Neuro Muscular Evaluation Protocol

NEURO MUSCULAR EVALUATION PROTOCOL

Briefly: GI neuro-muscular disorders are nearly universal in patients with the symptoms of GI dysmotility. Listed below is a summary of our ongoing quest. Of the three main aspects of medicine: anatomy, physiology and therapy, we have focused on the former, including a broad definition of anatomy to include chemical structure of any aspect of functioning. We have tried to correlate findings from this broad view  of anatomy onto ongoing physiological measures, including electrophysiology, and more recently into directed therapies for GI motility disorders.

History: Spurred by interest in anatomic evaluation of GI motility disorders, a longitudinal series of small bowel anatomy was begun in Memphis in 1988, using the techniques available then. By 2000, when over 100 consecutive samples had been obtained, new techniques were becoming available. Serologic analysis, including Western blot, has also been collected on patients from nearly the same time. Newer techniques, adapted from adult and pediatric neuromuscular medicine, have been applied to GI when possible.

Projects: In the early 2000s routine biopsies were changed from small bowel to stomach and have been adapted every since (see MUCOSAL AND FULL THICKNESS BIOPSY EVALUATIONS page in this web site.)

Routine evaluations now, done primarily on patients who are drug and device refractory include:

  1. Amino acid screen, serum
  2. Western blot of serum, when available
  3. Para-neoplastic antibody screen, for channelopathies and related disorders
  4. GAD-65 abs
  5. Thymidine phosphorylase and free thymidine, for MNGIE

Ongoing work has now focused on therapies for those patients who are identified as abnormal.

 

Original Publications, chronologically:

Mathias JR, Clench MH, Abell TL, Koch KL, Lehman G, Robinson M, Rothstein     R, Snape WJ. Effect of leuprolide acetate in treatment of abdominal pain and nauseaa in premenopausal women with functional bowel disease: a double-blind, placebo-controlled, randomized study. Dig Dis Sci. 1998: 43; 1347-1355.

Luo J, Al-Juburi A, Rashed H, O’Dorisio T, Marchal B, Starkebaum W, Abell TL. Gastric electrical stimulation is associated with improvement in pancreatic exocrine function in humans. Pancreas 29: e41-e44, 2004.

Abell TL, Familoni B, Voeller G, Werkman R, Dean P, Waters B, Smalley D, Salameh JR. Electrophysiologic, morphologic and serologic features of chronic unexplained nausea and vomiting: Lessons learned from 121 consecutive patients. Surgery. 2009: 145 (5); 476-485

 

Abstracts (numerous—available on request—some listed below)

Duncan U, Abell TL, Kuns J, Waters B, Voeller G, Dean P, Smalley D. Serum autoimmune antibodies levels as predictors of morphologic abnormalities of nerve and gut. Gastroenterology 106(Part 2): A491, 1994.

Duncan U, Abell T, Smalley D, Kuns J, VanFrank T, Dean P. Autoantibodies in chronic dyspepsia: prevalance and possible diagnostic role. Gastroenterology 106(Part 2):A491, 1994.

Kumar A, Abell TL, Voeller G, Werkman R, Smalley D, Duncan U, Dugdale M, Taylor J. Is thrombosis of central venous access in idiopathic upper GI dysmotility related to the presence of circulating autoantibodies. Gastroenterology 108(4): A734, 1995, Presented, AGA National Meeting, San Diego, May 1995.

Smalley DL, Shanklin DR, Abell T, Hall MF. Anamnestic immune response to silica following reexposure in a mammary implant patient. South Assoc Clin Microbiol Reviews 18(1): 12-13, 1995.

Bhaskar SK, Abell TL, Smalley D, Familoni. Voeller G. Correlation of full thickness biopsies and serum autoantibody scores in patients with unexplained nausea and vomiting. Gastroenterology 110(4): A634, 1996.

Abell TL, Bhaskar SK, Taylor J, Smalley D, Werkman R, Fisher J. Serum autoantibodies may predict response to leuprolide therapy in patients with chronic gastrointestinal motor disorders. Gastroenterology 110(4): A622, 1996.

Abell TL, Smalley D, Taylor J, Bhaskar S, Werkman R. Serum autoantibodies Predict outcome of therapy with leuprolide in patients with GI motor disorders Gastroenterology 112(4): A , 1997.

Deshmukh SL, Nash K, Familoni J, Smalley D, Voeller G, Dean P, Abell TL. Can Non-Histologic Techniques predict Visceral Myopathies or Neuropathies (DDW, May 15-22, 1998, New Orleans, LA).

Idris A, Nash K, Smalley D, Voeller G, Sietcher S, Dugdale M, Abell TL. Correlation Between the Occurrence of Thrombosis and Serum Autoantibody Levels in Luminal Gut Failure Patients with Central IV Access (DDW, May 15-22, 1998, New Orleans, LA).

Abell TL, C. Kasser, K Nash, E Brewer, D Adl, G Voeller, P Dean, D Smalley, Gastrointestinal Autoimmune Neuropathy (Gain): No Gain-No Pain? Gastroenterology 116 (4) (Part 2) A949, April 1999.

Mahmoud M. Alkeshen, Catheleen Edick, Lawrence Hak, M. K. Ismail, Kathy Nash, Steven Deitcher, Patricia Adams Graves, Marian Dugdale, David Smalley, Thomas L. Abell: High incidence of protein s abnormalities in patients with catheter-related thrombosis. Gastroenterology 118 (4) (Part 2) A1064, April 2000.

Siddiqui A, Ismail MK, Smalley D, Dan P, Werkman R, Voeller G, Abell TL: Visceral myopathies of the gut: clinical features, complications & long term followup. Gastroenterology 118 (4) (Part 2) A1197, April 2000.

Alkheshen MA, Edick C, Hak L, Ismail MK, Nash K, Deitcher, Graves PA, Dugdale M, Smalley D, Abell TL: Patients with IV catheter related thrombosis have multiple coagulation and autoimmune abnormalities on baseline diagnostic tests. Gastroenterology 118 (4) (Part 2) A1331, April 2000.

Bradley Creel, Amy Lobrano, William Rock, David Smalley, William D Johnson, Anil Minocha, Thomas L Abell. Correlation of Immune Markers, Overlap Symptoms and Hypercoagulable Measures in Patients with Gastroparesis: Can We Predict Which Patients Will Clot? Neurogastroenterology and Motility 18 (8), A322: August 2006.

Kedar, Archana; Nikitina, Yana; Martin, Evelyn; Vedanarayanan, Vetta; Abell, Thomas L.: Immunomodulation for Treatment of Drug and Device Refractory Gastroparesis: An Open Label Pilot Study of GAD65 Positive Patients. Poster Session. Neuroimmune Modulation of Gut Function, Including Inflammation, Infection and the Microbiome. May 21, 2113 – Orange County Convention Center.

 

Ongoing work: Has focused on: new markers on full thickness biopsies, additional correlations with serologic abnormalities and addition trials of therapies.

[updated 22 June 2014 by TLAbell]

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