Utility of sub-classification of severe gastrointestinal dysmotility in chronic intestinal failure

2020 ◽  
Vol 40 ◽  
pp. 531
Author(s):  
O.M. Elfadil ◽  
S. Velapati ◽  
R.T. Hurt ◽  
S. Lal ◽  
M.S. Mundi
Keyword(s):  
Intestinal Failure ◽  
Gastrointestinal Dysmotility

Gastroparesis

2015 ◽  
Author(s):  
Braden Kuo ◽  
Laurence Guay
Keyword(s):  
Multiple Sclerosis ◽  
Nervous System ◽  
Gastric Emptying ◽  
Clinical Manifestations ◽  
Gastrointestinal Dysmotility ◽  
Inflammatory Conditions ◽  
Gastric Physiology ◽  
Neuromuscular Apparatus ◽  
Pharmacologic Treatments

The gastric phase of digestion requires a tightly coordinated neuromuscular apparatus to permit appropriate timing for each step. Dysregulations in this apparatus may be related to the Cajal cells, the intrinsic enteric nervous system, the extrinsic nervous system, the muscle cells, or any combination of structures and may lead to abnormal gastric emptying, referred to as gastroparesis. Gastroparesis is idiopathic in 35 to 49.4% of cases but may also be related to diabetes, autoimmune and inflammatory conditions, multiple sclerosis, use of certain medications, and infections, among other factors. This review describes the epidemiology, etiology, pathophysiology, clinical manifestations, diagnosis, treatment, and prognosis of gastroparesis. The figure shows symptom mechanisms related to gastric physiology in gastroparesis patients. Tables list the physiopathologic mechanisms and symptoms associated with defective gastric physiologic phenomena, the classification of gastroparesis according to affected structures, and pharmacologic treatments for gastrointestinal dysmotility. This review contains 1 highly rendered figure, 3 tables, and 56 references.

scholarly journals Intravenous supplementation type and volume are associated with 1-year outcome and major complications in patients with chronic intestinal failure

Gut ◽  
2020 ◽  
Vol 69 (10) ◽  
pp. 1787-1795 ◽  
Author(s):  
Loris Pironi ◽  
Ezra Steiger ◽  
Francisca Joly ◽  
Geert J A Wanten ◽  
Cecile Chambrier ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Malignant Disease ◽  
Demographic Data ◽  
Intestinal Failure ◽  
Underlying Disease ◽  
Clinical Classification ◽  
Weekly Basis ◽  
Research Protocols ◽  
The Mean

Background and aimNo marker to categorise the severity of chronic intestinal failure (CIF) has been developed. A 1-year international survey was carried out to investigate whether the European Society for Clinical Nutrition and Metabolism clinical classification of CIF, based on the type and volume of the intravenous supplementation (IVS), could be an indicator of CIF severity.MethodsAt baseline, participating home parenteral nutrition (HPN) centres enrolled all adults with ongoing CIF due to non-malignant disease; demographic data, body mass index, CIF mechanism, underlying disease, HPN duration and IVS category were recorded for each patient. The type of IVS was classified as fluid and electrolyte alone (FE) or parenteral nutrition admixture (PN). The mean daily IVS volume, calculated on a weekly basis, was categorised as <1, 1–2, 2–3 and >3 L/day. The severity of CIF was determined by patient outcome (still on HPN, weaned from HPN, deceased) and the occurrence of major HPN/CIF-related complications: intestinal failure-associated liver disease (IFALD), catheter-related venous thrombosis and catheter-related bloodstream infection (CRBSI).ResultsFifty-one HPN centres included 2194 patients. The analysis showed that both IVS type and volume were independently associated with the odds of weaning from HPN (significantly higher for PN <1 L/day than for FE and all PN >1 L/day), patients’ death (lower for FE, p=0.079), presence of IFALD cholestasis/liver failure and occurrence of CRBSI (significantly higher for PN 2–3 and PN >3 L/day).ConclusionsThe type and volume of IVS required by patients with CIF could be indicators to categorise the severity of CIF in both clinical practice and research protocols.

scholarly journals Gastroesophageal Reflux Disease and Foregut Dysmotility in Children with Intestinal Failure

Nutrients ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3536
Author(s):  
Anna Rybak ◽  
Aruna Sethuraman ◽  
Kornilia Nikaki ◽  
Jutta Koeglmeier ◽  
Keith Lindley ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Gastroesophageal Reflux ◽  
Treatment Options ◽  
Hormone Secretion ◽  
Intestinal Failure ◽  
Pharmacological Management ◽  
Gastrointestinal Dysmotility ◽  
Critical Reduction ◽  
Intestinal Pseudo Obstruction

Gastrointestinal dysmotility is a common problem in a subgroup of children with intestinal failure (IF), including short bowel syndrome (SBS) and pediatric intestinal pseudo-obstruction (PIPO). It contributes significantly to the increased morbidity and decreased quality of life in this patient population. Impaired gastrointestinal (GI) motility in IF arises from either loss of GI function due to the primary disorder (e.g., neuropathic or myopathic disorder in the PIPO syndrome) and/or a critical reduction in gut mass. Abnormalities of the anatomy, enteric hormone secretion and neural supply in IF can result in rapid transit, ineffective antegrade peristalsis, delayed gastric emptying or gastroesophageal reflux. Understanding the underlying pathophysiologic mechanism(s) of the enteric dysmotility in IF helps us to plan an appropriate diagnostic workup and apply individually tailored nutritional and pharmacological management, which might ultimately lead to an overall improvement in the quality of life and increase in enteral tolerance. In this review, we have focused on the pathogenesis of GI dysmotility in children with IF, as well as the management and treatment options.

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