Document Detail


Postinfectious gastroparesis related to autonomic failure: a case report.
MedLine Citation:
PMID:  16420295     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND AIM: Severe dysautonomia may be secondary to viral infections, resulting in impaired autoimmune, cardiovascular, urinary and digestive dysfunction. Herein, we present a case of a 31-year-old white female patient who had severe gastroparesis related to autonomic failure following an episode of acute gastroenteritis. This seems to be the first report providing thorough assessment of the enteric and autonomic nervous system by analysis of full-thickness small intestinal biopsies, cardiovagal testing and autopsy.
HOSPITAL COURSE: This patient affected by a severe gastroparesis was treated with antiemetics, prokinetics, analgesics and gastric electrical stimulation to control symptoms. Nutritional support was made using jejunal feeding tube and, in the final stage of disease, with total parenteral nutrition. Autonomic studies revealed minimal heart rate variability and a disordered Valsalva manoeuvre although the enteric nervous system and the smooth muscle layer showed a normal appearance. Hospital courses were complicated by episodes of bacteraemia and fungemia. Serum antiphospholipid antibodies were noted but despite anticoagulation, she developed a pulmonary embolism and shortly thereafter the patient died. Autopsy revealed acute haemorrhagic Candida pneumonia with left main pulmonary artery thrombus. Sympathetic chain analysis revealed decreased myelinated axons with vacuolar degeneration and patchy inflammation consistent with Guillain-Barre syndrome. The evaluation of the enteric nervous system in the stomach and small bowel revealed no evidence of enteric neuropathy or myopathy.
CONCLUSION: A Guillain-Barre-like disease with gastroparesis following acute gastroenteritis is supported by physiological and autonomic studies with histological findings.
Authors:
A Lobrano; K Blanchard; T L Abell; A Minocha; W Boone; J Wyatt-Ashmead; J Fratkin; C Subramony; A Wee; G Di Nardo; G Barbara; V Stanghellini; R De Giorgio
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society     Volume:  18     ISSN:  1350-1925     ISO Abbreviation:  Neurogastroenterol. Motil.     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-01-19     Completed Date:  2006-03-29     Revised Date:  2013-07-15    
Medline Journal Info:
Nlm Unique ID:  9432572     Medline TA:  Neurogastroenterol Motil     Country:  England    
Other Details:
Languages:  eng     Pagination:  162-7     Citation Subset:  IM    
Affiliation:
Division of Digestive Diseases, University of Mississippi Medical Center, Jackson, MS 39216, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Autonomic Nervous System Diseases / complications*,  pathology,  physiopathology
Candidiasis / complications
Fatal Outcome
Female
Gastroenteritis / complications*
Gastroparesis / etiology*
Guillain-Barre Syndrome / pathology,  physiopathology
Humans
Pneumonia / microbiology
Stomach / innervation
Virus Diseases / complications

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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