Journal of Neurogastroenterology and Motility最新文献

{"title":"Surgical and Therapeutic Interventions for Chronic Intestinal Pseudo-obstruction: A Scoping Review.","authors":"Claire Dalby, Thomas Shen, Camille Thélin, Samer Ganam, Vic Velanovich, Joseph Sujka","doi":"10.5056/jnm241031","DOIUrl":"10.5056/jnm241031","url":null,"abstract":"<p><strong>Background/aims: </strong>Chronic intestinal pseudo-obstruction (CIPO) is a rare cause of intestinal dysmotility. First-line treatment in adult patients is medical and nutritional therapy. For patients who fail these treatment options, surgical interventions may be an option. In this scoping review, we aim to investigate the current research on surgical interventions for CIPO in adults.</p><p><strong>Methods: </strong>PubMed, Embase, and Scopus were queried for articles related to surgical interventions for adults with CIPO. Search terms included: intestinal dysmotility, intestinal pseudo-obstruction, global intestinal dysmotility, chronic intestinal pseudo-obstruction, gastrointestinal paresis, neurogastrointestinal motility disorder, and chronic small intestinal motility disorder.</p><p><strong>Results: </strong>Initial search identified 4763 records; 4722 were deemed irrelevant after screening and were excluded. The remaining 41 reports were retrieved and assessed for eligibility. Twenty-one additional studies were excluded after in-depth assessment. The remaining 20 reports were: 9 cohort studies, 7 case reports, and 4 reviews. Of these, 10 studies had study populations of < 10 patients, while 6 had ≥ 10 patients. The remaining 4 were reviews. Results of these papers described the safety and effectiveness of various surgical interventions for adults with CIPO, including percutaneous endoscopic procedures, surgical decompression, small bowel resection, and intestinal transplantation.</p><p><strong>Conclusions: </strong>Data pertaining to surgical therapy for CIPO is limited. Although this review suggests that surgical interventions for CIPO may be safe and effective for select patients, strong conclusions cannot be made due to limited number of relevant studies and small sample sizes. Concerted efforts to produce data from large studies on adults with CIPO are necessary.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"31 1","pages":"8-17"},"PeriodicalIF":3.3,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950320","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":"Effect of Buspirone on Upper Gastrointestinal Disorders of Gut-Brain Interaction: A Systematic Review and Meta-analysis.","authors":"Zahra Mohamedali, Gehanjali Amarasinghe, Christopher W P Hopkins, Calum D Moulton","doi":"10.5056/jnm24115","DOIUrl":"10.5056/jnm24115","url":null,"abstract":"<p><strong>Background/aims: </strong>Buspirone shows promise in treating disorders of gut-brain interaction (DGBIs), particularly functional dyspepsia. However, findings have been mixed.</p><p><strong>Methods: </strong>We systematically searched for prospective studies testing buspirone for any upper gastrointestinal DGBI in 4 databases (Cochrane, PubMed, Scopus, and PsycInfo). The primary outcome was any validated measure of gastrointestinal symptoms. Anxiety, depression and adverse events were secondary outcomes. For randomized controlled trials (RCTs), we performed random-effects meta-analysis of the standardized mean difference (SMD) in post-treatment scores between buspirone and control groups. Risk of bias in RCTs was assessed using the Cochrane Common Mental Disorders Depression Anxiety and Neurosis Group (CCDAN) scale.</p><p><strong>Results: </strong>Ten studies (n = 283) met inclusion criteria, comprising 5 RCTs, 1 N-of-1 trial, 1 cohort, 1 case series, and 2 case reports. Tolerability of buspirone was good. In meta-analysis, buspirone produced a non-significant improvement in functional dyspepsia/gastroparesis symptoms compared to placebo (SMD = -0.14; 95% CI, -0.44 to 0.17; <i>P</i> = 0.39; <i>I</i>² = 0%; N_studies = 3). Of individual symptoms, buspirone improved bloating severity more than placebo (SMD = -0.41; 95% CI, -0.77 to -0.04; <i>P</i> = 0.03; N_studies = 2) but did not improve post-prandial fullness (<i>P</i> = 0.24, N_studies = 2) or nausea (<i>P</i> = 0.75, N_studies = 2). All RCTs included in the meta-analysis were good quality but most treated for only 4 weeks.</p><p><strong>Conclusions: </strong>We found that buspirone did not improve functional dyspepsia symptoms more than placebo, though studies were small. Buspirone showed benefit for bloating severity, albeit based on few studies. Larger and longer trials of buspirone, targeting more defined groups such as patients with bloating, are warranted.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"31 1","pages":"18-27"},"PeriodicalIF":3.3,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950298","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":"Efficacy of Amitriptyline in Irritable Bowel Syndrome: A Systematic Review and Meta-analysis.","authors":"Minahil Iqbal, Sara Hira, Humza Saeed, Sufyan Shahid, Suha T Butt, Kamran Rashid, Mohammad Ahmad, Hammad Hussain, Anzalna Mughal, Gabriel P A Costa, Fernanda Gushken, Neil Nero, Shreya Sengupta, Akhil Anand","doi":"10.5056/jnm24084","DOIUrl":"10.5056/jnm24084","url":null,"abstract":"<p><strong>Background/aims: </strong>Amitriptyline is prescribed off-label for irritable bowel syndrome (IBS). We conducted a meta-analysis to assess its efficacy.</p><p><strong>Methods: </strong>A systematic literature review was conducted until November 10, 2023, using MEDLINE, Embase, Cochrane Library, and Web of Science to study the efficacy of amitriptyline in patients with IBS. We included all randomized controlled trials that compared amitriptyline to placebo. Revised Cochrane risk-of-bias tool was used to assess the quality of studies. Meta-analyses were performed using a bivariate random-effects model. Statistical analyses were performed using R Software 4.2.3 and heterogeneity was assessed with I2 statistics.</p><p><strong>Results: </strong>Seven trials were included with 796 patients (61% female). Amitriptyline was associated with better treatment response (OR, 5.30; 95% CI, 2.47 to 11.39; <i>P</i> < 0.001), reduced Irritable Bowel Syndrome Symptom Severity Scores (MD, -50.72; 95% CI, -94.23 to -7.20; <i>P</i> = 0.020) and improved diarrhea (OR, 10.55; 95% CI, 2.90 to 38.41; <i>P</i> < 0.001). No significant difference between the 2 groups regarding the adverse effects was observed. Three trials showed an overall low risk of bias, 2 trials showed an overall high risk of bias due to randomization and missing data, and 2 trials had some concerns regarding missing data.</p><p><strong>Conclusions: </strong>Amitriptyline was found to be well-tolerated and effective in treating IBS compared to placebo. These findings support the use of amitriptyline for the management of IBS, particularly among patients with the IBS diarrhea subtype. Future research should focus on the dose-dependent effects of amitriptyline in IBS to better guide clinicians in personalized titration regimens.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"31 1","pages":"28-37"},"PeriodicalIF":3.3,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950299","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":"Phrenic Ampulla Emptying Dysfunction: Unveiling the Role of Lower Esophageal Sphincter After-contraction.","authors":"Chang Seok Bang, Eun Jeong Gong","doi":"10.5056/jnm24122","DOIUrl":"10.5056/jnm24122","url":null,"abstract":"","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"30 4","pages":"383-384"},"PeriodicalIF":3.3,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11474549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467988","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":"Effectiveness of Abdominal Massage Versus Kinesio Taping in Women With Chronic Constipation: A Randomized Controlled Trial.","authors":"Yasemin Karaaslan, Aysenur Karakus, Deniz Ogutmen Koc, Amine Bayrakli, Seyda Toprak Celenay","doi":"10.5056/jnm23131","DOIUrl":"10.5056/jnm23131","url":null,"abstract":"<p><strong>Background/aims: </strong>Chronic constipation is an important public health problem and significantly affects women's lives. It is important to investigate nonpharmacological applications that can be used in the treatment of chronic constipation. The aim is to assess how abdominal massage and Kinesio taping impact constipation severity, quality of life (QOL), and perception of subjective improvement in women with chronic constipation.</p><p><strong>Methods: </strong>Following the Rome IV diagnostic criteria, women with constipation were randomly sorted into 3 distinct groups for study: massage group (lifestyle recommendations + abdominal massage, n = 22), taping group (lifestyle recommendations + Kinesio taping, n = 22), and control group (lifestyle recommendations, n = 22). Constipation Severity Instrument (CSI) (for constipation severity), 7 days bowel diary (for bowel function), Patient Assessment of Constipation QOL (PAC-QOL) questionnaire (for QOL), 4-item Likert-type scale (for perception of subjective improvement) was used.</p><p><strong>Results: </strong>The group x time interaction effect was significant in all CSI, bowel diary and PAC-QQL parameters, except for incomplete evacuation and PAC-QOL-worries/concerns, and a large effect size was found (Partial η2 > 0.14). Improvement scores of all parameters (except CSI-obstructive defecation, incomplete evacuation, PAC-QOL-worries/concerns) were similar in the massage and taping groups and were better than the control group. Noteworthy perceptions of subjective improvement and normalization of stool type predominantly manifested in the massage group (<i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>Abdominal massage and Kinesio taping are recommended as initial conservative interventions for managing chronic constipation within the therapeutic spectrum.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":" ","pages":"501-511"},"PeriodicalIF":3.3,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11474553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141200099","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":"Phrenic Ampulla Emptying Dysfunction in Patients with Esophageal Symptoms.","authors":"Sujin Kim, Walter Marquez-Lavenant, Ravinder K Mittal","doi":"10.5056/jnm23162","DOIUrl":"10.5056/jnm23162","url":null,"abstract":"<p><strong>Background/aims: </strong>Pharyngeal pump, esophageal peristalsis, and phrenic ampulla emptying play important roles in the propulsion of bolus from the mouth to the stomach. There is limited information available on the mechanism of normal and abnormal phrenic ampulla emptying. The goal of our study is to describe the relationship between bolus flow and esophageal pressure profiles during the phrenic ampulla emptying in normal subjects and patient with phrenic ampulla dysfunction.</p><p><strong>Methods: </strong>Pressure (using topography) and bolus flow (using changes in impedance) relationship through the esophagus and phrenic ampulla were determined in 15 normal subjects and 15 patients with retrograde escape of bolus from the phrenic ampulla into esophagus during primary peristalsis.</p><p><strong>Results: </strong>During the phrenic ampulla phase, 2 high pressure peaks (proximal, related to lower esophageal sphincter and distal, related to crural diaphragm) were observed in normal subjects and patients during the phrenic ampulla emptying phase. The proximal was always higher than the distal one in normal subjects; in contrast, reverse was the case in patients with the retrograde escape of bolus from the phrenic ampulla into the esophagus.</p><p><strong>Conclusions: </strong>We propose that a strong after-contraction of the lower esophageal sphincter plays an important role in the normal phrenic ampullary emptying. A defective lower esophageal after-contraction, along with high crural diaphragm pressure are responsible for the phrenic ampulla emptying dysfunction.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":" ","pages":"421-429"},"PeriodicalIF":3.3,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11474561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975907","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":"Clinicians' Knowledge, Attitudes, and Practices Regarding the Management of Functional Gastrointestinal Disorders With Neuromodulators and Psychological Treatment.","authors":"Seung Yong Shin, Ju Yup Lee, Sung Won Jung, Seung-Ho Jang, Han Seung Ryu, Ayoung Lee, Geun Tae Park, Woongki Chang, Minkyong Kim, Beom Seuk Hwang, Yong Sung Kim, Joong Goo Kwon","doi":"10.5056/jnm23161","DOIUrl":"10.5056/jnm23161","url":null,"abstract":"<p><strong>Background/aims: </strong>Little is known about the practical clinical application of neuromodulators and psychiatric treatments in patients with functional gastrointestinal disorders (FGIDs). We investigate the knowledge, attitudes, and practices of Korean clinicians regarding the use of neuromodulators and psychiatric treatments for FGIDs.</p><p><strong>Methods: </strong>This prospective, online, cross-sectional study was conducted between May and August 2022. A questionnaire regarding the knowledge, attitude, and practice of neuromodulators and psychiatric treatments for FGIDs was developed and administered to primary care clinicians and gastroenterologists in university hospitals in Korea.</p><p><strong>Results: </strong>Overall, 451 clinicians from primary (n = 179, 39.7%), secondary (n = 113, 25.1%), and tertiary (n = 159, 35.3%) hospitals participated in the survey. Most of them considered that neuromodulators (98.7%) and psychiatric treatment (86.5%) were required for patients with FGIDs. However, approximately one-third of them did not prescribe neuromodulators, mainly due to unfamiliarity with the drugs, and only one-quarter considered psychiatric referral. Compared to gastroenterologists at university hospitals, primary care clinicians' prescriptions had a lower rate (87.2% vs 64.2%, <i>P</i> < 0.001) and shorter duration of neuromodulator. The psychiatric referral rate was lower for primary care clinicians than for gastroenterologists at university hospitals (19.0% vs 34.2%, <i>P</i> < 0.001).</p><p><strong>Conclusions: </strong>Knowledge, attitude, and practice levels regarding neuromodulators and psychiatric treatment among clinicians are inhomogeneous, and a knowledge gap exists between primary care clinicians and gastroenterologists at university hospitals. Encouraging ongoing education for Korean clinicians regarding the appropriate use of neuromodulators and psychiatric treatments in patients with FGIDs is suggested.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"30 4","pages":"480-490"},"PeriodicalIF":3.3,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11474558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467979","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":"Optimal Diagnostic and Treatment Response Threshold of the Eosinophilic Esophagitis Endoscopic Reference Score: A Single-Center Study of 102 Patients With Eosinophilic Esophagitis.","authors":"Kwangbeom Park, Bokyung Ahn, Kee Wook Jung, Young Soo Park, Jun Su Lee, Ga Hee Kim, Hee Kyong Na, Ji Yong Ahn, Jeong Hoon Lee, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung","doi":"10.5056/jnm23172","DOIUrl":"10.5056/jnm23172","url":null,"abstract":"<p><strong>Background/aims: </strong>The proposed eosinophilic esophagitis (EoE) endoscopic reference score serves to diagnose and evaluate treatment responses in EoE. Nevertheless, the validated reference score thresholds for diagnosis and treatment response in Asian patients are yet to be established. This study aims to establish these thresholds for the first time among Asian patients with EoE.</p><p><strong>Methods: </strong>Patients presenting with ≥ 15 eosinophils/high power field and esophageal dysfunction symptoms between August 2007 and November 2021 were included. Age- and sex-matched non-EoE controls were also enrolled. Baseline characteristics, endoscopic reference score features, and scores were compared between patients and controls. Among patients, endoscopic reference score features and scores, along with peak eosinophil counts, were evaluated both before and after treatment. The optimal threshold was determined based on sensitivity, specificity, and the Youden index.</p><p><strong>Results: </strong>Overall, 102 patients were enrolled (74.5% men; mean age, 46.9 years). The mean endoscopic reference score was 2.65 and 0.52 for patients and controls, respectively (<i>P</i> < 0.001). An endoscopic reference score ≥ 2 was identified as the optimal diagnostic threshold for EoE (sensitivity, 0.79; specificity, 0.86; Youden index, 0.66). Post-treatment data regarding endoscopic findings and histology were available for 30 patients. Regarding histologic response, an endoscopic reference score of ≤ 3 demonstrated the optimal threshold (sensitivity, 0.95; specificity, 0.88; Youden index, 0.83).</p><p><strong>Conclusions: </strong>The optimal diagnostic and treatment response thresholds were determined to be endoscopic reference scores of ≥ 2 and ≤ 3, respectively. Further studies involving a larger patient cohort are necessary to validate these findings.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"30 4","pages":"430-436"},"PeriodicalIF":3.3,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11474565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467987","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":"Three-dimensional Anorectal Manometry in a Patient With Passive Fecal Incontinence and a History of Complex Perianal Fistula Treated With Fistulectomy.","authors":"Jesús Sánchez César, Marta Aparicio Cabezudo, Constanza Ciriza de Los Ríos","doi":"10.5056/jnm24075","DOIUrl":"10.5056/jnm24075","url":null,"abstract":"","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"30 4","pages":"515-516"},"PeriodicalIF":3.3,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11474557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467991","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":"Exploration of Diagnostic Value of Chicago Classification Version 4.0: Focusing on Rapid Drink Challenge.","authors":"Soo In Choi","doi":"10.5056/jnm24121","DOIUrl":"10.5056/jnm24121","url":null,"abstract":"","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"30 4","pages":"381-382"},"PeriodicalIF":3.3,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11474563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467983","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}