Journal of Neurogastroenterology and Motility最新文献

{"title":"Focal Hypoganglionosis-Associated Adult-Onset Megacolon: A Localized Enteric Neuropathy Distinct From Chronic Intestinal Pseudo-Obstruction.","authors":"Kee Wook Jung, Michael Camilleri, Roberto De Giorgio, Seung-Jae Myung","doi":"10.5056/jnm26208","DOIUrl":"10.5056/jnm26208","url":null,"abstract":"<p><p>Adult-onset megacolon is a heterogeneous disorder traditionally classified within the spectrum of idiopathic megacolon or chronic intestinal pseudo-obstruction (CIPO). However, accumulating evidence suggests that a subset of patients demonstrates distinct clinicopathologic features characterized by localized motor dysfunction resulting in focal colonic narrowing, proximal megacolon, and localized hypoganglionosis. In this review, we refer to this phenotype as focal hypoganglionosis-associated adult-onset megacolon (FHAM). Clinically, patients with FHAM frequently present with severe chronic constipation, progressive abdominal distension and pain, nausea, vomiting, recurrent sub-occlusive or pseudo-obstructive episodes, and repeated decompressive interventions. Computed tomography typically demonstrates proximal megacolon with focal functional narrowing, whereas small bowel motility is preserved despite severe colonic dilatation. Histopathologic studies additionally demonstrated inflammatory ganglionitis associated with CD3-positive lymphocytic infiltration within the myenteric plexus. Molecular and physiologic studies of resected colonic tissue further revealed impaired neuromuscular signaling and smooth muscle contractility within the affected segment, suggesting localized enteric neuropathy as a potential pathogenic mechanism. Importantly, accumulating evidence suggests that patients with FHAM generally demonstrate favorable long-term outcomes following adequate surgical resection compared with patients with CIPO, including markedly lower rates of postoperative reoperation (2.5% vs. 66.7% with CIPO) and long-term total parenteral nutrition requirement (0% vs. 46.2% with CIPO). In summary, current evidence supports the concept that FHAM in adults represents a surgically remediable localized enteric neuropathic phenotype that can be clinically distinguished from classical CIPO. Recognition of this phenotype is clinically important because timely diagnosis and appropriate surgical intervention may substantially improve long-term outcomes.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-resolution Manometry Catheter Insertion During Sedated Endoscopy; A Viable Option When Standard Intubation Fails.","authors":"James Endersby, Holly Mills, Humayra Dervin, Minerva De Silva, Natalia Zarate-Lopez, Rami Sweis","doi":"10.5056/jnm25240","DOIUrl":"https://doi.org/10.5056/jnm25240","url":null,"abstract":"<p><strong>Background/aims: </strong>: When high-resolution manometry (HRM) intubation is not tolerated or the catheter fails to traverse the lower esophageal sphincter, the test is often abandoned, leaving patients without a diagnosis to guide therapy. Although endoscopic placement of HRM catheters under sedation has been described, no study has directly compared this approach with routine outpatient HRM. This study provides the first direct comparison of sedated endoscopic insertion (EI) versus routine insertion (RI).</p><p><strong>Methods: </strong>: All patients who underwent EI of the HRM catheter between January 2020 and May 2025 were retrospectively reviewed and compared with a contemporaneous cohort who had RI. Each test included the standard protocol of ten 5 mL water swallows followed by a 200 g rice meal. Demographic data, endoscopic technique, sedation levels and manometric diagnoses were evaluated. Esophageal body function was defined in accordance with the Chicago classification version 4.0.</p><p><strong>Results: </strong>: Of 88 patients who had EI attempted, 79 (89.8%) were successfully intubated to the stomach and 78 (88.6%) completed the full swallow protocol. Endoscopic visualization was required for passage through the cricopharynx in 47 (53.4%) and through the esophagogastric junction in 23 (26.1%), with manual guidance needed in 8 (9.1%). Intubation success was comparable to routine insertion (RI) (89.8% EI vs 80.7% RI; <i>P</i> = 0.089) but protocol completion was higher (88.6% EI vs 72.7%; <i>P</i> = 0.008). No adverse events occurred.</p><p><strong>Conclusions: </strong>: Sedated EI of the HRM catheter enables protocol completion for patients unable to undergo routine testing, filling a key diagnostic gap while delivering manometric results comparable to standard, unsedated studies.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gut-Brain Axis-mediated Neurological Manifestations in Inflammatory Bowel Disease: Mechanisms and Disease Spectrum.","authors":"Bingchan Sun, Guoxin Wang, Xiaoxia Li, Huimin Liu, Huan Xv, Qifang Wu, Hongtao Li, Xiangrong Ye, Xijin Wang, Mingfu Tong","doi":"10.5056/jnm25167","DOIUrl":"https://doi.org/10.5056/jnm25167","url":null,"abstract":"<p><p>Inflammatory bowel disease (IBD) is a chronic immune-mediated disorder of the gastrointestinal tract that is frequently associated with neuropsychiatric comorbidities, such as anxiety, depression, and other neurological disorders. Accumulating evidence suggests that these neuropsychiatric disorders are secondary conditions caused by impaired gut-brain communication. The gut-brain axis connects the gut and the brain via neural, endocrine, and immune signaling pathways, disruption of which is usually caused by intestinal microbiota imbalance, intestinal barrier damage, neuroinflammation and immune activation, and neuroendocrine pathway abnormalities. These pathways constitute the pathological basis of the disease spectrum of neuropsychiatric comorbidities in IBD patients. This article comprehensively reviews the core mechanisms and disease spectrum of gut-brain axis-mediated neurological and mental complications in IBD, and discusses potential therapeutic strategies and challenges.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality in Irritable Bowel Syndrome: The Tohoku Medical Megabank Project Community-based Cohort Study.","authors":"Kumi Nakaya, Naoki Nakaya, Mana Kogure, Rieko Hatanaka, Ippei Chiba, Masato Takase, Sayuri Tokioka, Taku Obara, Satoshi Nagaie, Tomohiro Nakamura, Motoyori Kanazawa, Soichi Ogishima, Nobuo Fuse, Yoko Izumi, Shin Fukudo, Atsushi Hozawa","doi":"10.5056/jnm25142","DOIUrl":"https://doi.org/10.5056/jnm25142","url":null,"abstract":"<p><strong>Background/aims: </strong>: This prospective cohort study involving participants from the Miyagi part of the Tohoku Medical Megabank Project Community-Based Cohort Study investigates the association between irritable bowel syndrome, including not consulted medical care, and all-cause mortality.</p><p><strong>Methods: </strong>: A total of 15 354 participants were followed up through 2021. Irritable bowel syndrome was identified using the Rome II modular questionnaire. Hazard ratios (HR) and 95% confidence intervals (95% CI) for all-cause mortality were estimated using multivariate Cox proportional hazards regression models. Additional analysis was performed according to sex, irritable bowel syndrome subtype, baseline and second period surveys, and health checkup attendance within one year.</p><p><strong>Results: </strong>: A total of 2818 participants (18.4%) had irritable bowel syndrome at baseline. During a median follow-up of 6.7 years, 311 participants died. No significant differences in mortality were observed between those with and without irritable bowel syndrome (HR, 0.94; 95% CI, 0.68-1.29). Similar results were observed based on sex, subtype, and irritable bowel syndrome status in both surveys. Participants with irritable bowel syndrome who did not attend a health checkup within the previous year had observed higher mortality (HR, 2.11; 95% CI, 1.06-4.19) compared with those without it who attended a health checkup. The risk of death was not significantly increased in participants with irritable bowel syndrome who attended health checkups.</p><p><strong>Conclusions: </strong>: Irritable bowel syndrome, identified by self-reporting using the Rome II questionnaire, was not associated with all-cause mortality. Nonetheless, results suggest individuals with irritable bowel syndrome who did not undergo health checkups may have had higher overall mortality.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interactive Panometry: Using Proximal Balloon Distension During Functional Lumen Imaging Probe Panometry to Enhance Motility Evaluation of Inhibitory Function.","authors":"Ofer Z Fass, Muhammed M Alikhan, John E Pandolfino, Meagan Branch, Monica Tapia, Leya Chambo, Peter J Kahrilas, Dustin A Carlson","doi":"10.5056/jnm25245","DOIUrl":"https://doi.org/10.5056/jnm25245","url":null,"abstract":"<p><strong>Background/aims: </strong>: Descending inhibition facilitates esophageal peristalsis and lower esophageal sphincter relaxation, processes impaired in achalasia. The functional lumen imaging probe (FLIP) assesses esophageal motility and esophagogastric junction (EGJ) opening but does not directly evaluate neuromyogenic function. We developed \"Interactive Panometry,\" a novel FLIP maneuver utilizing proximal balloon distension to physiologically provoke descending inhibition.</p><p><strong>Methods: </strong>: Four healthy volunteers and 5 patients with untreated type II achalasia underwent FLIP Panometry with proximal esophageal balloon distension (20-mm in controls, 20-30 mm in achalasia) at 50-mL and 60-mL fill volumes. EGJ distensibility index (EGJ-DI), intra-bag pressure, and contractile response were measured before, during, and after distension. In 3 controls, simultaneous high-resolution manometry was performed to verify physiologic responses.</p><p><strong>Results: </strong>: Feasibility was first demonstrated in control subjects using simultaneous FLIP and high-resolution manometry. Proximal balloon distension induced cessation of repetitive antegrade contractions with concurrent increases in EGJ-DI and reductions in FLIP pressure. At a 50-mL FLIP fill volume and 20-mm proximal balloon distension, controls demonstrated a mean EGJ-DI increase of 3.5 mm²/mmHg and a 16.5-mmHg pressure reduction, whereas achalasia cases exhibited an EGJ-DI increase of 0.1 mm²/mmHg and a 0.2 mmHg pressure reduction. With 30-mm proximal distension, achalasia cases showed an EGJ-DI increase of 0.2 mm²/mmHg and a 5.3-mmHg pressure reduction. Trends were similar at 60-mL fill volumes.</p><p><strong>Conclusions: </strong>: Interactive Panometry is a feasible FLIP maneuver physiologically consistent with descending inhibition. This proof-of-concept study supports further investigation in larger cohorts of symptomatic patients with suspected esophageal dysmotility to validate its role in assessing descending inhibition.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and Patient Satisfaction With Zastaprazan in Real-world Practice: A Large-Scale Prospective Observational Study.","authors":"Seung In Seo, Kwang Hyun Ahn, Yong Sung Kim","doi":"10.5056/jnm26017","DOIUrl":"https://doi.org/10.5056/jnm26017","url":null,"abstract":"<p><strong>Background/aims: </strong>: Gastroesophageal reflux disease (GERD) remains a prevalent condition with unmet therapeutic needs. Zastaprazan is a novel potassium-competitive acid blocker (P-CAB) with potent acid suppression, but real-world evidence is limited. This study assesses symptom improvement and patient satisfaction with zastaprazan in patients with GERD.</p><p><strong>Methods: </strong>: This multicenter, prospective observational study enrolled adults diagnosed with GERD who received zastaprazan 20 mg daily for 4 weeks. Symptoms were assessed using the Reflux Disease Questionnaire (RDQ). The primary endpoint was the change in the mean GERD score of the RDQ. Secondary endpoints included the mean total RDQ score, patient satisfaction, compliance, and effectiveness stratified by prior medication use and diagnostic method.</p><p><strong>Results: </strong>: Among 5499 participants, the mean GERD score significantly decreased from 2.07 ± 1.12 to 0.44 ± 0.63 at week 4 (change: -1.63 ± 1.07, <i>P</i> < 0.0001). Symptom improvement was observed in treatment-naïve patients (n = 4906, -1.64 ± 1.08, <i>P</i> < 0.0001) and those previously treated with histamine-2 receptor antagonists, proton pump inhibitors, or P-CABs (n = 593, -1.60 ± 1.03, <i>P</i> < 0.0001). The switching group (within 2 days) also showed significant improvement (n = 304, -1.53 ± 1.05, <i>P</i> < 0.0001). Over 90% reported satisfaction, compliance was 93%, and only 2.25% required concomitant medications. Safety was excellent, with only 3 cases of mild adverse reactions (0.05%) and no serious events.</p><p><strong>Conclusion: </strong>Zastaprazan was associated with clinically meaningful symptom improvement in GERD patients, regardless of prior medication history, including proton pump inhibitors or other P-CABs, with high patient satisfaction, and a favorable safety profile.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Asian Neurogastroenterology and Motility Association and Asia-Pacific Association of Gastroenterology Chronic Constipation Consensus 2026.","authors":"Tanisa Patcharatrakul, Kewin T H Siah, Ari Fahrial Syam, Atsushi Nakajima, Hidekazu Suzuki, Yeong Yeh Lee, Mariko Hojo, Pakkapon Rattanachaisit, Panyavee Pitisuttithum, Sabrina Quek, Tao Bai, Yi Ping Ren, Akihito Nagahara, Andrew Ming-Liang Ong, Chien-Lin Chen, Ching-Liang Lu, Duc Trong Quach, Govind K Makharia, Justin C Y Wu, Kee Wook Jung, Kee Huat Chuah, Linda Zhong, M Masudur Rahman, Tae Hee Lee, Uday C Ghoshal, Xiaohua Hou, Xiucai Fang, Ying-Lian Xiao, Sutep Gonlachanvit","doi":"10.5056/jnm26076","DOIUrl":"https://doi.org/10.5056/jnm26076","url":null,"abstract":"<p><strong>Background/aims: </strong>: Chronic constipation is a common gastrointestinal (GI) disorder in Asia, characterized by heterogeneous symptom presentation, frequent overlap with other GI symptoms, and limited access to specialized diagnostic tests in many settings. These factors contribute to under-recognition and suboptimal management. The and the APAGE developed a regional consensus to provide practical, evidence-based guidance tailored to the Asian context.</p><p><strong>Methods: </strong>: A multidisciplinary task force comprising 24 voting members and 5 non-voting facilitators from across Asia was convened. Experts were divided into 4 working groups addressing clinical evaluation, non-pharmacological management, pharmacological management, and specialized investigations and treatments. Targeted literature reviews were performed, and statements were developed using a structured Delphi process with iterative anonymous voting. The certainty of the evidence and the strength of the recommendations were graded using the GRADE framework.</p><p><strong>Results: </strong>: Thirty-nine consensus statements were developed, covering clinical assessment and stepwise management. Recommendations emphasize comprehensive symptom assessment, early evaluation of disease severity and psychosocial impact, and prioritizing constipation treatment in patients with overlapping GI symptoms and those with pelvic floor damage. Initial management includes lifestyle modification and conventional laxatives, with treatment response assessed within 4 weeks. For inadequate response, treatment optimization, combination or switching of laxatives, and newer agents are recommended. The algorithm also highlights appropriate use of anorectal physiologic testing and biofeedback therapy for functional defecatory disorders. Surgical interventions are reserved for highly selected patients after comprehensive evaluation.</p><p><strong>Conclusion: </strong>This Asian Neurogastroenterology and Motility Association/Asia-Pacific Association of Gastroenterology consensus provides a practical, algorithm-based framework to improve management of chronic constipation across diverse Asian healthcare settings.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Analysis of Large Language Model Outputs for Pre-hypnotherapy Support in Irritable Bowel Syndrome - An Experimental Feasibility Study.","authors":"Praghya Godavarthy, Manish Ravi Iyer, Ravinraj Munnavan, Tanuri Levanya Halhaturage, Gauri Krishnaswamy, Ramisa Fariha","doi":"10.5056/jnm25145","DOIUrl":"https://doi.org/10.5056/jnm25145","url":null,"abstract":"<p><strong>Background/aims: </strong>: Gut directed hypnotherapy can assist with irritable bowel syndrome, but access remains limited. This feasibility study conducted an exploratory comparison of 4 large language models (LLMs) to evaluate the readability and information quality of model generated responses to common patient questions about pre- hypnotherapy support.</p><p><strong>Methods: </strong>: Four LLMs (ChatGPT-4o, Claude 3.7 Sonnet, Gemini, and DeepSeek-R1) were queried using a pre-specified set of 14 standardized patient-oriented prompts. Responses were assessed for readability using validated indices (FKGL, FRES, and CLI) and for information quality using the DISCERN instrument and 5 item Likert scale, rated by a single evaluator. Paired statistical tests were used, and results are reported with effect sizes and confidence intervals.</p><p><strong>Results: </strong>: In this exploratory evaluation, DeepSeek-R1 and ChatGPT-4o generated responses with relatively higher scores across readability metrices (Flesch-Kincaid Grade Level, Flesch Reading Ease Score, and Coleman-Liau Index) and information quality measures (DISCERN and Likert), which are distinct constructs assessed by separate instruments. Claude 3.7 Sonnet produced denser with lower readability and reliability scores, and Gemini showed intermediate performance. Interpretation is limited using automated readability metrics and single-rate design. As the DISCERN and Likert scores were generated by a single rater, statistical comparisons involving these measures cannot be considered definitive. The results below are presented solely to illustrate observable trends within this exploratory dataset.</p><p><strong>Conclusion: </strong>LLMs show potential for generating patient oriented pre-hypnotherapy information, but this feasibility study is not sufficient to determine clinical applicability. The findings primarily highlight the need for expanded evaluation with multiple expert raters, patient participants, and more robust quality assessment methods before considering any practical or clinical use.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnetic Resonance Defecography Criteria for the Diagnosis of Dyssynergic Defecation.","authors":"Suriya Keeratichananont, Kamonwon Cattapan, Jintaporn Heebpet, Siriporn Leelakiatpaiboon, Nisa Netinatsunton","doi":"10.5056/jnm26025","DOIUrl":"https://doi.org/10.5056/jnm26025","url":null,"abstract":"<p><strong>Background/aims: </strong>: Evidence regarding the diagnostic value of MR defecography (MRD) for confirming dyssynergic defecation (DD) is limited. We aim to evaluate the diagnostic performance of MRD parameters in identifying patients with DD.</p><p><strong>Methods: </strong>: This retrospective study was conducted at a university hospital. Data from 235 consecutive adult patients with chronic primary constipation who underwent high-resolution anorectal manometry (HR-ARM), balloon expulsion test, and MRD between 2020 and 2024 were analyzed. The diagnostic performance of each dynamic MRD parameter was assessed using HR-ARM combined with balloon expulsion test as the reference standard.</p><p><strong>Results: </strong>: A total of 109 participants (86 females; mean age 53.1 ± 15.3 years) were included, of whom 70 patients (64.2%) were diagnosed with DD. Quantitative dynamic MRD parameters, including the M-line, anorectal angle (ARA), and anal canal width (ACW), demonstrated significantly good discriminatory ability for differentiating patients with DD (all <i>P</i> < 0.05). At cutoff values of 2.0 cm for the M-line at defecation combined with prominent puborectalis muscle or abnormal evacuation of contrast during defecation, 1.6 cm for M-line change, 114° for ARA at defecation, -5° for ARA change, and 10 mm for ACW during defecation, these parameters demonstrated acceptable diagnostic performance, achieving optimal specificities (82.1% to 92.3%), positive likelihood ratios (3.66 to 7.06), and diagnostic odds ratios (8.25 to 14.25). Multivariate analysis identified ARA and ACW at defecation as independent diagnostic predictors of DD (<i>P</i> < 0.05).</p><p><strong>Conclusions: </strong>: These findings support the establishment of practical and reliable MR defecography-based diagnostic criteria for patients with dyssynergic defecation.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols Diet Is Effective in Irritable Bowel Syndrome With Constipation: A Single Center Tertiary Care Clinical Practice Evaluation.","authors":"Lee David Martin, Konstantinos C Fragkos","doi":"10.5056/jnm25126","DOIUrl":"10.5056/jnm25126","url":null,"abstract":"<p><strong>Background/aims: </strong>: The low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet is a well-researched treatment for diarrhea-predominant irritable bowel syndrome (IBS-D), but its value for constipation-predominant IBS (IBS-C) is uncertain. Clinicians may hesitate to recommend it for IBS-C, fearing it could worsen constipation or offer little relief. This study aims to assess the diet's effectiveness across all IBS subtypes, specifically investigating its impact on stool patterns in IBS-C and the correlation with symptom relief.</p><p><strong>Methods: </strong>: This prospective service evaluation involved 294 IBS patients (84% female, mean age 44.6) attending dietitian-led group sessions on FODMAP restriction (baseline) and reintroduction (follow-up). The primary outcome was \"satisfactory relief of gut symptoms\" via the global symptom question; secondary outcomes included changes in stool consistency, IBS subtype, and gastrointestinal symptoms.</p><p><strong>Results: </strong>: At baseline, 23.8% (70/294) had IBS-C and 35.7% IBS-D (105/294). All subtypes except IBS-M showed significant symptom relief at follow-up (<i>P</i> < 0.001), with no statistically significant difference between IBS-C (50.7%, 35/69) and IBS-D (44.8%, 47/105) (<i>P</i> = 0.158). After FODMAP restriction, 50.7% (35/69) IBS-C remained IBS-C, while 44.9% (31/69) shifted to unclassified IBS (IBS-U). Those who shifted (IBS-C to IBS-U) reported greater relief (74.2%, 23/31 vs 45.7% 16/35, P = 0.019) and reduced pain (<i>P</i> = 0.006), unlike those who remained IBS-C (<i>P</i> = 0.180).</p><p><strong>Conclusions: </strong>: IBS-C and IBS-D showed similar symptom relief after FODMAP restriction. Notably, 44.9% of IBS-C patients shifted to normal stool consistency (IBS-U), with greater symptom relief and reduced pain. FODMAP restriction does not necessarily exacerbate constipation in IBS-C and remains a viable treatment option in real world clinical practice.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"32 3","pages":"396-404"},"PeriodicalIF":3.7,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13425083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}