Immunomodulation for treatment of drug and device refractory gastroparesis
| Autor: | Evelyn Arendale, Vetta Vedanarayanan, Thomas L. Abell, Archana Kedar, Kaartik Soota, Yana Nikitina |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Pathology
medicine.medical_specialty Gastrointestinal medicine.medical_treatment Autoimmune diseases Immunology Glutamate decarboxylase Autonomic diseases Gastroenterology 03 medical and health sciences 0302 clinical medicine Refractory Internal medicine Full Length Article Biopsy medicine 030212 general & internal medicine Gastroparesis medicine.diagnostic_test business.industry Stomach Autoantibody Dysautonomia Immunotherapy Neuromuscular disease medicine.disease medicine.anatomical_structure 030211 gastroenterology & hepatology medicine.symptom business |
| Zdroj: | Results in Immunology |
| ISSN: | 2211-2839 |
| Popis: | ObjectivePatients with generalized autoimmune dysautonomia may also present with gastroparesis. Immune dysfunction in such patients can be evaluated using antibodies to glutamic acid decarboxylase (GAD) and full thickness biopsy of stomach. In this study, we utilize immunotherapy for treatment of drug and Gastric Electrical Stimulation (GES) resistant gastroparetic patients with evidence of neuroinflammation on full thickness gastric biopsy and had positive GAD65 autoantibodies.Material and methodsWe conducted a retrospective chart review of 11 female patients with drug and device resistant gastroparesis. Patients were treated for a total of 8–12 weeks with either intravenous immunoglobulin (IVIg), or combined mycophenolate mofetil (MM) and methylprednisolone, or only MM. Patients were excluded if they had previous side effects from steroid therapy, low scores on dual-energy X-ray absorptiometry (DEXA) scan results, immune-compromised conditions with infections like tuberculosis and zoster. Symptoms of nausea, vomiting, abdominal pain, early satiety/anorexia, bloating and total symptom score (TSS) as reported by the patients were recorded before and after the treatment at a follow up visit 2 to 16 weeks after initiation of therapy.ResultsMaximum symptom improvement was seen in patients treated with IVIg (67%). 6 patients (55%) had improvement in vomiting, whereas 5 patients (45%) had improvements in nausea, abdominal pain and bloating.ConclusionsImmunomodulatory therapy shows positive outcomes in improving vomiting symptom in some gastroparetic patients who have coexisting positive autoimmune profiles. This preliminary data suggests the need for further investigations in immunotherapy targeted to patients with gastroparetic symptoms refractory to approved drug and device therapies. |
| Databáze: | OpenAIRE |
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