G-LD 2 Higher Digestive Tract Motility Research Group
The Higher Digestive Tract Motility Research Group is formed by senior researchers, postdoctoral researchers and fellows from the Hospital de Mataró. It has formed part of the Research Consortium Ciberehd (Spanish Ministry of Science) since 2007. The goal of the group is to study the physiology of gastrointestinal motility and the pathophysiology of diseases associated with alterations of gastrointestinal motility, which are prevalent diseases with a high impact on health and quality of life of the population. The group combines basic and clinical researchers organized around a General Hospital and the Department of Physiology at the UAB and translates its research activities into clinical practice (Clinical Guidelines and Position Statements). The group has been recognized and funded by the Agency Gestió d'Ajuts Universitaris i de Recerca GRC2014 SRG789 and CIBEREHD
Line 1: Oropharyngeal dysphagia, risk factors and treatment
Oropharyngeal dysphagia (OD) is a common disorder that affects more than 50% of elderly people in hospital and patients who have suffered ictus or other neurological illnesses. OD is difficulty in transporting a bolus of food from the mouth to the oesophagus and can lead to aspiration and oesophageal residues. OD can cause serious nutritional complications (malnutrition and dehydration) and severe respiratory problems (respiratory infection, aspiration pneumonia) in affected patients. Despite this, OD is underestimated and little diagnosed, there is currently no specific pharmacological treatment because the potential therapeutic targets are unknown. Our objective is to develop neurohabilitation strategies using pharmacological stimulation strategies, electrical intrapharingeal or transcutaneous stimulation, transcranial magnetic stimulation (rTMS) and electrical transcranial stimulation.
The general objectives of this line are focussed on the study of risk factors that lead to the apparition of oropharyngeal dysphagia in elderly and ictus patients and on the development of therapeutic strategies to treat OD and recover deglutitionary function.
Line 2 - Oropharyngeal dysphagia, malnutrition and pneumonia
Oropharyngeal dysphagia can cause two groups of complications of great clinical importance: a) If there is a reduction in deglutition the patient will present malnutrition and/or dehydration; up to 50% of institutionalized elderly people are poorly nourished. B) If there is a reduction in safety of deglutition trans-bronchial aspiration occurs, this can cause pneumonia in 50% of cases with an associated mortality of 50%. In the elderly oropharyngeal dysphagia, the prevalence of malnutrition (MNA <17 or 10% weight los) rising to 33.3% correlated with poorer functional capacity (using the Barthel Index) and higher mortality (40.4%) one year after hospitalization. The prevalence of dysphagia in elderly patients with pneumonia is greater than 50% and the severity of the pneumonia in the elderly with dysphagia is worse than those without it and causes a mortality close to 55% a year after hospitalization.
The general objective is to study the risk factors for pneumonia from aspiration, malnutrition and dehydration in patients with oesophageal dysphagia and to develop protocols to reduce the incidence of these complications of OD using a protocol of stimulation, which we have called massive minimal, which is based on the bases of oral hygiene using thickeners and adapting the calories, protein content and texture of the diet.
Line 3: Colorectal motility
The general objective of this line is increase understanding of constipation in different elderly phenotypes in Catalonia. Specifically this involves the study of prevalence, risk factors, physiopathology and impact on quality of life of constipation in the elderly in Catalonia according to their fragility, determining the optimal dose of anally administered methoxamine in patients with faecal incontinence, studying the impact of faecal incontinence on quality of life of individuals and finding gender differences, evaluating different treatments for faecal incontinence and evaluating impact of treatments for faecal incontinence on physiology and cortical plasticity.
We work on the following lines:
- Study of prevalence of constipation in the elderly of Catalonia according to their fragility
- Randomized clinical trial to evaluate annually administered methoxadine
- Impact of gender on quality of life for patients with faecal incontinence
- Evaluation of efficacy of treatments for faecal incontinence and their impact on physiology
Line 4: Gastro-oesophageal Motility
The general objective is to broaden understanding of gastro-intestinal and vesical motility in order to discover its relation to appetite control in different population groups such as the robust elderly, fragile elderly, obese individuals and obese individuals who have undergone bariatric surgery. Specifically this focusses on understanding if there are alterations in gastrointestinal motility or the neuro-hormonal system which regulates appetite and sating, studying the alterations in gastrointestinal motility and neuro-hormonal appetite control in obese individuals, studying the modifications brought about in gastro-intestinal motility by restrictive bariatric surgery in obese individuals and the associated hormone alterations.
We work on the following lines:
- Study of gastro-intestinal and vesical motility in the robust and fragile elderly
- Study of gastro-intestinal and vesical motility in obese individuals who have undergone restrictive bariatric surgery
- Study of gastro-intestinal motility in obese individuals
- In vitro study of the effect of gastrointestinal hormones CCK, ghrelin and GLP-1 on gastro-intestinal motility
- In vitro study of the effect of therapeutic targets on prokinetics
Line 5: In vitro intestinal Motility
This research line centres on the study of human gastrointestinal pathologies which progress with severe disruption to gastrointestinal motility but currently have no specific treatment: diverticular disease and postoperative paralytic ileus.
Diverticular disease is a pathology which mainly affects the left colon and sigmoid. The physiopathology is not known, nor are the factors that contribute to its development despite a prevalence of 40-60% in the over 70s and the elevated costs of healthcare. Post-operative paralytic ileum occurs due to visceral manipulation and it effects the entire gastrointestinal tract. It affects patients who have major abdominal surgery and although it is one of the most common causes of prolongation of a hospital stay and represents a very high cost to health services the interaction between the cells of the immune system and the regulatory mechanisms of motility (neurones, muscles etc) is unknown.
The main objectives of this project are to establish the alterations to motility at the neurotransmission and muscular levels, which occur at different stages of diverticular disease and as a result of interactions with the cells of the immune system, basically mast cells in the paralytic ileum and to seek therapeutic pharmacological targets and the evaluation of new strategies to treat these patients.
Dr Pere Clavé
Dr Clavé is Director of Research and Academic Development at CSdM, Principla Investigator for the CIBEREHD group CSdM-UAB and President of the European Society for Swallowing Disorders.
Pere Clavé MD, PhD. Associate Professor of Surgery. Universitat Autònoma de Barcelona Hospital de Mataró
(34) 93 741 7700 ext 1046