Migraine is a recurrent and commonly disabling primary headache disorder that affects over 17% of women and 5%-8% of men. Migraine susceptibility is multifactorial with genetic, hormonal and environmental factors all ...Migraine is a recurrent and commonly disabling primary headache disorder that affects over 17% of women and 5%-8% of men. Migraine susceptibility is multifactorial with genetic, hormonal and environmental factors all playing an important role. The physiopathology of migraine is complex and still not fully understood. Many different neuropeptides, neurotransmitters and brain pathways have been implicated. In connection with the myriad mechanisms and pathways implicated in migraine, a variety of multisystemic comorbidities(e.g., cardiovascular, psychiatric and other neurological conditions) have been found to be closely associated with migraine. Recent reports demonstrate an increased frequency of gastrointestinal(GI) disorders in patients with migraine compared with the general population. Helicobacter pylori infection, irritable bowel syndrome, gastroparesis, hepatobiliary disorders, celiac disease and alterations in the microbiota have been linked to the occurrence of migraine. Several mechanisms involving the gut-brain axis, such as a chronic inflammatory response with inflammatory and vasoactive mediators passing to the circulatory system, intestinal microbiota modulation of the enteric immunological milieu and dysfunction of the autonomic and enteric nervous system, have been postulated to explain these associations. However, the precise mechanisms and pathways related to the gut-brain axis in migraine need to be fully elucidated. In this review, we survey the available literature linking migraine with GI disorders. We discuss the possible physiopathological mechanisms, and clinical implications as well as several future areas of interest for research.展开更多
BACKGROUND Laparoscopic sleeve gastrectomy(LSG)has been proposed as an effective and durable treatment for severe obesity and glucose metabolism disorders,and its prevalence has increased from 5%to 37%since 2008.One c...BACKGROUND Laparoscopic sleeve gastrectomy(LSG)has been proposed as an effective and durable treatment for severe obesity and glucose metabolism disorders,and its prevalence has increased from 5%to 37%since 2008.One common complication after bariatric surgery is a postprandial hyperinsulinemic hypoglycemic state.While rare,insulinomas can cause this state,where symptoms are more common in the fasting state;thus,evaluation of insulin secretion is needed.Until now,there have been no reports of insulinoma after LSG.CASE SUMMARY We describe the case of a 43-year-old woman who was referred to the obesity clinic 2 years after LSG was performed.She had symptoms of hypoglycemia predominantly in the fasting state and documented hypoglycemia of less than 30 mg/d L,which are compatible with Whipple’s triad.Initially,dumping syndrome was suspected,but after a second low fasting plasma glucose was documented,a 72-h fasting test was performed that tested positive.Computed tomography and endoscopic ultrasound were performed,identifying the presence of a homogeneous hypoechoic semioval tumoral lesion in the pancreas.The diagnosis was compatible with insulinoma.After laparoscopic enucleation of the insulinoma,the symptoms and hypoglycemia disappeared.The histopathological report described a well-differentiated grade 2 neuroendocrine tumor with positive chromogranin and synaptophysin and Ki67 immunopositivity in 4%of the neoplastic cells.CONCLUSION Insulinoma after LSG is a rare condition,and clinicians must be aware of it,especially if the patient has hypoglycemic symptoms during the fasting state.展开更多
文摘Migraine is a recurrent and commonly disabling primary headache disorder that affects over 17% of women and 5%-8% of men. Migraine susceptibility is multifactorial with genetic, hormonal and environmental factors all playing an important role. The physiopathology of migraine is complex and still not fully understood. Many different neuropeptides, neurotransmitters and brain pathways have been implicated. In connection with the myriad mechanisms and pathways implicated in migraine, a variety of multisystemic comorbidities(e.g., cardiovascular, psychiatric and other neurological conditions) have been found to be closely associated with migraine. Recent reports demonstrate an increased frequency of gastrointestinal(GI) disorders in patients with migraine compared with the general population. Helicobacter pylori infection, irritable bowel syndrome, gastroparesis, hepatobiliary disorders, celiac disease and alterations in the microbiota have been linked to the occurrence of migraine. Several mechanisms involving the gut-brain axis, such as a chronic inflammatory response with inflammatory and vasoactive mediators passing to the circulatory system, intestinal microbiota modulation of the enteric immunological milieu and dysfunction of the autonomic and enteric nervous system, have been postulated to explain these associations. However, the precise mechanisms and pathways related to the gut-brain axis in migraine need to be fully elucidated. In this review, we survey the available literature linking migraine with GI disorders. We discuss the possible physiopathological mechanisms, and clinical implications as well as several future areas of interest for research.
文摘BACKGROUND Laparoscopic sleeve gastrectomy(LSG)has been proposed as an effective and durable treatment for severe obesity and glucose metabolism disorders,and its prevalence has increased from 5%to 37%since 2008.One common complication after bariatric surgery is a postprandial hyperinsulinemic hypoglycemic state.While rare,insulinomas can cause this state,where symptoms are more common in the fasting state;thus,evaluation of insulin secretion is needed.Until now,there have been no reports of insulinoma after LSG.CASE SUMMARY We describe the case of a 43-year-old woman who was referred to the obesity clinic 2 years after LSG was performed.She had symptoms of hypoglycemia predominantly in the fasting state and documented hypoglycemia of less than 30 mg/d L,which are compatible with Whipple’s triad.Initially,dumping syndrome was suspected,but after a second low fasting plasma glucose was documented,a 72-h fasting test was performed that tested positive.Computed tomography and endoscopic ultrasound were performed,identifying the presence of a homogeneous hypoechoic semioval tumoral lesion in the pancreas.The diagnosis was compatible with insulinoma.After laparoscopic enucleation of the insulinoma,the symptoms and hypoglycemia disappeared.The histopathological report described a well-differentiated grade 2 neuroendocrine tumor with positive chromogranin and synaptophysin and Ki67 immunopositivity in 4%of the neoplastic cells.CONCLUSION Insulinoma after LSG is a rare condition,and clinicians must be aware of it,especially if the patient has hypoglycemic symptoms during the fasting state.
