Gastroparesis as a significant gastrointestinal adverse event during intensive chemotherapy for solid cancer

Proper management of chemotherapy-related gastrointestinal toxicities is essential to maximize therapeutic outcome for malignancies. Gastroparesis is characterized by delayed gastric emptying without gastrointestinal obstruction. Although it has not been well recognized as a complication of chemotherapy for solid malignancies, we here report a case of gastroparesis apparently due to neurotoxicity of high-intensity taxane- and platinum-based chemotherapy for a solid tumor. The patient experienced late-onset gastric dysmotility as evidenced by an abnormally dilated stomach even after cessation of feeding for several days. The gastroparesis was successfully controlled with a 5-HT4 receptor agonist, resulting in recovery of gastric motility and allowing completion of curative anticancer treatment. Despite its rarity in patients with solid cancers, gastroparesis should be recognized as a potential cause of persistent upper abdominal symptoms during neurotoxic chemotherapy in such individuals, given that a delay in its management may be detrimental to survival outcome.

Upper gastrointestinal endoscopy

Endoscopy is the procedure of choice in patients with retrosternal or upper abdominal symptoms who require investigation, and is essential in significant gastrointestinal bleeding to identify and—in most cases—treat the cause, with various therapeutic methods possible for erosions, ulcers, and oesophageal varices. More recent developments in the practice of upper gastrointestinal endoscopy include the use of enteroscopy for direct vision of the small bowel, video capsule endoscopy for diagnosis of obscure bleeding lesions, and an expanding range of minimally invasive therapeutic techniques. Endoscopic retrograde cholangiopancreatography is the standard of care for the removal of gallstones from the common bile duct, and palliating obstructing pancreatobiliary tumours.

Are the Symptoms of an NSAID-Induced Ulcer Truly Milder Than Those of an Ordinary Ulcer?

Objective. The percentage of patients with nonsteroidal anti-inflammatory drugs (NSAIDs) and low-dose aspirin- (LDA-) induced ulcers who complain of gastrointestinal symptoms has generally been considered to be low. The aim of this study was to examine and compare the symptoms and quality of life (QOL) at peptic ulcer onset. Methods. This study involved 200 patients who were confirmed by endoscopy to be in the acute stage of gastroduodenal ulcer (A1-H1). Patients completed a self-administered questionnaire (Global Overall Symptom score and SF-8) at ulcer onset, and data were compared between NSAIDs/LDA ulcers and non-NSAIDs/LDA ulcers. Results. The upper gastrointestinal symptoms score was significantly lower for patients using LDA only (20.5 ± 9.4 in the nonusing group, 19.6 ± 8.6 in the NSAIDs-only group, 16.7 ± 11.6 in the LDA-only group, and 18.5 ± 7.2 in the NSAIDs/LDA group, P<0.05). The QOL score (physical summary) was significantly lower in the NSAID group (42.1 ± 9.9) than in the nonusing group (47.6 ± 7.6) (P<0.05). Patients’ characteristics showed no significant differences among the groups, with the exception of age. Conclusion. The severity of upper abdominal symptoms at peptic ulcer onset was similar between NSAID users and nonusers.

Xiphoidectomy: A Surgical Intervention for an Underdocumented Disorder

Two patients who presented with nonspecific thoracic and upper abdominal symptoms and tenderness of the xiphoid process are discussed. Both patients had undergone extensive examinations, but no source for their symptoms could be found. Plain chest radiographs revealed an anterior displacement of the xiphoid process in both patients. Physical examination confirmed this to be the primary source of discomfort. Anterior displacement of the xiphoid process may be the result of significant weight gain. Repeated trauma of the afflicted area, unaccustomed heavy lifting, exercise, and perichondritis are, amongst other causes, believed to contribute to the development of xiphodynia. Both patients were treated by performing a xiphoidectomy, resulting in disappearance of the symptoms.

Silicea Gastrointestinal Gel Improves Gastrointestinal Disorders: A Non-Controlled, Pilot Clinical Study

Aim. To investigate efficacy and tolerability of Silicea Gastrointestinal Gel in patients with gastrointestinal disorders.Methods. Open, prospective pivotal phase IV study with oral Silicea Gastrointestinal Gel over 6 weeks. Symptom score was part 1 of the Nepean Dyspepsia Index: 15 questions addressing intensity, frequency and impact of upper abdominal symptoms. 10 lower abdominal symptoms were asked analogously. A responder showed reduction of score of >50%.Results. 62 of 90 patients were evaluated per protocol. Upper and lower abdomen sum scores decreased already in the first three weeks (P<0.001), which continued the following three weeks (P<0.01). Mean symptom score for upper abdomen decreased from52.2±31.0to33.7±28.7(or by 35.4%; responder rate 37%); for lower from39.6±24.7to22.6±21.7(by 42.9%; responder rate 46%). Subgroups with diarrhea, IBS and GERD presented highest responder rates. 6% of patients reported adverse reactions with probable or possible relationship to the test product.Conclusions. Silicea Gastrointestinal Gel seems suitable beyond infectious acute gastrointestinal disorders. Responses are relevant for chronic functional disorders, but it remains unclear, how much of that might be placebo-effect. Controlled studies are recommended in gastrointestinal syndromes like IBS or GERD.