Gastroparesis, Thymoma, and Asymptomatic Myasthenia: A Rare Clinical Scenario

Background: Paraneoplastic gastroparesis is a gastrointestinal syndrome that rarely precedes a tumor diagnosis. To increase awareness of this rare clinical entity, we present a case of severe gastroparesis, which was later proven to be associated with a thymoma. Case report: A 55-year old man had the sudden onset of severe abdominal cramps and abdominal distension, early satiety with postprandial nausea, acid regurgitation, belching, and flatulence. He lost about 20 pounds. The physical and imaging examination revealed stomach distension, gastroparesis, and the presence of a solid mass in the anterior mediastinum. Radical surgery was performed to remove the thymoma and, given the high value of Mib-1, the patient was submitted to postoperative chest radiation therapy. After thymectomy, a diagnosis of paraneoplastic myasthenia gravis with subacute autonomic failure was made. Conclusion: Autoimmune gastroparesis should be considered as a potential paraneoplastic syndrome in patients with thymoma, myasthenia gravis, and delayed gastric emptying in the absence of mechanical obstruction.

Comparative quantitative survey of patient experience in Barrett’s oesophagus and other gastrointestinal disorders

ObjectiveTo assess health-related quality of life in patients with non-dysplastic Barrett’s oesophagus (NDBO) and endoscopically treated dysplastic Barrett’s oesophagus (DBO).DesignThis quantitative, self-administered questionnaire study was conducted across three National Health Service hospitals. Data were collected from three other cohorts; gastro-oesophageal reflux disease (GORD), colonic polyp surveillance and healthy individuals. Fisher’s exact and Spearman’s rank correlation tests were used for analysis. Propensity score matching adjusted for age, sex and comorbidities.Results687 participants were eligible for analysis (NDBO n=306, DBO n=49, GORD n=132, colonic polyps n=152 and healthy n=48). 53% of NDBO participants reported similarly high cancer worry, comparable to DBO (50%, p=0.933) and colonic polyp participants (51%, p=0.355). Less cancer worry was reported in GORD participants (43.4%, p=0.01 vs NDBO). NDBO participants reported anxiety in 15.8% and depression in 8.6% of cases, which was similar to the other disease cohorts. Moderate or severe heartburn or acid regurgitation was found in 11% and 10%, respectively, in the NDBO cohort, comparable to DBO participants (heartburn 2% p=0.172, acid regurgitation 4% p=0.31) but lower (better) than GORD participants (heartburn 31% p=<0.001, acid regurgitation 25% p=0.001). NDBO participants with moderate or severe GORD symptoms were associated with higher rates of anxiety (p=<0.001), depression (p=<0.001) and cancer worry (p=<0.001). NDBO patients appropriately perceiving their cancer risk as low had lower rates of cancer worry (p=<0.001).ConclusionThis study provides insight into the problems Barrett’s oesophagus patients may face. Future care pathways must be more patient focussed to address misconceptions of cancer risk, oesophageal cancer related worry and GORD symptom control.

Correlation Analysis of Mental Health Status and Sleep Quality in Helicobacter pylori Positive Patients

Objective: To analyze the correlation between mental health and sleep quality in Helicobacter pylori Positive Patients (Hp-positive patients). Methods: Patients with 13C exhalation test stomach discomfort were taken as the subjects of study. The gastrointestinal symptoms table, Kessler10 scale and Pittsburgh sleep quality index (PSQI) scale questionnaires were used. Single factor and multi-factor linear regression analysis was performed using SPSS 22.0. Results: Univariate analysis showed that Kessler10 scale was related to 11 factors, including sex, drinking, preference for spicy food, current Hp situation, abdominal pain, abdominal distension, acid regurgitation, heartburn, belching, severity of gastrointestinal tract, and frequency of gastrointestinal attacks. The difference was statistically significant (P < 0.05). Multivariate analysis showed that Hp (P = 0.00) and gastrointestinal attack frequency (P = 0.002) were the influencing factors (P < 0.05). In addition, univariate analysis showed that PSQI scale was related to 10 factors, namely gender, preference for spicy food, current Hp situation, abdominal pain, abdominal distension, acid regurgitation, diarrhea, belching, severity of gastrointestinal tract and frequency of gastrointestinal attack, with statistically significant difference (P < 0.05). Multivariate analysis showed that gender (P = 0.009), current Hp situation (P = 0.020) and gastrointestinal attack frequency (P = 0.043) were the influencing factors (P < 0.05). Conclusion: Helicobacter pylori infection affects the mental health and sleep quality of patients.

The “Aachen sings” study (“Aachen choir engagement study into GERD symptoms”): moderate singing and breathing exercises in a choir reduce reflux symptoms – a cohort study in non-specialist choristers

Background The influence of singing activities and breathing exercises on the presence of gastroesophageal reflux disease (GERD) symptoms is not clear. While an Austrian study found symptom reduction, an Italian study showed more symptoms in professional opera choristers. These contradictory results may be due to differential intensity of the singing exercises. We therefore developed a questionnaire to investigate the presence of GERD typical symptoms and defined GERD in nonprofessional choristers with moderate singing activity and breathing exercises and compared the results to those from related non-singing control persons. Methods 434 actively engaged lay-choir persons and 310 non-singing friends or relatives answered questions in a questionnaire regarding basic data, singing habits, GERD symptoms, and past or present diagnostic events and medications. Results Non-singing control persons experienced more frequently heartburn (1.1 ± 4.1 vs. 0.5 ± 1.2 episodes/week, p = 0.001) and acid regurgitation (0.9 ± 4.1 vs. 0.5 ± 1.3 episodes/week, p < 0.001) and had more often already received the diagnosis of GERD (16.8 % vs. 10.4 %, p = 0.011). From the persons without known GERD, members of the control cohort more often fulfilled the simplified diagnostic criteria of GERD (14.3 % vs. 5.1 %, p < 0.001). A multivariate analysis identified non-singing, high body mass index, and smoking as significant risk factors for the presence of GERD symptoms. Conclusion The frequency of reflux symptoms and GERD is probably still increasing. Moderate singing activities and breathing exercises seem to be helpful in avoiding reflux symptoms such as heartburn and acid regurgitation.