Assessment of Gastrointestinal Autonomic Dysfunction: Present and Future Perspectives
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
Pathophysiology and Management of Diabetic Gastroenteropathy
Pathophysiology and management of diabetic gastroenteropathy Meldgaard, Theresa; Keller, Jutta; Olesen, Anne Estrup; Olesen, Søren Schou; Krogh, Klaus; Borre, Mette; Farmer, Adam; Brock, Birgitte; Brock, Christina; Drewes, Asbjørn Mohr Published in: Therapeutic Advances in Gastroenterology DOI: 10.1177/1756284819852047 Publication date: 2019 Document version Publisher's PDF, also known as Version of record Document license: CC BY-NC Citation for published version (APA): Meldgaard, T., Keller, J., Olesen, A. E., Olesen, S. S., Krogh, K., Borre, M., Farmer, A., Brock, B., Brock, C., & Drewes, A. M. (2019). Pathophysiology and management of diabetic gastroenteropathy. Therapeutic Advances in Gastroenterology, 12, 1-17. https://doi.org/10.1177/1756284819852047 Download date: 01. Oct. 2021 TAG0010.1177/1756284819852047Therapeutic Advances in GastroenterologyT Meldgaard, J Keller 852047review-article20192019 Therapeutic Advances in Gastroenterology Review Ther Adv Gastroenterol Pathophysiology and management of 2019, Vol. 12: 1–17 DOI:https://doi.org/10.1177/1756284819852047 10.1177/ diabetic gastroenteropathy 1756284819852047https://doi.org/10.1177/1756284819852047 © The Author(s), 2019. Article reuse guidelines: Theresa Meldgaard, Jutta Keller, Anne Estrup Olesen, Søren Schou Olesen, Klaus Krogh, sagepub.com/journals- Mette Borre, Adam Farmer, Birgitte Brock, Christina Brock and Asbjørn Mohr Drewes permissions Abstract: Polyneuropathy is a common complication to diabetes. Neuropathies within the Correspondence to: Theresa Meldgaard enteric nervous system are associated with gastroenteropathy and marked symptoms that Mech-Sense, Department of Gastroenterology and severely reduce quality of life. Symptoms are pleomorphic but include nausea, vomiting, Hepatology, Aalborg dysphagia, dyspepsia, pain, bloating, diarrhoea, constipation and faecal incontinence. The University Hospital, aims of this review are fourfold. First, to provide a summary of the pathophysiology underlying Denmark Department of Clinical diabetic gastroenteropathy. -
New Developments in Prokinetic Therapy for Gastric Motility Disorders
REVIEW published: 24 August 2021 doi: 10.3389/fphar.2021.711500 New Developments in Prokinetic Therapy for Gastric Motility Disorders Michael Camilleri* and Jessica Atieh Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States Prokinetic agents amplify and coordinate the gastrointestinal muscular contractions to facilitate the transit of intra-luminal content. Following the institution of dietary recommendations, prokinetics are the first medications whose goal is to improve gastric emptying and relieve symptoms of gastroparesis. The recommended use of metoclopramide, the only currently approved medication for gastroparesis in the United States, is for a duration of less than 3 months, due to the risk of reversible or irreversible extrapyramidal tremors. Domperidone, a dopamine D2 receptor antagonist, is available for prescription through the FDA’s program for Expanded Access to Investigational Drugs. Macrolides are used off label and are associated with tachyphylaxis and variable duration of efficacy. Aprepitant relieves some symptoms of gastroparesis. There are newer agents in the pipeline targeting diverse gastric (fundic, antral and pyloric) motor functions, including novel serotonergic 5-HT4 agonists, dopaminergic D2/3 antagonists, neurokinin NK1 antagonists, and ghrelin agonist. Novel Edited by: targets with potential to improve gastric motor functions include the pylorus, macrophage/ Jan Tack, inflammatory function, oxidative -
Autonomic Nervous System Dysfunction Involving the Gastrointestinal and the Urinary Tracts in Primary Sjögren’S Syndrome
Autonomic nervous system dysfunction involving the gastrointestinal and the urinary tracts in primary Sjögren’s syndrome L. Kovács1, M. Papós2, R. Takács3, R. Róka2, Z. Csenke4, A. Kovács1, T. Várkonyi3, L. Pajor5, L. Pávics2, G. Pokorny1 Department of Rheumatology1, Department of Nuclear Medicine2, 1st Department of Internal Medicine3 and Department of Urology5, University of Szeged, Faculty of Medicine, Szeged; Division of Urology, Municipial Clinic, Szeged, Hungary4 Abstract Objective Antibodies reacting with the m3 subtype muscarinic acetylcholine receptor appear to be an important patho- genic factor in primary Sjögren’s syndrome (pSS). As this receptor subtype is functionally important in the gastrointestinal and urinary tracts, and very little is known about the autonomic nervous system function in these organs in pSS patients, the occurrence and clinical significance of an autonomic nervous system dysfunction involving the gastrointestinal and urinary tracts were investigated. Methods Data on clinical symptoms attributable to an autonomic dysfunction were collected from 51 pSS patients. Gastric emptying scintigraphy and urodynamic studies were performed on 30 and 16 patients, respectively, and the results were correlated with patient characteristics and with the presence of autonomic nervous system symptoms. Results Gastric emptying was abnormally slow in 21 of the 30 examined patients (70%). Urodynamic findings compatible with a decreased detrusor muscle tone or contractility were found in 9 of the 16 patients tested (56%). Various symptoms of an autonomic nervous system dysfunction were reported by 2-16% of the patients. Conclusion Signs of an autonomic nervous system dysfunction involving the gastrointestinal and the urinary systems can be observed in the majority of pSS patients. -
Pharmacological Agents Currently in Clinical Trials for Disorders in Neurogastroenterology
Pharmacological agents currently in clinical trials for disorders in neurogastroenterology Michael Camilleri J Clin Invest. 2013;123(10):4111-4120. https://doi.org/10.1172/JCI70837. Clinical Review Esophageal, gastrointestinal, and colonic diseases resulting from disorders of the motor and sensory functions represent almost half the patients presenting to gastroenterologists. There have been significant advances in understanding the mechanisms of these disorders, through basic and translational research, and in targeting the receptors or mediators involved, through clinical trials involving biomarkers and patient responses. These advances have led to relief of patients’ symptoms and improved quality of life, although there are still significant unmet needs. This article reviews the pipeline of medications in development for esophageal sensorimotor disorders, gastroparesis, chronic diarrhea, chronic constipation (including opioid-induced constipation), and visceral pain. Find the latest version: https://jci.me/70837/pdf Review Pharmacological agents currently in clinical trials for disorders in neurogastroenterology Michael Camilleri Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Mayo Clinic, Rochester, Minnesota, USA. Esophageal, gastrointestinal, and colonic diseases resulting from disorders of the motor and sensory functions represent almost half the patients presenting to gastroenterologists. There have been significant advances in under- standing the mechanisms of these disorders, through basic and translational research, and in targeting the recep- tors or mediators involved, through clinical trials involving biomarkers and patient responses. These advances have led to relief of patients’ symptoms and improved quality of life, although there are still significant unmet needs. This article reviews the pipeline of medications in development for esophageal sensorimotor disorders, gastropa- resis, chronic diarrhea, chronic constipation (including opioid-induced constipation), and visceral pain. -
Peripheral Neuropathy Diagnostic Services
Peripheral Neuropathy Diagnostic Services Approximately 1 out of every 15 people (20 million) suffer from Neuropathy and more than 30% of all Neuropathies stem from Diabetes. Digirad provides Peripheral Neuropathy diagnostic services to healthcare providers that treat patients who are at risk from autonomic dysfunction or autonomic neuropathy. Adding these services is convenient for your patients and provides a new revenue stream for your practice. Program Overview The Peripheral Neuropathy Diagnostics service is performed by our technologist in a standard patient exam room. The patient’s peripheral nervous system is monitored and evaluated for its response to stimulation. The test is relatively quick, pain free and patient satisfaction is very high. After the test is performed, a detailed set of results and analysis are delivered back to you. The results provide a clear understanding of the presence, and extent of, peripheral autonomic dysfunction or disease. Additional studies may be performed to identify the cause of symptoms such as numbness, tingling, continuous pain and the early detection of diabetes complications. How it Works • The program is overseen by highly qualified Neurologists • One of our highly trained technologists will arrive on your scheduled date to perform testing • We provide the state-of-the-art equipment and tests are done in one of your exam rooms • Reports are delivered within 24-48 hours using Digirad’s digital delivery system • This system permanently stores patients’ test results allowing you unlimited access Contact us to learn more: 855-644-3443 | www.digirad.com Digirad delivers diagnostic imaging expertise. As Needed. When Needed. Where Needed. Autonomic Neuropathy Autonomic neuropathy is a disorder that affects involuntary body functions, including heart rate, blood pressure, perspiration and digestion. -
Classification Decisions Taken by the Harmonized System Committee from the 47Th to 60Th Sessions (2011
CLASSIFICATION DECISIONS TAKEN BY THE HARMONIZED SYSTEM COMMITTEE FROM THE 47TH TO 60TH SESSIONS (2011 - 2018) WORLD CUSTOMS ORGANIZATION Rue du Marché 30 B-1210 Brussels Belgium November 2011 Copyright © 2011 World Customs Organization. All rights reserved. Requests and inquiries concerning translation, reproduction and adaptation rights should be addressed to [email protected]. D/2011/0448/25 The following list contains the classification decisions (other than those subject to a reservation) taken by the Harmonized System Committee ( 47th Session – March 2011) on specific products, together with their related Harmonized System code numbers and, in certain cases, the classification rationale. Advice Parties seeking to import or export merchandise covered by a decision are advised to verify the implementation of the decision by the importing or exporting country, as the case may be. HS codes Classification No Product description Classification considered rationale 1. Preparation, in the form of a powder, consisting of 92 % sugar, 6 % 2106.90 GRIs 1 and 6 black currant powder, anticaking agent, citric acid and black currant flavouring, put up for retail sale in 32-gram sachets, intended to be consumed as a beverage after mixing with hot water. 2. Vanutide cridificar (INN List 100). 3002.20 3. Certain INN products. Chapters 28, 29 (See “INN List 101” at the end of this publication.) and 30 4. Certain INN products. Chapters 13, 29 (See “INN List 102” at the end of this publication.) and 30 5. Certain INN products. Chapters 28, 29, (See “INN List 103” at the end of this publication.) 30, 35 and 39 6. Re-classification of INN products. -
Tanibirumab (CUI C3490677) Add to Cart
5/17/2018 NCI Metathesaurus Contains Exact Match Begins With Name Code Property Relationship Source ALL Advanced Search NCIm Version: 201706 Version 2.8 (using LexEVS 6.5) Home | NCIt Hierarchy | Sources | Help Suggest changes to this concept Tanibirumab (CUI C3490677) Add to Cart Table of Contents Terms & Properties Synonym Details Relationships By Source Terms & Properties Concept Unique Identifier (CUI): C3490677 NCI Thesaurus Code: C102877 (see NCI Thesaurus info) Semantic Type: Immunologic Factor Semantic Type: Amino Acid, Peptide, or Protein Semantic Type: Pharmacologic Substance NCIt Definition: A fully human monoclonal antibody targeting the vascular endothelial growth factor receptor 2 (VEGFR2), with potential antiangiogenic activity. Upon administration, tanibirumab specifically binds to VEGFR2, thereby preventing the binding of its ligand VEGF. This may result in the inhibition of tumor angiogenesis and a decrease in tumor nutrient supply. VEGFR2 is a pro-angiogenic growth factor receptor tyrosine kinase expressed by endothelial cells, while VEGF is overexpressed in many tumors and is correlated to tumor progression. PDQ Definition: A fully human monoclonal antibody targeting the vascular endothelial growth factor receptor 2 (VEGFR2), with potential antiangiogenic activity. Upon administration, tanibirumab specifically binds to VEGFR2, thereby preventing the binding of its ligand VEGF. This may result in the inhibition of tumor angiogenesis and a decrease in tumor nutrient supply. VEGFR2 is a pro-angiogenic growth factor receptor -
Chemotherapy-Induced Neuropathy and Diabetes: a Scoping Review
Review Chemotherapy-Induced Neuropathy and Diabetes: A Scoping Review Mar Sempere-Bigorra 1,2 , Iván Julián-Rochina 1,2 and Omar Cauli 1,2,* 1 Department of Nursing, University of Valencia, 46010 Valencia, Spain; [email protected] (M.S.-B.); [email protected] (I.J.-R.) 2 Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain * Correspondence: [email protected] Abstract: Although cancer and diabetes are common diseases, the relationship between diabetes, neuropathy and the risk of developing peripheral sensory neuropathy while or after receiving chemotherapy is uncertain. In this review, we highlight the effects of chemotherapy on the onset or progression of neuropathy in diabetic patients. We searched the literature in Medline and Scopus, covering all entries until 31 January 2021. The inclusion and exclusion criteria were: (1) original article (2) full text published in English or Spanish; (3) neuropathy was specifically assessed (4) the authors separately analyzed the outcomes in diabetic patients. A total of 259 papers were retrieved. Finally, eight articles fulfilled the criteria, and four more articles were retrieved from the references of the selected articles. The analysis of the studies covered the information about neuropathy recorded in 768 cancer patients with diabetes and 5247 control cases (non-diabetic patients). The drugs investigated are chemotherapy drugs with high potential to induce neuropathy, such as platinum derivatives and taxanes, which are currently the mainstay of treatment of various cancers. The predisposing effect of co-morbid diabetes on chemotherapy-induced peripheral neuropathy depends on the type of symptoms and drug used, but manifest at any drug regimen dosage, although greater neuropathic signs are also observed at higher dosages in diabetic patients. -
( 12 ) United States Patent
US010317418B2 (12 ) United States Patent ( 10 ) Patent No. : US 10 ,317 ,418 B2 Goosens (45 ) Date of Patent: * Jun . 11 , 2019 (54 ) USE OF GHRELIN OR FUNCTIONAL 7 , 479 ,271 B2 1 / 2009 Marquis et al . GHRELIN RECEPTOR AGONISTS TO 7 ,632 , 809 B2 12 / 2009 Chen 7 ,666 , 833 B2 2 /2010 Ghigo et al. PREVENT AND TREAT STRESS -SENSITIVE 7 , 901 ,679 B2 3 / 2011 Marquis et al . PSYCHIATRIC ILLNESS 8 ,013 , 015 B2 9 / 2011 Harran et al . 8 ,293 , 709 B2 10 /2012 Ross et al . (71 ) Applicant: Massachusetts Institute of 9 ,724 , 396 B2 * 8 / 2017 Goosens A61K 38 /27 9 , 821 ,042 B2 * 11 /2017 Goosens .. A61K 39/ 0005 Technology , Cambridge , MA (US ) 10 , 039 ,813 B2 8 / 2018 Goosens 2002/ 0187938 A1 12 / 2002 Deghenghi (72 ) Inventor : Ki Ann Goosens, Cambridge , MA (US ) 2003 / 0032636 Al 2 /2003 Cremers et al. 2004 / 0033948 Al 2 / 2004 Chen ( 73 ) Assignee : Massachusetts Institute of 2005 / 0070712 A1 3 /2005 Kosogof et al. Technology , Cambridge , MA (US ) 2005 / 0148515 Al 7/ 2005 Dong 2005 / 0187237 A1 8 / 2005 Distefano et al. 2005 /0191317 A1 9 / 2005 Bachmann et al. ( * ) Notice : Subject to any disclaimer , the term of this 2005 /0201938 A1 9 /2005 Bryant et al. patent is extended or adjusted under 35 2005 /0257279 AL 11 / 2005 Qian et al. U . S . C . 154 ( b ) by 0 days. 2006 / 0025344 Al 2 /2006 Lange et al. 2006 / 0025566 A 2 /2006 Hoveyda et al. This patent is subject to a terminal dis 2006 / 0293370 AL 12 / 2006 Saunders et al . -
Fluoroscopic Characterization of Colonic Dysmotility Associated to Opioid and Cannabinoid Agonists in Conscious Rats
J Neurogastroenterol Motil, Vol. 25 No. 2 April, 2019 pISSN: 2093-0879 eISSN: 2093-0887 https://doi.org/10.5056/jnm18202 JNM Journal of Neurogastroenterology and Motility Original Article Fluoroscopic Characterization of Colonic Dysmotility Associated to Opioid and Cannabinoid Agonists in Conscious Rats Susana Díaz-Ruano,1 Ana E López-Pérez,1,5 Rocío Girón,2,3,4,5 Irene Pérez-García,2 María I Martín-Fontelles,2,3,4,5 and Raquel Abalo2,3,4,5* 1Unidad de Dolor, Servicio de Anestesiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; 2Departamento de Ciencias Básicas de la Salud, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain; 3Unidad Asociada I+D+i al Instituto de Investigación en Ciencias de la Alimentación, CIAL (CSIC), Madrid, Spain; 4Unidad Asociada I+D+i al Instituto de Química Médica, IQM (CSIC), Madrid, Spain; and 5Grupo de Excelencia Investigadora URJC-Banco de Santander-Grupo Multidisciplinar de Investigación y Tratamiento del Dolor (i+DOL), Madrid, Spain Background/Aims Gastrointestinal adverse effects have a major impact on health and quality of life in analgesics users. Non-invasive methods to study gastrointestinal motility are of high interest. Fluoroscopy has been previously used to study gastrointestinal motility in small experimental animals, but they were generally anesthetized and anesthesia itself may alter motility. In this study, our aim is to determine, in conscious rats, the effect of increasing doses of 2 opioid (morphine and loperamide) and 1 cannabinoid (WIN 55,212-2) agonists on colonic motility using fluoroscopic recordings and spatio-temporal maps. Methods Male Wistar rats received barium sulfate intragastrically, 20-22 hours before fluoroscopy, so that stained fecal pellets could be seen at the time of recording. -
What Is the Autonomic Nervous System?
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.74.suppl_3.iii31 on 21 August 2003. Downloaded from AUTONOMIC DISEASES: CLINICAL FEATURES AND LABORATORY EVALUATION *iii31 Christopher J Mathias J Neurol Neurosurg Psychiatry 2003;74(Suppl III):iii31–iii41 he autonomic nervous system has a craniosacral parasympathetic and a thoracolumbar sym- pathetic pathway (fig 1) and supplies every organ in the body. It influences localised organ Tfunction and also integrated processes that control vital functions such as arterial blood pres- sure and body temperature. There are specific neurotransmitters in each system that influence ganglionic and post-ganglionic function (fig 2). The symptoms and signs of autonomic disease cover a wide spectrum (table 1) that vary depending upon the aetiology (tables 2 and 3). In some they are localised (table 4). Autonomic dis- ease can result in underactivity or overactivity. Sympathetic adrenergic failure causes orthostatic (postural) hypotension and in the male ejaculatory failure, while sympathetic cholinergic failure results in anhidrosis; parasympathetic failure causes dilated pupils, a fixed heart rate, a sluggish urinary bladder, an atonic large bowel and, in the male, erectile failure. With autonomic hyperac- tivity, the reverse occurs. In some disorders, particularly in neurally mediated syncope, there may be a combination of effects, with bradycardia caused by parasympathetic activity and hypotension resulting from withdrawal of sympathetic activity. The history is of particular importance in the consideration and recognition of autonomic disease, and in separating dysfunction that may result from non-autonomic disorders. CLINICAL FEATURES c copyright. General aspects Autonomic disease may present at any age group; at birth in familial dysautonomia (Riley-Day syndrome), in teenage years in vasovagal syncope, and between the ages of 30–50 years in familial amyloid polyneuropathy (FAP). -
Akt Phosphorylation of Neuronal Nitric Oxide Synthase Regulates Gastrointestinal Motility in Mouse Ileum
Akt phosphorylation of neuronal nitric oxide synthase regulates gastrointestinal motility in mouse ileum Damian D. Guerraa, Rachael Boka, Vibhuti Vyasa, David J. Orlickyb, Ramón A. Lorcaa, and K. Joseph Hurta,c,1 aDivision of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045; bDepartment of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045; and cDivision of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045 Edited by Solomon H. Snyder, Johns Hopkins University School of Medicine, Baltimore, MD, and approved July 15, 2019 (received for review April 5, 2019) Nitric oxide (NO) is a major inhibitory neurotransmitter that mediates receptor activation (18–20). Some evidence suggests that phosphor- nonadrenergic noncholinergic (NANC) signaling. Neuronal NO syn- ylation of the equivalent Akt/PKA consensus site in nNOS, ser- + thase (nNOS) is activated by Ca2 /calmodulin to produce NO, which ine1412 (S1412), also stimulates neuronal NO synthesis (21). Because + causes smooth muscle relaxation to regulate physiologic tone. nNOS nNOS activity is more sensitive to [Ca2 ](21),andnNOSismore serine1412 (S1412) phosphorylation may reduce the activating rapidly dephosphorylated than eNOS (22), it is technically difficult to 2+ Ca requirement and sustain NO production. We developed and evaluate nNOS S1412 phosphorylation in vivo. Nonetheless, studies S1412A characterized a nonphosphorylatable nNOS knock-in mouse implicate nNOS S1412 phosphorylation in hippocampal excitotoxicity and evaluated its enteric neurotransmission and gastrointestinal (4), penile erection (22), and luteinizing hormone release (23). (GI) motility to understand the physiologic significance of nNOS Enteric neurons express high levels of nNOS, Akt, and PKA S1412 phosphorylation.