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Does Intravenous Immunoglobulin Benefit Patients with Autoimmune Gastrointestinal Dysmotility?
AGA Abstracts
Table
*p<0.05 ROME III EPS vs. ROME IV EPS; †p<0.05 ROME III EPS vs. ROME III PDS; #p<0.05 ROME IV EPS vs. ROME IV PDS; Data expressed as mean± SD
Tu1670 DOES INTRAVENOUS IMMUNOGLOBULIN BENEFIT PATIENTS WITH AUTOIMMUNE GASTROINTESTINAL DYSMOTILITY? Noemi J. Baffy, Hassan A. Siddiki, Brent P. Goodman, John K. DiBaise, Lucinda A. Harris Background Autoimmune gastrointestinal dysmotility (AGID) is an organ manifestation of autoimmune dysautonomia and has recently emerged as a clinical entity. Neural autoimmune markers are present in the majority of patients, whose common presentations include gastroparesis, esophageal dysmotility, colonic inertia, or intestinal pseudoobstruction. Few therapies exist for these disorders which are severely debilitating and known to decrease quality of life. Immunotherapy has been proposed as a diagnostic tool but there are limited data on therapeutic efficacy. Aims The aim of this study was to assess response to immunotherapy using intravenous immunoglobulin (IVIG) in patients with suspected AGID. Methods This was a retrospective chart review of patients with AGID receiving IVIG. Diagnosis was made based on positive neuronal antibody testing, symptoms suggestive of gastrointestinal (GI) dysmotility, and/ or a strong suspicion for autoimmune etiology (weight loss out of proportion to GI symptoms, hair loss, personal history of autoimmunity, family history of autoimmunity, onset following infection/surgery/immunization). Medical records were reviewed and data on gastrointestinal transit testing, manometry studies (esophageal, anorectal), autoantibody levels, autonomic reflex screen (ARS) and IVIG dose and duration were recorded. Response to therapy was defined by subjective improvement in GI symptoms determined from review of patient charts and objective improvement in diagnostic studies. Results Thirteen patients were identified with a mean age of 45.9 years (SD=18). All patients were Caucasian and most were female (77%). Ten patients had detectable antibodies prior to initiation of IVIG. Nine of the eleven patients who underwent autonomic testing with ARS had evidence of dysautonomia without generalized autonomic failure. Eleven patients had motility testing and dysmotility was confirmed by scintigraphy (8 patients) or esophageal manometry (3 patients). Nausea and vomiting (77%) followed by constipation (69%) and abdominal pain (38%) were the most common gastrointestinal symptoms. Response to immunotherapy was most apparent in subjective improvement of gastrointestinal symptoms (71%) and objectively by a decrease in antibody titer (21%), improved nuclear scintigraphy (14%) and ARS (7%). Two patients did not respond to therapy, one of whom did not have detectable antibody levels prior to initiation of therapy. (Table) Conclusions AGID should be considered in refractory cases of chronic dysmotility. This preliminary data suggest that an assessment of diagnostic autoimmune markers may identify those who will benefit from therapy with IVIG. Larger scale prospective studies are needed to further explore the clinical role of this promising therapeutic modality.
ARS: Autonomic reflex screen; ANA: Antinuclear antibody; GAD65: glutamic acid decarboxylase isoform 65; CCP: cyclic citrullinated peptide; ↓ - decreased
Tu1671 NO DIFFERENCE BETWEEN FUNCTIONAL DYSPEPSIA PATIENTS WITH AND WITHOUT DELAYED GASTRIC EMPTYING Noemi J. Baffy, Michael D. Crowell, John K. DiBaise Background Functional dyspepsia (FD) is a common global disorder characterized by postprandial fullness, early satiation, and epigastric pain or discomfort. The pathophysiology of FD is complex and likely multifactorial. Delayed gastric emptying (GE) has been reported in 25-35% of unselected FD patients; however, the relevance of delayed GE remains controversial given poor correlation between dyspeptic symptoms and delayed GE and response of these symptoms to prokinetic medications. Aim The aim of this study was to determine whether the presence of a delay in GE could identify important differences in sociodemographic characteristics, symptomatology, healthcare utilization, quality of life and psychological factors in patients with FD. Methods This was a single-center, prospective, observational study. Consecutive patients with FD based on Rome III criteria referred for GE scintigraphy as part of an evaluation of dyspeptic symptoms who agreed to participate were included. Patients with diabetes mellitus and prior gastrointestinal surgery (except appendectomy) were excluded. Data regarding sociodemographic characteristics, healthcare utilization, dyspeptic symptoms (GCSI), quality of life (PAGI-QOL, SF-12), and psychological status (HADS, PSS, PHQ-15, TAS-20, PANAS) were collected via standardized questionnaires. Delayed GE was defined as ≥16% gastric retention at four hours. Data were analyzed using analysis of variance or the Student t-test for comparisons between two groups. Results Two hundred and sixtysix patients participated in the study, and one hundred fifty-one met study inclusion criteria as well as Rome III criteria for FD. Forty-one patients had delayed GE (20 mild 16-25%, 10 moderate 26-35% and 11 severe delay >35%). Patient characteristics were similar except for gender distribution and employment status. There was a trend toward an increase in total symptoms score (p=0.052) and specifically the nausea/vomiting sub-score (p=0.057) in those with delayed GE. Healthcare utilization tended to be higher among patients with delayed GE; more emergency room visits reported in the year prior (p=0.057). Psychological status was similar between the two groups (Table). Quality of life also did not differ between the two groups. Conclusion In FD patients referred for testing of GE, no significant difference was seen in dyspeptic symptoms, healthcare seeking behaviors, quality of life or psychological comorbidity based on whether GE was delayed or normal. The presence of delayed GE in FD does not appear to provide important discriminating clinical information and further questions the utility of GE testing in this setting.
S-935
AGA Abstracts
Table
*p<0.05 ROME III EPS vs. ROME IV EPS; †p<0.05 ROME III EPS vs. ROME III PDS; #p<0.05 ROME IV EPS vs. ROME IV PDS; Data expressed as mean± SD
Tu1670 DOES INTRAVENOUS IMMUNOGLOBULIN BENEFIT PATIENTS WITH AUTOIMMUNE GASTROINTESTINAL DYSMOTILITY? Noemi J. Baffy, Hassan A. Siddiki, Brent P. Goodman, John K. DiBaise, Lucinda A. Harris Background Autoimmune gastrointestinal dysmotility (AGID) is an organ manifestation of autoimmune dysautonomia and has recently emerged as a clinical entity. Neural autoimmune markers are present in the majority of patients, whose common presentations include gastroparesis, esophageal dysmotility, colonic inertia, or intestinal pseudoobstruction. Few therapies exist for these disorders which are severely debilitating and known to decrease quality of life. Immunotherapy has been proposed as a diagnostic tool but there are limited data on therapeutic efficacy. Aims The aim of this study was to assess response to immunotherapy using intravenous immunoglobulin (IVIG) in patients with suspected AGID. Methods This was a retrospective chart review of patients with AGID receiving IVIG. Diagnosis was made based on positive neuronal antibody testing, symptoms suggestive of gastrointestinal (GI) dysmotility, and/ or a strong suspicion for autoimmune etiology (weight loss out of proportion to GI symptoms, hair loss, personal history of autoimmunity, family history of autoimmunity, onset following infection/surgery/immunization). Medical records were reviewed and data on gastrointestinal transit testing, manometry studies (esophageal, anorectal), autoantibody levels, autonomic reflex screen (ARS) and IVIG dose and duration were recorded. Response to therapy was defined by subjective improvement in GI symptoms determined from review of patient charts and objective improvement in diagnostic studies. Results Thirteen patients were identified with a mean age of 45.9 years (SD=18). All patients were Caucasian and most were female (77%). Ten patients had detectable antibodies prior to initiation of IVIG. Nine of the eleven patients who underwent autonomic testing with ARS had evidence of dysautonomia without generalized autonomic failure. Eleven patients had motility testing and dysmotility was confirmed by scintigraphy (8 patients) or esophageal manometry (3 patients). Nausea and vomiting (77%) followed by constipation (69%) and abdominal pain (38%) were the most common gastrointestinal symptoms. Response to immunotherapy was most apparent in subjective improvement of gastrointestinal symptoms (71%) and objectively by a decrease in antibody titer (21%), improved nuclear scintigraphy (14%) and ARS (7%). Two patients did not respond to therapy, one of whom did not have detectable antibody levels prior to initiation of therapy. (Table) Conclusions AGID should be considered in refractory cases of chronic dysmotility. This preliminary data suggest that an assessment of diagnostic autoimmune markers may identify those who will benefit from therapy with IVIG. Larger scale prospective studies are needed to further explore the clinical role of this promising therapeutic modality.
ARS: Autonomic reflex screen; ANA: Antinuclear antibody; GAD65: glutamic acid decarboxylase isoform 65; CCP: cyclic citrullinated peptide; ↓ - decreased
Tu1671 NO DIFFERENCE BETWEEN FUNCTIONAL DYSPEPSIA PATIENTS WITH AND WITHOUT DELAYED GASTRIC EMPTYING Noemi J. Baffy, Michael D. Crowell, John K. DiBaise Background Functional dyspepsia (FD) is a common global disorder characterized by postprandial fullness, early satiation, and epigastric pain or discomfort. The pathophysiology of FD is complex and likely multifactorial. Delayed gastric emptying (GE) has been reported in 25-35% of unselected FD patients; however, the relevance of delayed GE remains controversial given poor correlation between dyspeptic symptoms and delayed GE and response of these symptoms to prokinetic medications. Aim The aim of this study was to determine whether the presence of a delay in GE could identify important differences in sociodemographic characteristics, symptomatology, healthcare utilization, quality of life and psychological factors in patients with FD. Methods This was a single-center, prospective, observational study. Consecutive patients with FD based on Rome III criteria referred for GE scintigraphy as part of an evaluation of dyspeptic symptoms who agreed to participate were included. Patients with diabetes mellitus and prior gastrointestinal surgery (except appendectomy) were excluded. Data regarding sociodemographic characteristics, healthcare utilization, dyspeptic symptoms (GCSI), quality of life (PAGI-QOL, SF-12), and psychological status (HADS, PSS, PHQ-15, TAS-20, PANAS) were collected via standardized questionnaires. Delayed GE was defined as ≥16% gastric retention at four hours. Data were analyzed using analysis of variance or the Student t-test for comparisons between two groups. Results Two hundred and sixtysix patients participated in the study, and one hundred fifty-one met study inclusion criteria as well as Rome III criteria for FD. Forty-one patients had delayed GE (20 mild 16-25%, 10 moderate 26-35% and 11 severe delay >35%). Patient characteristics were similar except for gender distribution and employment status. There was a trend toward an increase in total symptoms score (p=0.052) and specifically the nausea/vomiting sub-score (p=0.057) in those with delayed GE. Healthcare utilization tended to be higher among patients with delayed GE; more emergency room visits reported in the year prior (p=0.057). Psychological status was similar between the two groups (Table). Quality of life also did not differ between the two groups. Conclusion In FD patients referred for testing of GE, no significant difference was seen in dyspeptic symptoms, healthcare seeking behaviors, quality of life or psychological comorbidity based on whether GE was delayed or normal. The presence of delayed GE in FD does not appear to provide important discriminating clinical information and further questions the utility of GE testing in this setting.
S-935
AGA Abstracts