Journal of Neurogastroenterology and Motility最新文献

{"title":"Proton Pump Inhibitor-unresponsive Laryngeal Symptoms Are Associated With Psychological Comorbidities and Sleep Disturbance: A Manometry and Impedance-pH Monitoring Study","authors":"Wen-Hsuan Tseng,&nbsp;Wei-Chung Hsu,&nbsp;Tsung-Lin Yang,&nbsp;Tzu-Yu Hsiao,&nbsp;Jia-Feng Wu,&nbsp;Hui-Chuan Lee,&nbsp;Hsiu-Po Wang,&nbsp;Ming-Shiang Wu,&nbsp;Ping-Huei Tseng","doi":"10.5056/jnm22099","DOIUrl":"https://doi.org/10.5056/jnm22099","url":null,"abstract":"<p><strong>Background/aims: </strong>Laryngeal symptoms are largely treated with empiric proton pump inhibitor (PPI) therapy if no apparent pathology shown on ear, nose, and throat evaluation and reflux-related etiologies are suspected. However, treatment response remains unsatisfactory. This study aimed to investigate the clinical and physiological characteristics of patients with PPI-refractory laryngeal symptoms.</p><p><strong>Methods: </strong>Patients with persistent laryngeal symptoms despite PPI treatment for ≥ 8 weeks were recruited. A multidisciplinary evaluation comprising validated questionnaires for laryngeal symptoms (reflux symptom index [RSI]), gastroesophageal reflux disease symptoms, psychological comorbidity (5-item brief symptom rating scale [BSRS-5]) and sleep disturbance (Pittsburgh sleep quality index [PSQI]), esophagogastroduodenoscopy, ambulatory impedance-pH monitoring, and high-resolution impedance manometry were performed. Healthy asymptomatic individuals were also recruited for comparison of psychological morbidity and sleep disturbances.</p><p><strong>Results: </strong>Ninety-seven adult patients and 48 healthy volunteers were analyzed. The patients had markedly higher prevalence of psychological distress (52.6% vs 2.1%, <i>P</i> < 0.001) and sleep disturbance (82.5% vs 37.5%, <i>P</i> < 0.001) than the healthy volunteers. There were significant correlations between RSI and BSRS-5 scores, and between RSI and PSQI scores (<i>r</i> = 0.26, <i>P</i> = 0.010, and <i>r</i> = 0.29, <i>P</i> = 0.004, respectively). Fifty-eight patients had concurrent gastroesophageal reflux disease symptoms. They had more prominent sleep disturbances (89.7% vs 71.8%, <i>P</i> < 0.001) than those with laryngeal symptoms alone but similar reflux profiles and esophageal motility.</p><p><strong>Conclusions: </strong>PPI-refractory laryngeal symptoms are mostly associated with psychological comorbidities and sleep disturbances. Recognition of these psychosocial comorbidities may help optimize management in these patients.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d7/be/jnm-29-3-314.PMC10334203.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9892350","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}

{"title":"Randomized Controlled Trial of Anti-reflux Mucosectomy Versus Radiofrequency Energy Delivery for Proton Pump Inhibitor-refractory Gastroesophageal Reflux Disease.","authors":"Yan Wang,&nbsp;Meihui Lv,&nbsp;Lin Lin,&nbsp;Liuqin Jiang","doi":"10.5056/jnm21240","DOIUrl":"https://doi.org/10.5056/jnm21240","url":null,"abstract":"<p><strong>Background/aims: </strong>The efficacy and safety of anti-reflux mucosectomy (ARMS) or radiofrequency energy delivery in the treatment of gastroesophageal reflux disease (GERD) have been reported, but the difference between the 2 remains unclear.</p><p><strong>Methods: </strong>This was a single center, randomized, comparative clinical study. Patients with symptoms of heartburn and/or regurgitation despite proton pump inhibitor treatment were randomly assigned to either ARMS group (n = 20) or radiofrequency group (n = 20). Primary outcome was the standardized GERD questionnaire (GERDQ) at 2 years after the procedures. Secondary outcomes were the proportions of patients with complete proton pump inhibitor (PPI) cessation and patients satisfied with the treatment.</p><p><strong>Results: </strong>A total of 18 patients randomized to ARMS and 16 to radiofrequency were analyzed in this study. The operation success rate of the 2 groups was 100%. In both ARMS and radiofrequency groups, GERDQ scores at 2 years after the procedures were significantly lower than that before operation (<i>P</i> = 0.044 and <i>P</i> = 0.046). At 2 years postoperatively, the scores of GERDQ did not differ between the 2 groups (<i>P</i> = 0.755). There was no significant difference in the rate of discontinuation of PPIs and patient satisfaction in the ARMS and radiofrequency groups (<i>P</i> = 0.642 and <i>P</i> = 0.934).</p><p><strong>Conclusions: </strong>The clinical efficacy of ARMS and radiofrequency for the PPI-refractory GERD is equivalent. ARMS, the efficacy of which could be maintained for at least 2 years, is promising endoscopic management for the treatment of refractory GERD.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fd/82/jnm-29-3-306.PMC10334194.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10156497","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}

{"title":"Comparison of Diagnosis of Esophageal Motility Disorders by Chicago Classification Versions 3.0 and 4.0.","authors":"Jin Hee Noh,&nbsp;Kee Wook Jung,&nbsp;In Ja Yoon,&nbsp;Hee Kyong Na,&nbsp;Ji Yong Ahn,&nbsp;Jeong Hoon Lee,&nbsp;Do Hoon Kim,&nbsp;Kee Don Choi,&nbsp;Ho June Song,&nbsp;Gin Hyug Lee,&nbsp;Hwoon-Yong Jung","doi":"10.5056/jnm22121","DOIUrl":"https://doi.org/10.5056/jnm22121","url":null,"abstract":"<p><strong>Background/aims: </strong>We aim to investigate the diagnostic accuracy and differences between Chicago classification version 3.0 (CC v3.0) and 4.0 (CC v4.0).</p><p><strong>Methods: </strong>Patients who underwent high-resolution esophageal manometry (HRM) for suspected esophageal motility disorders were prospectively recruited between May 2020 and February 2021. The protocol of HRM studies included additional positional change and provocative testing designed by CC v4.0.</p><p><strong>Results: </strong>Two hundred forty-four patients were included. The median age was 59 (interquartile range, 45-66) years, and 46.7% were males. Of these, 53.3% (n = 130) and 61.9% (n = 151) were categorized as normalcy by CC v3.0 and CC v4.0, respectively. The 15 patients diagnosed of esophagogastric junction outflow obstruction (EGJOO) by CC v3.0 was changed to normalcy by position (n = 2) and symptom (n = 13) by CC v4.0. In seven patients, the ineffective esophageal motility (IEM) diagnosis by CC v3.0 was changed to normalcy by CC v4.0. The diagnostic rate of achalasia increased from 11.1% (n = 27) to 13.9% (n = 34) by CC v4.0. Of patients diagnosed IEM by CC v3.0, 4 was changed to achalasia based on the functional lumen imaging probe (FLIP) results by CC v4.0. Three patients (2 with absent contractility and 1 with IEM in CC v3.0) were newly diagnosed with achalasia using a provocative test and barium esophagography by CC v4.0.</p><p><strong>Conclusions: </strong>CC v4.0 is more rigorous than CC v3.0 for the diagnosis of EGJOO and IEM and diagnoses achalasia more accurately by using provocative tests and FLIP. Further studies on the treatment outcomes following diagnosis with CC v4.0 are needed.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/05/74/jnm-29-3-326.PMC10334199.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9883379","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}

{"title":"Stigma and Efficacy of Zhizhu Kuanzhong Capsules Versus Doxepin in the Treatment of Refractory Functional Dyspepsia: A Randomized Controlled Trial.","authors":"Qian-Qian Wang,&nbsp;Li Cheng,&nbsp;Bi-Yu Wu,&nbsp;Hong-Yi Qiu,&nbsp;Ping Xu,&nbsp;Bo Wang,&nbsp;Xiu-Juan Yan,&nbsp;Sheng-Liang Chen","doi":"10.5056/jnm22145","DOIUrl":"https://doi.org/10.5056/jnm22145","url":null,"abstract":"<p><strong>Background/aims: </strong>Stigma related with antidepressants is prevalent in patients with functional dyspepsia. It affects medication compliance and efficacy. Herbal medicine acquired a deep-rooted cultural identity in relieving dyspeptic symptoms in Asians. The research was designed to compare the effectiveness of Zhizhu Kuanzhong capsules (ZZKZ) versus doxepin hydrochloride (doxepin) on alleviating stigma and medication nonadherence among patients with refractory FD (rFD).</p><p><strong>Methods: </strong>Patients with rFD from February 2021 to February 2022 were randomly allocated to receive either doxepin (n = 56) or ZZKZ (n = 57) combined with omeprazole for 4 weeks. Medication possession ratio (MPR), the disease- and medication-associated stigma were analyzed. The scales were utilized to assess dyspeptic symptoms (Leeds Dyspepsia Questionnaire) and psychological conditions (Generalized Anxiety Disorder Questionnaire and Patient Health Questionnaire).</p><p><strong>Results: </strong>The MPR values for ZZKZ were significantly higher than those for doxepin (<i>P</i> < 0.001). The stigma scores decreased in ZZKZ group while increased in doxepin group compared to baseline after treatment. The proportion of patients showing ZZKZ-associated stigma was significantly lower than doxepin-associated stigma (<i>P</i> < 0.001). The MPR values were negatively correlated with post-treatment stigma scores in both groups (<i>P</i> < 0.001). Dyspeptic symptoms and psychological condition were improved in both groups after treatment, with no significant difference on post-treatment Leeds Dyspepsia Questionnaire, Generalized Anxiety Disorder Questionnaire, or Patient Health Questionnaire scores between 2 groups.</p><p><strong>Conclusion: </strong>ZZKZ is superior to doxepin in alleviating stigma and medication non-adherence, with comparable efficacy in improving dyspeptic symptoms and psychological condition of patients with rFD.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/65/95/jnm-29-3-360.PMC10334204.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10269009","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}

{"title":"Autonomic Dysfunction and Somatization in Young Patients With Irritable Bowel Syndrome and Mitral Valve Prolapse Syndrome.","authors":"Jannis Kountouras,&nbsp;Apostolis Papaefthymiou,&nbsp;Stergios A Polyzos,&nbsp;Elisabeth Vardaka,&nbsp;Foteini Kyrailidi,&nbsp;Maria C Mouratidou,&nbsp;Christos Zavos,&nbsp;Evangelos Kazakos,&nbsp;Dimitrios Chatzopoulos,&nbsp;Maria Tzitiridou-Chatzopoulou,&nbsp;Dimitrios Tzilves,&nbsp;Christos Liatsos,&nbsp;Maria Touloumtzi,&nbsp;Michael Doulberis","doi":"10.5056/jnm23061","DOIUrl":"https://doi.org/10.5056/jnm23061","url":null,"abstract":"","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/44/5c/jnm-29-3-403.PMC10334193.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10269012","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}

{"title":"An Optogenetics-based Approach to Regulate Colonic Contractions by Modulating the Activity of the Interstitial Cells of Cajal in Mice.","authors":"Song Zhao,&nbsp;Weidong Tong","doi":"10.5056/jnm22181","DOIUrl":"https://doi.org/10.5056/jnm22181","url":null,"abstract":"<p><strong>Background/aims: </strong>The interstitial cells of Cajal (ICC) are pacemaker cells in the gastrointestinal (GI) tract. We examined whether the activity of ICC could be stimulated to control colonic contractions. An optogenetics-based mouse model in which the light-sensitive protein channelrhodopsin-2 (ChR2) was expressed was used to accomplish cell specific, direct stimulation of ICC.</p><p><strong>Methods: </strong>An inducible site-specific Cre-loxP recombination system was used to generate <i>Kit^CreERT2/+</i>;<i>ROSA^{ChR2(H134R)/tdTomato/+}</i> mice in which ChR2(H134R), a variant of ChR2, was genetically expressed in ICC after tamoxifen administration. Genotyping and immunofluorescence analysis were performed to confirm gene fusion and expression. Isometric force recordings were performed to measure changes in contractions in the colonic muscle strips.</p><p><strong>Results: </strong>ChR2 was specifically expressed in Kit-labeled ICC. The isometric force recordings showed that the contractions of the colonic muscle strips changed under 470 nm blue light. Light stimulation evoked premature low-frequency and high amplitude (LFHA) contractions and enhanced the frequency of the LFHA contractions. The light-evoked contractions were blocked by T16Ainh-A01, an antagonist of anoctamin 1 channels that are expressed selectively in ICC in colonic muscles.</p><p><strong>Conclusions: </strong>Our study demonstrates a potentially feasible approach to stimulate the activity of ICC by optogenetics. The colonic motor patterns of muscle strips, especially LFHA contractions, can be regulated by 470 nm light via ChR2, which is expressed in ICC.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/90/9b/jnm-29-3-388.PMC10334192.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10269013","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}

{"title":"A Median Arcuate Ligament Syndrome Could Be Re-termed as a Nutcracker Celiac Ganglion Abdominal Pain Syndrome.","authors":"Ji Eun Kim,&nbsp;Mira Kang,&nbsp;Ok Soon Jeong,&nbsp;Poong-Lyul Rhee","doi":"10.5056/jnm22158","DOIUrl":"https://doi.org/10.5056/jnm22158","url":null,"abstract":"<p><strong>Background/aims: </strong>Median arcuate ligament syndrome (MALS) is known as chronic recurrent abdominal pain related to compression of the celiac artery by the median arcuate ligament. We aim to seek the specific mechanism of the pain by evaluating symptoms and radiological characteristics on abdominal CT scans.</p><p><strong>Methods: </strong>We analyzed 35 patients who visited the emergency room for recurrent abdominal pain after cholecystectomy. We classified the characteristics of patients as 4 clinical components and 2 radiological components. We defined the sum of weighted clinical scores and weighted radiological scores as nutcracker ganglion abdominal pain syndrome (NCGAPS) scores. We categorized the patients into 3 groups classified by the degree of NCGAPS scores. The 3 patients with top-3 NCGAPS scores were recommended for CT angiography.</p><p><strong>Results: </strong>When the suspicion was graded by NCGAPS scores, post stenotic dilatation was significantly different among all groups (<i>P</i> < 0.001). The clinical components of pain varied positional or respirational change and continuous pain were significantly different among all the groups (<i>P</i> < 0.01). NCGAPS scores can remarkably differentiate highly suspicious patients in comparison to simply combined scores. Only 1 patient in the highly suspicious group by NCGAPS scores took the CT angiography and was confirmed with NCGAPS.</p><p><strong>Conclusions: </strong>We suggest renaming MALS as NCGAPS, nutcracker celiac ganglion abdominal pain syndrome, to better explain the mechanism of the recurrent abdominal pain. Further studies on the diagnostic cutoff of clinical and radiological scores of NCGAPS are needed not to miss the diagnosis of NCGAPS.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5f/d6/jnm-29-2-200.PMC10083118.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9721081","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}

{"title":"Prevalence of Irritable Bowel Syndrome in East Asia: Are There Differences Between Countries?","authors":"Cheol Min Shin","doi":"10.5056/jnm23042","DOIUrl":"https://doi.org/10.5056/jnm23042","url":null,"abstract":"c 2023 The Korean Society of Neurogastroenterology and Motility J Neurogastroenterol Motil, Vol. 29 No. 2 April, 2023 www.jnmjournal.org Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders seen by primary care physicians. The worldwide prevalence of IBS is reported to be over 10%, but there are differences in the prevalence of IBS across countries; its prevalence is reported to be 17.5% in Latin America, 9.6% in Asia, 7.1% in North America and Europe, and 5.8% in the Middle East and Africa. Also, the prevalence of IBS subtypes (ie, constipationpredominant IBS [IBS-C], diarrhea-predominant IBS [IBS-D], mixed IBS [IBS-M], and unclassified IBS [IBS-U]) also differs by country or ethnicity. In this issue, the prevalence of IBS were evaluated using internet-based survey in the 3 East Asian countries, Japan, China, and South Korea. These 3 countries have some similarities in ethnicity, diet, and experiencing rapid socioeconomic change, while they have their own unique cultures. Interestingly, the overall prevalence of IBS was quite different; IBS prevalence in China was statistically lower (6%) than those in Japan and South Korea (15% and 16%, respectively.) In terms of IBS subtypes, IBS-M was the most common subtype, followed by IBS-D, IBS-C, and IBS-U in the overall analysis (6.01%, 2.76%, 2.07% and 1.74%, respectively). IBS-M was the most common subtype in all 3 countries; however, the second most common subtype was IBS-D in Japan, IBS-C in China, and IBS-U in South Korea. Furthermore, the IBS prevalence was significantly higher in men, especially in the case of IBS-D. As females are reportedly more susceptible to IBS, verification of the results of this study is essential. Great caution is needed in interpreting the results of the study. Above all, in this study, nationally representative sampling of each country was not performed. This study could be highly biased as it is based on an internet-based questionnaire of the volunteers. Considering the nature of the internet surveys, it is important to provide the percentage of respondents out of the total number of respondents requesting a survey by country. For example, it is possible that Chinese IBS patients responded less, whereas Korean and Japanese IBS patients responded more actively. For the results of this study to be confirmed, it is necessary to determine what percentage of the response rate was in the 3 countries and whether there was a difference in the response rate. Also, the high prevalence of IBS in men, which is contrary to previous studies, may also be influenced by differences in response rates by sex. Furthermore, as the authors mentioned, as China is a large country and each region has different cultures and dietary habits, selection bias can be noticeable when a JNM J Neurogastroenterol Motil, Vol. 29 No. 2 April, 2023 pISSN: 2093-0879 eISSN: 2093-0887 https://doi.org/10.5056/jnm23042 Editorial Journal of Neurogastroenterology and Motility","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a3/08/jnm-29-2-127.PMC10083116.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9361273","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}

{"title":"Prevalence of Non-erosive Esophageal Phenotypes in Children: A European Multicenter Study.","authors":"Elisa Blasi,&nbsp;Ettore Stefanelli,&nbsp;Renato Tambucci,&nbsp;Silvia Salvatore,&nbsp;Paola De Angelis,&nbsp;Paolo Quitadamo,&nbsp;Claudia Pacchiarotti,&nbsp;Giovanni Di Nardo,&nbsp;Fanj Crocco,&nbsp;Enrico Felici,&nbsp;Valentina Giorgio,&nbsp;Nicoletta Staropoli,&nbsp;Simona Sestito,&nbsp;Efstratios Saliakellis,&nbsp;Osvaldo Borrelli,&nbsp;Licia Pensabene","doi":"10.5056/jnm22115","DOIUrl":"https://doi.org/10.5056/jnm22115","url":null,"abstract":"Background/Aims Since available data on pediatric non-erosive esophageal phenotypes (NEEPs) are scant, we investigated their prevalence and the phenotype-dependent treatment response in these children. Methods Over a 5-year period, children with negative upper endoscopy, who underwent esophageal pH-impedance (off-therapy) for persisting symptoms not responsive to proton pump inhibitor (PPI)-treatment, were recruited. Based on the results of acid reflux index (RI) and symptom association probability (SAP), patients were categorized into: (1) abnormal RI (non-erosive reflux disease [NERD]), (2) normal RI and abnormal SAP (reflux hypersensitivity [RH]), (3) normal RI and normal SAP (functional heartburn [FH]), and (4) normal RI and not-reliable SAP (normal-RI-not otherwise-specified [normal-RI-NOS]). For each subgroup, treatment response was evaluated. Results Out of 2333 children who underwent esophageal pH-impedance, 68 cases, including 18 NERD, 14 RH, 26 FH, and 10 normal-RI-NOS were identified as fulfilling the inclusion criteria and were analyzed. Considering symptoms before endoscopy, chest pain was more reported in NERD than in other cases (6/18 vs 5/50, P = 0.031). At long-term follow-up of 23 patients (8 NERD, 8 FH, 2 RH, and 5 normal-RI-NOS): 17 were on PPIs and 2 combined alginate, 1 (FH) was on benzodiazepine + anticholinergic, 1 (normal-RI-NOS) on citalopram, and 3 had no therapy. A complete symptom-resolution was observed in 5/8 NERD, in 2/8 FH, and in 2/5 normal-RI-NOS. Conclusions FH may be the most common pediatric NEEP. At long-term follow-up, there was a trend toward a more frequent complete symptom resolution with PPI-therapy in NERD patients while other groups did not benefit from extended acid-suppressive-treatment.","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b7/28/jnm-29-2-156.PMC10083122.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9367513","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}

{"title":"Diagnosis of Ineffective Esophageal Motility According to Chicago Classification Version 4.0: More Stringent Criteria, but Also New Difficulties.","authors":"Luigi Ruggiero,&nbsp;Antonella Santonicola,&nbsp;Paola Iovino","doi":"10.5056/jnm23041","DOIUrl":"https://doi.org/10.5056/jnm23041","url":null,"abstract":"c 2023 The Korean Society of Neurogastroenterology and Motility J Neurogastroenterol Motil, Vol. 29 No. 2 April, 2023 www.jnmjournal.org TO THE EDITOR: We read with great interest the study by Kurin et al about the clinical characteristics of patients with ineffective esophageal motility (IEM) comparing diagnosis according to the Chicago classification version 3.0 (CC v3.0) versus CC v4.0. Kurin et al demonstrated that 41 patients out of the 66 patients selected with IEM at high-resolution manometry (HRM) according to CC v3.0 also met the criteria for IEM according to the new CC v4.0. This subgroup of 41 patients had higher acid exposure time (especially in the supine position), lower adequate peristaltic reserve and higher Demeester score. We agree that CC v4.0, with its more stringent criteria, allows a clearer diagnosis of IEM. However, in our clinical practice, changes in the examination protocol have been brought to light critical issues. Specifically, the new HRM protocol according to CCv 4.0 includes 10 swallows in the supine or upright position followed by 5 swallows in the opposite position. We applied the new protocol to all new HRMs. In 15 patients who complained of dysphagia or were undergoing a pre-bariatric surgery evaluation we obtained a diagnosis of IEM in the supine or upright position but not in the opposite position. Compared with diagnosis of esophagogastric junction outflow obstruction or absent contractility in which CC v4.0 specifies the importance of pathological alterations in both positions, this aspect was not described in IEM diagnosis. Consequently, there is some concern in managing such an ambiguous situation. Our group evaluated the use of additional tests to support the diagnosis of IEM such as multiple rapid swallows’ or rapid drink challenge performed in both positions. Even in these contexts, we found mixed results related to the 2 positions. Another possible auxiliary test described is the use of solid swallowing, although scientific evidence to support this test is still lacking. In these complex situations, we provided an “inconclusive” diagnosis of IEM and recommended a 24-hour pH-impedance testing to assess for the presence of gastroesophageal reflux disease and a further manometric assessment after at least 1 year. We hope CC v5.0 will provide more clarity on this topic and allow us to obtain certainty in the diagnosis of IEM according to the new protocol for performing HRM.","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/71/bd/jnm-29-2-264.PMC10083105.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9737426","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}