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  • 1
    Electronic Resource
    Electronic Resource
    Treatment of diabetic gastroparesis with oral clonidine (1995)
    Oxford, UK : Blackwell Publishing Ltd
    Alimentary pharmacology & therapeutics 9 (1995), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background/Aims: Clonidine, a specific alpha-2-adrenergic receptor agonist, has been suggested to improve symptoms of gastroparesis in diabetics with diarrhoea. The aim of this study was to investigate the effects of clonidine on gastric emptying and symptoms suggestive of gastroparesis in patients with long-standing diabetes mellitus and evidence of autonomic neuropathy. Methods: Six diabetics with chronic, refractory symptoms of bloating, nausea and vomiting were studied. Gastric emptying of a liquid nutrient meal (250 mL; 430 kcal) was evaluated by scintigraphy and symptoms were scored. Patients were treated with clonidine (median dose: 0.3 mg/day) for 2–12 weeks (median : 4 weeks), after which symptoms and gastric emptying were re-evaluated. Treatment was then sustained for a median follow-up period of 7 weeks (range: 2–56 weeks). Results: Gastric emptying half-time values in diabetic patients ranged from 16 to 180 min (median: 100 min) and four patients had abnormally delayed emptying before treatment. In all patients, half-time values decreased during treatment (median : 35 min; range: 14–106 min, P 〈 0.025 vs. pre-treatment values) and in three of the four patients with abnormal gastric retention, half-time values returned to the normal range. During clonidine treatment, a substantial decrease in the score for symptoms was observed (median and range: 7.5; 2–9 vs. 0; 0–9). In four patients, symptoms virtually disappeared, an effect that was maintained throughout follow-up (6–56 weeks). Conclusions: These findings suggest that impairment of adrenergic influences on gastrointestinal motility control may play a role in the pathophysiology of diabetic gastroparesis and that clonidine may be a useful alternative for treating patients with this condition.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2036.1995.tb00368.x
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  • 2
    Electronic Resource
    Electronic Resource
    Short report: comparison of the effects of sublingual nifedipine and isosorbide dinitrate on oesophageal emptying in patients with Chagasic achalasia (1992)
    Oxford, UK : Blackwell Publishing Ltd
    Alimentary pharmacology & therapeutics 6 (1992), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The effects of sublingual nifedipine and isosorbide dinitrate on oesophageal emptying were compared in 11 patients with Chagasic achalasia. The oesophageal emptying of a radiolabelled test meal was assessed three times in each patient by a scintigraphic technique. No treatment preceded one of the studies (basal study). Nifedipine (20 mg) by the sublingual route 30 min before the meal, preceded one study. Isosorbide dinitrate, 5 mg by the sublingual route 5 min before the meal, preceded the third study. The order of the studies was allocated randomly for each patient. Oesophageal retention at the completion of the meal was significantly less (P 〈 0.01) after isosorbide dinitrate (median: 54%, range: 5–87%) than after sublingual nifedipine (median: 78%, range: 7–99%) or after the control study (median: 83%, range: 5–100%). This difference persisted up to 20 min after the meal. Values measured in the control study and after sublingual nifedipine were not different (P 〉 0.10).These results show that isosorbide dinitrate, but not sublingual nifedipine, enhances oesophageal emptying in Chagasic achalasia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2036.1992.tb00565.x
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  • 3
    Electronic Resource
    Electronic Resource
    Abnormal progression of a liquid meal through the stomach and small intestine in patients with Chagas' disease (1993)
    Springer
    Digestive diseases and sciences 38 (1993), S. 1511-1517 
    Details
    ISSN: 1573-2568
    Keywords: Chagas' disease ; enteric nervous system ; gastrointestinal transit ; gastric emptying ; stomach ; small intestine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This study describes the abnormal pattern of gastrointestinal progression of a liquid meal in patients with the digestive form of chronic Chagas' disease. This condition is known as a natural model of intramural denervation of the gut. Sixteen patients with clinical and radiographic evidence of esophageal and/or colonic involvement and 18 healthy volunteers were studied. Orocecal transit time after the ingestion of a 10% lactulose solution (180 ml) tagged with99mtechnetium was measured by a conventional H2 breath technique. Gastric emptying and the arrival of the front of the meal to regions of interest corresponding to proximal and distal areas of the small intestine were assessed by abdominal scintigraphy. Orocecal transit time was significantly greater (P〈0.05) in Chagas' disease patients (N=13) than in control subjects (N=18) (mean±sd: 100.7±48.7 min vs 62.9 ±18.2 min). Half-time for gastric emptying of liquids in chagasic patients (N=9) was significantly lower (P〈0.01) than in controls (N=7) (9.7±2.7 min vs 26.4±3.4 min). The time of arrival of the liquid meal to the proximal small intestine was also significantly shorter (P〈0.02) in patients than in controls (5.6±3.7 vs 11.4±5.5 min), but there was no difference between the two groups concerning the time the meal first arrived to the distal small intestine (15.0±11.0 min vs 23.5±11.4 min, P〉0.05). These results indicate that patients with Chagas' disease have a combination of exceedingly rapid gastric emptying and abnormally delayed transit of liquids through the more distal segments of the small bowel. These abnormalities are likely to be a consequence of gut intramural denervation and emphasize the complex modulatory role of the enteric nervous system in gastrointestinal transit regulation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01308613
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  • 4
    Electronic Resource
    Electronic Resource
    Abnormal Intragastric Distribution of a Liquid Nutrient Meal in Patients with Diabetes Mellitus (1998)
    Springer
    Digestive diseases and sciences 43 (1998), S. 1421-1429 
    Details
    ISSN: 1573-2568
    Keywords: GASTRIC EMPTYING ; INTRAGASTRIC DISTRIBUTION ; GASTRIC MOTILITY ; DIABETES MELLITUS ; AUTONOMIC NEUROPATHY ; DYSPEPSIA
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Disordered gastric motility and emptying arewell known complications of diabetes mellitus (DM), butthe pattern of intragastric distribution of food has notbeen extensively studied in diabetics. We examined the partition of a liquid nutrient meal betweenthe proximal and distal stomach and the relationshipsbetween intragastric distribution of food and gastricemptying (GE) and the symptoms in DM patients with and without autonomic neuropathy (AN).Fourteen healthy volunteers and 20 DM patients (13 withAN; 9 with dyspepsia symptoms) ingested a liquidnutrient meal (250 ml; 437 kcal) labeled with[99mTc]phytate. Anterior and posterior serial images of thestomach were taken for 90 min with a gamma camera.Regions of interest for the proximal and the distalhalves of the stomach and for the total gastric areawere defined. Counts from each region along timeallowed estimation of GE and the proportion of activityretained in the proximal stomach after meal ingestion(initial) and throughout GE (mean). GE half-times in controls (median; range: 66 min; 29-90 min)were not significantly different from diabetics (76 min;5-〉150 min, P 〉 0.10), but abnormal GE was foundin 11 DM patients (seven delayed and four rapid). In DM patients, initial retention inthe proximal stomach (42%; 16-79% ) was significantlylower (P 〈 0.02) than in controls (55%; 44-71%). Meanretention in the proximal stomach throughout emptying also was significantly lower (P 〈0.05) in DM patients (43%; 18-58%) than in controls(51%; 32-69%). There were no differences betweensubgroups of patients with normal, delayed, or rapid gastric emptying regarding mean meal retentionin the proximal stomach. Patients with evidence of AN orwith dyspepsia symptoms had significantly decreasedretention of food in the proximal stomach throughout gastric emptying. We concluded that patientswith diabetes mellitus have abnormally decreasedretention of gastric contents in the proximal stomachafter a liquid meal, which seems to be related to the occurrence of autonomic neuropathy anddyspepsia symptoms, but not to disordered gastricemptying.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1018834025351
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  • 5
    Electronic Resource
    Electronic Resource
    Effect of isosorbide dinitrate on gastroesophageal reflux in healthy volunteers and patients with Chagas' disease (1995)
    Springer
    Digestive diseases and sciences 40 (1995), S. 177-182 
    Details
    ISSN: 1573-2568
    Keywords: Chagas' disease ; gastroesophageal reflux ; gastric emptying ; scintigraphy ; esophageal motor disorder
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The effect of isosorbide dinitrate (ISD) on gastroesophageal reflux and gastric emptying during the 24-min period following a liquid meal was studied in healthy volunteers, Chagas' disease patients with normal esophageal motility (CD-1 group), and Chagas' disease patients with esophageal dysmotility (CD-2 group) with dynamic scintigraphy. At random, on two separate days, the subjects received 5 mg isosorbide dinitrate or an identical-appearing placebo tablet, by the sublingual route, and ingested a liquid test meal containing [99mTc]phytate colloid before scintigraphic studies were performed. Gastroesophageal reflux episodes were more frequent (P=0.016) and gastroesophageal reflux indexes were greater (P〈0.010) after isosorbide dinitrate than after placebo in CD-2 group (N=15) but not in healthy volunteers (N=14) or CD-1 group (N=9); six of seven CD-2 patients presenting with gastroesophageal reflux after isosorbide dinitrate had abnormal clearance of refluxate. Gastric emptying was similar in healthy volunteers (N=13), CD-1 patients (N=6), and CD-2 patients (N=13), and no effect of isosorbide dinitrate on it was detected in any of the groups. In separate studies, 5 mg isosorbide dinitrate reduced the lower esophageal pressure (P〈0.01) in seven CD-2 patients. These results indicate that ISD increases the tendency towards GER in CD-2 patients, but not in healthy volunteers or CD-1 patients. This effect is probably related to an exceedingly intense relaxation of the LES caused by ISD in CD-2 patients. Considering the role of the destruction of the intramural neurons in the pathogenesis of the esophageal motor disorder in Chagas' disease, these findings are likely to be a consequence of the loss of the normal neural influences on the lower esophageal sphincter in Chagas' disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02063962
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