Skip to main content

Advertisement

SpringerLink
Log in

Gastric Enterovirus Infection: A Possible Causative Etiology of Gastroparesis

  • Rapid Communications
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Gastroparesis (GP) is a disabling chronic gastroenterologic disorder with high morbidity that severely impacts patients’ quality of life. GP can present acutely after a viral-like gastrointestinal illness resulting in speculation that in some patients, neurologic damage caused by the infection might underlie the pathogenesis of idiopathic gastroparesis (IGP).

Aims

The aim of this study is to document case reports of Enterovirus (EV) infection as a possible cause of IGP.

Methods

Eleven patients referred with a diagnosis of GP underwent workup to exclude known causes of GP. Those with a history of flu-like symptoms or gastroenteritis prior to onset of GP symptoms had gastric biopsies taken during upper endoscopy to assess for the presence of gastric mucosal EV infection. Data on presenting symptoms, extra-intestinal symptoms and conditions, prior nutritional support requirements, upper endoscopy findings, and response to therapy were cataloged.

Results

Eleven patients were diagnosed as IGP. Nine had active EV infection on gastric biopsies and were included (7/9 female, mean age 43 years). Eight out of nine received EV treatment with antivirals and/or immune therapies, with a wide degree of variability in treatment regimens. Four out of eight who received EV treatment had symptomatic improvement. One patient had stable symptoms. Three patients are currently undergoing therapy.

Conclusions

Gastric EV infection was frequently detected (82 %) in patients undergoing investigation for IGP. Antiviral and/or immune therapies against EV seem to be favorable, as most of our patients had resolution of their GP symptoms after treatment. This is the first study to identify EV as a possible infectious etiology of IGP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

References

  1. Jung HK, Choung RS, Locke GR III, et al. The incidence, prevalence, and outcomes of patients with gastroparesis in Olmsted County, Minnesota, from 1996 to 2006. Gastroenterology. 2009;136:1225–1233.

    Article  PubMed  Google Scholar 

  2. Hyett B, Martinez FJ, Gill BM, et al. Delayed radionucleotide gastric emptying studies predict morbidity in diabetics with symptoms of gastroparesis. Gastroenterology. 2009;137:445–452.

    Article  PubMed  Google Scholar 

  3. Talley NJ, Young L, Bytzer P, et al. Impact of chronic gastrointestinal symptoms in diabetes mellitus on health-related quality of life. Am J Gastroenterol. 2001;96:71–76.

    Article  CAS  PubMed  Google Scholar 

  4. Waseem S, Moshiree B, Draganov PV. Gastroparesis: current diagnostic challenges and management considerations. World J Gastroenterol. 2009;15:25–37.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Stein B, Everhart KK, Lacy BE. Gastroparesis: a review of current diagnosis and treatment options. J Clin Gastroenterol. 2015;49:550–558.

    Article  PubMed  Google Scholar 

  6. Soykan I, Sivri B, Sarosiek I, et al. Demography, clinical characteristics, psychological and abuse profiles, treatment, and long-term follow-up of patients with gastroparesis. Dig Dis Sci. 1998;43:2398–2404.

    Article  CAS  PubMed  Google Scholar 

  7. Hasler WL, Wilson LA, Parkman HP, et al. Bloating in gastroparesis: severity, impact, and associated factors. Am J Gastroenterol. 2011;106:1492–1502.

    Article  PubMed  Google Scholar 

  8. Parkman HP, Yates K, Hasler WL, et al. Clinical features of idiopathic gastroparesis vary with sex, body mass, symptom onset, delay in gastric emptying, and gastroparesis severity. Gastroenterology. 2011;140:101–115.

    Article  PubMed  Google Scholar 

  9. Camilleri M, Parkman HP, Shafi MA, et al. Clinical guideline: management of gastroparesis. Am J Gastroenterol. 2013;108:18–37.

    Article  CAS  PubMed  Google Scholar 

  10. Bityutskiy LP, Soykan I, McCallum RW. Viral gastroparesis: a subgroup of idiopathic gastroparesis—clinical characteristics and long-term outcomes. Am J Gastroenterol. 1997;92:1501–1506.

    CAS  PubMed  Google Scholar 

  11. Spiller RC. Infection, immune function, and functional gut disorders. Clin Gastroenterol Hepatol. 2004;2:445–455.

    Article  PubMed  Google Scholar 

  12. Vassallo M, Camilleri M, Caron BL, et al. Gastrointestinal motor dysfunction in acquired selective cholinergic dysautonomia associated with infectious mononucleosis. Gastroenterology. 1991;100:252–258.

    Article  CAS  PubMed  Google Scholar 

  13. Debinski HS, Kamm MA, Talbot IC, et al. DNA viruses in the pathogenesis of sporadic chronic idiopathic intestinal pseudo-obstruction. Gut. 1997;41:100–106.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Lobrano A, Blanchard K, Abell TL, et al. Postinfectious gastroparesis related to autonomic failure: a case report. Neurogastroenterol Motil. 2006;18:162–167.

    Article  CAS  PubMed  Google Scholar 

  15. Camilleri M, Fealey RD. Idiopathic autonomic denervation in eight patients presenting with functional gastrointestinal disease. A causal association? Dig Dis Sci. 1990;35:609–616.

    Article  CAS  PubMed  Google Scholar 

  16. Parkman HP, McCallum RW. Gastroparesis Pathophysiology, Presentation and Treatment. New York, NY: Humana Press; 2012.

    Google Scholar 

  17. Tougas G, Eaker EY, Abell TL, et al. Assessment of gastric emptying using a low fat meal: establishment of international control values. Am J Gastroenterol. 2000;95:1456–1462.

    Article  CAS  PubMed  Google Scholar 

  18. Chia JK, Chia AY. Chronic fatigue syndrome is associated with chronic enterovirus infection of the stomach. J Clin Pathol. 2008;61:43–48.

    Article  CAS  PubMed  Google Scholar 

  19. Revicki DA, Rentz AM, Dubois D, et al. Development and validation of a patient-assessed gastroparesis symptom severity measure: the Gastroparesis Cardinal Symptom Index. Aliment Pharmacol Ther. 2003;18:141–150.

    Article  CAS  PubMed  Google Scholar 

  20. El-Serag HB, Chia J, Chia AY. Enterovirus infection of the stomach is associated with dyspepsia: a pilot controlled study. Gastroenterology. 2007;132:A73.

    Google Scholar 

  21. Chia JK, Chia AY, Wang D, et al. Functional dyspepsia and chronic gastritis associated with enteroviruses. Open J Gastroenterol. 2015;5:21–27.

    Article  Google Scholar 

  22. Khetsuriani N, LaMonte-Fowlkes A, Oberste S, et al. Enterovirus surveillance—United States, 1970–2005. MMWR Surveill Summ.. 2006;55:1–20.

    PubMed  Google Scholar 

  23. Flanagan EP, Saito YA, Lennon VA, et al. Immunotherapy trial as diagnostic test in evaluating patients with presumed autoimmune gastrointestinal dysmotility. Neurogastroenterol Motil. 2014;26:1285–1297.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Ng Q, He F, Kwang J. Recent progress towards novel EV71 anti-therapeutics and vaccines. Viruses. 2015;7:6441–6457.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Wang SM, Lei HY, Huang MC, et al. Modulation of cytokine production by intravenous immunoglobulin in patients with Enterovirus 71-associated brainstem encephalitis. J Clin Virol. 2006;37:47–52.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Dr. John Chia of EV MED Research, Lomita, California, for his assistance with performing Enterovirus testing for patients in this study.

Funding

The authors report no sources of funding for the study.

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, 1120 NW 14th Street, Clinical Research Building, Suite 1116 (D-49), Miami, FL, 33136, USA

    Jodie A. Barkin, Frank Czul, Jamie S. Barkin & Baharak Moshiree

  2. Institute for Neuro-Immune Medicine, Nova Southeastern University, 3440 South University Drive, Davie, FL, 33328, USA

    Nancy G. Klimas & Irma R. Rey

Authors
  1. Jodie A. Barkin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Frank Czul
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jamie S. Barkin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nancy G. Klimas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Irma R. Rey
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Baharak Moshiree
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jodie A. Barkin.

Ethics declarations

Conflict of interest

The authors report no relevant financial disclosures or conflicts of interest.

Statement of human rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Institutional Review Board approval was obtained.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Barkin, J.A., Czul, F., Barkin, J.S. et al. Gastric Enterovirus Infection: A Possible Causative Etiology of Gastroparesis. Dig Dis Sci 61, 2344–2350 (2016). https://doi.org/10.1007/s10620-016-4227-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-016-4227-x

Keywords

Search

Navigation