Resolution of severe gastroparesis induced by parasympathetic surge following facial trauma: a case report.
A case report
Gastric emptying
Gastroparesis
Intestinal motility disorder
Parasympathetic surge
Journal
Journal of medical case reports
ISSN: 1752-1947
Titre abrégé: J Med Case Rep
Pays: England
ID NLM: 101293382
Informations de publication
Date de publication:
16 May 2024
16 May 2024
Historique:
received:
15
01
2024
accepted:
22
04
2024
medline:
16
5
2024
pubmed:
16
5
2024
entrez:
15
5
2024
Statut:
epublish
Résumé
Gastroparesis is a condition that affects the motility of the gastrointestinal (GI) tract, causing a delay in the emptying process and leading to nausea, vomiting, bloating, and upper abdominal pain. Motility treatment along with symptom management can be done using antiemetics or prokinetics. This study highlights the diagnostic and therapeutic challenges of gastroparesis and suggests a potential link between facial trauma and symptom remission, indicating the need for further investigation. A 46-year-old Hispanic man with hypertension, type 2 diabetes (T2D), and hyperlipidemia on amlodipine 10 mg, lisinopril 5 mg, empagliflozin 25 mg, and insulin glargine presented with a diabetic foot ulcer with probable osteomyelitis. During hospitalization, the patient developed severe nausea and vomiting. The gastroenterology team advised continuing antiemetic medicine and trying very small sips of clear liquids. However, the patient didn't improve. Therefore, the gastroenterology team was contacted again. They advised having stomach emptying tests to rule out gastroparesis as the source of emesis. In addition, they recommended continuing metoclopramide, and starting erythromycin due to inadequate improvement. Studies found a 748-min stomach emptying time. Normal is 45-90 min. An uneventful upper GI scope was done. Severe gastroparesis was verified, and the gastroenterology team advised a percutaneous jejunostomy or gastric pacemaker for gastroparesis. Unfortunately, the patient suffered a mechanical fall resulting in facial trauma. After the fall, the patient's nausea eased, and emesis stopped. He passed an oral liquids trial after discontinuation of erythromycin and metoclopramide. This case exemplifies the difficulties in diagnosing and treating gastroparesis. An interesting correlation between parasympathetic surges and recovery in gastroparesis may be suggested by the surprising remission of symptoms following face injuries.
Sections du résumé
BACKGROUND
BACKGROUND
Gastroparesis is a condition that affects the motility of the gastrointestinal (GI) tract, causing a delay in the emptying process and leading to nausea, vomiting, bloating, and upper abdominal pain. Motility treatment along with symptom management can be done using antiemetics or prokinetics. This study highlights the diagnostic and therapeutic challenges of gastroparesis and suggests a potential link between facial trauma and symptom remission, indicating the need for further investigation.
CASE PRESENTATION
METHODS
A 46-year-old Hispanic man with hypertension, type 2 diabetes (T2D), and hyperlipidemia on amlodipine 10 mg, lisinopril 5 mg, empagliflozin 25 mg, and insulin glargine presented with a diabetic foot ulcer with probable osteomyelitis. During hospitalization, the patient developed severe nausea and vomiting. The gastroenterology team advised continuing antiemetic medicine and trying very small sips of clear liquids. However, the patient didn't improve. Therefore, the gastroenterology team was contacted again. They advised having stomach emptying tests to rule out gastroparesis as the source of emesis. In addition, they recommended continuing metoclopramide, and starting erythromycin due to inadequate improvement. Studies found a 748-min stomach emptying time. Normal is 45-90 min. An uneventful upper GI scope was done. Severe gastroparesis was verified, and the gastroenterology team advised a percutaneous jejunostomy or gastric pacemaker for gastroparesis. Unfortunately, the patient suffered a mechanical fall resulting in facial trauma. After the fall, the patient's nausea eased, and emesis stopped. He passed an oral liquids trial after discontinuation of erythromycin and metoclopramide.
CONCLUSION
CONCLUSIONS
This case exemplifies the difficulties in diagnosing and treating gastroparesis. An interesting correlation between parasympathetic surges and recovery in gastroparesis may be suggested by the surprising remission of symptoms following face injuries.
Identifiants
pubmed: 38750592
doi: 10.1186/s13256-024-04558-4
pii: 10.1186/s13256-024-04558-4
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
248Informations de copyright
© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.
Références
Camilleri M, Bharucha AE, Farrugia G. Epidemiology, mechanisms, and management of diabetic gastroparesis. Clin Gastroenterol Hepatol. 2011;9(1):5–12 (quiz e7).
doi: 10.1016/j.cgh.2010.09.022
pubmed: 20951838
Parkman HP, Hasler WL, Fisher RS. American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology. 2004;127(5):1592–622.
doi: 10.1053/j.gastro.2004.09.055
pubmed: 15521026
Choung RS, et al. Risk of gastroparesis in subjects with type 1 and 2 diabetes in the general population. Am J Gastroenterol. 2012;107(1):82–8.
doi: 10.1038/ajg.2011.310
pubmed: 22085818
Cherian D, Parkman HP. Nausea and vomiting in diabetic and idiopathic gastroparesis. Neurogastroenterol Motil. 2012; 24(3): 217–22, e103.
Camilleri M, et al. ACG clinical guideline: gastroparesis. Am J Gastroenterol. 2022;117(8):1197–220.
doi: 10.14309/ajg.0000000000001874
pubmed: 35926490
pmcid: 9373497
Hyett B, et al. Delayed radionucleotide gastric emptying studies predict morbidity in diabetics with symptoms of gastroparesis. Gastroenterology. 2009;137(2):445–52.
doi: 10.1053/j.gastro.2009.04.055
pubmed: 19410575
Horowitz M, Fraser RJ. Gastroparesis: diagnosis and management. Scand J Gastroenterol Suppl. 1995;213:7–16.
pubmed: 8578243
Abell TL, et al. Treatment of gastroparesis: a multidisciplinary clinical review. Neurogastroenterol Motil. 2006;18(4):263–83.
doi: 10.1111/j.1365-2982.2006.00760.x
pubmed: 16553582
Jung HK, et al. The incidence, prevalence, and outcomes of patients with gastroparesis in Olmsted County, Minnesota, from 1996 to 2006. Gastroenterology. 2009;136(4):1225–33.
doi: 10.1053/j.gastro.2008.12.047
pubmed: 19249393
Zheng T, Camilleri M. Management of gastroparesis. Gastroenterol Hepatol (N Y). 2021;17(11):515–25.
pubmed: 35466306
Horowitz M, et al. Effects of cisapride on gastric and esophageal emptying in progressive systemic sclerosis. Gastroenterology. 1987;93(2):311–5.
doi: 10.1016/0016-5085(87)91020-1
pubmed: 3596167
Marie I, et al. Gastric involvement in systemic sclerosis: a prospective study. Am J Gastroenterol. 2001;96(1):77–83.
doi: 10.1111/j.1572-0241.2001.03353.x
pubmed: 11197291
Kristinsson JO, et al. Gastroparesis in patients with inactive Crohn’s disease: a case series. BMC Gastroenterol. 2007;7:11.
doi: 10.1186/1471-230X-7-11
pubmed: 17376243
pmcid: 1838914
Parkman HP, et al. Similarities and differences between diabetic and idiopathic gastroparesis. Clin Gastroenterol Hepatol. 2011;9(12):1056–64 (quiz e133-4).
doi: 10.1016/j.cgh.2011.08.013
pubmed: 21871247
Cherian D, et al. Abdominal pain is a frequent symptom of gastroparesis. Clin Gastroenterol Hepatol. 2010;8(8):676–81.
doi: 10.1016/j.cgh.2010.04.027
pubmed: 20472097
O’Grady G, Carbone F, Tack J. Gastric sensorimotor function and its clinical measurement. Neurogastroenterol Motil. 2022;34(12): e14489.
doi: 10.1111/nmo.14489
pubmed: 36371709
pmcid: 10078602
Fontana RJ, Barnett JL. Jejunostomy tube placement in refractory diabetic gastroparesis: a retrospective review. Am J Gastroenterol. 1996;91(10):2174–8.
pubmed: 8855743
Haans JJ, Masclee AA. Review article: the diagnosis and management of gastroparesis. Aliment Pharmacol Ther. 2007;26(Suppl 2):37–46.
doi: 10.1111/j.1365-2036.2007.03534.x
pubmed: 18081647
Camilleri M, et al. Clinical guideline: management of gastroparesis. Am J Gastroenterol. 2013;108(1):18–37 (quiz 38).
doi: 10.1038/ajg.2012.373
pubmed: 23147521
Bateman DN, Rawlins MD, Simpson JM. Extrapyramidal reactions with metoclopramide. Br Med J (Clin Res Ed). 1985;291(6500):930–2.
doi: 10.1136/bmj.291.6500.930
pubmed: 3929968
Abell TL, et al. Long-term efficacy of oral cisapride in symptomatic upper gut dysmotility. Dig Dis Sci. 1991;36(5):616–20.
doi: 10.1007/BF01297028
pubmed: 2022163
Corinaldesi R, et al. Effect of chronic administration of cisapride on gastric emptying of a solid meal and on dyspeptic symptoms in patients with idiopathic gastroparesis. Gut. 1987;28(3):300–5.
doi: 10.1136/gut.28.3.300
pubmed: 3552906
pmcid: 1432703
Allen JH, et al. Cannabinoid hyperemesis: cyclical hyperemesis in association with chronic cannabis abuse. Gut. 2004;53(11):1566–70.
doi: 10.1136/gut.2003.036350
pubmed: 15479672
pmcid: 1774264
Chong K, Dhatariya K. A case of severe, refractory diabetic gastroparesis managed by prolonged use of aprepitant. Nat Rev Endocrinol. 2009;5(5):285–8.
doi: 10.1038/nrendo.2009.50
pubmed: 19444262
Prakash C, et al. Tricyclic antidepressants for functional nausea and vomiting: clinical outcome in 37 patients. Dig Dis Sci. 1998;43(9):1951–6.
doi: 10.1023/A:1018878324327
pubmed: 9753257
Sawhney MS, et al. Tricyclic antidepressants for chronic vomiting in diabetic patients. Dig Dis Sci. 2007;52(2):418–24.
doi: 10.1007/s10620-006-9378-8
pubmed: 17195923
Contreras-García IJ, et al. Levetiracetam Mechanisms of Action: From Molecules to Systems. Pharmaceuticals (Basel). 2022;15(4):475.
doi: 10.3390/ph15040475
pubmed: 35455472
Van der Ploeg L, et al. Preclinical gastrointestinal prokinetic efficacy and endocrine effects of the ghrelin mimetic RM-131. Life Sci. 2014;109(1):20–9.
doi: 10.1016/j.lfs.2014.06.003
pubmed: 24931905
Nelson AD, et al. Effects of ghrelin receptor agonist, relamorelin, on gastric motor functions and satiation in healthy volunteers. Neurogastroenterol Motil. 2016;28(11):1705–13.
doi: 10.1111/nmo.12870
pubmed: 27283792
pmcid: 5083171
Shin A, et al. The ghrelin agonist RM-131 accelerates gastric emptying of solids and reduces symptoms in patients with type 1 diabetes mellitus. Clin Gastroenterol Hepatol. 2013;11(11):1453-1459.e4.
doi: 10.1016/j.cgh.2013.04.019
pubmed: 23639598
pmcid: 3805699
Shin A, et al. Randomized controlled phase Ib study of ghrelin agonist, RM-131, in type 2 diabetic women with delayed gastric emptying: pharmacokinetics and pharmacodynamics. Diabetes Care. 2013;36(1):41–8.
doi: 10.2337/dc12-1128
pubmed: 22961573
Dukes GE, Scimia C, Kuo B. Safety, tolerability and pharmacodynamics of TAK-906, a dopamine 2,3 antagonist, in patients with diabetic or idiopathic gastroparesis. 2019. Presented at the 18th American Neurogastroenterology and Motility Society Annual Scientific Meeting; August 16–18, Chicago, IL. Abstract 6.