Subtypes of Gastroparesis

项目摘要 了解胃轻瘫的亚型和与胃轻瘫相关的症状的病理生理学 在设计出改进的治疗方法之前需要胃轻瘫。我们的目标是1） 使用胃肌电生理测试确定胃轻瘫的主要亚型 活动（GMA），调节和自主神经系统功能; 2）探索 胃轻瘫患者餐后症状的病理生理机制， 胃瘫样综合征。Cajal间质细胞（ICC）的可变消耗产生了一种新的细胞因子。 胃的电和收缩活动的连续功能障碍。生理 测试测量胃排空，胃肌电活动（GMA），和胃 调节反映了这种连续的ICC消耗从胃节律紊乱和正常 胃排空延迟。我们最近的观察揭示了两个重要的 胃轻瘫的亚型：1）梗阻性胃轻瘫和2）姿势性胃轻瘫 直立性心动过速综合征（POTS）。初步研究显示， 幽门疗法，氟氢可的松和维生素D，分别在这些亚型。的 这些胃轻瘫亚组的重要生理学差异提供了 更精确的个体化治疗刺激性试验餐期间的生理测试， 胃排空正常的症状性患者（例如慢性不明原因的恶心和 呕吐、运动障碍样消化不良或餐后窘迫综合征）揭示了以下亚型： 1)胃节律紊乱或正常3 cpm GMA和2）正常或异常胃 住宿.我们的研究将利用胃轻瘫临床研究的注册2数据库。 研究联盟，其中包含广泛的生理数据，在患者的特发性和 糖尿病胃轻瘫和胃排空正常的患者以及来自患者的新数据 登记加入书记官处的延续部分。该项目将表征临床重要 亚组的症状性患者有或无胃轻瘫，增加我们的理解， 胃溃疡相关症状的潜在病理生理学，并导致更多 根据生理测试结果进行合理治疗。

Project Summary Understanding subtypes of gastroparesis and the pathophysiology of symptoms associated with gastroparesis are required before improved treatments can be designed. Our aims are to 1) define major subtypes of gastroparesis using physiological testing for gastric myoelectrical activity (GMA), accommodation, and autonomic nervous system function and 2) explore pathophysiological mechanisms of meal-induced symptoms in patients with gastroparesis and gastroparesis-like syndromes. Variable depletion of interstitial cells of Cajal (ICCs) creates a continuum of dysfunction of electrical and contractile activities of the stomach. Physiological tests to measure gastric emptying, gastric myoelectrical activity (GMA), and gastric accommodation reflect this continuum of ICC depletion from gastric dysrhythmias and normal gastric emptying to delays in gastric emptying. Our recent observations revealed two important subtypes of gastroparesis: 1) obstructive gastroparesis and 2) gastroparesis with postural orthostatic tachycardia syndrome (POTS). Preliminary studies show positive responses to pyloric therapies and to fludrocortisone and vitamin D in these subtypes, respectively. The important physiological differences in these subgroups of gastroparesis provide the rationale for more precise, individual treatments. Physiological testing during provocative test meals in symptomatic patients with normal gastric emptying (e.g. chronic unexplained nausea and vomiting, dysmotility-like dyspepsia, or postprandial distress syndrome) unmasks subtypes with: 1) gastric dysrhythmias or normal 3 cpm GMA and 2) normal or abnormal gastric accommodation. Our studies will utilize the database of Registry 2 of the Gastroparesis Clinical Research Consortium which contains extensive physiologic data in patients with idiopathic and diabetic gastroparesis and in patients with normal gastric emptying and new data from patients enrolled in the continuation of the Registry. This project will characterize clinically important subgroups of symptomatic patients with or without gastroparesis, increase our understanding of the underlying pathophysiology of gastroparesis-associated symptoms, and lead to more rational therapies based on physiological test results.