extensively evident in the gut and appears to follow a rostrocaudal gradient. The gut may act as the starting point of PD pathology with spread toward the central nervous system. This spread of the synuclein pathology raises the possibility of prion-like propagation in PD pathogenesis. Recently, the role of gut microbiota in PD pathogenesis has received attention and some phenotypic correlation has also been shown. The extensive involvement of the gut in PD even in its early stages has led to the evaluation of enteric α-synuclein as a possible biomarker of early PD. The clinical manifestations of gastrointestinal dysfunction in PD include malnutrition, oral and dental disorders, sialorrhea, dysphagia, gastroparesis, constipation, and defecatory dysfunction. These conditions are quite distressing for the patients and require relevant investigations and adequate management. Treatment usually involves both pharmacological and non-pharmacological measures. One important aspect of gut dysfunction is its contribution to the clinical fluctuations in PD. Dysphagia and gastroparesis lead to inadequate absorption of oral anti-PD medications. These lead to response fluctuations, particularly delayed-on and no-on, and there is significant relationship between levodopa pharmacokinetics and gastric emptying in patients with PD. Therefore, in such cases, alternative routes of administration or drug delivery systems may be required.展开更多
文摘Gastroparesis refers to abnormal gastric motility characterized by delayed gastric emptying in the absence of mechanical obstruction. The most common etiologies include diabetes, post-surgical and idiopathic. The most common symptoms are nausea, vomiting and epigastric pain. Gastroparesis is estimated to affect 4% of the population and symptomatology may range from little effect on daily activity to severe disability and frequent hospitalizations. The gold standard of diagnosis is solid meal gastric scintigraphy. Treatment is multimodal and includes dietary modification, prokinetic and anti-emetic medications, and surgical interventions. New advances in drug therapy, and gastric electrical stimulation techniques have been introduced and might provide new hope to patients with refractory gastroparesis. In this comprehensive review, we discuss gastroparesis with emphasis on the latest developments; from the perspective of the practicing clinician.
文摘Functional dyspepsia(FD)and gastroparesis are two common functional gastrointestinal diseases,affecting millions of people in both China and around the world.However,treatment options are limited and difficult due to multiple factors involved in their pathophysiologies.Therefore it is critically important to assess and understand pathophysiologies of these diseases before a treatment is given.In this minireview we provide updates on recent development in the pathophysiologies and treatments of FD and gastroparesis.In addition to common abnormalities in gastric accommodation,antral hypomotility and visceral hypersensitivity,FD has recently been reported to display a number of impairment in duodenal functions,such as low-grade inflammation and increased permeability.For gastroparesis,macrophages have recently been reported to play an important role in its pathophysiology.A brief overview on the assessment of pathophysiologies of FD and gastroparesis is also provided;pros and cons of clinically available methodologies as well as emerging methods are discussed.Finally,available treatment options for FD and gastroparesis are presented in this minireview,including authors′opinions on the advantages and disadvantages of each therapy.Potential novel therapies for FD and gastroparesis,especially those associated with Traditional Chinese Medicine,are also introduced and discussed.
文摘Early involvement of gut is observed in Parkinson’s disease (PD) and symptoms such as constipation may precede motor symptoms. α-Synuclein pathology is extensively evident in the gut and appears to follow a rostrocaudal gradient. The gut may act as the starting point of PD pathology with spread toward the central nervous system. This spread of the synuclein pathology raises the possibility of prion-like propagation in PD pathogenesis. Recently, the role of gut microbiota in PD pathogenesis has received attention and some phenotypic correlation has also been shown. The extensive involvement of the gut in PD even in its early stages has led to the evaluation of enteric α-synuclein as a possible biomarker of early PD. The clinical manifestations of gastrointestinal dysfunction in PD include malnutrition, oral and dental disorders, sialorrhea, dysphagia, gastroparesis, constipation, and defecatory dysfunction. These conditions are quite distressing for the patients and require relevant investigations and adequate management. Treatment usually involves both pharmacological and non-pharmacological measures. One important aspect of gut dysfunction is its contribution to the clinical fluctuations in PD. Dysphagia and gastroparesis lead to inadequate absorption of oral anti-PD medications. These lead to response fluctuations, particularly delayed-on and no-on, and there is significant relationship between levodopa pharmacokinetics and gastric emptying in patients with PD. Therefore, in such cases, alternative routes of administration or drug delivery systems may be required.
