Citations 3
Joint Hypermobility, Autonomic Dysfunction, Gastrointestinal Dysfunction, and Autoimmune Markers: Clinical Associations and Response to Intravenous Immunoglobulin Therapy
Pasricha, Pankaj J. , McKnight, Megan, Villatoro, Luisa , Barahona, Guillermo , Brinker, Jeffrey, Hui, Ken , Polydefkis, Michael , Burns, Robert B., McMahan, Zsuzsanna H. , Gould, Neda F , Goodman, Brent P., Hentz, Joseph G. , Treisman, Glenn J. , Gould, Neda , Burns, Robert
American Journal of Gastroenterology | June 24, 2024 | Volume: 119 | Issue: 11 | Pages: 2298-2306
INTRODUCTION: We examined autoimmunity markers (AIM) and autonomic dysfunction in patients with chronic neurogastroenterological symptoms and their relationship to joint hypermobility/hypermobility spectrum disorder (JH/HSD). METHODS: AIM positivity was defined as a diagnosis of known autoimmune/autoinflammatory disorder with at least 1 positive seromarker of autoimmunity or at least 2 positive seromarkers by themselves. Three cohorts were studied: (i) retrospective (n = 300), (ii) prospective validation cohort (n = 133), and (iii) treatment cohort (n = 40), administered open-label intravenous immunoglobulin (IVIG). RESULTS: AIM positivity was found in 40% and 29% of the retrospective and prospective cohorts, the majority of whom (71% and 69%, respectively) had autoinflammatory disorder. Significantly more patients with AIM had elevations of C-reactive protein (31% vs 15%, P < 0.001) along with an increased proportion of cardiovascular autonomic dysfunction (48% vs 29%; P < 0.001), small fiber neuropathy (20% vs 9%; P = 0.002), and HLADQ8 positivity (24% vs 13%, P = 0.01). Patients with JH/HSD were more likely to have AIM (43% vs 15%, P = 0.001) along with more severe autonomic and gastrointestinal (GI) symptom scores. IVIG treatment was associated with robust improvement in pain, GI, and autonomic symptoms, but adverse events were experienced by 62% of patients. DISCUSSION: Autoimmune markers and autonomic dysfunction are common in patients with unexplained GI symptoms, especially in those with JH/HSD. Many patients seem to respond to IVIG treatment, but this needs to be confirmed by controlled trials. These results highlight the need for vigilance for autoimmune and autonomic factors and JH/HSD in patients with neurogastroenterological disorders. Clinicaltrials.gov, NCT04859829.
S1846 Non-Invasive Vagal Nerve Stimulation Reduces Nausea Rescue Medication in Patients With Gastroparesis and Related Disorders, With Additional Benefits on Multiple Other Associated Symptoms
Barahona, Guillermo , Villatoro, Luisa , Treisman, Glenn J. , McKnight, Megan, Burns, Robert B., McClure, Candace K. , Liebler, Eric , Pasricha, Pankaj J. , Burns, Robert
American Journal of Gastroenterology | October 18, 2023 | Volume: 118 | Issue: 10S | Pages: S1373-S1374
A Conceptual Framework for Understanding Chronic Pain in Patients with HIV
Merlin, Jessica S. , Zinski, Anne , Norton, Wynne E. , Saag, Michael S. , Treisman, Glenn J. , Hooten, W. Michael , Ritchie, Christine Seel , Mugavero, Michael J.
Pain Practice | April 1, 2013 | Volume: 14 | Issue: 3 | Pages: 207-216
AbstractChronic pain is common in persons with HIV and is often associated with psychiatric illness and substance abuse. Current literature links psychiatric illness and substance abuse with worse HIV outcomes; however, the relationship of chronic pain, alone and in the context of psychiatric illness and substance abuse, to outcomes in HIV has not been described. To develop this new area of inquiry, we propose an adapted biopsychosocial framework specifically for chronic pain in HIV. This framework will describe these relationships and serve as a conceptual framework for future investigations.