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T L Abell

Publications and source records attributed to T L Abell.

At least 19 recordsLinked to original sources
PubMed2006

Postinfectious gastroparesis related to autonomic failure: a case report.

BACKGROUND AND AIM: Severe dysautonomia may be secondary to viral infections, resulting in impaired autoimmune, cardiovascular, urinary and digestive dysfunction. Herein, we present a case of a 31-year-old white female patient who had severe gastroparesis related to autonomic failure following an episode of acute gastroenteritis. This seems to be the first report providing thorough assessment of the enteric and autonomic nervous system by analysis of full-thickness small intestinal biopsies, cardiovagal testing and autopsy. HOSPITAL COURSE: This patient affected by a severe gastroparesis was treated with antiemetics, prokinetics, analgesics and gastric electrical stimulation to control symptoms. Nutritional support was made using jejunal feeding tube and, in the final stage of disease, with total parenteral nutrition. Autonomic studies revealed minimal heart rate variability and a disordered Valsalva manoeuvre although the enteric nervous system and the smooth muscle layer showed a normal appearance. Hospital courses were complicated by episodes of bacteraemia and fungemia. Serum antiphospholipid antibodies were noted but despite anticoagulation, she developed a pulmonary embolism and shortly thereafter the patient died. Autopsy revealed acute haemorrhagic Candida pneumonia with left main pulmonary artery thrombus. Sympathetic chain analysis revealed decreased myelinated axons with vacuolar degeneration and patchy inflammation consistent with Guillain-Barre syndrome. The evaluation of the enteric nervous system in the stomach and small bowel revealed no evidence of enteric neuropathy or myopathy. CONCLUSION: A Guillain-Barre-like disease with gastroparesis following acute gastroenteritis is supported by physiological and autonomic studies with histological findings.

Adult↗
PubMed2006

Treatment of gastroparesis: a multidisciplinary clinical review.

This clinical review on the treatment of patients with gastroparesis is a consensus document developed by the American Motility Society Task Force on Gastroparesis. It is a multidisciplinary effort with input from gastroenterologists and other specialists who are involved in the care of patients with gastroparesis. To provide practical guidelines for treatment, this document covers results of published research studies in the literature and areas developed by consensus agreement where clinical research trials remain lacking in the field of gastroparesis.

Consensus Statements as Topic↗
PubMed2006

An energy algorithm improves symptoms in some patients with gastroparesis and treated with gastric electrical stimulation.

Gastric electrical stimulation (GES) is effective to improve symptoms of nausea and vomiting in most patients, but very little is known about the effect of varying stimulation parameters. We analysed stimulation parameters in a pilot study of 22 patients (12 idiopathic, four diabetic and four postsurgical) with drug-refractory gastroparesis who did not respond optimally to initial settings. Patients underwent high-frequency/low energy GES using identical initial stimulation parameters: 5 mA of current, 330 micros pulse width, 14 Hz for 0.1 s on and 5.0 s off. Due to lack on optimal response, 22 patients underwent alteration of an algorithm using stimulation parameters. At follow-up (mean of 4.3 years) a dose-response relationship for charge, power and energy were compared with baseline for the whole group and for each diagnostic subgroup by anova data are reported as mean +/- SE. Based on the mean of individual dose-response curves, differences in data are charge, current per pulse and energy per pulse were noted for the whole group at follow up vs baseline. The subgroup of patients with postsurgical gastroparesis required the most energy using the algorithm. In conclusion, an algorithmic approach to identify optimal stimulation parameters in GES for individual patients is associated with symptom improvement. Also, certain subgroups appear to have different energy parameters. Based on this preliminary data, the use of an algorithm for some patients with GES is feasible and may have potential for clinical application. A randomized-controlled trial of different stimulation parameters for GES seems warranted.

Adult↗
PubMed2005

Is gastric electrical stimulation superior to standard pharmacologic therapy in improving GI symptoms, healthcare resources, and long-term health care benefits?

CONTEXT: Severe upper gastrointestinal (GI) motor disorders, including gastroparesis (GP), can consume significant health care resources. Many patients are refractory to traditional drug therapy. OBJECTIVE: To compare symptoms, healthcare resource utilization and costs in two groups of patients with the symptoms of GP: those treated via gastric electrical stimulation (GES) and those treated with traditional pharmacological agents in an intensive outpatient program (MED). DESIGN: A long-term comparison of patients with devices (n = 9) vs intensive medical therapy (n = 9). SETTING AND PATIENTS: A total of 18 eligible patients with the symptoms of GP reported for 1-year baseline and long-term treatment for 3 years. INTERVENTIONS: Patients with the symptoms of GP were treated by a GES or intensive medical therapy (MED). MAIN OUTCOME MEASURES: GP Symptoms, healthcare resource utilization using investigator-derived independent outcome measure score (IDIOMS) and total hospital (inpatient and outpatient) billing costs. RESULTS: Gastrointestinal symptoms were significantly different from baseline (F = 3.03, P < 0.017) with GP patients treated via GES showing more sustained improvement over 36 months than those treated via MED. Healthcare resource usage, measured via the IDIOMS, significantly improved at 12, 24 and 36 month follow-up for GES patients (F = 10.49, P < 0.001), compared with patients receiving medical therapy, who demonstrated further deterioration. GP patients treated via GES also proved superior to medical therapy at 24 and 36 months with regard to decreased costs (F = 4.85, P < 0.001). Within group comparisons indicated significantly reduced hospital days for both patient groups; however, no statistical differences were noted between groups in terms of hospital days. Three of nine patients in the MED group died primarily from i.v. access related problems; none of the GES patients died. CONCLUSION: We conclude that GES is more effective in improving long-term GI symptoms and costs, and decreasing use of healthcare resources than intensive medical therapy, in this sample of patients with the symptoms of GP followed for 3 years. Certain patients with GP form a high-risk group in terms of costs, quality of life, morbidity and mortality.

Adult↗
PubMed2000

Assessment of gastric electrical activity and autonomic function among diabetic and nondiabetic patients with symptoms of gastroesophageal reflux.

Gastroesophageal reflux disease (GERD) may present differently in patients with diabetes mellitus (DM) than in nondiabetics (NDM). We compared three tests in two patient groups with GERD symptoms: a DM group (n = 10) and a NDM group (n = 13). The tests were 24-hr esophageal pH, autonomic function testing (AFT), and electrogastrography (EGG). Analysis of the 23 patients revealed the DM group had normal 24-hr pH values (9 of 10 patients, mean pH 3.1 +/- 1.7), while NDM displayed abnormal pH values (9 of 13 patients, mean pH 21.2 +/- 5.9). AFT results were abnormal in DM (demonstrating cholinergic/ adrenergic dysfunction), but normal in NDM. EGG values were abnormal in both groups (mean 3.31 +/- 0.1 in each). We conclude that in GERD-symptomatic patients, those with DM frequently have normal 24-hr pH, but abnormal autonomic functioning, in contrast to NDM, who have abnormal 24-hr pH but normal autonomic function. Both groups had identically abnormal mean EGG values.

Autonomic Nervous System↗
PubMed2000

Assessment of gastric emptying using a low fat meal: establishment of international control values.

OBJECTIVE: The diagnosis of gastroparesis implies delayed gastric emptying. The diagnostic gold standard is scintigraphy, but techniques and measured endpoints vary widely among institutions. In this study, a simplified scintigraphic measurement of gastric emptying was compared to conventional gastric scintigraphic techniques and normal gastric emptying values defined in healthy subjects. METHODS: In 123 volunteers (aged 19-73 yr, 60 women and 63 men) from 11 centers, scintigraphy was used to assess gastric emptying of a 99Tc-labeled low fat meal (egg substitute) and percent intragastric residual contents 60, 120, and 240 min after completion of the meal. In 42 subjects, additional measurements were taken every 10 min for 1 h. In 20 subjects, gastric emptying of a 99Tc-labeled liver meal was compared with that of the 99Tc-labeled low fat meal. RESULTS: Median values (95th percentile) for percent gastric retention at 60, 120, and 240 min were 69% (90%), 24% (60%) and 1.2% (10%) respectively. A power exponential model yielded similar emptying curves and estimated T50 when using images only taken at 1, 2 and 4 h, or with imaging taken every 10 min. Gastric emptying was initially more rapid in men but was comparable in men and women at 4 h; it was faster in older subjects (p < 0.05) but was independent of body mass index. CONCLUSIONS: This multicenter study provides gastric emptying values in healthy subjects based on data obtained using a large sample size and consistent meal and methodology. Gastric retention of >10% at 4 h is indicative of delayed emptying, a value comparable to those provided by more intensive scanning approaches. Gastric emptying of a low fat meal is initially faster in men but is comparable in women at 4 h; it is also faster in older individuals but is independent of body mass.

Adult↗
PubMed1999

Autonomic function in cyclic vomiting syndrome and classic migraine.

Cyclic vomiting syndrome is an idiopathic disorder characterized by attacks of severe vomiting, interspersed with normal periods, and found in patients with a family history of migraine headaches. In this report, we investigated the characterization of the autonomic abnormalities in cyclic vomiting syndrome, contrasting them with values in pediatric population, as well as adults with migraine headache. We studied five groups: 41 normal pediatric controls (NPC), 12 patients with pediatric chronic vomiting (PCV), 15 patients with cyclic vomiting syndrome (CVS), 21 adults patients with migraine headaches (MHA), and 40 normal adult controls (NAC). We studied the sympathetic and cholinergic functions: two measures of sympathetic adrenergic function-vasoconstriction to cold and postural adjustment ratio; two measures of vagal cholinergic function--Valsalva ratio and ECG R-R interval; and one measure of total autonomic score. Comparisons were performed between and within groups by t tests and reported as mean +/- SEM. Although cholinergic function measures were lower in cyclic vomiting and migraine groups, the most distinct abnormality was low postural adjustment ratio in both cyclic vomiting and migraine groups vs normal pediatric and pediatric chronic vomiting groups. There was also a significant difference between cyclic vomiting and pediatric chronic vomiting groups (P < 0.05 in three other parameters). Cyclic vomiting syndrome is associated with distinctive adrenergic autonomic abnormalities similar to those in patients with migraine headaches and is usually characterized by a low postural adjustment ratio. These findings may have implications for both confirmation and diagnosis of cyclic vomiting syndrome.

Adolescent↗
PubMed1998

Biliary, pancreatic, and sphincter of Oddi electrical and mechanical signals recorded during ERCP.

Measurements of biliary tract motility have focused on radiologic and pressure measurements to quantify biliary motility rather than measurements of electrical activity of the biliary tract. We previously reported the recording of biliary electrical signals during ERCP and now report on the continued development and validation of a system to measure biliary tract electrical activity as well as biliary mechanical activity. In 26 patients presenting with a variety of clinical indications, we recorded measurements of electrical activity from the common bile duct sphincter (16 patients), pancreatic duct sphincter (eight patients), and/or sphincter of Oddi (eight patients). Electrical recordings were performed with a specially modified ERCP catheter, using two circular electrodes as well as a custom catheter that measured both electrical and mechanical activity. Electrical activity of the biliary tract was successfully recorded in 25 of 26 patients (96%), including the common bile duct sphincter (16 patients, 62%), pancreatic duct sphincter (eight patients, 31%) and sphincter of Oddi (eight patients, 31%). Along with the electrical recordings, common bile duct sphincter mechanical activity was recorded in 12 patients (67%), pancreatic duct sphincter mechanical activity in six patients (33%), and sphincter of Oddi mechanical activity in six patients (33%). Frequency analysis of electrical signals revealed a mean frequency (cycles/min) of 4.7 +/- 0.5 in the common bile duct sphincter, 4.1 +/- 0.6 in the pancreatic duct sphincter, and 4.9 +/- 0.7 in the sphincter of Oddi. Phasic mechanical frequency in cycles per minute was recorded at a frequency of 4.8 +/- 0.5 in common bile duct sphincter, 4.0 +/- 0.6 in pancreatic duct sphincter, and 5.3 +/- 0.9 in sphincter of Oddi. Tonic pressure (averaged 12.1 +/- 1.5 mm Hg) in common bile duct sphincter, 12.4 +/- 1.4 mm Hg in pancreatic duct sphincter, and 15.0 +/- 5.1 mm Hg in sphincter of Oddi. Analysis of wave form propagations (noted as percentage antegrade, retrograde, or indeterminant) revealed 50% antegrade, 23% retrograde, and 27% indeterminant). One patient was recorded on two occasions via ERCP; the same patient had an intraoperative recording. All three recordings showed similarities. We conclude that measurements of biliary, pancreatic, and sphincter of Oddi electrical and mechanical activity are feasible and can be done as part of ERCP. There was good correlation between biliary tract electrical and mechanical events and different wave form characteristics were noted for different parts of the biliary tree. Further studies are warranted to evaluate the potential usefulness of measurement of biliary tract electrical activity, and to confirm its correlation with mechanical events in the pancreato-biliary tree.

Adult↗
PubMed1998

Effect of leuprolide acetate in treatment of abdominal pain and nausea in premenopausal women with functional bowel disease: a double-blind, placebo-controlled, randomized study.

We have previously reported impressive results in using a gonadotropin-releasing hormone analog, leuprolide acetate (Lupron), in the treatment of moderate to severe symptoms (especially abdominal pain and nausea) in patients with functional bowel disease (FBD). Pain is the hallmark of patients with FBD, and there is no consistent therapy for the treatment of these patients. The purpose of the present study was to expand the investigation to study similar patients (menstruating females) in a multicenter, double-blind, placebo-controlled, randomized study using Lupron Depot (which delivers a continuous dose of drug for one month), 3.75 mg (N = 32) or 7.5 mg (N = 33), or placebo (N = 35) given intramuscularly every four weeks for 16 weeks. Symptoms were assessed using daily diary cards to record abdominal pain, nausea, vomiting, early satiety, anorexia, bloating, and altered bowel habits. Additional assessment tools were quality of life questionnaires, psychological profile, oral-to-cecal transit using the hydrogen breath test, antroduodenal manometry, reproductive hormone levels, and global evaluations by both patient and investigator. Patients in both Lupron Depot-treated groups showed consistent improvement in symptoms; however, only the Lupron Depot 7.5 mg group showed a significant improvement for abdominal pain and nausea compared to placebo (P < 0.001). Patient quality of life assessments and global evaluations completed by both patient and investigators were highly significant compared to placebo (P < 0.001). All reproductive hormone levels significantly decreased for both Lupron Depot-treated groups by week 4 and were significantly different compared to placebo at week 16 (P < 0.001). This study shows that leuprolide acetate is effective in controlling the debilitating symptoms of abdominal pain and nausea in patients with FBD.

Abdominal Pain↗
PubMed1997

Efficacy of electrical stimulation at frequencies higher than basal rate in canine stomach.

The optimum frequency for electrically stimulating motility in the stomach is still in question. Some studies of gastric electrical stimulation (GES) at near physiologic frequencies have reported gastric electrical entrainment but with little efficacy in improving motility. In this study we examined the effectiveness of electrical stimulation at a broad range of frequencies in entraining gastric electrical activity (GEA) and eliciting contractions in a canine model. The stomachs of six dogs, each implanted with four pairs of stainless steel electrodes and two strain gauges were stimulated at frequencies ranging from 3 to 30 cycles/min. GEA and contractions were monitored before and during electrical stimulation. The ability of GES at different frequencies to reverse the effect of glucagon was also investigated. GEA was entrained in most animals at frequencies close to the intrinsic rate as well as at four to five times the intrinsic rate. At other stimulation frequencies, the recorded electrical control activity either remained unchanged, uncoupled, or became dysrhythmic. Contractile response to stimulation at four to five times the intrinsic rate were significantly higher than those at frequencies close to the intrinsic rate (P < 0.05). GES did not alter the effect of glucagon. Stimulation at a frequency of four times the basal rate of 5/min elicited the largest motility index in dogs. Stimulation at frequencies much higher than the physiologic rate warrants further study as a possible optimum range for GES.

Animals↗
PubMed1996

Gastrointestinal motility disorders.

A careful history can localize gastrointestinal motility disorders and suggest appropriate diagnostic tests. Dysphagia, odynophagia, heartburn and reflux have esophageal origins. The same symptoms occur in achalasia, a classic motor disorder of the lower esophageal sphincter, which can be diagnosed by barium swallow, endoscopy and esophageal motility studies. Nausea, vomiting, anorexia, bloating and abdominal pain are symptoms of motor disorders of the stomach and small intestine. When these symptoms are accompanied by unexplained right upper quadrant pain, elevated liver enzyme levels and unexplained recurrent pancreatitis, the diagnosis of impaired biliary motility is suggested. Colorectal motility disorders may present as abdominal pain, diarrhea, constipation and/or fecal incontinence. If symptoms do not resolve with dietary changes and appropriate medications and the anatomy is normal on lower gastrointestinal studies, colorectal motility studies may be indicated.

Biliary Dyskinesia↗
PubMed1996

Symptom improvement from prokinetic therapy corresponds to improved quality of life in patients with severe dyspepsia.

Prokinetic therapy has been shown to improve patients' symptoms associated with gastrointestinal motility disorders and quality of life. This study investigated the correlation between clinical improvement and quality of life after 12 months of treatment with cisapride or domperidone in patients with severe dyspepsia. Psychological and quality-of-life measures were assessed at baseline and after 12 months of therapy using three patient-administered, standardized questionnaires: the Minnesota Multiphasic Personality Inventory, the Millon Behavioral Health Inventory, and the Sickness Impact Profile. Changes in clinical symptoms were correlated with changes in these measures. Twenty-seven patients with symptoms of severe dyspepsia were treated with cisapride or domperidone (60-80 mg/day) for 12 months. Symptoms and quality-of-life measures were improved at the end of therapy. There were significant correlations between improvement in clinical symptoms and improvement in quality of life parameters. Patients with more marked symptom improvement had more significant improvements in quality of life measures. We conclude that prokinetic therapy improved symptoms and quality of life. Standardized questionnaires can be used to quantify response to prokinetic therapy and to individualize treatment regimens for patients with dyspepsia who have specific psychologic or behavioral characteristics.

Adult↗
PubMed1995

A model of gastric electrical activity in health and disease.

The idea of diagnosing gastric dysfunction from noninvasive measurements of gastric electrical activity (GEA) is intuitively appealing, but the predictive accuracy of the cutaneous signal, especially that of its amplitude, is still in question. Mathematical modeling provides a means of investigating, analyzing, and predicting GEA measured percutaneously. In this study, a model of GEA applicable both in health and disease was developed and simulated for a cylindrical body surface. Body-surface maps of the simulated electrogastrogram (EGG) were generated at a 20 by 20 array of sites on the model's surface, and the accuracy of the percutaneous method in detecting simulated gastric electrical abnormalities was determined. The relationship between the amplitude of the simulated surface EGG and the velocity of propagation of the myogenic activity was also investigated. This was compared to a similar investigation of the fluctuations in the amplitude of the surface EGG with the velocity of propagation of the serosal activity measured in humans. The diagnostic accuracy of the measured cutaneous EGG in humans was also determined. The results obtained from the mathematical model show that the amplitude of the electrogastrogram increases with the propagation velocity of GEA. Similar results were obtained from the experimental measurements. The amplitude of the simulated and measured cutaneous signal correlated well (p < 0.05) with the phase shift of the simulated and measured activities, (-0.85, -0.54), respectively. Serosal normal activity, tachygastria, and uncoupling were detected 67%, 90%, and 0% of the time, respectively, at the cutaneous electrode in humans. In simulations, normal activity and tachygastria were accurately detected at all 400 sites on the surface. Uncoupling simulated with 50% of the myogenic sources "diseased" was detected at only 20 of the 400 sites. The results confirm that the amplitude of the cutaneous signal is a function of the velocity of propagation of the myogenic signal. It also confirms that while GEA in health may be accurately predicted from percutaneous recordings, frequency and phase/coupling abnormalities are poorly detected from single-channel electrogastrograms. This suggests the use of multiple-channel surface recordings in clinical electrogastrography.

Body Surface Potential Mapping↗
PubMed1994

Predominant symptoms in irritable bowel syndrome correlate with specific autonomic nervous system abnormalities.

BACKGROUND/AIMS: Irritable bowel syndrome may be influenced by the autonomic nervous system. Abnormalities in autonomic function, colon transit time, and psychological profiles in 21 patients were assessed. METHODS: Using modified Manning criteria for irritable bowel syndrome, patients were classified as constipation-predominant or diarrhea-predominant. Autonomic function was determined by one vagal cholinergic and two sympathetic adrenergic measures. Colon transit was assessed by radiopaque markers, and psychological profiles were determined by three inventories. RESULTS: Autonomic function tests showed that diarrhea-predominant subgroup values for one sympathetic adrenergic measure (postural adjustment ratio) were significantly different from controls (P < 0.01). Constipation-predominant subgroup values were significantly lower for the vagal cholinergic measure R-R interval (P < 0.05). Colon transit measures differed by subgroup in left, right, rectosigmoid, and total colon transit times. Both subgroups differed significantly from controls on psychological measures; the constipation subgroup showed more psychological distress. CONCLUSIONS: Irritable bowel syndrome specific-symptom subgroups had different patterns of autonomic functioning, colonic transit, and psychological measures. The constipation subgroup is associated with a cholinergic abnormality and the diarrhea-predominant subgroup with an adrenergic abnormality. These findings suggest specific associations between the autonomic nervous system, predominant physical symptoms, colon transit time, and psychological factors in patients with irritable bowel syndrome.

Adult↗
PubMed1994

Measurement of gastric and small bowel electrical activity at laparoscopy.

Recordings of gastric electrical activity can be employed in the diagnosis of certain gastric motility disorders. Since the best recordings are obtained from electrodes implanted at laparotomy, the scope of application of this technique is limited. The current study details a method of measuring gastric electrical activity at laparoscopy. The patients were 3 Caucasian women whose age range was 16 to 30 years. Their pertinent history included symptoms of nausea, vomiting, constipation, and abdominal pain. Gastric and small bowel electrical activity was measured with stainless steel electrodes implanted into the serosa of the stomach and small bowel at laparoscopy. Laparoscopy was performed for small bowel biopsy, bowel resection, or feeding tube placement. The recorded signals were evaluated by manual analysis. Good quality gastric and small bowel electrical activities were obtained. Amplitude, frequency, rhythmicity, and direction of propagation information were readily obtained by visual inspection. Laparoscopic measurement of gastric electrical activity produces excellent quality recordings comparable with recordings from electrodes implanted at laparostomy. The technique combines the advantage of laparoscopy with the usefulness of serosal measurement of gastrointestinal electrical activity.

Adolescent↗
PubMed1994

Cutaneous exposure to warfarin-like anticoagulant causing an intracerebral hemorrhage: a case report.

A case of intercerebral hematoma due to warfarin-induced coagulopathy is presented. The 39-year-old woman had spread a warfarin-type rat poison around her house weekly using her bare hands, with no washing post application. Percutaneous absorption of warfarin causing coagulopathy, reported three times in the past, is a significant risk if protective measures, such as gloves, are not used. An adverse drug interaction with piroxicam, which she took occasionally, may have exacerbated the coagulopathy.

Administration, Cutaneous↗