The Experts below are selected from a list of 1059 Experts worldwide ranked by ideXlab platform
Michael Camilleri - One of the best experts on this subject based on the ideXlab platform.
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The surgeon's role in the treatment of chronic Intestinal Pseudoobstruction.
The American journal of gastroenterology, 1995Co-Authors: Michel M. Murr, Michael G. Sarr, Michael CamilleriAbstract:Objective : The surgeon's role in the treatment of patients with chronic Intestinal Pseudoobstruction (CIP) is under-appreciated. Our aim was to determine the effects of operative treatment on symptomatic relief of CIP. Methods : Records of all 21 patients who underwent surgery for CIP from 1980 to 1990 were reviewed. CIP was diagnosed by a combination of manometric, radiological, and/or histological examinations. Results : Six of the nine patients who underwent resection or bypass of presumably localized disease are currently maintained on oral intake ; one patient with multiple sclerosis who cannot eat is fed via a gastrostomy tube. Enterostomy tube(s) were placed in the other 12 patients ; four no longer use the enterostomy tube(s), and eight rely on these decompressive tube enterostomies for symptomatic relief. After operative treatment, hospital readmissions decreased from a mean of 0.5 to 0.1 admission/year. All 19 patients currently alive report improved quality of life. Conclusions: Selective and directed operative treatment of patients with CIP can result in therapeutic and palliative benefits. The surgeon should have an active role in the evaluation and possible treatment of patients with CIP.
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Enteric neuronal autoantibodies in Pseudoobstruction with small-cell lung carcinoma.
Gastroenterology, 1991Co-Authors: Vanda A. Lennon, Michael Camilleri, Juan R. Malagelada, Daryl F. Sas, Michael F. Busk, Bernd W. Scheithauer, Laurence J. MillerAbstract:Severe gastroIntestinal dysmotility is a newly recognized paraneoplastic syndrome that occurs with small-cell lung carcinoma. Thirty-four patients with small-cell carcinoma, of whom 5 had chronic Intestinal Pseudoobstruction and 29 had no digestive symptoms, were studied serologically. Four of the 5 patients with gut dysmotility had immunoglobulin G antibodies reactive with neurons of the myenteric and submucosal plexuses of jejunum and stomach in an indirect immunofluorescence assay. Antibodies of this type were not found in any of the 29 patients who had no gut dysmotility, nor were they found in patients with chronic idiopathic Intestinal Pseudoobstruction (n = 8), ovarian cancer (n = 20), or epilepsy (n = 4) or in normal subjects (n = 9). In 4 of the patients with paraneoplastic Pseudoobstruction, antibodies in highly diluted serum (1:4000-1:8000) bound selectively to nuclei and cytoplasm of neuronal elements in the gut. This novel autoantibody activity suggests that Intestinal Pseudoobstruction occurring in patients with small-cell carcinoma may have an autoimmune basis. From a clinical standpoint, serological testing offers a simple means for determining which patients with gut dysmotility syndromes may have associated small-cell carcinoma, thereby enabling earlier diagnosis and treatment of the tumor.
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Ileocolonic transfer of solid chyme in small Intestinal neuropathies and myopathies
Gastroenterology, 1990Co-Authors: Martin P. Greydanus, Michael Camilleri, Manuel L. Brown, Luc J. Colemont, Sidney F. Phillips, George M. ThomfordeAbstract:The aims of this study were to assess gastric emptying, small bowel transit and colonic filling in patients with motility disorders, with particular attention to the patterns of colonic filling. GastroIntestinal transit was assessed using a previously validated radiolabeled mixed meal. Fourteen patients with clinical and manometric features of chronic Intestinal Pseudoobstruction & classified as Intestinal neuropathy and 6 as Intestinal myopathy, were studied. The results were compared with those from 10 healthy controls studied similarly. Gastric emptying and small bowel transit of solids were significantly slower in both groups of patients than in healthy controls (P less than 0.05). In health, the ileocolonic transit of solid chyme was characterized by intermittent bolus transfers. The mean size of boluses transferred to the colon (expressed as a percentage of ingested radiolabel) was significantly less (P less than 0.05) in patients with Intestinal myopathy (10% +/- 4% (SEM)] than in healthy controls (25% +/- 4%) or in patients with Intestinal neuropathy (25% +/- 4%). The intervals between bolus transfer of solids (plateaus in the colonic filling curve) were longer (P less than 0.05) in myopathies (212 +/- 89 minutes) than in health (45 +/- 7 minutes) or neuropathies (53 +/- 11 minutes). Thus, gastric emptying and small bowel transit were delayed in small bowel neuropathies and myopathies. Bolus filling of the colon was less frequent and less effective in patients with myopathic Intestinal Pseudoobstruction, whereas bolus transfer was preserved in patients with neuropathic Intestinal Pseudoobstruction.
Sang-heon Lee - One of the best experts on this subject based on the ideXlab platform.
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= Abstract = A Case of Intestinal Pseudoobstruction Associated with Systemic Sclerosis Successfully Treated with Erythromycin and Octreotide
2016Co-Authors: Byum Sung Kim, Hae Rim Kim, Sang-heon LeeAbstract:Systemic sclerosis is an autoimmune disease, characterized by inflammation, microangiopathy and fibrosis in the skin and various Intestinal organs. GastroIntestinal involvement is one of the major causes of serious morbidity, and next to the skin, the gastroIntestinal tract is the most commonly involved organ. While esophageal involvement is most common gastroIntestinal manifestation, the involvement of the small intestine and colon is less common but may lead to life-threatening complications like chronic pesudoobstruction or pneumatosis cystoids Intestinalis. Here, we describe a case of progressive systemic sclerosis associated with Intestinal Pseudoobstruction. 28 year-old male presented abdominal pain and vomiting and he was diagnosed as having Intestinal Pseudoobstruction. His symptoms were well managed using th
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A Case of Intestinal Pseudoobstruction Associated with Systemic Sclerosis Successfully Treated with Erythromycin and Octreotide
The Journal of the Korean Rheumatism Association, 2007Co-Authors: Hyun Sung Yoon, Tae Ho Seo, Eung Jun Lee, Byum Sung Kim, Hae Rim Kim, Sang-heon LeeAbstract:Systemic sclerosis is an autoimmune disease, characterized by inflammation, microangiopathy and fibrosis in the skin and various Intestinal organs. GastroIntestinal involvement is one of the major causes of serious morbidity, and next to the skin, the gastroIntestinal tract is the most commonly involved organ. While esophageal involvement is most common gastroIntestinal manifestation, the involvement of the small intestine and colon is less common but may lead to life-threatening complications like chronic pesudoobstruction or pneumatosis cystoids Intestinalis. Here, we describe a case of progressive systemic sclerosis associated with Intestinal Pseudoobstruction. 28 year-old male presented abdominal pain and vomiting and he was diagnosed as having Intestinal Pseudoobstruction. His symptoms were well managed using the combination of octreotide, a long-acting somatostatin analogue, and erythromycin.
Michael A Kamm - One of the best experts on this subject based on the ideXlab platform.
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Electrogastrography in chronic Intestinal Pseudoobstruction
Digestive Diseases and Sciences, 1996Co-Authors: H S Debinski, Shiban Ahmed, Peter J. Milla, Michael A KammAbstract:This study aimed to characterize the disturbance of gastric electrical control activity in chronic Intestinal Pseudoobstruction (CIP) and to determine whether surface electrogastrography (EGG) could be used to diagnose the presence and type of CIP. Gastric electrical control activity was recorded for 30 min in each of the fasting and fed states by EGG in 14 adults with CIP proven on clinical, radiological, and histological grounds, and in 14 age- and sex-matched controls. Electrical activity was recorded from four pairs of Ag-AgCl bipolar skin electrodes, the captured signal amplified and digitalized, and running spectral analysis performed. The dominant frequency and power of spectrum were calculated using a sequence of computerized algorithms. Results were correlated with the known pathological diagnoses [visceral myopathy (M), N =7; visceral neuropathy (N), N =4; undifferentiated (U), N =3]. Dysrhythmias were present in 13 of 14 patients. Tachygastria (electrical control activity frequency >5 cycles/minute) and a normal amplitude response to food, was seen in five patients (N=4, U=1). Irregular continuous activity without a dominant frequency or bradyarrhythmia, together with a diminished electrical response activity (ERA) to food, were found in six patients (M=5, U=1). Mixed abnormalities were seen in two patients (M=1, U=1), and normal activity with a clear dominant frequency of 3 cycles/minute was present in only one patient (M=1). This noninvasive technique is both sensitive and specific in providing evidence of a dysrhythmia in patients with CIP and discriminates between primary pathologies. EGG may prove diagnostically useful in these disorders and may provide insight into the disturbance of electrical control activity.
Amy Foxx-orenstein - One of the best experts on this subject based on the ideXlab platform.
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Chronic Intestinal Pseudoobstruction
Current Treatment Options in Gastroenterology, 2004Co-Authors: Greg Lyford, Amy Foxx-orensteinAbstract:Patients with chronic Intestinal Pseudoobstruction (CIP) experience a constellation of symptoms including abdominal pain, nausea, fullness, and malaise which fluctuates in severity and invariably result in a diminished quality of life. Though surgical resection or transplantation may be an option for some, there currently is no cure for CIP. Thus, management strategies utilize pharmacologic, intravenous, endoscopic, and surgical techniques to promote transit, minimize painful bloating, reduce complications of stasis, and improve quality of life. Prokinetic agents such as erythromycin, metoclopramide, cisapride, neostigmine, and tegaserod may be effective for acute exacerbations. Octreotide may reduce symptoms of bacterial overgrowth and bloating by stimulating migrating motor complexes. Enteral tubes for venting and nutritional support may reduce hospitalizations. Total parenteral nutrition (TPN), fraught with well-known complications, may be the only tolerated source for nutrients and fluid. Advanced disease may magnify nutritional problems, difficulties of long term intravenous and Intestinal access, and poor symptom control. Because the initial process may manifest in other Intestinal regions following surgery, resection of involved segments should be performed with caution. Small Intestinal transplantation is a high-risk surgery performed in persons unable to tolerate intravenous (IV) nutrition. Optimal management for persons with CIP should not only provide nutritional and symptom focused care but should be part of a supportive network which links patients to their appropriate healthcare needs.
Lionel Larue - One of the best experts on this subject based on the ideXlab platform.
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Deletion of Pten in the mouse enteric nervous system induces ganglioneuromatosis and mimics Intestinal Pseudoobstruction
Journal of Clinical Investigation, 2009Co-Authors: Isabel Puig, Delphine Champeval, Pascal De Santa Barbara, Francis Jaubert, Stanislas Lyonnet, Lionel LarueAbstract:Intestinal ganglioneuromatosis is a benign proliferation of nerve ganglion cells, nerve fibers, and supporting cells of the enteric nervous system (ENS) that can result in abnormally large enteric neuronal cells (ENCs) in the myenteric plexus and chronic Intestinal Pseudoobstruction (CIPO). As phosphatase and tensin homolog deleted on chromosome 10 (PTEN) is a phosphatase that is critical for controlling cell growth, proliferation, and death, we investigated the role of PTEN in the ENS by generating mice with an embryonic, ENC-selective deletion within the Pten locus. Mutant mice died 2 to 3 weeks after birth, with clinical signs of CIPO and hyperplasia and hypertrophy of ENCs resulting from increased activity of the PI3K/PTEN-AKT-S6K signaling pathway. Further analysis revealed that PTEN was only expressed in developing mouse embryonic ENCs from E15.5 and that the rate of ENC proliferation decreased once PTEN was expressed. Specific deletion of the Pten gene in ENCs therefore induced hyperplasia and hypertrophy in the later stages of embryogenesis. This phenotype was reversed by administration of a pharmacological inhibitor of AKT. In some human ganglioneuromatosis forms of CIPO, PTEN expression was found to be abnormally low and S6 phosphorylation increased. Our study thus reveals that loss of PTEN disrupts development of the ENS and identifies the PI3K/PTEN-AKT-S6K signaling pathway as a potential therapeutic target for ganglioneuromatosis forms of CIPO.
