Neurogastroenterology and Motility最新文献

{"title":"Role of prokinetics in ineffective esophageal motility: A call for broader consideration and future innovations.","authors":"Andrea Pasta, Francesco Calabrese, Edoardo Vincenzo Savarino, Edoardo Giovanni Giannini, Elisa Marabotto","doi":"10.1111/nmo.14961","DOIUrl":"10.1111/nmo.14961","url":null,"abstract":"","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":" ","pages":"e14961"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576567","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":"Authors' Reply to Letter-Role of Prokinetics in Ineffective Esophageal Motility: A Call for Broader Consideration and Future Innovations.","authors":"Amrit K Kamboj, David A Katzka, Marcelo F Vela, Rena Yadlapati, Karthik Ravi","doi":"10.1111/nmo.14964","DOIUrl":"10.1111/nmo.14964","url":null,"abstract":"","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":" ","pages":"e14964"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624769","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":"Symptom Patterns in Adults With Cyclic Vomiting Syndrome: A 6-Month Prospective Observational Study.","authors":"Yaozhu J Chen, Danielle Rodriguez, Camilla A Richmond, William L Hasler, David J Levinthal, B U K Li, Ioannis Petrakis, Karin S Coyne, Melody Wu, Jan Tack, Thangam Venkatesan","doi":"10.1111/nmo.14974","DOIUrl":"10.1111/nmo.14974","url":null,"abstract":"<p><strong>Background: </strong>Data are limited on the natural history and symptom patterns of cyclic vomiting syndrome (CVS), a disorder of gut-brain interaction characterized by recurrent stereotypical vomiting, retching, and nausea episodes.</p><p><strong>Methods: </strong>A 6-month, observational, remote study prospectively assessed symptom patterns in adults with CVS using an electronic daily diary. Patients recorded their disease experience, including CVS symptoms and associated severity, in the daily diary. The study defined a CVS episode start as the first day of 5 or more vomiting and/or retching (V + R) events. Episode end was defined as the first day of ≥ 7 (prespecified main analysis) or ≥ 4 (sensitivity analysis) days without any diary V + R events.</p><p><strong>Key results: </strong>Eighty-eight of 93 (94.6%) enrolled patients (62 female; mean age, 37.7 years) had daily diary data recorded during the study; 61 (69.3%) patients had at least one episode. In the prespecified main analysis, 191 episodes (median, 0.6 per 30 diary days) were reported (median duration, 3.0 days); 17.8% of the episodes lasted > 10 days. In the sensitivity analysis, 248 episodes (median, 0.7 per 30 diary days) were reported (median duration, 2.0 days). Thirteen of 88 (14.8%) patients with diary data had interepisodic V + R (reported V + R events without meeting the threshold for study-defined episode). Other CVS-related (non-V + R) symptoms (most frequently nausea, abdominal pain, and sweating) were reported more frequently during the episode versus the interepisodic period.</p><p><strong>Conclusions and inferences: </strong>This prospective longitudinal study shows marked heterogeneity of CVS episodes and highlights the need to better define and characterize episodes in these patients.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":" ","pages":"e14974"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907440","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":"Splenectomy prevents brain orexin, ghrelin, or oxytocin but not GLP-1-induced improvement of intestinal barrier function in rats.","authors":"Takuya Funayama, Tsukasa Nozu, Masatomo Ishioh, Sho Igarashi, Hiroki Tanaka, Chihiro Sumi, Takeshi Saito, Yasumichi Toki, Mayumi Hatayama, Masayo Yamamoto, Motohiro Shindo, Shuichiro Takahashi, Toshikatsu Okumura","doi":"10.1111/nmo.14949","DOIUrl":"10.1111/nmo.14949","url":null,"abstract":"<p><strong>Background: </strong>Accumulating evidence has suggested that neuropeptides such as orexin, ghrelin, or oxytocin act centrally in the brain to regulate intestinal barrier function through the vagus nerve. It has been reported that the vagal cholinergic anti-inflammatory pathway was blocked by splenectomy. In the present study, we therefore examined the effect of splenectomy on neuropeptides-induced improvement of increased intestinal permeability.</p><p><strong>Methods: </strong>Colonic permeability was determined in vivo by quantifying the absorbed Evans blue in colonic tissue for 15 min spectrophotometrically in rats.</p><p><strong>Results: </strong>Splenectomy increased colonic permeability. The increased permeability by splenectomy was significantly blocked by vagal activation induced by carbachol or 2-deoxy-d-glucose which was prevented by atropine, suggesting vagal activation could prevent colonic hyperpermeability in splenectomized rats. In the splenectomized rats, intracisternal injection of orexin, ghrelin, oxytocin, or butyrate failed to inhibit increased colonic permeability while intracisternal glucagon-like peptide-1 (GLP-1) analogue, liraglutide, potently blocked the increased colonic permeability in a dose-dependent manner. The liraglutide-induced improvement of increased colonic permeability was blocked by atropine in splenectomized rats. Intracisternal injection of GLP-1 receptor antagonist attenuated 2-deoxy-d-glucose-induced improvement of colonic hyperpermeability in splenectomized rats.</p><p><strong>Conclusion: </strong>The present results suggested that the spleen is important in the improvement of intestinal barrier function by brain orexin, ghrelin or oxytocin, and butyrate. On the other hand, GLP-1 acts centrally in the brain to improve colonic hyperpermeability in a spleen-independent manner. All these results suggest that dual mechanisms (spleen dependent or independent) may exist for the brain-gut regulation in intestinal barrier function.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":" ","pages":"e14949"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504791","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":"Evaluation of a Novel Smart Capsule Bacterial Detection System Device for Diagnosis of Small Intestinal Bacterial Overgrowth.","authors":"Shaoying Nikki Lee, Pejman Rahimian, Cheryl Stork, Baharak Moshiree, Mitchell Jones, Emil Chuang, Chris Wahl, Sharat Singh, Satish S C Rao","doi":"10.1111/nmo.14965","DOIUrl":"10.1111/nmo.14965","url":null,"abstract":"<p><strong>Background: </strong>There is a large unmet need for alternative, non-invasive, and accurate diagnosis of small intestinal bacterial overgrowth (SIBO). The smart capsule bacterial detection system (SCBDS) device contains a targeted sampling technology and an onboard SCBDS assay to detect metabolically active bacteria in the small intestine. Here, we evaluated the agreement of SCBDS assay with duodenal aspiration/culture ex vivo in a multicenter clinical study.</p><p><strong>Methods: </strong>Duodenal aspiration was performed in subjects with gastrointestinal symptoms suggestive of SIBO. Aspirated fluid was sent to local and central microbiology labs to evaluate the agreement for detecting bacteria with SCBDS assay compared to the total bacterial count (TBC) reference standard. The performance of SCBDS assay was evaluated using a receiver operator curve, sensitivities, and specificities.</p><p><strong>Key results: </strong>Aspirates from 66 patients were collected and analyzed for TBC and SCDBS assay. The overall agreement between the two assays was 82%-92% across 3 clinical sites. The SCBDS assay had a sensitivity of 67%-100% and a specificity of 90%-97% using either ≥ 10³ or 10⁵ CFU mL^-1 cutoff. Additionally, there was a good correlation (r = 0.82) for the TBC culture between the local and central labs.</p><p><strong>Conclusions and inferences: </strong>The SCBDS assay showed a high level of agreement with TBC and improved performance compared to other non-invasive tests. These results demonstrate the potential utility of SCBDS device to aid SIBO diagnosis as a simple and non-invasive tool that merits further clinical validation.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":" ","pages":"e14965"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716273","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":"A Software Framework for the Functional Lumen Imaging Probe-Mechanics (MechView).","authors":"Sourav Halder, Wenjun Kou, Eric Goudie, Peter J Kahrilas, Neelesh A Patankar, Dustin A Carlson, John E Pandolfino","doi":"10.1111/nmo.14981","DOIUrl":"10.1111/nmo.14981","url":null,"abstract":"<p><strong>Background: </strong>The functional lumen imaging probe (FLIP) has proven to be a versatile device for diagnosing esophageal motility disorders and estimating esophageal wall compliance, but there is a lack of viable software for quantitative assessment of FLIP measurements.</p><p><strong>Methods: </strong>A Python-based web framework was developed for a unified assessment of FLIP measurements including clinical metrics such as esophagogastric junction (EGJ) distensibility index (DI), maximum EGJ opening diameter, mechanics-based metrics for estimating strength, and effectiveness of contractions, such as contraction power and displaced volume, and machine learning-based clustering and predictive algorithms such as the virtual disease landscape (VDL) and EGJ obstruction probability. The clinical and VDL probability metrics were then validated using FLIP data from 121 subjects constituting different categories of EGJ opening which were diagnosed by expert clinicians.</p><p><strong>Results: </strong>The clinical metrics estimated by the framework matched the manual diagnosis of the clinicians. Misclassifications were minimal and were mostly between neighboring groups, that is, normal and borderline normal or borderline normal and borderline reduced EGJ opening. Similar results were also obtained for the VDL probability metrics. The misclassifications were further analyzed by clinicians and approved.</p><p><strong>Conclusion: </strong>The FLIP web framework was developed and validated to reliably estimate various clinical, mechanical, and machine learning-based metrics for diagnosing esophageal motility disorders.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":" ","pages":"e14981"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824370","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":"Dumping syndrome: Update on pathophysiology, diagnosis, and management.","authors":"Jan Tack, Karlien Raymenants, Cedric Van de Bruaene, Emidio Scarpellini","doi":"10.1111/nmo.14962","DOIUrl":"10.1111/nmo.14962","url":null,"abstract":"<p><strong>Background: </strong>Dumping syndrome is a complex of gastrointestinal symptoms originally studied in peptic ulcer surgery patients. At present, it is most prevalent in patients who underwent bariatric, upper gastrointestinal cancer or anti-reflux surgery. The symptom pattern comprises early and late dumping symptoms. Several management options have been reported including nutritional, pharmacological and surgical approaches.</p><p><strong>Aims and methods: </strong>In this study, we aimed to review the current evidence on dumping syndrome definition, diagnosis and treatment, including preliminary data from newer pharmacological studies.</p><p><strong>Results: </strong>Current pathophysiological concepts and analyses of provocative tests has led to a clear definition of dumping syndrome, including both early and late dumping symptoms. The term postbariatric hypoglycemia represents a limited focus on late dumping only. The diagnosis relies on recognition of symptoms and signs in a patient with appropriate surgical history; and can be confirmed by provocative testing or registration of spontaneous hypoglycemia. The initial treatment focuses on dietary intervention, to which meal viscosity enhancers and/or the glycosidase inhibitor acarbose can be added. The most effective therapy is the use of short- or long-acting somatostatin analogues, which is however expensive and entails side effect issues. In case of refractory hypoglycemia, diazoxide or SGLT2 inhibitors can be considered, based on limited evidence. In refractory patients, continuous enteral feeding or (rarely) surgical reinterventions have been advocated, although not supported by solid evidence. Therapies under current evaluation include the broad-spectrum somatostatin analogue pasireotide, GLP-1 receptor antagonists, GLP-1 receptor agonists and administration of stable forms of glucagon are currently under study.</p><p><strong>Conclusions: </strong>Dumping syndrome is a well-defined but probably under-diagnosed complication of upper gastrointestinal, especially bariatric, and surgeries. Diagnosis is confirmed by a provocative test and incremental therapies starting with diet, adding meal viscosity enhancers or glycosidase inhibitors and adding somatostatin analogues in refractory cases. A number of emerging therapies targeting intestinal propulsion, peptide hormone effects and hypoglycemic events are under evaluation.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":" ","pages":"e14962"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624776","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":"Mean Nocturnal Baseline Impedance May Be Greater Than 2500 Ohms in Chinese Patients With GERD.","authors":"Dongke Wang, Chaofan Duan, Xiaohao Zhang, Junying Xu, Xiaohua Hou, Xuelian Xiang","doi":"10.1111/nmo.14986","DOIUrl":"10.1111/nmo.14986","url":null,"abstract":"<p><strong>Background: </strong>According to the Lyon Consensus 2.0, mean nocturnal baseline impedance (MNBI) greater than 2500 Ω is considered evidence against gastroesophageal reflux disease (GERD). However, we have observed that a subset of GERD patients presents with MNBI exceeding 2500 Ω.</p><p><strong>Aims: </strong>To investigate MNBI characteristics in Chinese GERD patients, identify clinical features of those with normal MNBI, and examine factors influencing MNBI values.</p><p><strong>Methods: </strong>We retrospectively investigated 259 patients with typical reflux symptoms. Demographics, symptoms, proton pump inhibitor (PPI) response, esophageal motility parameters were compared between patients with different AET levels and MNBI levels.</p><p><strong>Results: </strong>Among the cohort, 38.2% had AET 4%-6%, and 37.5% had AET > 6%. Notably, 95.2% of patients with AET < 4%, 49.5% with AET 4%-6%, and 17.6% with AET > 6% had MNBI > 2500 Ω. Independent risk factors for MNBI > 2500 Ω included the number and duration of supine acid reflux and lower esophageal sphincter (LES) resting pressure. In GERD patients with heartburn, patients with MNBI ≤ 2500 Ω had higher PPI response than MNBI > 2500 Ω (81.1% vs. 55.6%, p = 0.009).</p><p><strong>Conclusions: </strong>Approximately one-third of Chinese GERD patients have an MNBI > 2500 Ω. The thresholds of MNBI for supporting or ruling out GERD in the Chinese population should be adjusted. MNBI values are independently predicted by the severity of supine acid reflux and the LES resting pressure. GERD patients with mild supine acid reflux may still exhibit normal MNBI levels. Patients with lower MNBI values tend to show better responses to PPI therapy.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":" ","pages":"e14986"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142910077","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":"Repetitive antegrade contractions on high-resolution manometry: A physiologic pattern related to sustained esophageal distention in Abelchia.","authors":"Dustin A Carlson, Peter J Kahrilas, John E Pandolfino","doi":"10.1111/nmo.14934","DOIUrl":"10.1111/nmo.14934","url":null,"abstract":"","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":" ","pages":"e14934"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11750596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142350783","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":"Perceptions and Practices of Primary Care Providers in Europe and the US in the Diagnosis and Treatment of Irritable Bowel Syndrome: A Multinational Survey.","authors":"Joel J Heidelbaugh, A Pali Hungin, Olafur S Palsson, Foteini Anastasiou, Lars Agreus, Pierluigi Fracasso, Heidi-Ingrid Maaroos, Jalena Rakik Matic, Juan M Mendive, Bohumil Seifert, Douglas A Drossman","doi":"10.1111/nmo.14967","DOIUrl":"10.1111/nmo.14967","url":null,"abstract":"<p><strong>Background: </strong>The knowledge and proficiency of primary care practitioners (PCPs) in diagnosing and managing irritable bowel syndrome (IBS) remain generally low and variable internationally. This variability is partly due to a lack of familiarity with the Rome Foundation diagnostic criteria and treatment guidelines for this condition.</p><p><strong>Methods: </strong>We conducted an electronic survey of PCPs in the United States and nine European countries to assess their understanding of IBS pathophysiology; the use of Rome IV criteria in diagnosis, knowledge of and frequency in prescribing various recommended treatments; and the likelihood of referring patients with suspected IBS to subspecialists.</p><p><strong>Results: </strong>Most PCPs in the United States and Europe perceive IBS as a diagnosis of exclusion rather than a definitive diagnosis. They also believe IBS is underdiagnosed in primary care and challenging to diagnose confidently. The majority of PCPs consider diet as a crucial component of IBS management. Notably, US PCPs reported greater confidence than their European counterparts in recommending dietary interventions such as increased dietary fiber, a low FODMAP diet, and gluten restriction. Conversely, both groups exhibited moderate to high confidence in recommending over-the-counter treatments. European PCPs showed greater confidence in treating IBS with antispasmodics and secretagogues, while US PCPs expressed greater confidence in prescribing neuromodulators. Additionally, US PCPs were more likely to refer patients with suspected IBS to a gastroenterologist, whereas both US and European PCPs showed similar referral patterns to dietitians and referred very few patients to mental health providers. Both US and European PCPs reported that IBS is moderately to extremely difficult to treat effectively and emphasized the importance of a strong and longitudinal doctor-patient relationship in managing the condition.</p><p><strong>Conclusion: </strong>Despite the Rome Foundation recommendations and criteria to support a positive diagnosis of IBS, most PCPs still rely on exclusionary investigations such as endoscopy and a serologic workup, while a significant percentage suggest referring patients to gastroenterologists.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":" ","pages":"e14967"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682462","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}