Journal of Neurogastroenterology and Motility最新文献

{"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":"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":"304-312"},"PeriodicalIF":3.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12241913/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Ulcerative Colitis and Irritable Bowel Syndrome Are Diagonally Opposite.\" Missing the Trees for the Woods.","authors":"Kok-Ann Gwee","doi":"10.5056/jnm25049","DOIUrl":"10.5056/jnm25049","url":null,"abstract":"","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"31 3","pages":"289-290"},"PeriodicalIF":3.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12241916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584106","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":"The Value of 3-Dimensional Anorectal Manometry in the Evaluation of Obstetric Anal Sphincter Injuries.","authors":"Yaiza Altuzarra Ranedo, Laura García Pravia, Marta Aparicio Cabezudo, Ana Zatarain Vallés, Constanza Ciriza de Los Ríos","doi":"10.5056/jnm25042","DOIUrl":"10.5056/jnm25042","url":null,"abstract":"","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"31 3","pages":"396-398"},"PeriodicalIF":3.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12241922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584195","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":"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":"313-320"},"PeriodicalIF":3.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12241921/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics and Associated Factors in Mexican Patients With Cyclic Vomiting Syndrome and Cannabinoid Hyperemesis Syndrome.","authors":"Francisco A Felix-Tellez, Eliana C Morel-Cerda, Raúl A Jiménez-Castillo, Luis R Valdovinos-García, Octavio Gómez-Escudero, Miguel Á Valdovinos-Díaz, Enrique Coss-Adame, José A Velarde-Ruiz Velasco, Erick M Toro Monjaraz, Ericka Montijo-Barrios, Alberto A Solís-Ortega, Rosita De Jesus Frazier, Thangam Venkatesan, José M Remes-Troche","doi":"10.5056/jnm24182","DOIUrl":"10.5056/jnm24182","url":null,"abstract":"<p><strong>Background/aims: </strong>Cyclic vomiting syndrome (CVS) and cannabinoid hyperemesis syndrome (CHS) are emerging gastroduodenal disorders with a growing prevalence. However, little is known about their prevalence and clinical characteristics in Latin American populations, particularly in Mexico. This study aims to explore the clinical presentation of CVS and CHS in Mexico.</p><p><strong>Methods: </strong>A cross-sectional study was conducted in 5 medical centers across Mexico, involving patients diagnosed with CVS or CHS based on the Rome IV criteria. Data collected included sociodemographic variables, substance use, comorbidities, and clinical characteristics, with a specific focus on the relationship between substance use, particularly cannabis, and symptomatology.</p><p><strong>Results: </strong>The study included 46 patients, with 30 diagnosed with CVS and 16 with CHS. CVS patients were younger (median age 23 years) compared to CHS patients (median age 27 years; <i>P</i> = 0.043). CHS patients exhibited higher tobacco consumption (50.0% vs 26.7%; <i>P</i> = 0.019) and risky alcohol use (31.3% vs 0.0%; <i>P</i> = 0.003). Cannabis use was reported by 13.3% of CVS patients. The time to diagnosis was longer for CVS (35.4 ± 9.8 months) compared to CHS (26.5 ± 16.0 months; <i>P</i> = 0.016). No significant differences were found in the number of hospital admissions, as well as length of stay between patients with CVS and CHS.</p><p><strong>Conclusions: </strong>This study presents the first detailed analysis of CVS and CHS in the Mexican population, revealing some demographic and clinical differences from global data. These findings highlight the importance of developing region-specific guidelines for diagnosing and managing these conditions, especially given Mexico's changing cannabis policies.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"31 3","pages":"330-339"},"PeriodicalIF":3.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12241915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584187","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":"Does Mean Nocturnal Baseline Impedance Play a Role in Managing Gastroesophageal Reflux Disease?","authors":"Seung Han Kim","doi":"10.5056/jnm25080","DOIUrl":"10.5056/jnm25080","url":null,"abstract":"","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"31 3","pages":"291-292"},"PeriodicalIF":3.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12241917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584190","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":"Long-term Effects of Potassium-competitive Acid Blockers and Proton Pump Inhibitors on Gastrin, Gastric Emptying Rate, and Small Intestinal Microbiota in Rats.","authors":"Hyun Seok Choi, Min Seob Kim, Myeong Hwan Yu, Jisong You, Dahyun Seon, Gwangpyo Ko, Tatsuya Unno, Moon Young Lee, Yong Sung Kim","doi":"10.5056/jnm25024","DOIUrl":"10.5056/jnm25024","url":null,"abstract":"<p><strong>Background/aims: </strong>Proton pump inhibitors (PPIs) are widely used for gastric acid suppression but are associated with adverse effects such as hypergastrinemia and delayed gastric emptying (GE). Potassium-competitive acid blockers (P-CABs), a new class of acid suppressants, rapidly and sustainably inhibit gastric acid secretion. We compared the long-term effects of different P-CABs and PPIs on gastric pH, serum gastrin levels, GE, and small intestinal microbiota in a rat model.</p><p><strong>Methods: </strong>Seventy-two male Sprague-Dawley rats were assigned to receive control, esomeprazole, tegoprazan, or vonoprazan by oral gavage for 1, 2, or 4 weeks. After sacrifice, gastric pH, serum gastrin levels, and GE were measured, and the small intestinal microbiota were analyzed using 16S ribosomal RNA sequencing.</p><p><strong>Results: </strong>All drug-treated groups exhibited significantly higher gastric pH than the control group. Tegoprazan achieved the highest pH at week 2, surpassing those of esomeprazole and vonoprazan. Serum gastrin levels were significantly elevated in all drug-treated groups but remained stable from weeks 1 to 4, indicating a plateau effect. GE was transiently delayed at week 2 but returned to baseline by week 4 in all drug-treated groups. Long-term administration of both P-CABs and PPI led to reduced microbial diversity and distinct taxonomic shifts with changes in the abundance of <i>Prevotella</i> and <i>Acetatifactor</i> in the small intestine. However, with prolonged administration, these differences in microbiota composition gradually diminished.</p><p><strong>Conclusions: </strong>Long-term administration of P-CABs and PPIs altered gastrin levels, GE, and gut microbiota. Therefore, the acid suppression-related adverse effects of P-CABs and PPIs are expected to be similar.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"31 3","pages":"384-395"},"PeriodicalIF":3.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12241910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584193","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":"Diagnostic Criteria and Symptom Profiles in Adult Idiopathic Gastroparesis: A Systematic Review.","authors":"Valencia R Zhang, Qin Xiang Ng, Yi Ping Ren, Ansel S P Tang, Farisah Sulaimi, Clyve Y L Yaow, Kewin T H Siah","doi":"10.5056/jnm24160","DOIUrl":"10.5056/jnm24160","url":null,"abstract":"<p><strong>Background/aims: </strong>Adult idiopathic gastroparesis, characterized by delayed gastric emptying without mechanical obstruction, presents with symptoms such as nausea, vomiting, early satiety, and postprandial fullness. Diagnostic criteria vary across studies, leading to inconsistencies in diagnosis and management. This systematic review explores the diagnostic criteria and categorization of definite, probable, and possible idiopathic gastroparesis in the literature.</p><p><strong>Methods: </strong>Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, we searched Medline, EMBASE, and Cochrane Library databases for relevant articles published in English up to January 2024. Observational studies (cross-sectional, case-control, and cohort designs) that provided diagnostic criteria for idiopathic gastroparesis were included. Data were extracted on demographics, co-existing conditions, symptoms, and diagnostic approaches. Quality was assessed using Joanna Briggs Institute checklists.</p><p><strong>Results: </strong>Of 2235 initial results, 11 studies met our inclusion criteria. Most studies were of high quality, exclusively from Western research centers, and had a preponderance of female patients (61.7% to 85.9%) with mean ages ranging from 40.0 years to 58.9 years. Diagnostic variability was noted. A definite diagnosis was most often based on clinical symptoms and positive gastric emptying scintigraphy, while probable gastroparesis was identified by suggestive symptoms with normal upper endoscopy findings. Nausea and upper abdominal pain were frequently reported symptoms. Significant overlaps were observed between idiopathic gastroparesis and functional dyspepsia.</p><p><strong>Conclusions: </strong>The findings highlight the inherent diagnostic challenges and underscores the need for confirming delayed gastric emptying to clinch an accurate diagnosis of gastroparesis. Future research should focus on developing consistent diagnostic criteria across diverse populations to improve the diagnosis and management of idiopathic gastroparesis.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"31 3","pages":"296-303"},"PeriodicalIF":3.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12241925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584189","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":"From Trials to Practice: Exploring the Clinical Value of Potassium-competitive Acid Blockers","authors":"Yong Sung Kim, Hyun Lim, Boram Cha, Seung Han Kim, Da Hyun Jung, Su Jin Kim, Suck Chei Choi","doi":"10.5056/jnm25099","DOIUrl":"10.5056/jnm25099","url":null,"abstract":"","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"31 3","pages":"401-402"},"PeriodicalIF":3.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12241912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584192","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":"Amitriptyline for the Treatment of Extra-esophageal Symptoms in Proton Pump Inhibitor-refractory Patients With Suspected Gastroesophageal Reflux Disease.","authors":"Jieun Woo, Eun Jeong Gong, Chang Seok Bang, Jae Jun Lee","doi":"10.5056/jnm25121","DOIUrl":"https://doi.org/10.5056/jnm25121","url":null,"abstract":"<p><strong>Background/aims: </strong>Gastroesophageal reflux disease (GERD) is a chronic, heterogeneous condition that impairs quality of life. Extraesophageal symptoms (eg, globus sensation, chronic cough, hoarseness, wheezing) often persist despite proton pump inhibitor (PPI) therapy. Tricyclic antidepressants are recommended for such refractory cases, but supporting evidence is limited. This study aimed to evaluate the efficacy of low-dose amitriptyline in treating extraesophageal GERD symptoms.</p><p><strong>Methods: </strong>We conducted a single-center, single-blind, randomized, controlled crossover pilot trial (2016-2021). Forty patients with typical GERD symptoms plus ≥ 1 atypical symptom (eg, globus, cough) unresponsive to ≥ 4 weeks of PPI therapy were randomized to receive either lansoprazole 30 mg daily plus amitriptyline 10 mg at bedtime or lansoprazole alone for 4 weeks, followed by crossover to the alternate regimen. The primary outcome was symptom improvement assessed by numeric rating scale. Secondary outcomes included changes in quality of life (QoL) measured by the 36-item Short Form survey.</p><p><strong>Results: </strong>All 40 patients completed the trial. Overall, 75% reported symptom improvement: 65% in the amitriptyline group vs. 85% in the PPI group (<i>P</i> = 0.27). Both groups showed significant reductions in symptom severity (between-group <i>P</i> = 0.90) and improvements in QoL (physical and mental summary scores; <i>P</i> = 0.60 and 0.41, respectively). These improvements persisted post-crossover.</p><p><strong>Conclusions: </strong>Adding low-dose amitriptyline to PPI therapy did not offer a short-term advantage over PPI alone. Both treatments improved symptoms and QoL. Given the challenging nature of GERD's extraesophageal manifestations and mixed evidence for neuromodulator therapy, further studies are needed to identify patient subgroups that may benefit from adjunctive neuromodulator therapy.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731818","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}