Browsing by Author "Moshiree, Baharak"

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    Baseline Predictors of Longitudinal Changes in Symptom Severity and Quality of Life in Patients with Suspected Gastroparesis
    (Elsevier, 2022) Lee, Allen A.; Rao, Krishna; Parkman, Henry P.; McCallum, Richard W.; Sarosiek, Irene; Nguyen, Linda A.; Wo, John M.; Schulman, Michael I.; Moshiree, Baharak; Rao, Satish; Kuo, Braden; Hasler, William L.; Medicine, School of Medicine
    Background & aims: Whether gastric emptying tests predict longitudinal outcomes in patients with symptoms of gastroparesis is unclear. We aimed to determine whether baseline gastric emptying tests and gut motility parameters could impact longitudinal symptom(s) and quality of life (QOL) in a prospective, observational cohort study of patients with symptoms of gastroparesis. Methods: One hundred fifty patients with gastroparesis symptoms underwent simultaneous scintigraphy (GES) and wireless motility capsule (WMC) measurement of gastric emptying and other motility parameters. Patient Assessment of Upper Gastrointestinal Symptoms and Quality of Life were administered at baseline, and 3 and 6 months after testing. Multivariable generalized linear marginal models were fit to determine which baseline parameters predict longitudinal changes in symptoms and QOL. Results: Overall upper GI symptoms and QOL scores were moderate in severity at baseline and significantly improved over 6 months. Clinical variables, including female gender, harder stools by Bristol stool form score, and presence of functional dyspepsia (FD) by Rome III criteria, were predictive of more severe upper GI symptoms. Even after controlling for these clinical factors, delayed gastric emptying by GES or WMC was associated with worse symptom severity and QOL scores. Low gastric and elevated small bowel contractile parameters by WMC were also independently associated with more severe upper GI symptoms and worse QOL scores. Conclusions: Baseline features, including demographic and clinical variables, delayed gastric emptying and abnormal gastrointestinal contractility, were independent predictors of more severe longitudinal symptoms and worse quality of life outcomes. These factors may help to risk stratify patients and guide treatment decisions.
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    Benefits of Prokinetics, Gastroparesis Diet, or Neuromodulators Alone or in Combination for Symptoms of Gastroparesis
    (Elsevier, 2023-10-23) Hasler, William L.; Lee, Allen A.; Moshiree, Baharak; Surjanhata, Brian C.; Rao, Satish; Parkman, Henry P.; Nguyen, Linda A.; Sarosiek, Irene; Wo, John M.; Schulman, Michael I.; McCallum, Richard W.; Kuo, Braden; Medicine, School of Medicine
    Background & Aims Prokinetics have limited effectiveness for treating symptoms of gastroparesis. Thus, alternative or adjunct therapies, such as gastroparesis diets or neuromodulators, are often prescribed. Their therapeutic benefits alone or in combination remain unclear. Methods One hundred and twenty-nine patients with symptoms of gastroparesis underwent wireless motility capsule gastric emptying time and gastric emptying scintigraphy. Based on test results, changes in therapy were recommended. Changes in Gastroparesis Cardinal Symptom Index (GCSI) and individual symptom scores over 6 months were related to recommendations for prokinetics, gastroparesis diet, or neuromodulators given as solo new therapies or in dual combinations. Multivariate analyses were performed to adjust for gastric emptying and other variables. Results In the whole group regardless of therapy, GCSI scores decreased by 0.53 points (interquartile range, -1.25 to 0.05; P < .0001) over 6 months. GCSI did not decrease for prokinetics as solo new therapy (P = .95). Conversely, neuromodulators as solo therapy decreased GCSI scores (P = .04) and all individual symptoms except nausea/vomiting (P = .86). Prokinetics combined with gastroparesis diets or neuromodulators improved GCSI scores (P ≤ .04) and most individual symptoms. Adjusting for gastric emptying time on multivariate analyses showed greater GCSI decreases for nondelayed emptying for neuromodulators as solo new therapy (P = .01). Gastric emptying scintigraphy, gender, diabetes, and functional dyspepsia did not influence responses to any treatment. Conclusions Initiating prokinetics as solo new therapy had little benefit for patients with symptoms of gastroparesis. Neuromodulators as the only new therapy decreased symptoms other than nausea and vomiting, especially with nondelayed gastric emptying. Adding gastroparesis diets or neuromodulators to prokinetics offered relief, suggesting that combination therapies may be more useful in managing these patients. (ClinicalTrials.gov NCT02022826.)
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    Updated Consensus Guidelines on the Management of Phelan-McDermid Syndrome
    (Wiley, 2023) Srivastava, Siddharth; Sahin, Mustafa; Buxbaum, Joseph D.; Berry-Kravis, Elizabeth; Valluripalli Soorya, Latha; Thurm, Audrey; Bernstein, Jonathan A.; Asante-Otoo, Afua; Bennett, William E., Jr.; Betancur, Catalina; Brickhouse, Tegwyn H.; Bueno, Maria Rita Passos; Chopra, Maya; Christensen, Celanie K.; Cully, Jennifer L.; Dies, Kira; Friedman, Kate; Gummere, Brittany; Holder, J. Lloyd, Jr.; Jimenez-Gomez, Andres; Kerins, Carolyn A.; Khan, Omar; Kohlenberg, Teresa; Lacro, Ronald V.; Levi, Lori A.; Levy, Tess; Linnehan, Diane; Loth, Eva; Moshiree, Baharak; Neumeyer, Ann; Paul, Scott M.; Phelan, Katy; Persico, Antonio; Rapaport, Robert; Rogers, Curtis; Saland, Jeffrey; Sethuram, Swathi; Shapiro, Janine; Tarr, Phillip I.; White, Kerry M.; Wickstrom, Jordan; Williams, Kent M.; Winrow, Dana; Wishart, Brian; Kolevzon, Alexander; Pediatrics, School of Medicine
    Phelan-McDermid syndrome (PMS) is a genetic condition caused by SHANK3 haploinsufficiency and characterized by a wide range of neurodevelopmental and systemic manifestations. The first practice parameters for assessment and monitoring in individuals with PMS were published in 2014; recently, knowledge about PMS has grown significantly based on data from longitudinal phenotyping studies and large-scale genotype-phenotype investigations. The objective of these updated clinical management guidelines was to: (1) reflect the latest in knowledge in PMS and (2) provide guidance for clinicians, researchers, and the general community. A taskforce was established with clinical experts in PMS and representatives from the parent community. Experts joined subgroups based on their areas of specialty, including genetics, neurology, neurodevelopment, gastroenterology, primary care, physiatry, nephrology, endocrinology, cardiology, gynecology, and dentistry. Taskforce members convened regularly between 2021 and 2022 and produced specialty-specific guidelines based on iterative feedback and discussion. Taskforce leaders then established consensus within their respective specialty group and harmonized the guidelines. The knowledge gained over the past decade allows for improved guidelines to assess and monitor individuals with PMS. Since there is limited evidence specific to PMS, intervention mostly follows general guidelines for treating individuals with developmental disorders. Significant evidence has been amassed to guide the management of comorbid neuropsychiatric conditions in PMS, albeit mainly from caregiver report and the experience of clinical experts. These updated consensus guidelines on the management of PMS represent an advance for the field and will improve care in the community. Several areas for future research are also highlighted and will contribute to subsequent updates with more refined and specific recommendations as new knowledge accumulates.