Sacral nerve stimulation for fecal incontinence: results of a 120-patient prospective multicenter study.

Background: Sacral nerve stimulation has been approved for use in treating urinary incontinence in the United States since 1997, and in Europe for both urinary and fecal incontinence (FI) since 1994. The purpose of this study was to determine the safety and efficacy of sacral nerve stimulation in a large population under the rigors of Food and Drug Administration-approved investigational protocol.

Methods: Candidates for SNS who provided informed consent were enrolled in this Institutional Review Board-approved multicentered prospective trial.

Motility of the antroduodenum in healthy and gastroparetics characterized by wireless motility capsule.

Background: The wireless motility capsule (WMC) measures intraluminal pH and pressure, and records transit time and contractile activity throughout the gastrointestinal tract. Our hypothesis is that WMC can differentiate antroduodenal pressure profiles between healthy people and patients with upper gut motility dysfunctions. This study aims to analyze differences in the phasic pressure profiles of the stomach and small intestine in healthy and gastroparetic subjects.

Efficacy of tricyclic antidepressant therapy in adults with cyclic vomiting syndrome: a two-year follow-up study.

Aim: To investigate the effects of prolonged tricyclic antidepressants (TCAs) therapy on the frequency and duration of episodes of cyclic vomiting syndrome (CVS) in adults, and the global assessment of clinical improvement and the number of emergency department (ED) visits and/or hospitalizations.

Method: An open labeled study was conducted in adult CVS patients treated with a TCA and followed for up to 2 years. Demographic data, TCA dosage, duration and frequency of CVS episodes, ED visits, and hospitalizations at baseline and during TCA therapy were recorded, and patients were monitored for any adverse events.

Small intestinal bacterial overgrowth in gastroparesis: are there any predictors?

Background: There is some degree of overlap in the symptomatic spectrum of patients with gastroparesis and small intestinal bacterial overgrowth (SIBO) and some of the etiologies for gastroparesis, such as diabetes mellitus and vagotomy are known to predispose to SIBO. The aims of our study were to measure the prevalence of SIBO in a cohort of gastroparetic patients with prominence of abdominal pain and bloating and try to identify predictors with regard to demographics, concurrent use of medications such as prokinetics, proton pump inhibitors, and opiate analgesics, and predominant bowel movement abnormality.

Methods: Glucose breath testing (GBT) for SIBO was performed in 50 patients (41 females) with gastroparesis.

Gastroparesis and functional dyspepsia: excerpts from the AGA/ANMS meeting.

Background: Despite the relatively high prevalence of gastroparesis and functional dyspepsia, the aetiology and pathophysiology of these disorders remain incompletely understood. Similarly, the diagnostic and treatment options for these two disorders are relatively limited despite recent advances in our understanding of both disorders.

Purpose: This manuscript reviews the advances in the understanding of the epidemiology, pathophysiology, diagnosis, and treatment of gastroparesis and functional dyspepsia as discussed at a recent conference sponsored by the American Gastroenterological Association (AGA) and the American Neurogastroenterology and Motility Society (ANMS).

Do stool form and frequency correlate with whole-gut and colonic transit? Results from a multicenter study in constipated individuals and healthy controls.

Objectives: Despite a lack of supportive data, stool form and stool frequency are often used as clinical surrogates for gut transit in constipated patients. The aim of this study was to assess the correlation between stool characteristics (form and frequency) and gut transit in constipated and healthy adults.

Methods: A post hoc analysis was performed on 110 subjects (46 chronic constipation) from nine US sites recording stool form (Bristol Stool Scale) and frequency during simultaneous assessment of whole-gut and colonic transit by wireless motility capsule (WMC) and radio-opaque marker (ROM) tests.

The effect of a meal and water loading on heart rate variability in children with functional dyspepsia.

Background: Alteration in autonomic function has been implicated as a possible pathophysiologic mechanism in functional dyspepsia (FD) in adults.

Methods: This was a two-part study. For the first part of the study, nine children with FD and 28 controls underwent heart rate variability (HRV) analysis for 30 min baseline and for 60 min following a test meal.

Who are the nonresponders to standard treatment with tricyclic antidepressant agents for cyclic vomiting syndrome in adults?

Background: Cyclic vomiting syndrome in adults is a disorder characterized by recurrent and stereotypic episodes of severe nausea and vomiting separated by symptom-free periods.

Aims: To investigate the demographic and clinical characteristics of adult cyclic vomiting syndrome patients not responding to standard tricyclic antidepressant (TCA) therapy.

Methods: A total of 132 adults (62 men) with cyclic vomiting syndrome were followed for a mean of 1.

The assessment of regional gut transit times in healthy controls and patients with gastroparesis using wireless motility technology.

Background: Wireless pH and pressure motility capsule (wireless motility capsule) technology provides a method to assess regional gastrointestinal transit times.

Aims: To analyse data from a multi-centre study of gastroparetic patients and healthy controls and to compare regional transit times measured by wireless motility capsule in healthy controls and gastroparetics (GP).

Methods: A total of 66 healthy controls and 34 patients with GP (15 diabetic and 19 idiopathic) swallowed wireless motility capsule together with standardized meal (255 kcal).

Heightened colon motor activity measured by a wireless capsule in patients with constipation: relation to colon transit and IBS.

Relationships of regional colonic motility to transit in health, constipation, and constipation-predominant irritable bowel syndrome (C-IBS) are poorly characterized. This study aimed to 1) characterize regional differences in colon pressure, 2) relate motor differences in constipation to colon transit, and 3) quantify the role of IBS in altered contractility with constipation. Colon pH and pressure were measured by wireless capsules in 53 healthy and 36 constipated subjects.

Treatment Challenges in the Management of Gastroparesis-Related GERD.

The relationship between gastroparesis and GERD is multi-factorial. The delay in gastric emptying associated with gastroparesis can lead to prolonged gastric retention of food that may have a propensity to reflux. Because gastroparesis allows material to remain in the stomach, there is an increase in the gastroesophageal pressure gradient, gastric volume, and the volume of potential refluxate.

Mechanisms of symptomatic improvement after gastric electrical stimulation in gastroparetic patients.

The aims were to investigate the effects of gastric electrical stimulation (GES) on autonomic function, gastric distention and tone, and central control mechanisms in gastroparetic patients. Ten gastroparetic patients refractory to standard medical therapy participated in this study and data were collected at baseline, within two weeks before surgery for implantation of GES system, and at follow-up sessions between 6 and 12 weeks after GES therapy was initiated. In each session, electrocardiogram, electrogastrogram (EGG) and gastric barostat measurements were conducted before and after a caloric liquid meal.

Dumping syndrome: establishing criteria for diagnosis and identifying new etiologies.

Aims: To investigate the current incidence and identify the current etiologies of rapid gastric emptying (dumping syndrome) in patients with a spectrum of gastrointestinal symptoms, including nausea, vomiting, abdominal pain, or diarrhea.

Methods: The results for a 4-h radionuclide gastric emptying test (GET) using a standardized scintigraphic technique were reviewed in 545 patients to see which patients met criteria for rapid gastric emptying, defined as >50% emptying of isotope-labeled solid meal at 1 h.

Results: Forty-eight of 545 (8.

Disturbances of esophageal motility in eosinophilic esophagitis: a case series.

Esophageal manometry (EM) findings were reviewed in 14 (13 male) adults diagnosed with eosinophilic esophagitis (EE). One had complete nonperistaltic contractions (amplitude range = 30-180 mmHg) and incomplete relaxation of the lower esophageal sphincter (LES), suggesting vigorous achalasia. After 6 months of steroid therapy the repeat EM showed near-normal findings.

Effect of oxygen content on the magnetic properties of multiferroic YMn(2)O(5+δ).

The effect of oxygen content on magnetic properties in the multiferroic YMn(2)O(5+δ) system was investigated with samples prepared under different oxygen pressures. Our results show that, with increasing oxygen content, the magnetic response changes from being dominated by the anomaly at ∼45 K to the one around 20 K. However, specific heat measurements and neutron powder diffraction studies indicate that the presence of the magnetic transition at ∼45 K is independent of oxygen content.

Association of the status of interstitial cells of Cajal and electrogastrogram parameters, gastric emptying and symptoms in patients with gastroparesis.

Our goal was to investigate associations between the status of interstitial cells of Cajal (ICC) and electrogastrogram (EGG) parameters, gastric emptying and symptoms in a large cohort of patients with gastroparesis. Forty-one patients with refractory gastroparesis who were referred for gastric electrical stimulation (GES) underwent full thickness gastric (antrum) biopsy during the surgery to place the GES device. The biopsy samples were stained with c-kit and scored for the presence of ICC based on criteria obtained from 10 controls.

Review article: gastric electrical stimulation for gastroparesis--physiological foundations, technical aspects and clinical implications.

Background: Application of electrical stimulation to the gut, primarily the stomach, has rapidly advanced in the last two decades, from mostly animal studies to the clinical arena. Most studies focused on the use of electrical stimulation for gastroparesis, the only approved indication for such intervention.

Aim: To review the physiological basis of gastric electrical activity and the technical aspects and clinical outcome of gastric electrical stimulation (GES) for gastroparesis.

Gastroparesis, pseudoachalasia and impaired intestinal motility as paraneoplastic manifestations of small cell lung cancer.

Lung cancer is the worldwide leading cause of cancer deaths. Small cell lung cancer (SCLC) represents about 15% of lung cancers with a poor 5-year survival rate. SCLC can manifest as a paraneoplastic syndrome, which can include unexplained gastrointestinal dysmotility symptoms.

Retinal thickening in iridocyclitis.

Purpose: To determine the frequency of retinal thickening (RT) in eyes with iridocyclitis and to examine the correlations among anterior chamber (AC) inflammation, RT, and visual acuity.

Design: Retrospective, observational case series.

Methods: Records were reviewed of patients seen at the Duke University Eye Center Uveitis Clinic from January 2002 through March 2008.

Efficacy of gastric electrical stimulation in improving functional vomiting in patients with normal gastric emptying.

The objective of this study is to evaluate the utility of gastric electrical stimulation (GES) in the subgroup of patients with refractory nausea and vomiting in the presence of normal gastric emptying. Eighteen patients (15 females) underwent GES implantation for dyspeptic symptoms in the presence of normal gastric emptying. Upper gastrointestinal (UGI) symptom score, health-related quality of life (HR-QOL), nutritional status and weight, and medication use (prokinetics and antiemetics) were assessed at baseline and at 1 year after GES placement.

Comparison of anorectal manometry to endoanal ultrasound in the evaluation of fecal incontinence.

Background: Fecal incontinence (FI) is a common clinical condition with a negative impact on the quality of life. Commonly performed tests to evaluate FI include anorectal manometry (ARM) and endoanal ultrasonography (EAU). Objective of our study was to compare the results of these 2 tests in a cohort of patients with FI.