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Joon Koo Han - One of the best experts on this subject based on the ideXlab platform.
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efficacy of Gastric Balloon dilatation and or retrievable stent insertion for pyloric spasms after pylorus preserving gastrectomy retrospective analysis
PLOS ONE, 2015Co-Authors: Jae Seok Bae, Se Hyung Kim, Cheong Il Shin, Ijin Joo, Jeong Hee Yoon, Hyukjoon Lee, Han Kwang Yang, Jee Hyun Baek, Tae Han Kim, Joon Koo HanAbstract:Purpose We retrospectively investigated the feasibility and clinical efficacy of Balloon dilatation and subsequent retrievable stent insertion, when necessitated, for pyloric spasms after pylorus-preserving gastrectomy (PPG). Materials and Methods Forty-five patients experiencing pyloric spasms after PPG underwent fluoroscopic Balloon dilations to alleviate obstructive symptoms due to delayed Gastric emptying. Patients showing poor response to Balloon dilation underwent subsequent retrievable stent insertion. Safety of the procedures was analyzed, and subjective symptoms and objective signs of pyloric spasms were analyzed and compared before and after treatment. Results Thirty-three patients (73.3%, 33/45) showed good response to Balloon dilatation requiring no further treatment (Balloon group). Conversely, 12 patients (26.7%, 12/45) showed poor or no response after Balloon dilation requiring subsequent stent insertion (stent group). Balloon dilations and/or stent insertions were safely performed in all patients except one patient who suffered a transmural tear after Balloon dilatation. In both groups, mean subjective symptom score was significantly improved and mean pyloric canal-to-height of the adjacent vertebral body ratio was significantly increased after the procedures (P <.05). Conclusion Balloon dilation is a safe and effective treatment for patients with pyloric spasms after PPG. In patients refractory to Balloon dilations, retrievable stent placement can be a safe alternative tool.
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Efficacy of Gastric Balloon Dilatation and/or Retrievable Stent Insertion for Pyloric Spasms after Pylorus-Preserving Gastrectomy: Retrospective Analysis
2015Co-Authors: Jae Seok Bae, Se Hyung Kim, Cheong Il Shin, Ijin Joo, Jeong Hee Yoon, Hyukjoon Lee, Han Kwang Yang, Jee Hyun Baek, Tae Han Kim, Joon Koo HanAbstract:PurposeWe retrospectively investigated the feasibility and clinical efficacy of Balloon dilatation and subsequent retrievable stent insertion, when necessitated, for pyloric spasms after pylorus-preserving gastrectomy (PPG).Materials and MethodsForty-five patients experiencing pyloric spasms after PPG underwent fluoroscopic Balloon dilations to alleviate obstructive symptoms due to delayed Gastric emptying. Patients showing poor response to Balloon dilation underwent subsequent retrievable stent insertion. Safety of the procedures was analyzed, and subjective symptoms and objective signs of pyloric spasms were analyzed and compared before and after treatment.ResultsThirty-three patients (73.3%, 33/45) showed good response to Balloon dilatation requiring no further treatment (Balloon group). Conversely, 12 patients (26.7%, 12/45) showed poor or no response after Balloon dilation requiring subsequent stent insertion (stent group). Balloon dilations and/or stent insertions were safely performed in all patients except one patient who suffered a transmural tear after Balloon dilatation. In both groups, mean subjective symptom score was significantly improved and mean pyloric canal-to-height of the adjacent vertebral body ratio was significantly increased after the procedures (P
Jae Seok Bae - One of the best experts on this subject based on the ideXlab platform.
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efficacy of Gastric Balloon dilatation and or retrievable stent insertion for pyloric spasms after pylorus preserving gastrectomy retrospective analysis
PLOS ONE, 2015Co-Authors: Jae Seok Bae, Se Hyung Kim, Cheong Il Shin, Ijin Joo, Jeong Hee Yoon, Hyukjoon Lee, Han Kwang Yang, Jee Hyun Baek, Tae Han Kim, Joon Koo HanAbstract:Purpose We retrospectively investigated the feasibility and clinical efficacy of Balloon dilatation and subsequent retrievable stent insertion, when necessitated, for pyloric spasms after pylorus-preserving gastrectomy (PPG). Materials and Methods Forty-five patients experiencing pyloric spasms after PPG underwent fluoroscopic Balloon dilations to alleviate obstructive symptoms due to delayed Gastric emptying. Patients showing poor response to Balloon dilation underwent subsequent retrievable stent insertion. Safety of the procedures was analyzed, and subjective symptoms and objective signs of pyloric spasms were analyzed and compared before and after treatment. Results Thirty-three patients (73.3%, 33/45) showed good response to Balloon dilatation requiring no further treatment (Balloon group). Conversely, 12 patients (26.7%, 12/45) showed poor or no response after Balloon dilation requiring subsequent stent insertion (stent group). Balloon dilations and/or stent insertions were safely performed in all patients except one patient who suffered a transmural tear after Balloon dilatation. In both groups, mean subjective symptom score was significantly improved and mean pyloric canal-to-height of the adjacent vertebral body ratio was significantly increased after the procedures (P <.05). Conclusion Balloon dilation is a safe and effective treatment for patients with pyloric spasms after PPG. In patients refractory to Balloon dilations, retrievable stent placement can be a safe alternative tool.
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Efficacy of Gastric Balloon Dilatation and/or Retrievable Stent Insertion for Pyloric Spasms after Pylorus-Preserving Gastrectomy: Retrospective Analysis
2015Co-Authors: Jae Seok Bae, Se Hyung Kim, Cheong Il Shin, Ijin Joo, Jeong Hee Yoon, Hyukjoon Lee, Han Kwang Yang, Jee Hyun Baek, Tae Han Kim, Joon Koo HanAbstract:PurposeWe retrospectively investigated the feasibility and clinical efficacy of Balloon dilatation and subsequent retrievable stent insertion, when necessitated, for pyloric spasms after pylorus-preserving gastrectomy (PPG).Materials and MethodsForty-five patients experiencing pyloric spasms after PPG underwent fluoroscopic Balloon dilations to alleviate obstructive symptoms due to delayed Gastric emptying. Patients showing poor response to Balloon dilation underwent subsequent retrievable stent insertion. Safety of the procedures was analyzed, and subjective symptoms and objective signs of pyloric spasms were analyzed and compared before and after treatment.ResultsThirty-three patients (73.3%, 33/45) showed good response to Balloon dilatation requiring no further treatment (Balloon group). Conversely, 12 patients (26.7%, 12/45) showed poor or no response after Balloon dilation requiring subsequent stent insertion (stent group). Balloon dilations and/or stent insertions were safely performed in all patients except one patient who suffered a transmural tear after Balloon dilatation. In both groups, mean subjective symptom score was significantly improved and mean pyloric canal-to-height of the adjacent vertebral body ratio was significantly increased after the procedures (P
Harvey J. Grill - One of the best experts on this subject based on the ideXlab platform.
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leptin and the control of food intake neurons in the nucleus of the solitary tract are activated by both Gastric distension and leptin
Endocrinology, 2007Co-Authors: Lisa Y. Maeng, Christian Bjørbæk, Harvey J. GrillAbstract:Leptin reduces food intake by an unspecified mechanism. Studies show that forebrain ventricular leptin delivery increases the inhibitory effects of gastrointestinal (GI) stimulation on intake and amplifies the electrophysiological response to Gastric distension in neurons of the medial subnucleus of the nucleus tractus solitarius (mNTS). However, forebrain ventricular delivery leaves unspecified the neuroanatomical site(s) mediating leptin’s effect on intake. Detailed anatomical analysis in rats and mice by phosphorylated signal transducer and activator of transcription 3 immunohistochemistry shows that hindbrain leptin-responsive neurons are located exclusively within the mNTS. Here, we investigate 1) whether leptin and Gastric distension affect the same mNTS neurons and 2) whether the intake-inhibitory action of Gastric distension is potentiated by hindbrain leptin delivery. Twenty-five minutes after Gastric Balloon distension or sham distension, rats were injected with leptin or vehicle and killed 35 m...
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Leptin and the control of food intake: neurons in the nucleus of the solitary tract are activated by both Gastric distension and leptin.
Endocrinology, 2007Co-Authors: Lihong Huo, Lisa Y. Maeng, Christian Bjørbæk, Harvey J. GrillAbstract:Leptin reduces food intake by an unspecified mechanism. Studies show that forebrain ventricular leptin delivery increases the inhibitory effects of gastrointestinal (GI) stimulation on intake and amplifies the electrophysiological response to Gastric distension in neurons of the medial subnucleus of the nucleus tractus solitarius (mNTS). However, forebrain ventricular delivery leaves unspecified the neuroanatomical site(s) mediating leptin's effect on intake. Detailed anatomical analysis in rats and mice by phosphorylated signal transducer and activator of transcription 3 immunohistochemistry shows that hindbrain leptin-responsive neurons are located exclusively within the mNTS. Here, we investigate 1) whether leptin and Gastric distension affect the same mNTS neurons and 2) whether the intake-inhibitory action of Gastric distension is potentiated by hindbrain leptin delivery. Twenty-five minutes after Gastric Balloon distension or sham distension, rats were injected with leptin or vehicle and killed 35 min later. Double-fluorescent immunohistochemistry for phosphorylated signal transducer and activator of transcription 3 and c-Fos revealed that about 40% of leptin-responsive cells also respond to Gastric distension. A paradigm was then developed to examine the relationship between leptin and Gastric distension volume on intake inhibition. At subthreshold levels, hindbrain ventricular leptin or distension volume were without effect. When combined, an interaction occurred that significantly reduced food intake. We conclude that 1) leptin-responsive neurons in the hindbrain are primarily located in the mNTS at the level of the area postrema, a key vagal afferent projection zone of the GI system; 2) a significant proportion of leptin-responsive neurons in the mNTS are activated by stomach distension; and 3) leptin delivered to the hindbrain is sufficient to potentiate the intake-suppressive effects of an otherwise ineffective volume of Gastric distension. These results are consistent with the hypothesis that leptin acts directly on neurons within the mNTS to reduce food intake through an interaction with GI signal processing.
Hansrudolf Berthoud - One of the best experts on this subject based on the ideXlab platform.
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Gastric distension-induced c-fos expression in catecholaminergic neurons of rat dorsal vagal complex
2016Co-Authors: Alison E Willing, Hansrudolf Berthoud, Alison E, Hans-rudolf Berthoud GastricAbstract:distension-induced c-fos expression in catecholaminergic neu-rons of rat dorsal vagal complex. Am. J. Physiol. 272 (Regula-tory Integrative Comp. Physiol. 41): R59-R67, 1997.-Functionally specific vagal afferents were stimulated by Gastric Balloon distension in unanesthetized rats, followed by double c-fosldopamine P-hydroxylase (DBH) immunocyto-chemistry, to identify second-order neurons in the dorsal vagal complex. Continuous and repeated phasic distension with similar volumes produced similar numbers and patterns of c-fos expression, with most of the activated neurons in the medial and commissural nucleus of the solitary tract (NTS) and dorsal motor nucleus (DMNX). Larger distension acti-vated significantly more neurons in all responsive areas, but there was no differential effect. In most NTS subnuclei and the DMNX, a small (3-5%) proportion of Gastric distension
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Gastric distension induced c fos expression in catecholaminergic neurons of rat dorsal vagal complex
American Journal of Physiology-regulatory Integrative and Comparative Physiology, 1997Co-Authors: Alison E Willing, Hansrudolf BerthoudAbstract:Functionally specific vagal afferents were stimulated by Gastric Balloon distension in unanesthetized rats, followed by double c-fos/dopamine beta-hydroxylase (DBH) immunocytochemistry, to identify second-order neurons in the dorsal vagal complex. Continuous and repeated phasic distension with similar volumes produced similar numbers and patterns of c-fos expression, with most of the activated neurons in the medial and commissural nucleus of the solitary tract (NTS) and dorsal motor nucleus (DMNX). Larger distension activated significantly more neurons in all responsive areas but there was no differential effect. In most NTS subnuclei and the DMNX, a small (3-5%) proportion of Gastric distension-activated neurons was DBH-immunoreactive (DBH-IR), and this proportion did not significantly change with type of distension. With continuous and repeated small distensions, 10-12% and, with the large distension, 22-30% of all DBH-IR neurons expressed c-fos. The results suggest a large degree of convergence between rapidly adapting mucosal receptors and slowly adapting tension receptors, but not between low- and high-threshold tension receptors, and a relatively minor role of catecholaminergic second-order neurons in the dissemination of distension signals in the brain.
Patrick Dupont - One of the best experts on this subject based on the ideXlab platform.
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differential brain responses to gradual intraGastric nutrient infusion and Gastric Balloon distension a role for gut peptides
NeuroImage, 2017Co-Authors: Patrick Dupont, Jan Tack, Koen Van Laere, Inge Depoortere, L. Van OudenhoveAbstract:Abstract Background Rapid Gastric Balloon distension to discomfort threshold activates the “pain neuromatrix” and deactivates exteroceptive sensory and “default mode network” regions. However, little is known about brain mechanisms underlying tolerance of meal-induced Gastric distension. We aimed to directly compare brain responses to gradual Balloon distension and intraGastric nutrient infusion and to explore the role of differential gut peptide release in these responses. Materials and methods Brain responses to Balloon- and nutrient-induced distension (to individually titrated pain or maximal satiation threshold) were measured in 15 healthy volunteers using H215O-PET on 2 separate days in counterbalanced order. The effects of increasing Gastric distension and plasma levels of ghrelin and peptide YY3-36 (PYY3-36) on neural activity were assessed. Results Balloon distension progressively activated pain-responsive regions and deactivated exteroceptive sensory and “default mode network” areas. During nutrient infusion, “pain neuromatrix” regions and the orbitofrontal cortex were progressively deactivated, while the midbrain was activated. Plasma levels of PYY3-36 and ghrelin increased and decreased, respectively, during nutrient infusion only; decreasing ghrelin levels correlated with increasing midbrain activity. Conclusion Different brain responses to Gastric Balloon distension and intraGastric nutrient infusion are associated with nutrient-induced gut-brain signals, particularly to the midbrain, where these signals may interfere with both descending pain modulatory and mesolimbic reward processes. Deactivation of the “pain neuromatrix” during nutrient infusion may constitute the neurophysiological mechanism underlying the tolerance of normal meal volumes in health without induction of (painful) symptoms. Nutrient-induced deactivation of the orbitofrontal cortex may represent a key interoceptive meal termination signal.
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lack of endogenous opioid release during sustained visceral pain a 11c carfentanil pet study
Pain, 2013Co-Authors: Huynh Giao Ly, Brecht Geeraerts, Patrick Dupont, Guy Bormans, Jan Tack, Koen Van Laere, Lukas Van OudenhoveAbstract:Abstract Opioidergic neurotransmission in the central nervous system is involved in somatic pain, but its role in visceral pain remains unknown. We aimed to quantify endogenous opioid release in the brain during sustained painful Gastric distension. Therefore, 2 dynamic [ 11 C]carfentanil positron emission tomography scans were performed in 20 healthy subjects during 2 conditions: sustained (20 minutes) painful proximal Gastric Balloon distension at predetermined individual discomfort threshold (PAIN) and no distension (NO PAIN), in counterbalanced order. Pain levels were assessed during scanning using visual analogue scales and after scanning using the McGill Pain Questionnaire. Emotional state was rated after scanning using the Positive and Negative Affect Schedule. Distribution volume ratios in 21 volumes of interest in the pain matrix were used to quantify endogenous opioid release. During the PAIN compared to the NO PAIN condition, volunteers reported a significantly higher increase in negative affect (5.50 ± 1.29 versus 0.10 ± 1.08, P = .0147) as well as higher pain ratings (sensory: 74.05 ± 9.23 versus 1.50 ± 0.95, P P
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Different regional brain activity during physiological Gastric distension compared to Balloon distension: a H215O-PET study
Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society, 2010Co-Authors: Brecht Geeraerts, L. Van Oudenhove, Patrick Dupont, Dominique Vanderghinste, Guy Bormans, K. Van Laere, J. TackAbstract:Background Stepwise Gastric Balloon distension progressively activates a ‘visceral pain neuromatrix’, ultimately inducing discomfort and pain. On the other hand, normal meal ingestion requires Gastric volume expansion without induction of pain. The aim was to test the hypothesis that physiological Gastric distension (liquid meal infusion) until maximal satiation elicits brain responses similar to Balloon distension at discomfort threshold. Methods Brain H215O-positron emission tomography (PET) was performed in two different groups of healthy volunteers (both n = 14) during continuous and stepwise infusion of a liquid meal through a nasoGastric tube, until maximal satiation. Brain (de)activation patterns were compared with historical controls in which discomfort was elicited using Gastric Balloon distension. This latter reference group was acquired on the same scanner using the same acquisition protocol; all data were analyzed using statistical parametric mapping (SPM2). Within each group, brain activity at maximal distension was compared to baseline activity and between-group comparisons were made. Key Results IntraGastric volumes and satiation/Gastric sensation scores at endpoint were similar in all groups. Continuous and stepwise nutrient infusion was associated with progressive deactivations in key areas of the ‘visceral pain neuromatrix’ that were activated during Balloon distension. Additionally, stepwise infusion progressively activated prefrontal areas and showed deactivations in ‘default network’ brain regions also found to be deactivated during Balloon distension. Conclusions & Inferences Compared to Gastric Balloon distension, physiological Gastric distension using nutrient infusion elicits opposite brain responses in the ‘visceral pain neuromatrix’, but similar responses in other areas. We interpret this finding as a prerequisite for tolerance of normal meal volumes in health.