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Biomedical subjects

Thomas L Abell

Publications and source records attributed to Thomas L Abell.

13 recordsLinked to original sources
PubMed2006

Prevalence, sociodemography, and quality of life of older versus younger patients with irritable bowel syndrome: a population-based study.

We studied the prevalence as well as the sociodemographic characteristics and QOL of older adults (> 50 years) with irritable bowel syndrome (IBS) among the population at large and compared it to their younger counterparts'. We hypothesized that IBS is less prevalent among older persons and they suffer poorer QOL compared to younger IBS patients. A total of 1000 adults from nine sites, including a medical center, churches, and a blood bank in our metropolitan area (670 African Americans, 320 Caucasians, and 10 others), completed self-administered questionnaires providing sociodemographic information and details regarding bowel habits and associated symptoms for diagnosing the IBS based on Rome II criteria. QOL was assessed by the SF-12 questionnaire. The study database was divided into two groups, younger (< 50 years) and older (> or = 50 years). The two age groups were similar with respect to gender and household income. Ninety-five of the 1000 participants had IBS, giving a total sample prevalence of 9.5% (< 50 years, 9.9%, vs > or = 50 years, 7.6%). The prevalence of IBS was similar in the two groups irrespective of race, sex, marital status, size of household, location of residence (rural versus urban), level of educational status, and household income. Compared to the older group, there was a trend toward a higher prevalence of IBS among divorced subjects (12.7% vs 0%; P = 0.1) and those below poverty level of income (15.3% vs 7.5%; P = 0.09) in the younger subjects. In contrast, older IBS patients were more likely to attend church regularly (32.5% vs 58.8%; P < 0.05). There were no differences in history of traveler's diarrhea, food intolerance, and drug allergies between the two groups. Health care utilization was similar between the two IBS groups in terms of number of physician visits, use of prescription and alternative medications, and being disabled due to IBS. There was no difference in the overall QOL score means (27.8 vs 29.5; P = NS) or in its general health and physical functioning components. However, older IBS patients had better social functioning (9.1 vs 9.8; P < 0.05). Although in our study IBS occurred less frequently among older adults than among younger patients, the difference is not statistically significant. While IBS affects QOL at all ages, social functioning was actually better on average among older compared to younger IBS patients.

Adolescent↗
PubMed2006

Gastrointestinal complications of bariatric surgery: diagnosis and therapy.

Severe or morbid obesity, with body mass indexes exceeding 35 to 40, are often refractory to all therapies other than surgery. The increasing number of patients undergoing bariatric surgery will result in increasing numbers of patients with gastrointestinal complications. The types of complications vary with type of surgery, whether restrictive, malabsorptive, or both, depending on what anatomical and physiologic changes occur postoperatively. One complication of bariatric surgery (gallstones) is due to weight loss after surgery, not the surgery itself. Based on previous meta-analyses, most of the top 10 complications from bariatric surgery are gastrointestinal: dumping, vitamin/mineral deficiencies, vomiting (and nausea), staple line failure, infection, stenosis (and bowel obstruction), ulceration, bleeding, splenic injury, and perioperative death. Two other gastrointestinal complications of bariatric surgery are indirect consequences of the surgery: bacterial overgrowth and diarrhea. Awareness of the types and frequency of gastrointestinal complications of bariatric surgery allows for timely diagnosis and appropriate therapy. As new surgical, and even endoscopic, procedures to treat obesity are developed, new gastrointestinal complications will need to be recognized.

Avitaminosis↗
PubMed2006

Looking to the future: electrical stimulation for obesity.

Among all classes of therapies for morbid obesity-behavioral, drugs, devices, and surgery-devices for electrical stimulation are a relatively new approach. This article reviews the history of electrical therapies for the gastrointestinal tract with an emphasis on the development of stimulation for obesity. Based on similar animal work, electrical stimulation of the gastrointestinal tract has been applied to treat morbid obesity much in the way it has been used to treat nausea and vomiting. The current status of gastrointestinal electrical stimulation for the treatment of morbid obesity is reviewed, with an emphasis on human studies. The physics of electrical stimulation and the possible mechanism of stimulation in the gastrointestinal tract, including for the treatment of morbid obesity, are also discussed. Future work on stimulation for obesity offers the opportunity for better understanding of possible mechanisms of action.

Animals↗
PubMed2006

Gastric electrical stimulation has an immediate antiemetic effect in patients with gastroparesis.

BACKGROUND: Electrical stimulation has been successfully employed to treat diseases involving electro-pathology in the heart, skeletal muscles, and the brain, but not in the GI tract. AIM: This study examined the clinical feasibility and efficacy of GES in treating patients with severe gastroparesis. METHODS: Nausea, vomiting, GEA, and liquid and solid gastric emptying were monitored in eleven patients with refractory gastroparesis at baseline and after one week of continuous electrical stimulation administered at 12 cycles/min. Eight patients were subsequently implanted with permanent stimulation devices. Follow-up studies were conducted after 1, 3, 6, and 12 mo. of stimulation. RESULTS: After one week of stimulation, patients' quantified symptoms of nausea and vomiting decreased significantly, and liquid emptying and GEA improved. This improvement was maintained over time in the patients who continued to receive stimulation. Emptying of solids showed progressive improvement that became significant after 3 mo. The three patients who did not receive stimulation after the trial period showed significantly higher symptoms at 12 mo. CONCLUSION: This paper demonstrates that GES at a frequency of 12 cycles/min has an immediate antiemetic effect, followed by an improvement in disordered gastric emptying.

Adult↗
PubMed2006

Nutrition aspects of gastroparesis and therapies for drug-refractory patients.

Gastroparesis, broadly defined as disordered gastric emptying, is a commonly encountered clinical problem. Nutrition problems frequently occur in gastroparesis, primarily due to inadequate oral intake but also due to losses from vomiting or diarrhea. Treatment of gastroparesis may include dietary modification with or without medication. Some patients require supplementation with either enteral or parenteral nutrition for survival. However, many patients with gastroparesis are drug-refractory and invariably do not do well with enteral or parenteral access. Historically, these patients have been without effective therapeutic options. The development of gastrointestinal electrical stimulation has allowed many with drug-refractory gastroparesis to be treated successfully. Enteric electrical stimulation for gastroparesis often corrects many of the nutrition abnormalities, along with improving symptoms and quality of life and reducing costs; for some categories of patients, it may improve survival rates.

Diet↗
PubMed2005

Driving gastric electrical activity with electrical stimulation.

Gastric electrical stimulation (GES) therapy is generating a lot of interest, but it is still investigational. Its efficacy in driving gastric electrical activity and improving motility, and the ideal frequency for bringing this about are still controversial. In this study, a rule-based computer model of tissue electrical response to stimulation was developed to examine the interaction between tissue electrical refractoriness and the onset of tissue activation. The results were compared to response to GES in 8 dogs implanted with electrodes and strain gauges and stimulated at frequencies ranging from 3 to 30 cycles/min. Simulated electrical control activity at an intrinsic frequency of 5/min was entrained from 2.0 cycles/min to 7.92 cycles/min. The regularity of the ECA elicited by stimulation depended on the number of pulses injected. Electrical stimulation in canine stomach entrained the native electrical control activity from a baseline average of 5.14 +/- 0.32 cycles/min up to 9.2 cycles/min. Contractile response to stimulation at 20-30 cycles/min were significantly higher (p < 0.05). Computer simulation of GES may be a useful tool to complement and reduce some of the costs associated with empirical studies of gastric electrical stimulation in establishing its possible use in treating drug refractory gastroparesis.

Animals↗
PubMed2005

Pilot study on gastric electrical stimulation on surgery-associated gastroparesis: long-term outcome.

OBJECTIVES: Patients with postgastric surgery gastroparesis are often unresponsive to conventional medical therapy. Gastric electrical stimulation (GES) with the use of high-frequency and low-energy neural stimulation is an approved technique for patients with idiopathic and diabetic gastroparesis. METHODS: We hypothesized that GES would improve symptoms, health resource utilization, and gastric emptying in six patients with postsurgical gastroparesis from a variety of surgical procedures. Patients were evaluated by means of the following criteria: symptoms, health-related quality of life, and gastric emptying tests at baseline over time. RESULTS: All patients noted improvements after device implantation for up to 46 months: the frequency score for weekly vomiting went from a baseline of 3.2 down to 0.4 immediately after treatment before settling at 1.4 by the long-term follow up. Total gastrointestinal symptom score went from 36.5 at baseline down to 12.3 before settling at 20.5 at long-term follow up. Improvements were also seen in health-related quality of life and solid and liquid gastric emptying. CONCLUSIONS: We conclude that GES is associated with clinical improvements in this group of patients with either postsurgical or surgery-associated gastroparesis. This pilot study with long-term outcomes offers evidence for a new therapy for otherwise refractory patients with gastroparesis associated with previous surgery.

Adult↗
PubMed2004

Gastric electrical stimulation is associated with improvement in pancreatic exocrine function in humans.

OBJECTIVE: To define the possible effects of gastric electrical stimulation (GES) for gastroparesis on pancreatic function, we performed 2 related human studies. METHODS: Fecal elastase values were compared in 2 patient groups: (1) GES devices ON and (2) GES devices OFF and (2) in 3 control groups: (1) no response (NR) to prokinetic medications, (2) positive response (RES) to medications, and (3) normal controls. Polypeptide levels in 7 of 9 GES patients with device ON and OFF, elastase results, GI symptoms (TSS), and heart rate variability (HRV) were compared by paired t tests and/or ANOVA and reported as mean +/- SE. RESULTS: Elastase was different for GES-ON and OFF (508.0 +/- 92.2 vs. GES-OFF 378.6 +/- 87.4, P < 0.05). Elastase was lower in medication NR and RES than in normal controls. Postprandial pancreatic polypeptide was greater with GES ON than OFF (P = 0.07). HRV revealed a lower percentage of change with device ON versus OFF (44.2 +/- 5.5 vs. 48.5 +/- 5.2, P = 0.08) and lower TSS with ON versus OFF (15.9 +/- 4.5 vs. 25.7 +/- 5.3, P < 0.05). CONCLUSIONS: GES improves exocrine pancreatic release, effects autonomic control, and improves GI symptoms, suggesting a possible role for GES in the treatment of pancreatic insufficiency associated with gastroparesis.

Drug Resistance↗
PubMed2002

Gastric electrical stimulation in intractable symptomatic gastroparesis.

BACKGROUND: The treatment of gastroparesis remains unsatisfactory despite prokinetic and anti-emetic drugs. Gastric electrical stimulation has been proposed as a therapeutic option. We have assessed the effect of gastric electrical stimulation on symptoms, medical treatment, body weight and gastric emptying in patients with intractable symptomatic gastroparesis in a non-placebo-controlled study. METHODS: In this multicenter study, 38 highly symptomatic patients with drug-refractory gastroparesis were enrolled. Patients first received temporary electrical stimulation using percutaneous electrodes. The 33 responders to temporary stimulation then underwent surgical implantation of a permanent stimulator. Severity of vomiting and nausea was assessed before and after stimulation. Patients were reassessed 3, 6, and 12 months after permanent implantation. RESULTS: With stimulation, 35/38 patients (97%) experienced >80% reduction in vomiting and nausea. This effect persisted throughout the observation period (2.9-15.6 months, 341 patient-months). Gastric emptying did not initially change, but improved in most patients at 12 months. At 1 year, the average weight gain was 5.5% and 9/14 patients initially receiving enteral or parenteral nutrition were able to discontinue it. CONCLUSION: Electrical stimulation of the stomach has an immediate and potent anti-emetic effect. It offers a safe and effective alternative for patients with intractable symptomatic gastroparesis.

Adolescent↗
PubMed2002

Gastroparesis and the gastric pacemaker: a revolutionary treatment for an old disease.

Gastroparesis--or delayed gastric emptying--can apply to either solids or liquids but the term (gastroparesis) usually refers to delayed solid emptying, in an appropriate clinical setting. Impaired gastric emptying can occur acutely in a variety of conditions from neurologic to metabolic. Intractable nausea and vomiting, and the inability to tolerate oral intake, occurs frequently in patients with severe gastroparesis. The patients' nutritional status is adversely affected by gastroparesis as are the socioeconomic aspects of patient's lives. The previous treatments of gastroparesis, such as medications and surgery, were often not successful. Our recent understanding of the normal gastric electro-mechanical function and its abnormalities/dysrythmias has led to the development of a gastric electrical stimulator, analagous to other devices used to stimulate dysfunctional organs. Gastric electrical stimulation is associated with improvements in symptomatic relief, nutritional status, health resource utilization and costs and is now approved by the FDA as a humanitarian use device. It offers a new and hopeful therapy for patients with refractory gastroparesis where none have existed before.

Electric Stimulation Therapy↗
PubMedDate not supplied

Assessing thrombosis risk in patients with idiopathic, diabetic, and postsurgical gastroparesis.

Patients with severe gastrointestinal motility disorders are often found to have intravenous access clots or deep venous thrombosis. It has previously been reported that many patients who have intravenous access thrombosis have concomitant thrombotic risk factors. In this study, the goal was to determine the underlying prevalence of hypercoagulable risk in a series of patients with documented gastroparesis. Investigators studied 62 consecutive patients (52 female; mean age, 42 y) who had symptoms of gastroparesis. All patients were evaluated for placement of a gastric neural stimulation device, or they had had one placed previously. Patients underwent a hematologic interview and standardized coagulation measures of thrombotic risk. Laboratory studies measured acquired elevations of Factor VII, Factor VIII, fibrinogen, lupus anticoagulant panel, antiphospholipid antibody panel, homocysteine (in the setting of kidney disease), and activated protein resistance. Investigators also measured congenital factors: Factor VIII (with C-reactive protein levels), antithrombin III, protein C, protein S (total and free), Factor II mutation, Factor V Leiden, methylenetetrahydrofolate reductase, and homocysteine. Fifty-five patients (89%) were found to have detectable hypercoagulable risk factors. Twenty-five of the 62 patients (40%) had a documented history of abnormal clotting, including deep venous thrombosis, intravenous access thrombosis, and pulmonary embolism. All patients with a previous history of thrombosis had detectable clotting abnormalities. Of 56 patients, 40 (71%) had hypercoagulability and did not have diabetes (P=.036), and 20 (36%) had hypercoagulability and no known history of infection. However, this value was not statistically significant when infection and hypercoagulability were compared (P=.408). A high prevalence of acquired and congenital hypercoagulable defects has been observed in patients with gastroparesis, which may predispose them to arterial and venous clots. This unique finding warrants consideration of coagulation evaluation in patients with severe gastroparesis, especially when these patients are placed in high-risk thrombophilic situations, such as hospitalization, prolonged intravenous access, and surgery.

Adult↗
PubMedDate not supplied

Laparoscopy shortens length of stay in patients with gastric electrical stimulators.

BACKGROUND: Gastric electrical stimulation has been proven effective for drug-refractory gastroparesis. Placement of stimulator leads and device usually requires a laparotomy, although laparoscopic placement has also been used. METHODS: To compare laparotomy with laparoscopy, we examined 36 patients, 18 undergoing laparoscopy and 18 undergoing laparotomy, matched for primary diagnosis and health resource usage. We compared baseline symptoms, length of surgery, length of postoperative hospital stay, gastric emptying, and health resources in each of the 2 groups over time, to see what variables, if any, differed. RESULTS: Baseline symptoms, gastric emptying, and health resource usage were similar. Operative times were also similar, but length of stay declined from a mean of 6.4 days for laparotomy to 1.1 days for laparoscopy. Long-term outcome, via symptoms, gastric emptying, and health resource utilization were comparable between the 2 groups. CONCLUSION: Laparoscopic placement of gastric electrical stimulator leads and device is associated with shorter lengths of postoperative hospital stay. However, the patients who underwent laparotomy had higher vomiting scores and more previous abdominal surgeries at baseline, and higher long-term mortality at follow-up, suggesting that they may be more ill, as a group, than the laparoscopic patients. Laparoscopic placement of devices may be preferable when technically feasible.

Adult↗