Autoimmune Gastrointestinal Dysmotility (AGID) Evaluation
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The following questions were submitted by viewers and answered by the presenter, Andrew McKeon, MB, BCh, MD (N-AI), consultant in the Neuroimmunology Laboratory in the Division of Clinical Biochemistry and Immunology, Department of Laboratory Medicine and Pathology at Mayo Clinic in Rochester, Minnesota. Questions are presented as submitted (unedited).
Differential diagnosis before beginning the study of the patient will need broad experience. Can you comment?
Any cause of autonomic neuropathy could produce similar disorders. These would include amyloidosis, parkinsonism, multiple system atrophy and primary dysautonomia (no cause found or presumed degenerative). Medications, including narcotic analgesics, and electrolyte abnormalities can produce gastrointestinal dysmotility also.
How common is AGID? The symptoms listed are quite vague and easily dismissed by physicians. It seems the testing would only be used if the patient had a previous cancer that may be associated with the known autoantibodies.
I agree it is difficult to know what the spectrum of disorders is here. The incidence of AGID is unknown, and it is difficult in some patients to determine when to test. Recent data would suggest that neural autoimmunity is not the basis for most cases of functional dyspepsia or irritable bowel syndrome. Suspicion would definitely be raised in patients with persisting symptoms of gastrointestinal dysmotility (early satiety and bloating not otherwise explained, history of pseudoobstruction or severe constipation), and who have a history of autoimmunity and/or cancer. Gastrointestinal transit studies may help to objectify. Whether there is a broader spectrum of milder disorders is not known at present, but may become known with time as more patients are evaluated.