Journal of Neurogastroenterology and Motility最新文献

{"title":"Constipation in Patients With Chronic Kidney Disease.","authors":"Ra Ri Cha,&nbsp;Seon-Young Park,&nbsp;Michael Camilleri","doi":"10.5056/jnm23133","DOIUrl":"10.5056/jnm23133","url":null,"abstract":"<p><p>Constipation is a frequent symptom in patients with chronic kidney disease (CKD). This review outlines the mechanisms and management of constipation in patients with CKD from a physician's perspective. Common causes of constipation in patients with CKD include concomitant medications, low dietary fiber intake, water-restricted diet, lack of physical activity, altered gut microbiota, and reduced gastrointestinal motility. Constipation has a negative impact on overall health, and, in particular, the presence of constipation has been associated with worsening kidney function and increased risk of developing advanced stages of CKD. Although lifestyle and dietary modifications may not always be practical for patients with CKD, they are recommended because they are beneficial as they lower mortality in patients with CKD. The use of laxatives containing magnesium salts, bulking agents, and osmotic laxatives may have insufficient efficacy and may be associated with adverse effects. In contrast, lactulose and lubiprostone have been shown to exhibit reno-protective effects. Linaclotide and plecanatide have very limited systemic absorption and appear safe in patients with CKD. Tenapanor reduces paracellular intestinal phosphate absorption in addition to blocking sodium uptake by enterocytes, and provides additional benefit in patients patients with CKD who have hyperphosphatemia and constipation. Prucalopride leads to improvements in bowel function and constipation-related symptoms in cases in which response to conventional laxatives are inadequate. However, the dose of prucalopride should be reduced to 1 mg once daily for patients with CKD. In conclusion, there are important advances on the impact and treatment of constipation in patients with CKD.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10577456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41182858","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":"Deciphering the Immune Complexity of Esophageal Achalasia.","authors":"Hyunsoo Chung","doi":"10.5056/jnm23141","DOIUrl":"10.5056/jnm23141","url":null,"abstract":"infiltration is a known characteristic of EA, with eosinophils accumulating in the lower esophageal sphincter. Surprisingly, this study revealed a reduction in peripheral eosinophil counts in EA patients, particularly in those with severe symptoms. This discrepancy between local and systemic eosinophil levels suggests a complex relationship between tissue-specific immune responses and peripheral immune regulation. To gain further insights into the molecular mechanisms underlying EA, the researchers conducted RNA sequencing of peripheral blood mono-nuclear cells. This analysis identified 170 differentially expressed genes (DEGs) associated with EA. These DEGs were linked to various immune-related processes, including humoral immune responses, lymphocyte-mediated immunity, and complement activa-JNM","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10577466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41182859","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":"Revisiting the Role of Esophageal Mucosal Dilated Intercellular Spaces in the Diagnosis and Pathophysiology of Heartburn.","authors":"Volkan Gorgulu,&nbsp;Pelin Ergun,&nbsp;Sezgi Kipcak,&nbsp;Basak Doganavsargil,&nbsp;Daniel Sifrim,&nbsp;Serhat Bor","doi":"10.5056/jnm22142","DOIUrl":"10.5056/jnm22142","url":null,"abstract":"<p><strong>Background/aims: </strong>Dilated intercellular spaces (DISs) facilitate the diffusion of noxious agents into the deep layers of the esophageal epithelium. The role of DIS in heartburn pathogenesis is still controversial. Therefore, we aim to reinvestigate DIS in an extensively evaluated group of patients and healthy controls (HCs).</p><p><strong>Methods: </strong>We classified 149 subjects into the following groups: 15 HC, 58 mild erosive reflux disease (ERD), 17 severe ERD, 25 nonerosive reflux disease (NERD), 15 reflux hypersensitivity (RH), and 19 functional heartburn (FH). A total of 100 length measurements were performed for each patient's biopsy.</p><p><strong>Results: </strong>The overall intercellular spaces (ISs) value of gastroesophageal reflux disease (GERD) patients was higher than that of HC (<i>P</i> = 0.020). In phenotypes, mild ERD (vs HC [<i>P</i> = 0.036], NERD [<i>P</i> = 0.004], RH [<i>P</i> = 0.014]) and severe ERD (vs HC [<i>P</i> = 0.002], NERD [<i>P</i> < 0.001], RH [<i>P</i> = 0.001], FH [<i>P</i> = 0.004]) showed significantly higher IS. There was no significant difference between the HC, NERD, RH, and FH groups. The 1.12 μm DIS cutoff value had 63.5% sensitivity and 66.7% specificity in the diagnosis of GERD. There was a weak correlation (<i>r</i> = 0.302) between the IS value and acid exposure time, and a weak correlation (<i>r</i> = -0.359) between the IS value and baseline impedance. A strong correlation was shown between acid exposure time and baseline impedance (<i>r</i> = -0.783).</p><p><strong>Conclusions: </strong>Since the IS length measurement had better discrimination power only in erosive groups, it is not feasible to use in daily routine to discriminate other nonerosive phenotypes and FH. The role of DIS in heartburn in nonerosive patients should be reconsidered.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10577464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41182868","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":"Spot Hydrogen Breath Test for Predicting Response to Low Fermentable Oligo-, Di-, Mono-saccharides, and Polyols Dietary Advice in Patients With Bloating.","authors":"Pochara Somvanapanich,&nbsp;Panyavee Pitisuttithum,&nbsp;Jarongkorn Sirimongkolkasem,&nbsp;Pakkapon Rattanachaisit,&nbsp;Sureeporn Jangsirikul,&nbsp;Tanisa Patcharatrakul,&nbsp;Sutep Gonlachanvit","doi":"10.5056/jnm22214","DOIUrl":"10.5056/jnm22214","url":null,"abstract":"<p><strong>Background/aims: </strong>An increase in postprandial intestinal gas plays a role in bloating symptoms. We aim to study the utility of spot breath hydrogen (H₂) level in predicting the response to a low fermentable oligo-, di-, mono-saccharides, and polyols (FODMAPs) diet.</p><p><strong>Methods: </strong>Patients with functional gastrointestinal disorders diagnosed by Rome IV criteria with bothersome bloating for > 6 months were prospectively enrolled. Patients completed 7-day food diaries and collected a breath sample 2 hours after their usual lunch at baseline and 4 weeks after low FODMAPs dietary advice by a dietitian. The responder was defined as an improvement of ≥ 30% bloating scores in the fourth week.</p><p><strong>Results: </strong>Thirty-eight patients (32 female, 52.6 ± 13.8 years; 22 irritable bowel syndrome) completed the study. Twenty-one patients (55%) were classified as responders. Baseline global gastrointestinal symptoms, bloating, abdominal pain scores, and numbers of high FODMAPs items were similar between responders and non-responders. Both groups significantly decreased high FODMAPs items intake with similar numbers at the follow-up. The area under the curve for predicting low FODMAPs responsiveness using baseline H₂ levels was 0.692 (95%CI, 0.51-0.86; <i>P</i> < 0.05), with the best cutoff at 8 parts per million (sensitivity 66.7%, specificity 82.4%). 66% of responders had baseline H₂ level > 8 parts per million vs 17% of non-responders (<i>P</i> < 0.05). The baseline spot hydrogen level in responders was 9.5 (3.3-17.3) vs 4.5 (3.3-6.3) in non-responders (<i>P</i> < 0.05).</p><p><strong>Conclusions: </strong>A higher baseline breath hydrogen level was associated with bloating improvement after low FODMAPs dietary advice. A spot breath test after lunch, a simple point-of-care test, is possibly helpful in managing patients with bloating.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10577458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41182869","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 Curcumin on the Gut-Brain Axis: Therapeutic Implications.","authors":"Ayesheh Enayati,&nbsp;Aida Soghi,&nbsp;Alexandra E Butler,&nbsp;Manfredi Rizzo,&nbsp;Amirhossein Sahebkar","doi":"10.5056/jnm23065","DOIUrl":"10.5056/jnm23065","url":null,"abstract":"<p><p>The gut-brain axis describes the bidirectional communication between the gut, the enteric nervous system, and the central nervous system. The gut-brain axis has attracted increasing attention owing to its regulatory effect on dysbiosis and a wide range of related diseases. Several types of nutrients, such as curcumin, have been proposed as regulators of the dysbiotic state, and preclinical experiments have suggested that curcumin is not only beneficial but also safe. This review focuses on the interplay between curcumin and the gut microbiota. Moreover, it provides a comprehensive review of the crosstalk between the gut-brain axis and disease, whilst also discussing curcumin-mediated gut-brain axis-dependent and -independent signaling about modulation of gut microbiota dysbiosis. This will help to define the utility of curcumin as a novel therapeutic agent to regulate intestinal microflora dysbiosis.</p>","PeriodicalId":16543,"journal":{"name":"Journal of Neurogastroenterology and Motility","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10577457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41182871","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":"Extended Wireless pH Monitoring Significantly Increases Gastroesophageal Reflux Disease Diagnoses in Patients With a Normal pH Impedance Study.","authors":"Sebastian S Zeki,&nbsp;Ismail Miah,&nbsp;Pierfrancesco Visaggi,&nbsp;Anna Wolak,&nbsp;Minerva deSilva,&nbsp;Jason M Dunn,&nbsp;Andrew Davies,&nbsp;James Gossage,&nbsp;Abrie Botha,&nbsp;Guiping Sui,&nbsp;Jafar Jafari,&nbsp;Terry Wong","doi":"10.5056/jnm22130","DOIUrl":"https://doi.org/10.5056/jnm22130","url":null,"abstract":"<p><strong>Background/aims: </strong>Extended wireless pH monitoring (WPM) is used to investigate gastroesophageal reflux disease (GERD) as subsequent or alternative investigation to 24-hour catheter-based studies. However, false negative catheter studies may occur in patients with intermittent reflux or due to catheter-induced discomfort or altered behavior. We aim to investigate the diagnostic yield of WPM after a negative 24-hour multichannel intraluminal impedance pH (MII-pH) monitoring study and to determine predictors of GERD on WPM given a negative MII-pH.</p><p><strong>Methods: </strong>Consecutive adult patients (> 18 years) who underwent WPM for further investigation of suspected GERD following a negative 24-hour MII-pH and upper endoscopy between January 2010 and December 2019 were retrospectively included. Clinical data, endoscopy, MII-pH, and WPM results were retrieved. Fisher's exact test, Wilcoxon rank sum test, or Student's t test were used to compare data. Logistic regression analysis was used to investigate predictors of positive WMP.</p><p><strong>Results: </strong>One hundred and eighty-one consecutive patients underwent WPM following a negative MII-pH study. On average and worst day analysis, 33.7% (61/181) and 34.2% (62/181) of the patients negative for GERD on MII-pH were given a diagnosis of GERD following WPM, respectively. On a stepwise multiple logistic regression analysis, the basal respiratory minimum pressure of the lower esophageal sphincter was a significant predictor of GERD with OR = 0.95 (0.90-1.00, <i>P</i> = 0.041).</p><p><strong>Conclusions: </strong>WPM increases GERD diagnostic yield in patients with a negative MII-pH selected for further testing based on clinical suspicion. Further studies are needed to assess the role of WPM as a first line investigation in patients with GERD symptoms.</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/a9/16/jnm-29-3-335.PMC10334198.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9892343","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":"Gastroesophageal Reflux Characteristics in Supragastric Belching Patients With Positive Versus Negative pH Monitoring: An Evidence of Secondary Gastroesophageal Reflux Disease From Excessive Belching.","authors":"Suriya Keeratichananont,&nbsp;Tanisa Patcharatrakul,&nbsp;Sutep Gonlachanvit","doi":"10.5056/jnm22198","DOIUrl":"https://doi.org/10.5056/jnm22198","url":null,"abstract":"<p><strong>Background/aims: </strong>A high prevalence of GERD has been reported in patients with supragastric belching. We aim to evaluate reflux characteristics and explore the temporal relationship between supragastric belches (SGBs) and reflux episodes in GERD patients with excessive belching.</p><p><strong>Methods: </strong>Twenty-four hour esophageal pH-impedance monitoring was analyzed. Reflux episodes were classified into: refluxes preceded by SGBs, followed by SGBs, and lone refluxes. Reflux characteristics were compared between patients with pH-positive (pH+) and pH-negative(pH-).</p><p><strong>Results: </strong>Forty-six patients (34 Female, age 47 ± 13 years) were included. Fifteen patients (32.6%) had pH+. Almost half (48.1 ± 21.0%) of refluxes were preceded by SGBs. The number of SGBs significantly correlated with the number of reflux episodes preceded by SGBs (<i>r</i> = 0.43, <i>P</i> < 0.05) and % time pH < 4 at the distal esophagus (<i>r</i> = 0.41, <i>P</i> < 0.05). Patients with pH+ had significantly more SGBs and reflux episodes preceded by SGBs/day than pH- patients (<i>P</i> < 0.05). The difference in the number of refluxes between pH+ and pH- patients was caused by reflux episodes preceded by SGBs, but not lone refluxes and refluxes followed by SGBs. The proportion of SGBs followed by reflux/total SGBs was similar between patients with pH+ and pH- (<i>P</i> > 0.05). Reflux episodes preceded by SGBs and followed by SGBs extended more proximal and had longer bolus and acid contact time than lone refluxes (<i>P</i> < 0.05).</p><p><strong>Conclusions: </strong>In patients with GERD and SGB, the number of SGBs positively correlates with the number of reflux episodes preceded by SGBs. Identifying and managing SGB may be beneficial and more likely to improve 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/39/63/jnm-29-3-343.PMC10334197.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9892347","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 <i>Helicobacter pylori</i> Eradication on Body Weight: A Multicenter Propensity Score-matched Analysis in Korea.","authors":"Jong Wook Kim,&nbsp;Myong Ki Baeg,&nbsp;Chang Seok Bang,&nbsp;Jong-Kyu Park,&nbsp;Jung-Hwan Oh,&nbsp;The Diet","doi":"10.5056/jnm22179","DOIUrl":"https://doi.org/10.5056/jnm22179","url":null,"abstract":"<p><strong>Background/aims: </strong>There is growing interest in whether <i>Helicobacter pylori</i> eradication (HPE) can affect body weight.</p><p><strong>Methods: </strong>Data from 5 universities between January 2013 and December 2019 were analyzed retrospectively. <i>H. pylori</i>-positive subjects who had body weight measurements taken at least twice at intervals of 3 months or longer were included. Using propensity score (PS)-matched data, changes in body mass index (BMI) and the lipid profile after HPE were compared with the non-HPE group.</p><p><strong>Results: </strong>Among 363 eligible patients, 131 HPE patients were PS-matched to 131 non-HPE patients. The median intervals between the measurements were 610 (range, 154-1250) days and 606 (range, 154-1648) days in the HPE and non-HPE groups, respectively. In both groups, the mean BMI increased (from 24.5 kg/m² to 24.7 kg/m² in the HPE group, and from 24.4 kg/m² to 24.5 kg/m² in the non-HPE group). The 2 groups did not show significantly different changes (<i>P</i> = 0.921). In the lowest baseline BMI quartile, the BMI increased after HPE by 1.23 (standard deviation [SD], 3.72) kg/m² (<i>P</i> = 0.060), and the non-HPE group showed a decreased BMI at the time of follow-up (by -0.24 [SD, 5.25] kg/m²; <i>P</i> = 0.937) (between-group <i>P</i> = 0.214). Triglyceride levels increased after HPE (mean: 135 [SD, 78] to 153 [SD, 100] mg/dL; between-group <i>P</i> = 0.053).</p><p><strong>Conclusion: </strong>The overall BMI change was not significantly different between the HPE and non-HPE groups, but patients with low BMI showed a tendency to gain weight after HPE. Triglyceride levels increased after HPE with marginal significance.</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/fc/jnm-29-3-352.PMC10334196.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9892349","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 Use of Intraoperative Esophageal Functional Luminal Imaging Probe for Prediction of Therapeutic Outcomes in Achalasia Patients.","authors":"Meng Xia,&nbsp;Yu-Lin Chen,&nbsp;Jianlin Lv","doi":"10.5056/jnm23007","DOIUrl":"https://doi.org/10.5056/jnm23007","url":null,"abstract":"c 2023 The Korean Society of Neurogastroenterology and Motility J Neurogastroenterol Motil, Vol. 29 No. 3 July, 2023 www.jnmjournal.org TO THE EDITOR: With great interest, we read the article of Hsing et al The authors assessed correlation of the diagnostic parameters of functional luminal imaging probe (FLIP) panometry and high-resolution manometry and Eckardt scores. Those parameters were compared before and after peroral endoscopic myotomy (POEM), and those changes were differentially revealed that the patients who showed repetitive antegrade contraction (RAC) and/or diagnosed as achalasia II before POEM were most likely resulted in presence of contractility (POC), a normal contractile response to sustained esophageal distension. A total of 68 achalasia patients underwent POEM were monitored upon measurements as shown in Table 1. Pre-POEM, those patients had similarities in Eckardt score and FLIP motility esophagogastric junction–distensibility index (EGJ-DI) compared in 3 subtypes of achalasia; post-POEM in follow-up 36 patients, Eckardt score was overall achieved < 3 (P < 0.01), integrated relaxation pressure was decreased to < 15 mmHg (P < 0.01) and EGJ-DI > 8 (P < 0.01). Authors obtained a good efficacy of POEM in consistent to other studies. However, all of those cannot be for prediction in correlative to POEM efficacy. Thus, Hsing et al suggested that the POC is one of critical indexes reflecting a good restoration of motility function of lower esophagus sphincter, which was seen in 8%, 67%, and 25% respectively from type-I, -II, and -III achalasia after POEM, ie, there is a better expectation from POEM in achalasia subtype II than I or III. Furthermore, the POC was absolutely not seen when RAC(–), and all other important parameters indicating improvement changes do not correlate to POC as shown in Table","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/65/1e/jnm-29-3-400.PMC10334195.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10269008","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":"Do Proton Pump Inhibitor-refractory Laryngeal Symptoms Represent a True Acid-related Disease?","authors":"Kwon-Eui Hong,&nbsp;Cheal Wung Huh","doi":"10.5056/jnm23074","DOIUrl":"https://doi.org/10.5056/jnm23074","url":null,"abstract":"c 2023 The Korean Society of Neurogastroenterology and Motility J Neurogastroenterol Motil, Vol. 29 No. 3 July, 2023 www.jnmjournal.org Gastroesophageal reflux disease (GERD) is a condition characterized by regurgitation of stomach contents into the esophagus or mouth, leading to troublesome symptoms or complications. Globally, the overall burden of GERD has continued to worsen. The number of prevalent cases increased by 77.53% from 441.57 million in 1990 to 783.95 million in 2019. A systematic review conducted in Asia in 2011 revealed an increasing prevalence of symptom-based GERD in Eastern Asia: 2.5-4.8% before 2005 and 5.2-8.5% between 2005 and 2010. Moreover, this study found that extraesophageal symptoms were more common in patients with GERD than in healthy individuals. Laryngopharyngeal reflux (LPR) is an extraesophageal manifestation of GERD. It refers to the reflux of gastric contents into the larynx, causing symptoms such as throat clearing, hoarseness, pain, globus sensation, coughing, excessive mucus in the throat, and dysphonia. However, no gold standard currently exists for the diagnosis and treatment of LPR, which presents a challenge to health-care systems. In a study published in this issue, Tseng et al focused on examining the physiological and clinical characteristics of patients who experienced laryngeal symptoms despite receiving empirical proton pump inhibitor (PPI) therapy for an adequate duration. The authors not only investigated typical reflux symptoms but also considered comorbidities such as sleep disturbances and other psychological problems. According to several studies about the correlation between LPR and anxiety, depressive disorders, or insomnia, PPI-unresponsive laryngeal symptoms may be associated with psychological factors and sleep disturbances. In a study conducted in South Korea in 2022, the association between LPR and insomnia was investigated using multiple intraluminal impedance-pH (MIIpH) monitoring and a questionnaire survey (Insomnia Severity Index questionnaire). The results of that study are consistent with the findings of the current study. Tseng et al used various multidisciplinary assessment tools, including the 5-item Brief Symptom Rating Scale and the Pittsburgh Sleep Quality Index, to obtain objective information from patients and healthy asymptomatic individuals. However, it is difficult to generalize the study results because of the single-center design and lack of a cause-effect relationship. Moreover, a concern exists that endoscopy and MII-pH monitoring may not be adequate for evaluating patients with extraesophageal symptoms suggestive of LPR, as indicated in a previous study. LPR remains a challenging issue in clinical practice because JNM J Neurogastroenterol Motil, Vol. 29 No. 3 July, 2023 pISSN: 2093-0879 eISSN: 2093-0887 https://doi.org/10.5056/jnm23074 Editorial Journal of Neurogastroenterology and Motility","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/1e/0e/jnm-29-3-267.PMC10334205.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9892346","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}