Gastroparesis in the 2020s: New Treatments, New Paradigms

被引:11
作者
Sharma A. [1 ]
Coles M. [2 ]
Parkman H.P. [3 ]
机构
[1] Division of Gastroenterology & Hepatology, Medical College of Georgia, Digestive Health Center, Augusta University, 1120 15th St, AD-2226, Augusta, 30912, GA
[2] Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA
[3] Division of Gastroenterology & Hepatology, Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, PA
关键词
Gastric emptying breath test; Gastric emptying scintigraphy; Gastroparesis; Neuromodulation; Pro-motility agents; Wireless motility capsule;
D O I
10.1007/s11894-020-00761-7
中图分类号
学科分类号
摘要
Purpose of Review: This review highlights recent work that will lead to near-term advances in the understanding and treatment of gastroparesis (Gp). Recent Findings: Major current advancements in the pathophysiology of Gp, include recognition of the SIP syncytium as the pacemaking unit rather than ICC alone and that Gp may be part of a pan-enteric autoimmune and/or autonomic disorder with macrophage imbalance. The development of newer techniques to assess gastric emptying (gastric emptying breath test and wireless motility capsule) and pyloric distensibility (EndoFLIP®) are allowing clinicians better characterization of their patients. In addition to pharmaceutical compounds in the pipeline, neuromodulation and endosurgical techniques, such as G-POEM, may help address refractory Gp. Summary: We expect that the 2020 decade will witness exciting developments. Treatments targeting gastrointestinal motility, immunological dysfunction, and inflammatory mediators will be evaluated. We anticipate future studies will be guided by biomarkers correlated with patient outcomes and therapeutic efficacy to establish new paradigms in the management of Gp. © 2020, Springer Science+Business Media, LLC, part of Springer Nature.
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共 94 条
[81]  
Gottfried-Blackmore A., Adler E.P., Fernandez-Becker N., Et al., Open-label pilot study: non-invasive vagal nerve stimulation improves symptoms and gastric emptying in patients with idiopathic gastroparesis, Neurogastroenterol Motil, 5, (2019)
[82]  
Moraveji S., Bashashati M., Elhanafi S., Sunny J., Sarosiek I., Davis B., Torabi A., McCallum R., Depleted interstitial cells of Cajal and fibrosis in the pylorus: novel features of gastroparesis, Neurogastroenterol Motil, 28, pp. 1048-1054, (2016)
[83]  
Mearin F., Camilleri M., Malagelada J.-R., Pyloric dysfunction in diabetics with recurrent nausea and vomiting, Gastroenterology, 90, pp. 1919-1925, (1986)
[84]  
Gourcerol G., Tissier F., Melchior C., Touchais J.Y., Huet E., Prevost G., Leroi A.M., Ducrotte P., Impaired fasting pyloric compliance in gastroparesis and the therapeutic response to pyloric dilatation, Aliment Pharmacol Ther, 41, pp. 360-367, (2015)
[85]  
Malik Z., Sankineni A., Parkman H., Assessing pyloric sphincter pathophysiology using Endo FLIP in patients with gastroparesis, Neurogastroenterol Motil, 27, pp. 524-531, (2015)
[86]  
Ahuja N.K., Clarke J.O., Pyloric therapies for gastroparesis, Curr Treat Options Gastroenterol, 15, pp. 230-240, (2017)
[87]  
Arts J., Holvoet L., Caenepeel P., Bisschops R., Sifrim D., Verbeke K., Janssens J., Tack J., Clinical trial: a randomized-controlled crossover study of intrapyloric injection of botulinum toxin in gastroparesis, Aliment Pharmacol Ther, 26, pp. 1251-1258, (2007)
[88]  
Friedenberg F.K., Palit A., Parkman H.P., Et al., Botulinum toxin a for the treatment of delayed gastric emptying, Am J Gastroenterol, 103, (2008)
[89]  
Khashab M.A., Besharati S., Ngamruengphong S., Kumbhari V., el Zein M., Stein E.M., Tieu A., Mullin G.E., Dhalla S., Nandwani M.C., Singh V., Canto M.I., Kalloo A.N., Clarke J.O., Refractory gastroparesis can be successfully managed with endoscopic transpyloric stent placement and fixation (with video), Gastrointest Endosc, 82, pp. 1106-1109, (2015)
[90]  
Hibbard M.L., Dunst C.M., Swanstrom L.L., Laparoscopic and endoscopic pyloroplasty for gastroparesis results in sustained symptom improvement, J Gastrointest Surg, 15, pp. 1513-1519, (2011)