Original ResearchFull Report: Clinical—Alimentary TractLoss of Interstitial Cells of Cajal and Patterns of Gastric Dysrhythmia in Patients With Chronic Unexplained Nausea and Vomiting
Section snippets
Materials and Methods
Ethical approval was granted by the New Zealand Regional Ethics Committee, and by the Institutional Review Boards at the University of Mississippi and Mayo Clinic. All patients provided informed consent.
Study Populations
The CUNV cohort consisted of 9 consecutive patients (4 diabetic), with a median 4-hour gastric retention of 4% (range, 2%–9%) and a median total symptom score of 16 (range, 9.5–20). The mean time from the gastric emptying test to surgery was 2.1 ± 2.3 months. The HR mapping controls also consisted of 9 patients of comparable age with the CUNV cohort (P = .14). Table 1 compares the CUNV and HR mapping control populations, with individual patient data provided in Supplementary Tables 1 and 2. The
Discussion
CUNV is accompanied by considerable morbidity, but has remained a poorly characterized disorder of unknown etiology. This study quantified ICC numbers and ultrastructural features, in combination with modern slow-wave mapping techniques,12 to investigate pathogenic mechanisms contributing to CUNV. It was found that CUNV patients had ICC depletion and abnormal slow-wave initiation and conduction, compared with controls. Further comparison with a historic cohort of gastroparetic patients9 showed
Acknowledgments
The authors thank the clinical research and operating room staff at the University of Mississippi Medical Center, and Mr Simon Bull and Ms Rachel Berry for their valued assistance.
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Conflicts of interest This author discloses the following: Thomas Abell is a licensor, consultant, and investigator for Medtronic, Inc. The remaining authors disclose no conflicts.
Funding Supported by the New Zealand Health Research Council, National Institutes of Health and the Gastroparesis Clinical Research Consortium (R01 DK64775, DK57061, DK73983, DK74008, and U01 DK074007), New Zealand Medical Technologies Centre of Research Excellence, a Young Investigator Clinical Research grant from the American Neurogastroenterology and Motility Society (G.O.G.), the Rutherford Foundation Trust (P.D.), and the Marsden Fund (P.D.).
Author names in bold designate shared co-first authors.