Journal of Neurogastroenterology and Motility最新文献

{"title":"Globus: Its True Relationship to Acid Reflux? Opposing Patterns of Location-specific Basal Pressure Compared to Gastroesophageal Reflux Disease.","authors":"Boram Cha","doi":"10.5056/jnm25044","DOIUrl":"https://doi.org/10.5056/jnm25044","url":null,"abstract":"","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"31 2","pages":"131-132"},"PeriodicalIF":3.3,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11986651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012456","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":"Overlapping Reflux Symptoms in Functional Dyspepsia Are Mostly Unrelated to Gastroesophageal Reflux.","authors":"Songfeng Chen, Xingyu Jia, Qianjun Zhuang, Xun Hou, Kewin T H Siah, Mengyu Zhang, Fangfei Chen, Niandi Tan, Junnan Hu, Yinglian Xiao","doi":"10.5056/jnm24091","DOIUrl":"https://doi.org/10.5056/jnm24091","url":null,"abstract":"<p><strong>Background/aims: </strong>Reflux symptoms frequently present in patients diagnosed with functional dyspepsia (FD). This investigation sought to elucidate the contribution of gastroesophageal reflux in the overlap relationship.</p><p><strong>Methods: </strong>Consecutive patients presenting with reflux symptoms and/or FD symptoms were prospectively included. Comprehensive assessments, including symptoms evaluation, endoscopy, esophageal functional examinations (high-resolution manometry and reflux monitoring), and proton pump inhibitor (PPI) treatment efficacy evaluation, were conducted in these patients.</p><p><strong>Results: </strong>The study enrolled 315 patients, 43.2% of which had concurrent FD symptoms and overlapping reflux symptoms. Notably, a mere 28.7% of patients in the overlap symptoms group had objective gastroesophageal reflux disease evidences (the grade of esophagitis ≥ B or the acid exposure time ≥ 4.2%). Functional heartburn was demonstrated to be the main cause of overlapping reflux symptoms (55.1%). Reflux parameters analysis revealed that the reflux burden in the overlap symptoms group paralleled that of the FD symptoms group, with both registering lower levels than the reflux symptoms group (<i>P</i> < 0.05). Furthermore, PPI response rates were notably diminished in the overlap symptoms group (<i>P</i> < 0.001), even for those with objective gastroesophageal reflux disease evidences.</p><p><strong>Conclusions: </strong>The study illuminated that overlapping reflux symptoms in FD was common. Strikingly, these symptoms primarily diverged from reflux etiology and exhibited suboptimal responses to PPI intervention. These findings challenge prevailing paradigms and accentuate the imperative for nuanced therapeutic approaches tailored to the distinctive characteristics of overlapping reflux symptoms in the context of FD.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"31 2","pages":"218-226"},"PeriodicalIF":3.3,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11986649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968139","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":"2025 Seoul Consensus on Clinical Practice Guidelines for Irritable Bowel Syndrome.","authors":"Yonghoon Choi, Young Hoon Youn, Seung Joo Kang, Jeong Eun Shin, Young Sin Cho, Yoon Suk Jung, Seung Yong Shin, Cheal Wung Huh, Yoo Jin Lee, Hoon Sup Koo, Kwangwoo Nam, Hong Sub Lee, Dong Hyun Kim, Ye Hyun Park, Min Cheol Kim, Hyo Yeop Song, Sung-Hoon Yoon, Sang Yeol Lee, Miyoung Choi, Moo-In Park, In-Kyung Sung","doi":"10.5056/jnm25007","DOIUrl":"https://doi.org/10.5056/jnm25007","url":null,"abstract":"<p><p>Irritable bowel syndrome (IBS) is a chronic, disabling, and functional bowel disorder that significantly affects social functioning and reduces quality of life and increases social costs. The Korean Society of Neurogastroenterology and Motility published clinical practice guidelines on the management of IBS based on a systematic review of the literature in 2017, and planned to revise these guidelines in light of new evidence on the pathophysiology, diagnosis, and management of IBS. The current revised version of the guidelines is consistent with the previous version and targets adults diagnosed with or suspected of having IBS. These guidelines were developed using a combination of de novo and adaptation methods, with analyses of existing guidelines and discussions within the committee, leading to the identification of key clinical questions. Finally, the guidelines consisted of 22 recommendations, including 3 concerning the definition and risk factors of IBS, 4 regarding diagnostic modalities and strategies, 2 regarding general management, and 13 regarding medical treatment. For each statement, the advantages, disadvantages, and precautions were thoroughly detailed. The modified Delphi method was used to achieve expert consensus to adopt the core recommendations of the guidelines. These guidelines serve as a reference for clinicians (including primary care physicians, general healthcare providers, medical students, residents, and other healthcare professionals) and patients, helping them to make informed decisions regarding IBS management.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"31 2","pages":"133-169"},"PeriodicalIF":3.3,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11986658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986690","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":"Overlap Between Gastroesophageal Reflux Disease and Functional Dyspepsia: Do We Need a New Management Paradigm?","authors":"So Young Byun, Kee Wook Jung","doi":"10.5056/jnm25030","DOIUrl":"https://doi.org/10.5056/jnm25030","url":null,"abstract":"","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"31 2","pages":"129-130"},"PeriodicalIF":3.3,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11986656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968136","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":"Potassium-competitive Acid Blockers for Treatment of Extraesophageal Symptoms and Signs.","authors":"Gwang Ha Kim, Ronnie Fass","doi":"10.5056/jnm24159","DOIUrl":"https://doi.org/10.5056/jnm24159","url":null,"abstract":"<p><p>Extraesophageal symptoms and signs of gastroesophageal reflux disease (GERD), such as throat clearing, globus sensation, hoarseness, cough, asthma, pulmonary fibrosis, otitis, sinusitis, and dental erosions, are common and pose diagnostic and therapeutic challenges. Proton pump inhibitors (PPIs) are the mainstay of treatment for GERD, but have demonstrated a limited effectiveness for extraesophageal symptoms and signs in several meta-analyses. Potassium-competitive acid blockers (P-CABs) offer more rapid and sustained acid inhibition than PPIs; therefore, P-CABs may have the potential to be at least as good or superior to PPIs in relieving extraesophageal symptoms and signs of GERD. To date, there have been 4 prospective randomized trials demonstrating similar efficacy of P-CABs to PPIs in the treatment of extraesophageal symptoms and signs, but more rapid and greater efficacy in patients with severe symptoms. Therefore, P-CABs appear to have a treatment role in extraesophageal symptoms and signs of GERD. However, considering that P-CABs are not superior to PPIs, large-scale, multi-center studies with double dose P-CABs over a prolonged period of time may elucidate a subgroup of patients in whom P-CABs are beneficial in ameliorating extraesophageal symptoms and signs.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"31 2","pages":"170-177"},"PeriodicalIF":3.3,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11986662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996927","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":"Irritable Bowel Syndrome-like Symptoms in Patients With Ulcerative Colitis in Remission as Compared to Irritable Bowel Syndrome: Symptom Severity and Inflammatory Markers.","authors":"Shikha Sahu, Anshika Varshney, Moni Chaudhary, Ujjala Ghoshal, Uday C Ghoshal","doi":"10.5056/jnm24010","DOIUrl":"https://doi.org/10.5056/jnm24010","url":null,"abstract":"<p><strong>Background/aims: </strong>Patients with ulcerative colitis in remission (UC-R) may experience symptoms consistent with irritable bowel syndrome (IBS). This prospective study aims to examine the relative influence of peripheral factors, such as gut mucosal inflammation, and central factors, like psychological conditions, on the severity of IBS symptoms to evaluates (1) the IBS Symptom Severity Score (IBS-SSS), (2) levels of inflammatory markers, and (3) the presence of psychological comorbidities across 3 groups: UC patients with IBS symptoms (UC-IBS), UC-R patients without IBS, and individuals with usual IBS.</p><p><strong>Methods: </strong>Rome III and IV IBS criteria were used in UC-R patients (Mayo score 0), with symptom severity measured by IBS-SSS. Serum and fecal inflammation markers were compared across UC-R without IBS, UC-IBS, and IBS groups.</p><p><strong>Results: </strong>Among UC-R patients, 31.3% (26/83) met Rome III and 9.6% (8/83) met Rome IV IBS criteria. IBS-SSS scores were significantly lower in UC-IBS compared to IBS (n = 50; 167.5 [150-200] vs 255 [225-325]; <i>P</i> < 0.001). Fecal calprotectin levels were higher in UC-IBS than in UC-R or IBS (62.6 μg/g [34.1-85.6] vs 50.6 μg/g [27.3-96.6] vs 37.6 μg/g [12.1-62.3], <i>P</i> = 0.057), while other fecal markers (lactoferrin and MMP-9) showed no significant differences between UC-IBS and UC-R. Serum inflammatory marker including tumor necrosis factor-alpha, interleukin-6, interleukin-10, and granulocyte-macrophage colony-stimulating factor, C-reactive protein were similar across groups. Patients with IBS reported significantly higher anxiety, pain, functional impairment, and coping difficulties (all <i>P</i> < 0.001) compared to UC-IBS, with the lowest levels observed in UC-R without IBS.</p><p><strong>Conclusions: </strong>One-third and one-tenth of UC-R patients met Rome III and IV IBS criteria, respectively. UC-IBS had lower IBS-SSS and higher fecal calprotectin than IBS. Psychological comorbidities were worse in IBS, least in UC-R without IBS, suggesting more peripheral inflammation and less central involvement in UC-IBS.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997519","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":"When Manometry and Functional Lumen Imaging Probe Disagree: The Current Limitations of the Chicago Classification Version 4.0 and Probable Extended Indications of Functional Lumen Imaging Probe.","authors":"Kee Wook Jung, John E Pandolfino","doi":"10.5056/jnm25054","DOIUrl":"https://doi.org/10.5056/jnm25054","url":null,"abstract":"<p><p>High-resolution manometry (HRM) has revolutionized evaluation of esophageal motility disorders, offering detailed pressure topography and refined diagnostic criteria codified through the Chicago classification (CC). However, patients with dysphagia may present with borderline or near-normal HRM findings, exhibiting clinically significant symptoms. CC version 4.0 (v4.0) addresses such scenarios by recommending provocative maneuvers and ancillary tests, notably functional lumen imaging probe (FLIP) and timed barium esophagography. However, growing evidence indicates that FLIP, which measures luminal distensibility under balloon distention, can detect structural or biomechanical abnormalities, such as hypertrophy or fibrosis, that remain inconspicuous on HRM. These discordant findings point to limitations in CC v4.0. FLIP complements HRM by assessing passive tissue properties and capturing balloon-induced contractility, thereby unmasking subtle esophageal wall stiffness not always reflected in integrated relaxation pressure or standard peristaltic metrics. Such discrepancies can arise in early or atypical achalasia, esophagogastric junction outflow obstruction, eosinophilic esophagitis, and even epiphrenic diverticula, where \"normal\" manometry may belie significant pathology. Present CC v4.0 guidelines do not specify how to incorporate FLIP-derived measures or reconcile disagreements with timed barium esophagography results, leaving certain phenotypes-including repetitive simultaneous contractions-under-recognized. These gaps underscore an overreliance on integrated relaxation pressure alone and insufficient integration of evolving FLIP technology. Thus, standardizing FLIP protocols, establishing normative distensibility data, and clarifying management pathways for manometry-FLIP discordance remain critical. Prospective, multicenter studies are needed to investigate long-term clinical outcomes and to refine how FLIP metrics can be formally integrated into future CC iterations. Ultimately, multimodal, symptom-driven approaches that leverage both HRM and FLIP are essential to fully characterize esophageal dysmotility and optimize therapy.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988673","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":"Delayed Gastric Emptying Correlates With Decreased Post-prandial Motility in Children: A Single-center Retrospective Review.","authors":"Raul E Sanchez, Elizabeth Reichard, Adam Bobbey, Neetu Bali Puri, Peter L Lu, Desale Yacob, Carlo Di Lorenzo, Kent Williams, Karla K H Vaz","doi":"10.5056/jnm24057","DOIUrl":"10.5056/jnm24057","url":null,"abstract":"<p><strong>Background/aims: </strong>Pediatric patients with suspected gastroparesis often undergo antroduodenal manometry (ADM) and gastric emptying scintigraphy (GES) for diagnostic purposes. However, it is unknown if delayed gastric emptying (DGE) correlates with manometric findings. This study evaluates whether ADM parameters differ between normal and abnormal GES in pediatric patients.</p><p><strong>Methods: </strong>Data from pediatric patients undergoing ADM and GES at Nationwide Children's Hospital from 2011-2020 were retrospectively reviewed. Manometry parameters including motility index (Ln [sum of amplitudes × number of contractions + 1]), number of antral contractions, and direction of the phase III migrating motor complex (MMC) were compared to GES results from age-matched patients with DGE (n = 32) and normal gastric emptying (NGE) (n = 32) of similar sex, body mass index, and weight.</p><p><strong>Results: </strong>Children with DGE had a lower post-prandial antral motility index and antral contraction number than those with NGE (9.4 vs 11.2, <i>P</i> = 0.005; 21.8 vs 49.6, <i>P</i> < 0.001). The gastric emptying percentage at 4 hours was lower in patients with retrograde phase III (59.2% vs 83.9%, <i>P</i> = 0.022) and in those without an antral component in the fasting phase III of the migrating motor complex (70.3% vs 86.5%, <i>P</i> = 0.003). Post-prandial antral hypomotility occurred more frequently in the DGE group than in the NGE group (41% vs 9%, <i>P</i> = 0.008).</p><p><strong>Conclusions: </strong>ADM findings differ between children with DGE and NGE. Children with DGE are more likely to have abnormal fasting phase III patterns and decreased post-prandial antral activity during ADM testing.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"31 1","pages":"102-109"},"PeriodicalIF":3.3,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950296","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":"Exploring Diagnostic Challenges at the Intersection of Eating Disorders and Functional Dyspepsia: Implications for Rome V.","authors":"Yong Sung Kim, Sung Hoon Yoon, Suck Chei Choi","doi":"10.5056/jnm24172","DOIUrl":"10.5056/jnm24172","url":null,"abstract":"","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"31 1","pages":"6-7"},"PeriodicalIF":3.3,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950303","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":"Optimizing Assessment of Contraction Reserve in Ineffective Esophageal Motility: A Study of Upright Multiple Rapid Swallows.","authors":"Tian Li, D Chamil Codipilly, Diana Snyder, Karthik Ravi, Maoyin Pang, Andree H Koop","doi":"10.5056/jnm24097","DOIUrl":"10.5056/jnm24097","url":null,"abstract":"<p><strong>Background/aims: </strong>Multiple rapid swallows (MRS) is a provocative test during high-resolution esophageal manometry (HRM) to evaluate contraction reserve (CR). This study aims to determine the prevalence of CR in patients with ineffective esophageal motility (IEM) and MRS performed in the upright position, and to assess the ideal number of MRS sequences.</p><p><strong>Methods: </strong>We enrolled adult patients diagnosed with IEM according to the Chicago classification version 4.0 who underwent HRM with 3 MRS sequences. Presence of CR was identified as either: the distal contraction integral (DCI) of the post-MRS sequence exceeding the mean DCI of single swallows (ratio > 1) or the mean DCI of the 3 post-MRS sequences surpassing the mean DCI of single swallows. The occurrence of CR was compared following 1, 2, and 3 MRS sequences.</p><p><strong>Results: </strong>When assessing CR in 57 patients referenced to mean single supine swallow DCI, the pooled prevalence of CR following 1, 2, and 3 MRS sequences was 23/57 (40.4%), 31/57 (54.4%), and 33/57 (57.9%), respectively. More patients had CR after 2 MRS sequences compared to 1 (<i>P</i> < 0.001), but there was no significant difference in CR between 2 and 3 MRS sequences (<i>P</i> = 0.160). More patients had CR after 2 (<i>P</i> = 0.013) and 3 MRS sequences (<i>P</i> = 0.034) when CR was referenced to single upright compared to single supine swallows.</p><p><strong>Conclusion: </strong>Among patients with IEM, 58.0% had CR after 3 upright MRS sequences and 2 were adequate to assess CR.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"31 1","pages":"38-44"},"PeriodicalIF":3.3,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950318","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}