title: Gastric Enterovirus Infection: A Possible Causative Etiology of Gastroparesis.
abstract: Gastroparesis (GP) is a disabling chronic gastroenterologic disorder with high morbidity that severely impacts patients' quality of life. GP can present acutely after a viral-like gastrointestinal illness resulting in speculation that in some patients, neurologic damage caused by the infection might underlie the pathogenesis of idiopathic gastroparesis (IGP).
  
  
  
  The aim of this study is to document case reports of Enterovirus (EV) infection as a possible cause of IGP.
  
  
  
  Eleven patients referred with a diagnosis of GP underwent workup to exclude known causes of GP. Those with a history of flu-like symptoms or gastroenteritis prior to onset of GP symptoms had gastric biopsies taken during upper endoscopy to assess for the presence of gastric mucosal EV infection. Data on presenting symptoms, extra-intestinal symptoms and conditions, prior nutritional support requirements, upper endoscopy findings, and response to therapy were cataloged.
  
  
  
  Eleven patients were diagnosed as IGP. Nine had active EV infection on gastric biopsies and were included (7/9 female, mean age 43 years). Eight out of nine received EV treatment with antivirals and/or immune therapies, with a wide degree of variability in treatment regimens. Four out of eight who received EV treatment had symptomatic improvement. One patient had stable symptoms. Three patients are currently undergoing therapy.
  
  
  
  Gastric EV infection was frequently detected (82 %) in patients undergoing investigation for IGP. Antiviral and/or immune therapies against EV seem to be favorable, as most of our patients had resolution of their GP symptoms after treatment. This is the first study to identify EV as a possible infectious etiology of IGP.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, 1120 NW 14th Street, Clinical Research Building, Suite 1116 (D-49), Miami, FL, 33136, USA. jabarkin@med.miami.edu.
authors.forename: Jodie A
authors.initials: JA
authors.lastname: Barkin
authors.affiliation: Division of Gastroenterology, Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, 1120 NW 14th Street, Clinical Research Building, Suite 1116 (D-49), Miami, FL, 33136, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Czul
authors.affiliation: Division of Gastroenterology, Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, 1120 NW 14th Street, Clinical Research Building, Suite 1116 (D-49), Miami, FL, 33136, USA.
authors.forename: Jamie S
authors.initials: JS
authors.lastname: Barkin
authors.affiliation: Institute for Neuro-Immune Medicine, Nova Southeastern University, 3440 South University Drive, Davie, FL, 33328, USA.
authors.forename: Nancy G
authors.initials: NG
authors.lastname: Klimas
authors.affiliation: Institute for Neuro-Immune Medicine, Nova Southeastern University, 3440 South University Drive, Davie, FL, 33328, USA.
authors.forename: Irma R
authors.initials: IR
authors.lastname: Rey
authors.affiliation: Division of Gastroenterology, Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, 1120 NW 14th Street, Clinical Research Building, Suite 1116 (D-49), Miami, FL, 33136, USA.
authors.forename: Baharak
authors.initials: B
authors.lastname: Moshiree
mesh_terms: D015075:2-Aminopurine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D001706:Biopsy; D004769:Enterovirus Infections / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D000077595:Famciclovir; D005260:Female; D005756:Gastritis / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D005764:Gastroesophageal Reflux / Q000453:epidemiology; D018589:Gastroparesis / Q000453:epidemiology* / Q000628:therapy / Q000821:virology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D007542:Inosine Pranobex / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D054972:Postural Orthostatic Tachycardia Syndrome / Q000453:epidemiology; D012254:Ribavirin / Q000627:therapeutic use; D013270:Stomach / Q000473:pathology; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D015075:2-Aminopurine; D012254:Ribavirin; D000077595:Famciclovir; D007542:Inosine Pranobex
keywords: Enterovirus; Gastroparesis; Idiopathic; Infection