Pathophysiology of Gastroparesis Syndromes Includes Anatomic and Physiologic Abnormalities

Thomas L. Abell, Archana Kedar, Abigail Stocker, Karen Beatty, Lindsay McElmurray, Michael Hughes, Hani Rashed, William Kennedy, Gwen Wendelschafer-Crabb, Xiu Yang, Mostafa Fraig, Leila Gobejishvili, Endashaw Omer, Ed Miller, Michael Griswold, Christina Pinkston

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Background: Factors underlying gastroparesis are not well defined. Aims: We hypothesized that multiple systems may be involved in patients with gastroparesis symptoms and performed a comparative physiologic study. Methods: We studied 43 consecutive eligible patients with gastroparetic symptoms categorized by GI symptoms, metabolic status, illness quantification, and gastric physiology. Patients were evaluated by two methods in each of five core areas: inflammatory, autonomic, enteric, electrophysiologic, and hormonal with abnormalities examined by correlations. Results: Patients had similar GI symptoms regardless of baseline gastric emptying or diabetic/idiopathic status, and all patients demonstrated abnormalities in each of the 5 areas studied. Nearly all patients presented with elevated markers of serum TNFα (88%) and serum IL-6 (91%); elevated cutaneous electrogastrogram frequency (95%); and interstitial cells of Cajal count abnormalities (inner: 97%, outer: 100%). Measures of inflammation correlated with a number of autonomic, enteric anatomy, electrophysiologic and hormonal abnormalities. Conclusions: We conclude that patients with the symptoms of gastroparesis have multiple abnormalities, when studied by traditional, as well as newer, diagnostic assessments. Inflammation appears to be a fundamental abnormality that affects other organ systems in symptomatic patients. Future work on gastroparetic syndromes and their treatment may benefit from a focus on the diffuse nature of their illness, diverse pathophysiologic mechanisms involved, especially the possible causes of underlying inflammation and disordered hormonal status. Trail Registry: This study is registered with Clinicaltrials.gov under study # NCT03178370 https://clinicaltrials.gov/ct2/show/NCT03178370.

Original languageEnglish (US)
Pages (from-to)1127-1141
Number of pages15
JournalDigestive Diseases and Sciences
Volume66
Issue number4
DOIs
StatePublished - Apr 23 2020

Bibliographical note

Funding Information:
The authors would like to thank the following: Bridget Cannon, Heather Barker, Shirish Barve, Craig McClain, Tad Dryden, Cam Falkner, Marion McClain, Samir Vermani, Chirag Patel, Andy Patel, Shifat Ahmed, Kaartik Soota, Siva Cheetirala, Malathi Perugula, Jpriyanga Jayakumar, Pramod Kumar Savarapu, Sathya Krishnasamy, Hamza Hassan, Warren Starkebaum, and Steve Mahanes. The authors would like to thank the staff of Jewish Hospital including the GI Motility Clinic and the University of Louisville CTR/Liver Research Unit as well as the help of Catherine McBride in manuscript preparation. The authors would also like to thank Greg O?Grady for review of the manuscript.

Publisher Copyright:
© 2020, Springer Science+Business Media, LLC, part of Springer Nature.

Keywords

  • Abdominal pain
  • Electrophysiology
  • Gastric emptying
  • Gastroparesis
  • Hormones
  • Nausea and vomiting

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