Gastrointestinal Complications in Patients with Myelodysplastic Syndrome or Acute Myeloid Leu-kemia Undergoing Treatment with 5-Azacitidine (GAS-COL)
Translated title
Gastrointestinale Komplikationer hos Patienter med Myleodysplastisk Syndrom eller Akut Myeloid Leukæmi i Behandling med 5-Azacitidin (GAS-COL)
Authors
Zaugg, Victoria Sarah ; Wigh, Ida Marie Nørum
Term
5. Term (Master thesis)
Education
Publication year
2022
Submitted on
2022-01-06
Pages
22
Abstract
This study aimed to explore whether nausea and other gastrointestinal complaints in patients with myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML) treated with 5-azacitidine are linked to delayed gastric emptying and autonomic dysfunction. We conducted two complementary designs: (I) a planned follow-up with baseline assessment before treatment and a post-initiation assessment (one patient included, baseline only) and (II) a cross-sectional study including two patients on ongoing 5-azacitidine and 21 healthy controls for reference. Assessments included questionnaires, a Wireless Motility Capsule to evaluate gastrointestinal transit, and autonomic testing (Cardiac Vagal Tone, heart rate variability, orthostatic blood pressure, and SUDOSCAN). Owing to the very small patient sample, no comparative statistics were performed. Both treated patients exhibited prolonged gastric emptying; autonomic findings suggested possible cardiovascular autonomic neuropathy (one pathological, one borderline), variable sudomotor function, and orthostatic hypotension in one case. These preliminary observations indicate that delayed gastric emptying may contribute to symptoms and that the Wireless Motility Capsule is feasible for clinical research. However, underlying mechanisms appear multifactorial and remain unclear; larger, well-powered studies are needed to guide targeted antiemetic management in this population.
Formålet med dette studie var at undersøge, om kvalme og andre gastrointestinale gener hos patienter med myelodysplastisk syndrom (MDS) eller akut myeloid leukæmi (AML) i behandling med 5-azacitidin kan hænge sammen med forsinket ventrikeltømning og autonom dysfunktion. Vi gennemførte to delstudier: (I) et planlagt follow-up-forløb med basismåling før behandlingsstart og opfølgning efter opstart (én patient inkluderet, kun basismåling gennemført) og (II) et tværsnitsstudie med to patienter i igangværende 5-azacitidin-behandling samt 21 raske kontroller som reference. Undersøgelserne omfattede spørgeskemaer, Wireless Motility Capsule til måling af mave-tarm-passage samt autonome målinger (Cardiac Vagal Tone, hjerterytmevariabilitet, ortostatisk blodtryk og SUDOSCAN). På grund af meget få patienter blev der ikke udført sammenlignende statistiske analyser. Hos de to behandlede patienter fandtes forlænget ventrikeltømning; der sås derudover tegn på mulig kardiovaskulær autonom neuropati (én patologisk og én grænseværdig score), varieret sudomotorfunktion og ortostatisk hypotension hos én patient. Resultaterne peger på, at forsinket ventrikeltømning kan bidrage til de rapporterede symptomer, og at Wireless Motility Capsule er anvendelig i klinisk forskning. De underliggende mekanismer synes dog multifaktorielle og er endnu ikke klarlagt; større, veltilrettelagte studier er nødvendige for at optimere antiemetisk behandling i denne patientgruppe.
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