“Comprehensive management of gastroparesis in patients with advanced non-oncological chronic diseases or in palliative care: a systematic review”
DOI:
https://doi.org/10.70577/asce.v5i2.831Keywords:
palliative care; chronic diseases; gastrointestinal motility disorders; gastric emptying; Parkinson's disease.Abstract
Patients with advanced non-oncological chronic diseases under palliative care frequently presented with gastroparesis, a condition that impaired quality of life and created a critical pathophysiological problem by hindering the absorption of essential drugs such as levodopa, which precipitated severe motor crises. The objective of this study was to identify pharmacological and non-pharmacological strategies for the management of gastroparesis within the framework of advanced chronic diseases. The methodology consisted of a systematic review without meta-analysis based on PRISMA 2020 guidelines, which included searches in PubMed and ScienceDirect databases for the 2020-2025 period. After the evaluation of 175 initial records in Mendeley and the application of exclusion criteria, eight studies were selected for final analysis. The results evidenced that pharmacological strategies, such as subcutaneous infusions and the use of opicapone, achieved plasma stability and widened the therapeutic window of levodopa by bypassing gastric transit. Regarding non-pharmacological interventions, auricular neuromodulation, gastric peroral endoscopic myotomy, and deep brain stimulation were effective in rehabilitating gastric motility and emptying. It was concluded that comprehensive management required a transition from the oral route toward methods that guaranteed drug bioavailability, which proved fundamental for clinical stability in palliative care settings.
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Bergquist, F., Ehrnebo, M., Nyholm, D., Johansson, A., Lundin, F., Odin, P., Svenningsson, P., Hansson, F., Bring, L., Eriksson, E., & Dizdar, N. (2022). Pharmacokinetics of intravenously (DIZ101), subcutaneously (DIZ102), and intestinally (LCIG) infused levodopa in advanced Parkinson disease. Neurology, 99(10), e965–e976. https://doi.org/10.1212/WNL.0000000000200804
Bhidayasiri, R., Phuenpathom, W., Tan, A. H., Leta, V., Phumphid, S., Chaudhuri, K. R., & Pal, P. K. (2022). Management of dysphagia and gastroparesis in Parkinson’s disease in real-world clinical practice – Balancing pharmacological and non-pharmacological approaches. Frontiers in Aging Neuroscience, 14, Artículo 979826. https://doi.org/10.3389/fnagi.2022.979826
Camilleri, M. (2024). Gastroparesis: An updated overview of diagnosis and management. The Nurse Practitioner. Advance online publication. https://doi.org/10.1016/j.nurpra.2024.00307
Chang, J. J., Gadi, S. R. V., Videnovic, A., Kuo, B., & Pasricha, T. S. (2023). Impact of outpatient gastroenterology consult on pharmacotherapy and management of gastrointestinal symptoms in Parkinson’s disease. Clinical Parkinsonism & Related Disorders, 9, 100215. https://doi.org/10.1016/j.prdoa.2023.100215
Chastan, N., Achamrah, N., Derrey, S., Maltete, D., Coeffier, M., Leroi, A. M., Dechelotte, P., Welter, M. L., & Gourcerol, G. (2021). Role of gastric motility in weight gain after subthalamic nucleus stimulation in Parkinson's disease. Brain Stimulation, 14(4), 801–803. https://doi.org/10.1016/j.brs.2021.04.027
Du, P., Maharjan, A., Calder, S., Schultz, M., Schamberg, G., Gharibans, A., O’Grady, G., & Cakmak, Y. O. (2024). Transcutaneous auricular vagus nerve stimulation normalizes induced gastric myoelectrical dysrhythmias in controls assessed by body-surface gastric mapping. Neuromodulation: Technology at the Neural Interface, 27(2), 333-342. https://doi.org/10.1016/j.neurom.2023.02.078
International Parkinson and Movement Disorder Society. (2022). Estimation of the 2020 global population of Parkinson’s disease (PD) [Abstract de congreso]. MDS Abstracts. https://www.mdsabstracts.org/abstract/estimation-of-the-2020-global-population-of-parkinsons-disease-pd/
Labonde, A., Lades, G., Debourdeau, A., Ragi, O., Lehmann, L., Vitton, V., Barthet, M., Legros, R., Albouys, J., Geyl, S., Loustaud-Ratti, V., Monteil, J., Gonzalez, S., Gonzalez, J.-M., & Jacques, J. (2022). Gastric peroral endoscopic myotomy in refractory gastroparesis: Long-term outcomes and predictive score to improve patient selection. Gastrointestinal Endoscopy, 96(3), 500-508. https://doi.org/10.1016/j.gie.2022.04.002
Lubomski, M., Davis, R. L., & Sue, C. M. (2020). Gastrointestinal dysfunction in Parkinson’s disease. Journal of Neurology, 267(5), 1377–1388. https://doi.org/10.1007/s00415-020-09723-5
Malek, N., Lawton, M. A., & Grosset, K. A. (2021). Acute gastric dilatation: A life-threatening complication in Parkinson’s disease. Parkinsonism & Related Disorders, 84, 168–170. https://doi.org/10.1016/j.parkreldis.2021.02.012
Pahwa, R., Aldred, J., Merola, A., Gupta, N., Terasawa, E., Garcia-Horton, V., Steffen, D. R., Kandukuri, P. L., Bao, Y., Ladhani, O., Yan, C. H., Chaudhari, V., & Isaacson, S. H. (2022). Long-term results of carbidopa/levodopa enteral suspension across the day in advanced Parkinson's disease: Post-hoc analyses from a large 54-week trial. Clinical Parkinsonism & Related Disorders, 8, 100181. https://doi.org/10.1016/j.prdoa.2022.100181
Pellegrini, C., Antonioli, L., Colucci, R., Blandizzi, C., & Fornai, M. (2024). Motor dysfunction and gastric emptying disorders in Parkinson’s disease. Journal of Neurology. Advance online publication. https://doi.org/10.1016/j.neulet.2024.137093
Rodríguez-Sanz, A., Peña-Llamas, E., Alonso-Cánovas, A., Alonso-Frech, F. A., Borrue-Fernández, C., Catalán, M. J., Fanjul-Arbós, S., García-Cobos, E., García-Ramos, R., García Ruiz-Espiga, P., Herreros-Rodríguez, J., Kurtis-Urra, M., López-Lozano, J. J., López-Manzanares, L., Martínez-Castrillo, J. C., Martínez-Fernández, R., Mata, M., Pérez-Sánchez, J. R., Posada, I. J., Rojo, A., Romero-Muñoz, J. P., Ruiz-Huete, C., Sánchez-Alonso, M. P., & Vivancos-Matellano, F. (2020). Experiencia clínica en el tratamiento de las fluctuaciones motoras en la enfermedad de Parkinson: Consenso Delphi de un grupo de expertos en trastornos del movimiento. Revista de Neurología, 71(11), 407–420. https://doi.org/10.33588/rn.7111.2020088
Santos García, D., Fernández Pajarín, G., Oropesa-Ruiz, J. M., Escamilla Sevilla, F., Rahim López, R. R. A., & Muñoz Enríquez, J. G. (2022). Opicapone Improves Global Non-Motor Symptoms Burden in Parkinson's Disease: An Open-Label Prospective Study. Brain Sciences, 12(3), 383. https://doi.org/10.3390/brainsci12030383
Soliman, H., Coffin, B., & Gourcerol, G. (2021). Gastroparesis in Parkinson disease: Pathophysiology and clinical management. Brain Sciences, 11(7), Artículo 831. https://doi.org/10.3390/brainsci11070831
Wang, Y., Gao, P., Zhang, X., Lv, B., Xu, Z., & Cheng, H. (2021). Bilateral Subthalamic Nucleus Deep Brain Stimulation Improves Gastric Emptying Time in Parkinson Disease. World Neurosurgery, 154, e683–e688. https://doi.org/10.1016/j.wneu.2021.07.112
Zheng, T., & Camilleri, M. (2021). Management of Gastroparesis. Gastroenterology & Hepatology, 17(11), 515–525. https://pubmed.ncbi.nlm.nih.gov/35002534/
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