Disorders

da | 1 Ago 2006 | N.U.G.shell

Main Psyconeurological Disorders Affecting Gastrointestinal Functions

 PSYCHIC
  • Psychiatric disorders
  • Somatization*
  • Health anxiety*
  • Conversion syndrome*
BRAIN
  • Cerebrovascular accidents (USA: 400,000; GI Dysfunctions > 40%)
  • Head injury
  • Movement disorders (Parkinsonism) (70-180/100,000; GI Dysfunctions > 55%)
  • Multiple sclerosis (USA: 250,000; GI Dysfunctions 68%)
  • Cerebral Palsy -Alzheimer’s d (4% population > 65 yrs)
SPINAL CORD
  • Traumatic lesions
  • Spina bifida (1-4/1,000 live births; GI Dysfunctions > 75%)
  • Multiple sclerosis (USA: 250,000; GI Dysfunctions 68%)
AUTONOMIC NERVOUS SYSTEM
  • Sympathetic dysfunction *
  • Parasympathetic dysfunction *
  • Dorsal horn neurons sensitization *
  • Autonomic (diabetic) neuropathy

See also ANS

ENTERIC NERVOUS SYSTEM
  • Achalasia (1:100,000)
  • Hirschsprung’s d (1:6,000 live births)
  • Visceral neuropathy (neuronal intestinal dysplasia, hyperganglionosis, paraneoplastic; Infectious; myopathies)
  • Sensory neurons sensitization * *

See also ENS

The sum of these conditions about 40% of the GI patient population

Clinical

da | 1 Ago 2006 | N.U.G.shell

Clinical Manifestations of Psyconeurological Disorders

Psychoneurological disorders may manifest with one or more of the following gastrointestinal symptoms:

  • Dysphagia
  • Heartburn
  • Regurgitation
  • Nausea
  • Vomiting
  • Postprandial fullness/early satiety
  • Anorexia nervosa
  • Bulimia
  • Constipation
  • Diarrhea
  • Fecal incontinence
  • Chronic visceral pain
  • Visceral discomfort

Diagnosis

da | 1 Ago 2006 | N.U.G.shell

Diagnosis & Management of Gastrointestinal Manifestations of Psyconeurological Disorders

 

Pathophysiology of the dysfunctions leading to symptoms or to non-symptomatic gastrointestinal alterations may be similar, or may vary substantially, in the different psychoneurological disorders and, not infrequently, in patients with different degree/expression of the same disorder.

Thus proper management of the patients is based on the diagnostic work-up of the individual patient aimed to establish:

a) the nature of psychic or neurological disorder,
b) the pathophysiologic mechanism(s) of the GI dysfunction(s).

DYSPHAGIA

NAUSEA/VOMITING, POSTPRANDIAL FULLNESS/EARLY SATIETY

ANOREXIA NERVOSA, BULIMIA

CONSTIPATION

FECAL INCONTINENCE

DIARRHEA

CHRONIC VISCERAL PAIN AND DISCOMFORTS

 

Dysphagia

da | 1 Ago 2006 | N.U.G.shell

Oro-Pharyngeal Dysphagia

Causes of oro-pharyngeal dysphagia
  • All CNS disorders can variably affect the oral and/or pharyngeal phases of the deglutition act.
Diagnosis oro-pharyngeal dysphagia
  • Videofluoroscopic recording of barium swallow.
Management oro-pharyngeal dysphagia

majority of patients:

    • retraining and rehabilitative swallowing maneuvers.

specific groups of patients:

  • percutaneous endoscopic gastrostomy; cricopharyngeal myotomy or endoscopic botulin injection

 Esophageal Dysphagia, HeartBurn, Regurgitation

Causes of esophageal dysphagia, heartburn, regurgitation
  • All CNS disorders, more frequently in cerebral palsy, can variably induce gastro-esophageal reflux and esophagitis, and occasionally achalasic-like dysfunctions.
  • Achalasia

Diagnosis of esophageal dysphagia, heartburn, regurgitation
  • Videofluoroscopic recording of barium swallow
  • Upper GI endoscopy
  • pH-metry
  • Manometry
Management of esophageal dysphagia, heartburn, regurgitation
  • Achalasia & achalasic-like dysfunctions: pneumatic dilatation; Heller’s myotomy; endoscopic botulin injection; calcium antagonists; nitrate derivates;
  • GE reflux-Esophagitis: H2-antagonists; proton pump inhibitors, cisapride; domperidone; sucralfate; surgery, Nissen fundoplication

Vomiting and satiety

da | 1 Ago 2006 | N.U.G.shell

 Nausea-Vomiting, Postprandial Fullness-Early Satiety

 

Causes of nausea & vomiting, postprandial fullness & early satiety

  • Parkinson’s d and anti-Parkinson therapy
  • Cerebral palsy
  • Gastric neuropathy with stasis

Psychic Diagnosis of nausea & vomiting, postprandial fullness & early satiety

all patients

    • *upper GI endoscopy to exclude structural alterations
    • *gastric emptying tests, electrogastrography

specific patients

  • *autonomic tests, manometry

Management of nausea & vomiting, postprandial fullness & early satiety

Parkinson’s d

In Parkinson’s d gastric emptying time:
a) plays a relevant role in controlling the access of levodopa tablets to its absorptive sites in the small bowel and thus to an efficient management of the neurological manifestations;
b) can be delayed for the disease itself and for the antiparkinson therapy with consequent GI symptoms and worsening in the control of the neurological manifestations.

  • Optimize antiparkinson therapy (dopamine agonists and anticholinergics delay gastric emptying)
  • Drugs to accelerate gastric emptying of levodopa tablets: domperidone (also anti-nausea), cisapride
  • Peripheral dopamine antagonists and/or prokinetics which accelerate normal gastric emptying
  • Liquid levodopa –

Other neurological disorders

Gastric stasis

    • cisapride

    • Motilides

Nausea/vomiting

  • Dopamine-antagonists:Metoclopramide, levosulpiride, domperidone
  • 5HT3-antagonists

Psychic disorders

Gastric stasis

    • Specific psycho-therapy
    • Dopamine-antagonists