Neurogastroenterology and Motility最新文献

{"title":"Proopiomelanocortin (POMC)-β-Endorphin System in the Rat Colon: Expression, Up Regulation by Stress, and Correlation With Stress-Induced Visceral Analgesia.","authors":"Pu-Qing Yuan, Muriel Larauche, Vincent Wu, Yvette Taché","doi":"10.1111/nmo.70451","DOIUrl":"10.1111/nmo.70451","url":null,"abstract":"<p><strong>Background: </strong>The pituitary proopiomelanocortin (POMC)-β-endorphin (β-END) system is activated by hypothalamic corticotropin-releasing factor (CRF) signaling and stress. We investigated whether this pathway is also expressed in the rat colon, regulated by peripheral CRF and stress, and correlated with stress-induced visceral analgesia.</p><p><strong>Methods: </strong>POMC and the prohormone convertases PC1/3 and PC2 transcripts were assessed by RT-PCR, and POMC and β-END localization was examined by immunohistochemistry in the proximal and distal colon of naïve adult male Sprague-Dawley rats. Proximal colonic POMC mRNA was quantified by real-time quantitative PCR 1 h after intraperitoneal injection of CRF (10 μg/kg) or saline and on day 11 after assessing visceromotor responses (VMRs) to colorectal distension (CRD) using a non-invasive method in rats subjected to repeated water avoidance stress (rWAS) (1 h/day for 10 days) or control handling. The correlation between POMC gene expression and VMRs was evaluated.</p><p><strong>Results: </strong>POMC, PC1/3, and PC2 transcripts were detected in the proximal and distal colon. POMC- and β-END-immunoreactive cells are localized in the lamina propria and enteric plexuses. CRF increased POMC mRNA expression by 2.5-fold. rWAS decreased VMRs to CRD in a pressure-dependent manner, with a reduction of up to 52% at 60 mmHg, and increased POMC expression 10-fold compared with controls; POMC expression was inversely correlated with cumulative VMRs (r = -0.655, p = 0.034).</p><p><strong>Conclusions: </strong>POMC-β-END system expression in the rat colonic enteric plexus, together with CRF/stress-induced upregulation of POMC and its correlation with analgesic responses to CRD, suggests a possible relevance in modulating visceral pain.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":"38 10","pages":"e70451"},"PeriodicalIF":3.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112629","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":"PTSD Is Associated With Severity of Upper GI Symptoms in Patients With Gastroparesis.","authors":"Madison Simons, Elise Hokr, Jack Loesch, Sarah Kim, Samita Garg, Valentin Mocanu, Andrew Grubic, Matthew Allemang, Anthony Lembo","doi":"10.1111/nmo.70449","DOIUrl":"https://doi.org/10.1111/nmo.70449","url":null,"abstract":"<p><strong>Background: </strong>Posttraumatic stress disorder may contribute to chronic overactivation of the sympathetic nervous system and exacerbate GI symptoms. The purpose of this study was to evaluate the impacts of PTSD on GI symptom severity and psychological functioning in patients with gastroparesis.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of gastroparesis patients at a tertiary care center. Patients completed questionnaires at the initial evaluation. Objective markers of gastric function were extracted from the medical record. Patients were determined to have probable PTSD based on a total score greater than 33 on the Patient Checklist for DSM-5 (PCL-5).</p><p><strong>Key results: </strong>Of the 207 patients with gastroparesis included in the final analysis (mean age = 45.5 years, 93% female, 93% White), 128 (61.8%) endorsed having ever experienced a traumatic event and 58 (28%) screened positive for PTSD. There were no significant differences in severity of gastric delay (p = 0.2) or impaired gastric accommodation (p = 0.48) between those with and without PTSD, but those with PTSD had reduced myoelectric activity on electrogastrography (p = 0.01). Patients with PTSD reported worse symptoms on most outcomes measured, including GI symptom severity. Regression analysis demonstrated age, anorectal dysfunction, and depression/anxiety to be the strongest predictors of PTSD severity.</p><p><strong>Conclusion and inferences: </strong>PTSD was not associated with greater delay in gastric emptying or impairments in gastric accommodation but was associated with more severe symptoms and psychosocial impairment. Further exploration should assess the effects of undergoing trauma-focused therapy in improving symptoms.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":"38 10","pages":"e70449"},"PeriodicalIF":3.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to the Letter to the Editor: Phenotyping Esophageal Motor Dysfunction in Eosinophilic Esophagitis.","authors":"Mentore Ribolsi, Elisa Marabotto, Nicola De Bortoli, Pierfrancesco Visaggi, Michele Cicala, Edoardo Vincenzo Savarino","doi":"10.1111/nmo.70461","DOIUrl":"https://doi.org/10.1111/nmo.70461","url":null,"abstract":"","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":"38 10","pages":"e70461"},"PeriodicalIF":3.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Value of the Anal Endoluminal Functional Luminal Imaging Probe for the Diagnosis of Anismus: An Exploratory Study.","authors":"Charlotte Desprez, Thomas Duflot, Chloé Melchior, Guillaume Gourcerol, Ali Zifan, Estelle Houivet, Céline Savoye-Collet, Anne-Marie Leroi","doi":"10.1111/nmo.70452","DOIUrl":"https://doi.org/10.1111/nmo.70452","url":null,"abstract":"<p><strong>Background and aims: </strong>The aim of this exploratory study was to evaluate the performance of the anal EndoFLIP in diagnosing anismus in patients with functional constipation and suspected to have a dyssynergic defecation based on a composite reference standard (anorectal manometry, surface electromyography, and defecography).</p><p><strong>Methods: </strong>Patients underwent anorectal manometry, surface electromyography, and defecography. At least two of the three tests needed to be positive to diagnose anismus. Anal EndoFLIP was performed during push maneuvers at 40 and 50 mL of distension, and pressure-cross-sectional-area (CSA) loops were built for each push maneuver to identify parameters that could best predict a diagnosis of anismus (ROC curve analysis). Two-variable CSA-pressure classifiers were evaluated using nested repeated five-fold cross-validation.</p><p><strong>Results: </strong>Diagnosis of anismus using the composite reference standard was made in 29/57 patients (50.8%). An analysis of CSA-pressure loops indicated that, at 40 mL of distension, maximal absolute ΔCSA and maximal relative ΔCSA were lower compared to patients without anismus (p < 0.001). Among quantitative CSA indices, an exploratory threshold under 12.8 mm² for a maximal absolute ΔCSA at 40 mL provided the highest accuracy and AUC (0.81) and excellent specificity (0.93) for the diagnosis of anismus. Using nested repeated cross-validation, two-variable GLM and CART classifiers yielded mean out-of-sample AUCs of 0.767 and 0.764 at 40 mL and 0.754 and 0.658 at 50 mL, respectively.</p><p><strong>Conclusion: </strong>The results suggest that anal EndoFLIP may help distinguish patients with anismus from those without. Further external validation studies are needed to establish clinically applicable thresholds.</p><p><strong>Trial registration: </strong>Clinical.</p><p><strong>Trials: </strong>gov: NCT04155307.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":"38 10","pages":"e70452"},"PeriodicalIF":3.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13631694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112647","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":"Gastroparesis Phenotyping: Current Methods and Emerging Opportunities With Magnetic Resonance Imaging.","authors":"Xiaokai Wang, Michael Camilleri, Zhongming Liu","doi":"10.1111/nmo.70454","DOIUrl":"10.1111/nmo.70454","url":null,"abstract":"<p><strong>Background: </strong>Gastroparesis is a complex gastrointestinal motility disorder characterized by delayed gastric emptying. Its pathophysiology varies across patients, arising from impaired fundic tone, antral hypomotility, pylorospasm, antropyloroduodenal incoordination, or combinations thereof. Current clinical diagnostic tools provide only a fragmented assessment of gastric function and lack the comprehensive spatiotemporal details necessary to differentiate these pathophysiological phenotypes, limiting the ability to deliver personalized treatments.</p><p><strong>Purpose: </strong>To overcome this gap, we advocate for dynamic magnetic resonance imaging (MRI) as a non-invasive \"all-in-one\" diagnostic platform for simultaneous evaluation of gastric accommodation, regional wall kinematics, pyloric function, and overall emptying within a single exam following the oral ingestion of a natural-ingredient test meal. This integrated assessment offers a unique capability for gastroparesis phenotyping by characterizing how various types of regional motor dysfunction lead collectively to delayed gastric emptying in each patient. Quantifying MRI-derived phenotypes using a standardized surface scaffold of the gastric musculature creates a functional mapping framework to contrast patient-specific deviations against normative baselines established from healthy cohorts. The framework enables the integration of localized motor phenotypes with underlying structural knowledge for objective explanation of clinical symptoms and evidence-based, personalized treatments. Ultimately, establishing dynamic MRI as the emerging diagnostic standard promises to transform gastroparesis management from an empirical practice into a new era of precision gastroenterology.</p><p><strong>Summary: </strong>Gastroparesis is a disease condition characterized by delayed gastric emptying, which may arise from different underlying causes that existing tests cannot fully distinguish. We review recent advances in dynamic MRI of the upper gastrointestinal tract and demonstrate that dynamic MRI can simultaneously assess gastric emptying, fundic tone, antral and duodenal contractions, and pyloric opening, all in a single examination. We highlight its potential to identify patient-specific patterns of dysfunction and support more precise diagnosis and treatment.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":"38 10","pages":"e70454"},"PeriodicalIF":3.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128105","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":"Correction to \"Deciphering Gut Microbiome Dynamics in Irritable Bowel Syndrome Using Deep Learning\".","authors":"","doi":"10.1111/nmo.70445","DOIUrl":"https://doi.org/10.1111/nmo.70445","url":null,"abstract":"","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":"38 10","pages":"e70445"},"PeriodicalIF":3.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Accuracy of High-Resolution Manometry for Assessing Fundoplication Integrity: Validation of the Padova Classification.","authors":"Arianna Vittori, Giovanni Capovilla, Matteo Santangelo, Rena Yadlapati, C Prakash Gyawali, Edoardo Vincenzo Savarino, Luca Provenzano, Francesca Forattini, Matteo Pittacolo, Irene Sole Zuin, Giulia Nezi, Loredana Nicoletti, Michele Valmasoni, Renato Salvador","doi":"10.1111/nmo.70457","DOIUrl":"https://doi.org/10.1111/nmo.70457","url":null,"abstract":"<p><strong>Background: </strong>Recurrent symptoms after laparoscopic fundoplication (LF) are not fully understood, with ongoing research focusing on their mechanisms. This study aimed to validate the Padova Classification, a postoperative high-resolution manometry (HRM) framework to distinguish functioning from defective fundoplications.</p><p><strong>Methods: </strong>Prospectively collected data from consecutive patients who underwent post-LF HRM (2010-2025) were analyzed and categorized as functioning and effective LF (FELF), post-fundoplication outflow obstruction (PFOO), and ineffective neo-barrier (INB). Primary analysis involved between-group comparisons. Padova Classification diagnostic accuracy was evaluated against a composite reference standard (clinical, radiological, endoscopic, and pH-monitoring criteria) by calculating sensitivity, specificity, positive predictive value, and negative predictive value for each diagnostic category. Diagnostic performance of postoperative integrated relaxation pressure (IRP) for identifying PFOO was evaluated using receiver operating characteristic curve analysis.</p><p><strong>Key results: </strong>Among 373 patients (42.4% female; median age 54 years, median BMI 25.9 kg/m²; 55.2% Nissen, 44.8% Toupet), FELF, INB, and PFOO were observed in 58.7%, 21.4%, and 18.0% of patients, respectively, with PFOO most frequently seen with Nissen fundoplication (p = 0.001). The Padova Classification showed sensitivity/specificity 94.7%/97.1% for FELF, 88.8%/96.9% for INB, and 100%/97.4% for PFOO. Postoperative integrated relaxation pressure accurately discriminated PFOO (AUC 0.959-0.984; cutoff 18.1 mmHg; sensitivity 97.7%-98.0%, specificity 93.2%-96.8%), with no difference between ROC curves derived from Padova Classification and reference standard (p = 0.12).</p><p><strong>Conclusions: </strong>This study confirms that the Padova Classification demonstrates strong performance in assessing postoperative LF function.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":"38 10","pages":"e70457"},"PeriodicalIF":3.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13631549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112711","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":"Development and Validation of the Food Expectation Questionnaire (FEX-Q): An Image-Based Instrument to Assess Food-Related Perceptions and Symptom Expectations.","authors":"Ryo Katsumata, Stine Störsrud, Magnus Simrén, Sanna Nybacka","doi":"10.1111/nmo.70464","DOIUrl":"10.1111/nmo.70464","url":null,"abstract":"<p><strong>Background: </strong>Food-related gastrointestinal (GI) symptoms are highly prevalent in patients with IBS. Although dietary components may trigger symptoms through luminal mechanisms, cognitive expectations may also shape symptom perception within the gut-brain axis. No validated instrument exists to measure food-related symptom expectations. We developed and validated the Food Expectation Questionnaire (FEX-Q).</p><p><strong>Methods: </strong>The FEX-Q was developed using a stepwise process including patient input, face-to-face validation, and an online validation. The finalized questionnaire presents food images rated on six visual analogue scale items, with food-related GI symptom expectation as the core measure, alongside taste preference, willingness to eat, perceived healthiness, and perceived fat and carbohydrate content. Adults with IBS and non-IBS controls completed the FEX-Q together with validated questionnaires assessing GI symptoms, psychological distress, food-related quality of life, and food avoidance.</p><p><strong>Results: </strong>Face-to-face validation supported food recognition, item comprehension, and response processes, resulting in the final 44-image version. In the online survey including 134 patients with IBS and 126 non-IBS controls, the FEX-Q demonstrated known-groups validity with higher symptom expectation scores in IBS than in non-IBS controls (50.1 vs. 18.4). Validity of the nutrient-perception items was supported by correlations between perceived and calculated fat (r = 0.78) and carbohydrate content (r = 0.59). Convergent validity was demonstrated through significant associations with GI symptom severity (r = 0.42) and food-related quality of life (r = -0.39). Split-half reliability was high (r = 0.88).</p><p><strong>Conclusion: </strong>The FEX-Q is a promising instrument for assessing food-related symptom expectations and perceptions. It may facilitate future mechanistic research into food-related symptom generation and inform personalized dietary management in IBS.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":"38 10","pages":"e70464"},"PeriodicalIF":3.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171885","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":"Phenotyping Esophageal Motor Dysfunction in Eosinophilic Esophagitis.","authors":"Amir Mari","doi":"10.1111/nmo.70459","DOIUrl":"https://doi.org/10.1111/nmo.70459","url":null,"abstract":"","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":"38 10","pages":"e70459"},"PeriodicalIF":3.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical Assessment During High-Resolution Impedance Manometry Enhances Characterization of Inconclusive Esophagogastric Junction Outflow Obstruction.","authors":"Aidan D Smires, Wenjun Kou, John E Pandolfino, Panyavee Pitisuttithum, Eric Goudie, Muhammed M Alikhan, Neelesh A Patankar, Dustin A Carlson","doi":"10.1111/nmo.70450","DOIUrl":"10.1111/nmo.70450","url":null,"abstract":"<p><strong>Background: </strong>Esophagogastric junction outflow obstruction (EGJOO) identified on high-resolution manometry (HRM) remains a clinically heterogeneous and inconclusive finding. Additional complementary testing with functional lumen imaging probe (FLIP) or timed barium esophagram (TBE) is recommended to confirm clinically relevant obstruction. We aimed to assess the association of novel Four-Dimensional (4D) HRM metrics against FLIP and TBE outcomes among symptomatic patients with inconclusive EGJOO on HRM.</p><p><strong>Methods: </strong>Adult patients with inconclusive HRM-EGJOO who completed corresponding FLIP and TBE studies were identified for inclusion in a cross-sectional, retrospective study. Primary 4D HRM metrics of EGJ opening, EGJ distensibility index (4D EGJ-DI), and 4D maximum EGJ diameter were analyzed relative to reference outcomes defined by FLIP and esophagram.</p><p><strong>Results: </strong>Among 123 patients (mean age 59 years; 60% female), 4D EGJ-DI and 4D maximum EGJ diameter differed significantly across FLIP and TBE outcome categories (all p < 0.01). Lower 4D EGJ-DI and lower 4D maximum EGJ diameter were associated with reduced EGJ opening on FLIP and abnormal retention on esophagram. There were 0 patients with normal EGJ opening on FLIP that had 4D maximum EGJ diameter < 8.0 mm and 0 patients with reduced EGJ opening on FLIP that had a 4D EGJ-DI > 2.2 mm²/mmHg and 4D maximum EGJ diameter > 10.2 mm.</p><p><strong>Conclusions: </strong>By integrating biomechanical assessment of EGJ opening with conventional pressure metrics, 4D HRM provides complementary physiologic information for evaluating esophageal motor function. This additional information may improve characterization of patients with inconclusive EGJOO.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":"38 10","pages":"e70450"},"PeriodicalIF":3.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128057","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}