Table 2b. Clinical Characteristics of 17 patients with immunotherapy-responsive gastrointestinal dysmotility.
| Patient | Manometry abnormalities |
Neural autoantibody detected (titer) |
Cancer detected |
Immunotherapy diagnostic trial |
GI symptom improvement |
Recorded response |
Improved Scintigraphy |
Repeat neural autoantibody after immunotherapy |
Other objective evidence of improvement |
|---|---|---|---|---|---|---|---|---|---|
| 1 | - | gAChR (5.89 nmol/L) | - | IVIg | Yes | Mild | Yes | gAChR (3.69 nmol/L) | Improved autonomic tests |
| 2 | Gastroduodenal: neuropathic | gAChR (0.09 nmol/L) | - | IVMP | No | - | Yes | gAChR (0.19 nmol/L) | - |
| 3 | Colonic: motor dysfunction | Peripherin (1:1920) | - | IVIg | Yes | BM daily compared to once per week | Yes | Peripherin (1:15360) | - |
| 4 | Colonic: motor dysfunction | Peripherin (1:960), striated muscle (1:240) | - | IVIg | Yes | Mild | Yes | - | Improved autonomic tests and manometry study |
| 5* | - | ANNA-1 (1:3840) | Lung, small-cell | IVIg | Yes | Weight gain 55 lb (from 110 to 165 lbs) | - | ANNA-1 (1:240) | - |
| 6 | - | - | - | IVMP | Yes | Normalized | Yes | - | Improved autonomic tests |
| 7 | - | - | - | IVMP | No | - | Yes | - | - |
| 8 | gAChR (0.06 nmol/L) and striated muscle (1:240) | - | IVIg | Yes | Nausea resolved; weight gain 10 lbs | - | gAChR (0.00 nmol/L) and striated muscle (1:60) | Improved autonomic tests | |
| 9* | Gastroduodenal: mechanical dysfunction, attributed to AGID | ANNA-1 (1:15360) VGKC (0.10 nmol/L) | Cervix, small-cell | IVMP followed by IVIg | Yes | Nausea and vomiting resolved | - | ANNA-1 (1:3840) VGKC (0.07 nmol/L) | - |
| 10 | Gastroduodenal: neuropathic | gAChR (0.17 nmol/L) and VGKC (0.15 nmol/L) | - | IVIg followed by prednisone and mycophenolate | Yes | J tube able to be removed | - | gAChR (0.15 nmol/L) | Improved autonomic tests |
| 11 | - | ANNA-1 (1:61440), GAD65 (0.17 nmol/L), VGKC (0.19 nmol/L) | Thymoma | IVMP | Yes | Subjectively reported 80% improvement | - | ANNA-1 (negative) VGKC (0.18 nmol/L) | - |
| 12 | - | gAChR (5.36 nmol/L) | - | IVIg | Yes | Moderate | - | gAChR (2.04 nmol/L) | - |
| 13 | Gastroduodenal: neuropathic | - | - | IVIg | Yes | Weight gain 50lbs; J tube removed | - | - | Improved autonomic tests and manometry study |
| 14 | - | CCN (0.07 nmol/L) | - | IVIg | Yes | Daily vomiting completely resolved. | Yes | - | - |
| 15 | - | gAChR (0.17 nmol/L) and striated muscle (1:960) | - | IVIg | Yes | Nausea less and feeding tube removed | - | gAChR (0.16 nmol/L) | - |
| 16 | - | - | - | IVMP | No | - | Yes | - | - |
| 17 | - | - | - | IVIg | No | - | Yes | - | - |
Abbreviations: AGID, autoimmune gastrointestinal dysmotility; ANNA-1, anti-neuronal nuclear autoantibody type 1 (negative, <1:60) ; BM, bowel motion; BMI, body mass index; CCN, calcium channel N-type (negative, ≤0.02 nmol/L); gAChR, ganglionic acetylcholine receptor (negative, ≤0.02 nmol/L); F, female; GAD65, glutamic acid decarboxylase 65 (negative, ≤0.02 nmol/L; hr, hour; Hx, history; IVIg, intravenous immune globulin; IVMP, intravenous methylprednisolone; Kg, kilogram; M, male; peripherin (negative, <1:60); striated muscle antibodies (negative, <1:60); VGKC, voltage-gated potassium channel-complex antibodies (negative, ≤0.02 nmol/L).
Reported previously(1);
Prior to immunotherapy unless stated;
after immunotherapy (no details available for BMI prior to immunotherapy)