Journal of Neurogastroenterology and Motility最新文献

{"title":"2025 Focused Update of the Seoul Consensus on Gastroesophageal Reflux Disease: Evidence-based Recommendations on Acid Suppressive Therapy.","authors":"Cheal Wung Huh, Jin Won Chang, Nak-Hoon Son, Da Hyun Jung, Hye-Kyung Jung, Seung Joo Kang, Seung Young Kim, Miyoung Choi, Da Mi Jeong, Hyun Jin Kim, Moo In Park, In-Kyung Sung, Young Hoon Youn, Kwang Jae Lee","doi":"10.5056/jnm25128","DOIUrl":"10.5056/jnm25128","url":null,"abstract":"<p><p>Gastroesophageal reflux disease (GERD) is a chronic and relapsing gastrointestinal disorder characterized by the reflux of gastric contents into the esophagus, leading to troublesome symptoms and/or complications. Since the publication of the 2020 Seoul Consensus on GERD, significant new evidence has emerged, particularly regarding acid-suppressive therapies and diagnostic approaches. This 2025 focused update aims to refine GERD management strategies by incorporating the latest evidence on acid suppressive therapies and regional considerations in Asian populations. This study builds on the 2020 Seoul Consensus by integrating systematic reviews, meta-analyses, and expert consensuses to offer updated recommendations for the definition and medical treatment of GERD. These guidelines incorporate recent advances in acid-suppressive therapies, particularly potassium-competitive acid blockers, and adopt updated diagnostic frameworks in accordance with the Lyon Consensus 2.0. Key clinical questions were identified and structured using the following format: Population, Intervention, Comparator, Outcome. The resulting recommendations address the initial treatment, long-term maintenance strategies, and role of personalized therapy based on disease severity, such as the grade of reflux esophagitis. Six key statements are presented: updated definition and classification of GERD (Statement 1); initial and long-term treatment strategies tailored to GERD phenotypes, such as non-erosive reflux disease, mild erosive esophagitis, and severe erosive esophagitis (Statements 2-5); and dose optimization strategies for long-term safety (Statement 6). These guidelines aim to support gastroenterologists and general healthcare providers in making individualized evidence-based decisions for GERD management.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":" ","pages":"7-18"},"PeriodicalIF":3.7,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12780910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186088","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":"Expanding the Physiological Role of the Endoluminal Functional Lumen Imaging Probe From the Esophagus to Pediatric Pylorus.","authors":"Kee Wook Jung","doi":"10.5056/jnm25238","DOIUrl":"10.5056/jnm25238","url":null,"abstract":"","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"32 1","pages":"4-6"},"PeriodicalIF":3.7,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12780903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145906116","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":"Mean Basal Esophagogastric Junction Pressure Is a Better High-resolution Manometry Predictor of Gastroesophageal Reflux Disease Than Esophagogastric Junction Contractile Integral.","authors":"Edoardo Vespa, Alberto Barchi, Jacopo Fanizza, Rukaia Barà, Ernesto Fasulo, Sarah Bencardino, Francesca Bernardi, Ilaria Faggiani, Silvio Danese, Sandro Passaretti","doi":"10.5056/jnm25029","DOIUrl":"10.5056/jnm25029","url":null,"abstract":"<p><strong>Background/aims: </strong>: Esophagogastric junction contractile integral (EGJ-CI) is a metric of EGJ barrier function assessed on high-resolution manometry (HRM). However, its clinical utility may be limited by measurement discrepancies and wide variability. Mean basal EGJ pressure (MBEP) is a novel, simple HRM metric assessing barrier function. We compared their performance to predict conclusive gastroesophageal reflux disease (GERD).</p><p><strong>Methods: </strong>: Consecutive patients undergoing esophageal function testing for known or suspected GERD were retrospectively evaluated. MBEP and EGJ-CI were manually calculated. Conclusive GERD was defined as acid exposure time > 6% or histologically confirmed Barrett's esophagus. Statistical analyses including Mann-Whitney and Kruskal-Wallis tests, receiver operating characteristic (ROC) curves, univariable and multivariable logistic regression were performed.</p><p><strong>Results: </strong>: Two hundred and twenty-six patients (mean age 52.8 ± 14.6 years, 58% males) were included. Applying Lyon 2.0 consensus criteria, 41% had conclusive GERD, 8% had borderline GERD, 8% had reflux hypersensitivity, and 43% had no GERD evidence. Patients with conclusive GERD had significantly lower MBEP compared to those without (11.8 mmHg vs 18.5 mmHg; <i>P</i> < 0.001). MBEP showed greater predictive performance for conclusive GERD (area under the ROC curve [AUROC]: 0.71; 95% CI, 0.65-0.78) than EGJ-CI (AUROC: 0.66; 95% CI, 0.59-0.74), also discriminating Lyon 2.0 subgroups (P < 0.001) and EGJ morphology types (P < 0.001). On multivariable analysis, MBEP independently predicted conclusive GERD (per 1-mmHg increase OR, 1.11; <i>P</i> = 0.022), while EGJ-CI did not (OR, 0.99; <i>P</i> = 0.207).</p><p><strong>Conclusions: </strong>: MBEP is a simple HRM metric to evaluate anti-reflux barrier function, predicting conclusive GERD and differentiating reflux phenotypes with better performance than EGJ-CI. This metric could serve as a valuable adjunctive tool in GERD diagnosis.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"32 1","pages":"35-45"},"PeriodicalIF":3.3,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12780901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145906114","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":"Mean Nocturnal Baseline Impedance in Gastroesophageal Reflux Disease: Considerations on the Study by Lee et al.","authors":"Francesco Calabrese, Andrea Pasta, Edoardo V Savarino, Edoardo G Giannini, Elisa Marabotto","doi":"10.5056/jnm25153","DOIUrl":"10.5056/jnm25153","url":null,"abstract":"","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"32 1","pages":"136-137"},"PeriodicalIF":3.3,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12780915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145906132","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":"Transient Gastric Pressure Elevation Synergizing With Impaired Esophagogastric Junction Barrier Function Plays a Pivotal Role in the Refractory Gastroesophageal Reflux Disease.","authors":"Xin Huang, Yuzhu Chen, Xiaolin Ji, Lingling Zhu, Tianzhuang Li, Zhiwei Xia, Zhijie Xu, Ying Ge, Kun Wang, Liping Duan","doi":"10.5056/jnm25050","DOIUrl":"10.5056/jnm25050","url":null,"abstract":"<p><strong>Background/aims: </strong>: The pathophysiology of refractory gastroesophageal reflux disease (RGERD), which differs from proton pump inhibitor dependent gastroesophageal reflux disease (DGERD), remains incompletely elucidated. This study aims to compare esophageal motility patterns, transdiaphragmatic pressure gradients (TPG), and reflux profiles between RGERD and DGERD patients, and to delineate dynamic pressure gradient-esophagogastric junction (EGJ) interactions in these patients.</p><p><strong>Methods: </strong>: In this retrospective study, 274 patients who underwent 24-hour impedance-pH monitoring and high-resolution manometry, along with an assessment of proton pump inhibitor responsiveness, were classified as RGERD (32.5%), DGERD (54.4%), or non-GERD (13.1%). Clinical characteristics, TPG, esophageal motility, and reflux metrics were compared between RGERD and DGERD patients. Subgroup analysis excluding hiatal hernia (HH) was conducted to investigate the pathophysiology of RGERD.</p><p><strong>Results: </strong>: The RGERD group exhibited a significantly higher proportion of chest pain compared to the DGERD group. Regarding reflux profiles, RGERD patients without HH (RGERD^HH- group) experienced increased weakly acidic reflux (<i>P</i> < 0.001) and prolonged bolus exposure (<i>P</i> = 0.006) compared to their counterparts (DGERD^HH- group). Mechanistically, the RGERD^HH- group showed reduced lower esophageal sphincter basal pressure (<i>P</i> = 0.010) and EGJ contractile integral (<i>P</i> = 0.005). Notably, following a wet-swallow, the RGERD^HH- group experienced the significant elevation in gastric pressure and TPG. Correlation analyses revealed weakly acidic reflux and bolus exposure were positively correlated with gastric pressure variation, and inversely correlated with lower esophageal sphincter basal pressure.</p><p><strong>Conclusions: </strong>: Transient gastric pressure elevation and compromised EGJ barrier function drive weakly acidic reflux and esophageal bolus exposure. This pressure gradient-barrier mismatch underpins the refractoriness of RGERD.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"32 1","pages":"71-85"},"PeriodicalIF":3.3,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12780913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145906157","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 Effect of Tegoprazan on Serum Gastrin Levels and the Development of Hypergastrinemia in the Maintenance Treatment for Gastroesophageal Reflux Disease: Comparison to Lansoprazole.","authors":"Kwang Jae Lee, Da Hyun Jung, Oh Young Lee","doi":"10.5056/jnm25104","DOIUrl":"10.5056/jnm25104","url":null,"abstract":"<p><strong>Background/aims: </strong>Safety data on potassium-competitive acid blockers are limited. We aim to evaluate the effect of tegoprazan on serum gastrin levels during maintenance treatment for gastroesophageal reflux disease compared to lansoprazole.</p><p><strong>Methods: </strong>In a prospective, randomized trial, patients who underwent initial treatment with a standard dose of a proton pump inhibitor (n = 121) or tegoprazan (n = 226) were randomized to receive a half-dose of tegoprazan (n = 173) or lansoprazole (n = 174) as maintenance treatment for up to 24 weeks. Serum gastrin levels were measured immediately after initial treatment and monitored throughout the maintenance treatment period.</p><p><strong>Results: </strong>Baseline gastrin levels were similar between the tegoprazan and lansoprazole groups (<i>P</i> = 0.335). During maintenance treatment, gastrin levels were significantly lower in the tegoprazan group at week 16 (<i>P</i> = 0.001) and week 24 (<i>P</i> = 0.012) compared to the lansoprazole group. Although the proportion of hypergastrinemia (> 115 pg/mL) was similar at baseline between the tegoprazan and lansoprazole groups (<i>P</i> = 0.114), it was significantly lower in the tegoprazan group during maintenance treatment (<i>P</i> = 0.003, 0.033, and 0.039 at weeks 8, 16, and 24, respectively) than in the lansoprazole group. Multivariate analysis revealed that age, sex, baseline gastrin levels, <i>Helicobacter pylori</i> infection, and the drug group were independently associated with final gastrin levels.</p><p><strong>Conclusion: </strong>Tegoprazan has a smaller impact on increasing serum gastrin levels and the development of hypergastrinemia than lansoprazole, suggesting that tegoprazan may reduce safety concerns related to hypergastrinemia, particularly at half doses.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"31 4","pages":"527-533"},"PeriodicalIF":3.3,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12527955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280458","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":"Behavioral Postprandial Distress in Autism Spectrum Disorder: Behavioral Clues Beyond Physiology.","authors":"Lin Long, Haiyan Zhang, Jing Liu, Jun Zhou, Peiling Bao","doi":"10.5056/jnm25084","DOIUrl":"10.5056/jnm25084","url":null,"abstract":"","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"31 4","pages":"543-544"},"PeriodicalIF":3.3,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12527962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280465","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 Clinical Characteristics and Long-term Prognosis of Focal Hypoganglionosis With Adult-onset Megacolon and Chronic Intestinal Pseudo-obstruction.","authors":"Jung-Bin Park, Kee Wook Jung, June Hwa Bae, Kyuwon Kim, Min Hui Lee, Gyeong-Chae Bae, Seung Wook Hong, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Suk-Kyun Yang, Jong Lyul Lee, Yong Sik Yoon, Chan Wook Kim, Chang Sik Yu, Seung-Jae Myung","doi":"10.5056/jnm24179","DOIUrl":"10.5056/jnm24179","url":null,"abstract":"<p><strong>Background/aims: </strong>Focal hypoganglionosis with adult-onset megacolon (FHAM) is marked by colon dilation proximal to a narrowed segment, with unaffected small bowel motility. Despite similar initial symptoms, FHAM may be more amenable to surgical intervention without recurrence, unlike chronic intestinal pseudo-obstruction (CIPO). The long-term outcomes of FHAM remain underexplored, prompting a comparison of its clinical features and prognosis with CIPO.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of patients presenting with chronic constipation and megacolon, prospectively recruited between January 2017 and December 2023. Within this cohort, 87 patients were diagnosed with FHAM and 13 with CIPO, all of whom were included in the study. The median follow-up period was 3.0 years for patients with FHAM and 2.8 years for those with CIPO.</p><p><strong>Results: </strong>The proportion of females was greater in both groups (FHAM, 67.8%; CIPO, 53.8%). The median age at diagnosis was similar between the groups (FHAM, 54.5 years; CIPO, 45.3 years). Surgery was performed in 46.0% of patients with FHAM and 69.2% of those with CIPO. Unplanned postoperative hospitalizations and the need for reoperation due to disease recurrence were notably lower in patients with FHAM. None of the patients with FHAM required long-term total parenteral nutrition, in contrast to 46.2% of patients with CIPO. Significant inter-group differences were observed in body mass index at the last follow-up.</p><p><strong>Conclusions: </strong>Patients with FHAM exhibit a more favorable long-term prognosis and lower postoperative recurrence rates than patients with CIPO. This study underscores the importance of differentiating between these conditions and precisely selecting surgical candidates.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"31 4","pages":"501-511"},"PeriodicalIF":3.3,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12527952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280517","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 Need for Objective Testing in Proton Pump Inhibitor-refractory Extraesophageal Gastroesophageal Reflux Disease.","authors":"Seung Young Kim","doi":"10.5056/jnm25138","DOIUrl":"10.5056/jnm25138","url":null,"abstract":"","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"31 4","pages":"405-406"},"PeriodicalIF":3.3,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12527960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280440","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":"Treatment of Irritable Bowel Syndrome With Antispasmolytics in Taiwan, Hong Kong, and Vietnam: A Delphi Expert Consensus Statement.","authors":"Sabera Hashim, Shan Wang, Benjamin Burr, Swarali Tadwalkar, Radhika Mehta, Ankur Gupta","doi":"10.5056/jnm25035","DOIUrl":"10.5056/jnm25035","url":null,"abstract":"<p><strong>Background/aims: </strong>In Hong Kong, Taiwan and Vietnam, the burden of irritable bowel syndrome (IBS) is poorly documented, with limited evidence-based treatments and outdated guidelines. We used a modified Delphi method to reach expert consensus on different aspects of disease management and gain insights into the current clinical practice for IBS in these 3 countries, focusing on treatment with antispasmolytics.</p><p><strong>Methods: </strong>Evidence from a targeted literature review was used to draft consensus statements for a multidisciplinary 3-round Delphi survey. Consensus was defined as ≥ 70% agreement among experts from the same country (qualitative data) or a SD < 5% on rate estimates (quantitative data). Data were grouped and analyzed by expert specialty and country.</p><p><strong>Results: </strong>Thirty-six experts (12 per country; primary care physicians, n = 6; gastroenterologists, n = 4; and pharmacists, n = 2) participated in the 3 voting rounds. Consensus was reached for 17/25 (68.0%) statements. Respondents agreed that IBS diagnosis relies on symptoms and guidelines. Regarding antispasmolytics, most experts were highly satisfied with the available medications, particularly hyoscine and otilonium bromide, and agreed on a short (< 2 weeks) treatment duration. Mean 1-year relapse rate was 38.3-48.0% with antispasmolytics overall and 20.5-26.5% with otilonium bromide. In all 3 countries, consensus was reached that frequent IBS relapses affect patients' daily routine and quality of life frequently and that long-term treatment strategies addressing relapse represent a key unmet need in IBS management.</p><p><strong>Conclusions: </strong>Although antispasmolytics provide immediate symptom relief, their long-term effectiveness needs further investigations in Asian populations. Our findings may inform clinical decision-making and guideline updates.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":"31 4","pages":"512-526"},"PeriodicalIF":3.3,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12527961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280443","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}