GI Information from the UMDF Conference

[Guest guest]

Sorry so long overdue!!!! Featured speaker Mahmoud Sabri, MD from C.H.O.P.S. I thought this was a great talk with lots of new info.

" Dysmotility & Pseudo-Obstruction "

Outline/Presentation overview:

Identify if the patients GI issues are due to a Neuropathy (contractions not coordinated) or a Myopathy (contractions weak)

Various Motility tests that can be done: Esophageal Manometry, Antro-Duodena mano, colonic mano, anorectal mano, biliary mano, barostat, etectrogastrography (non- invasive), transit study, and sitz markers

Intestine (submucosal plexus and myentericplecus= the "gut brain")

The gut has as many neurones as the spianl cord

Manometry can be done in the office--go home results will record and then you can go back(no overnight stay needed)

Barostat tests more the function of the stomache. (the stomache has 3 units they are: 1) fundus 2) body 3) pyloric antrum

Anal achalesia is when the anus will not relax. Treatment that can be used--BOTOX!!

Motilitiy drugs--prokinetics/meto clopramide, bethanechol, cisparide

"off label drug uses": erthromycin (in a high dose for gastroparesis, octreotide (delays GI bleeding and gastric emptying) Peppermint oil for patients with spastic abdominal pain

Cisparide-was one of the most effective drugs but it was taken off the market it is available under some circumstances.

Neostigmine is used to treat acute colonic pseudo obstruction (2 mg IV over 2 minutes. A BM usually occurs after 4 minutes. This MUST be given in an ICU setting. No side effects.

Domperidone--Available in New Mexico, Canadan. Good for adults w/diabetic gastropathy. Intestianl and possibly esophageal motility. * some pharmacys can compound this drug (legality??)

Serotonin-95% is in GI tract, 5% in the CNS

Alosteron-Used in IBS of the "diarhea" trype. withdrawn on 11/28/00. Available on limited basis. Need to apply for it.

Tegaserod-found to stimulate peristalitic relex in animals, increases colonic motility.

Small Bowel Transplant 25 have been done at C.H.O.P.S. (only done when morbidity is evident)

Pacemaker--Gastric Electric Stimulator (approval within the next few years)

Prokinetics/The Future:

Erythromycin deritivatives Motildes

Enterokinetics more selective serotonin agonists

Nitric oxide synthase inhibitors

Botulum toxins

Dr. Sabri is going to try to have his PowerPoint presentation posted at the Children's Hospital of Pittsburgh web site. Also, you can buy video or audio tapes of this or any other presentation at : Encore Audio Archives 1- (cost is very low)