Neurogastroenterology and Motility最新文献

{"title":"Consensus on Safe Initiation and Monitoring of Transanal Irrigation to Optimize Adherence With Therapy.","authors":"Anton Emmanuel, Klaus Krogh, Brigitte Perrouin-Verbe, Andrei Krassiukov, Sacha Koch, Giovanni Mosiello, Gabriele Bazzocchi, Peter Christensen, Gianna Rodriguez, Concetta Brugaletta","doi":"10.1111/nmo.15011","DOIUrl":"https://doi.org/10.1111/nmo.15011","url":null,"abstract":"<p><strong>Background: </strong>Transanal irrigation is a well-established minimally invasive therapy that addresses symptoms of both constipation and incontinence. The therapy has been extended from just neurogenic bowel dysfunction patients to those with disorders of brain-gut interaction and postsurgical conditions.</p><p><strong>Aim: </strong>To summarized the literature on transanal irrigation and update the contraindication profile.</p><p><strong>Materials and methods: </strong>We undertook a literature review of transanal irrigation complications and outcomes.</p><p><strong>Results: </strong>Initiation of therapy as part of a bowel care regime is becoming more common outside specialist centers. In addition, the concept of both high- and low-volume irrigation schedules has entered the treatment paradigm, and it is clear that there is a differing safety profile. We present an update from the previous long list of contraindications.</p><p><strong>Discussion: </strong>We describe how optimizing long-term adherence depends on these factors in addition to a structured follow-up programme.</p><p><strong>Conclusion: </strong>Transanal irrigation is an increasingly used therapy, with a good safety profile, further improved by the advent of low-volume irrigation options. Key to safe and effective usage of transanal irrigation is careful patient selection allied to tailored initial training of the patient.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":" ","pages":"e15011"},"PeriodicalIF":3.5,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024156","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":"Effects of the Transcutaneous Electrical Stimulation System on Heartburn, Regurgitation and Esophageal Acid Exposure in GERD Patients-An Uncontrolled Feasibility Study.","authors":"Ram Dickman, Rita Brun, Sigal Levy, Yishai Ron, Tova Rainis, Timna Naftali, Maor Hazani-Pauker, Doron Boltin, Tsachi Tsadok Perets, Ronnie Fass, Rachel Gingold-Belfer","doi":"10.1111/nmo.15002","DOIUrl":"https://doi.org/10.1111/nmo.15002","url":null,"abstract":"<p><strong>Background: </strong>Proton pump inhibitors (PPI) for gastroesophageal reflux disease (GERD) are associated with a high failure rate. Our uncontrolled feasibility study aimed determining the effect of a transcutaneous electrical stimulation system (TESS) on GERD symptoms and acid exposure time (AET).</p><p><strong>Methods: </strong>Recruited patients with heartburn and regurgitation. During the first phase (one-week, run-in period, off-PPI's), patients completed symptom diaries and demographic questionnaires. Thereafter, all patients underwent gastroscopy with subsequent placement of a wireless esophageal pH capsule, off-PPI. Based on pH analysis in the first 24 h, only those with increased AET (percent total time pH < 4 above 6%) continued to the next phase. During that phase, patients were treated for up to 3 weeks with TESS and documented their symptoms. The Primary endpoint was the magnitude of reduction in GERD-related symptoms. The secondary endpoints were the magnitude of reduction of AET and DeMeester score, as compared with their baseline values.</p><p><strong>Results: </strong>Included 31 patients and of those, 26 patients (42% females, aged 49 ± 15 years, mean BMI 25 ± 3 kg/m²) completed the first two phases of the study. At baseline, mean number of daily heartburn and regurgitation episodes was 2.55 ± 1.79 and 1.40 ± 1.73, respectively. Following TESS, mean number of daily heartburn and regurgitation episodes dropped to 0.77 ± 0.75 and 0.36 ± 0.8, respectively (p < 0.001). At base line, mean AET and DeMeester score were 12.4 ± 5.6 and 32.1 ± 12.7, respectively. Following TESS mean AET dropped to 6.0 ± 3.5 and DeMeester score dropped to 16.2 ± 8.2 (p < 0.001).</p><p><strong>Conclusions: </strong>TESS is effective in reducing both symptoms and esophageal AET in GERD patients.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":" ","pages":"e15002"},"PeriodicalIF":3.5,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024159","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":"Effect of Thickened Fluids on Swallowing Function in Oropharyngeal Dysphagia: Impact of Shear Rheology and Disorder Subtype.","authors":"T Omari, A Ross, M Schar, J Campbell, A Thompson, L Besanko, D A Lewis, I Robinson, M Farahani, C Cock, B Mossel","doi":"10.1111/nmo.15003","DOIUrl":"https://doi.org/10.1111/nmo.15003","url":null,"abstract":"<p><strong>Introduction: </strong>Fluid thickeners used in the management of oropharyngeal dysphagia exhibit non-Newtonian shear-thinning rheology, impacting their viscosity during deglutition. This study investigated how the rheological properties of thickened fluids affect pharyngeal swallowing parameters in patients with oropharyngeal motor disorders diagnosed by pharyngeal high-resolution manometry impedance (P-HRM-I).</p><p><strong>Methods: </strong>Seventy-two patients (18-89 years) referred for P-HRM-I were diagnostically assessed with a 10 mL thin bolus. In 57 of the patients, 10 mL swallows of two moderately thick formulations-xanthan gum (XG) and sodium carboxymethylcellulose gum (CMC)-were also tested. The XG and CMC fluids had equivalent empirical thickness but different viscosity at pharyngeal phase shear rates: XG 87 mPa.s (83-91) versus CMC mean 157 mPa.s (148-164) at 300 s^-1. Standard metrics of pharyngeal and upper esophageal sphincter (UES) function were derived from P-HRM-I recordings and analyzed to characterize patients into one of four disorder subtypes: (i) No Disorder, (ii) UES Disorder, (iii) Pharyngeal Disorder, and (iv) Combination UES/Pharyngeal Disorder. Impedance recordings also assessed pharyngeal bolus transit.</p><p><strong>Results: </strong>Patients with a Combination UES/Pharyngeal Disorder were most likely to have abnormal bolus transit (82%, p < 0.001). Increasing bolus viscosity significantly influenced UES residual pressure, UES opening area, and post-swallow residue. Patients with UES Disorder exhibited pronounced increases in UES residual pressure with CMC compared to XG. Pharyngeal contractility was unaffected by viscosity changes. Post-swallow residue increased with CMC, particularly in patients with a Combination Disorder. Case-by-case analysis revealed individual variability in response to the different viscosities.</p><p><strong>Conclusion: </strong>The rheological properties of thickened fluids significantly affect swallowing function, with these effects dependent upon the disorder subtype.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":" ","pages":"e15003"},"PeriodicalIF":3.5,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008799","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":"Gastric Accommodation Testing Using Hybrid Nuclear Imaging Volumetry and Combined High-Resolution Manometry-Nutrient Drink Test: A Pilot Study in Healthy Individuals.","authors":"Nashrulhaq Tagiling, Yeong Yeh Lee, Mohd Fazrin Mohd Rohani, Muhamad Yusri Udin, Azliani Abdul Aziz, Siti Norhasliza Muhamad, Marianie Musarudin, Mohammad Khairul Azhar Abdul Razab, Nurul Ain Shafiqah Zainol, Phei Oon Tan, Norazlina Mat Nawi","doi":"10.1111/nmo.15006","DOIUrl":"https://doi.org/10.1111/nmo.15006","url":null,"abstract":"<p><strong>Background: </strong>Gastric accommodation (GA) testing is gaining clinical recognition as novel and minimally invasive modalities emerge. We investigated the feasibility of hybrid nuclear imaging volumetry (SPECT/CT) and combined high-resolution manometry-nutrient drink test (HRM-NDT) to assess GA.</p><p><strong>Methods: </strong>In this non-randomized pilot study, [^99mTc]NaTcO₄ gastric SPECT/CT (250 mL protocol) and proximal gastric HRM-NDT (~60 mL/min protocol) were performed separately within 30 days using Ensure Gold test meal (1.05 kcal/mL; Abbott). GA parameters were measured, and their preliminary associations were examined using Spearman's ρ and Hoeffding's D correlation tests. Data were presented as median ± normalized median absolute deviation.</p><p><strong>Key results: </strong>Twenty healthy, asymptomatic individuals (11 females; 23.5 ± 2.2 years, 23.7 ± 2.2 kg/m²) completed both procedures without serious adverse events and interrupted sessions. The accommodation volume and postprandial-to-fasting volume ratio from SPECT/CT were 325.8 ± 28.5 mL and 5.31 ± 1.28, respectively. During HRM-NDT, the nadir-intragastric pressure (IGP) was -6.6 ± 3.6 mmHg at an ingested volume of 360.0 ± 177.9 mL, and the area-under-curve of IGP was -1566.0 ± 1596.8 mmHg·mL. The maximum tolerated volume for reaching satiety/maximum discomfort was 450.0 ± 177.9 mL, and the area-under-curve of satiation score was 900.0 ± 266.9 satiation-unit·mL. The area-under-curve of IGP showed significant associations with maximum tolerated volume (ρ: -0.702; D: 0.234) and the area-under-curve of satiation score (D: 0.119): all p < 0.01. No correlations were found between volumetric with manometric and subjective NDT GA parameters.</p><p><strong>Conclusions & inferences: </strong>SPECT/CT and HRM-NDT are feasible and tolerable techniques for measuring GA in healthy individuals. Thus, determining their diagnostic utility among patient populations requires further optimization and standardization.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":" ","pages":"e15006"},"PeriodicalIF":3.5,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008809","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":"Disrupted Paraventricular Hypothalamic Nucleus Functional Connectivity in Parkinson's Disease With Constipation.","authors":"Xiaorong Hou, Hongfei Zhou, Qiugui Zhou, Jiajian Zhang, Xuxiong Tang, Ziwei Gong, Ying Tang, Junhong Duan, Song Peng, Lifeng Li, Hong Jiang, Beisha Tang, Yin Liu, Lifang Lei","doi":"10.1111/nmo.15005","DOIUrl":"https://doi.org/10.1111/nmo.15005","url":null,"abstract":"<p><strong>Background: </strong>Constipation is one of the most common non-motor symptoms in patients with Parkinson's disease (PD), which could manifest during the early stage of the disease. However, the etiology of constipation in PD remains largely unknown. Previous studies supported that gastrointestinal dysfunction may be associated with functional connectivity alterations in paraventricular hypothalamic nucleus (PVN). Therefore, this study aimed to investigate the potential contribution of the PVN to the pathogenesis of constipation in a cohort of early-stage patients with PD and to compare brain network organization between PD patients with and without constipation.</p><p><strong>Methods: </strong>A total of 66 PD patients (PD with constipation and without constipation) and 30 healthy controls were prospectively enrolled. All participants acquired T1-weighted and resting-state fMRI scans. Then we employed voxel-based morphometry analysis and functional connectivity analysis.</p><p><strong>Results: </strong>We observed a decreased functional connectivity in the PVN-pontine tegmentum pathway in PD patients with constipation compared to the patients without constipation (p = 0.006, t = 5.37), while we did not find any changes in basal ganglia circuitry between these two groups. In addition, we found that the functional connectivity between PVN and pontine tegmentum was negatively associated with the UPDRS I, II, III and NMSS scores (p < 0.05). Meanwhile, these two types of patients also showed substantial differences in functional connections linking the inferior frontal gyrus and cerebellum with multiple brain regions. We discovered no statistical difference in gray matter volume among these two groups.</p><p><strong>Conclusions: </strong>Our study provides further insights into the dysfunctional mechanisms of constipation, suggesting that abnormal PVN functional connectivity may be related to the mechanism of constipation in PD. Meanwhile, the inferior frontal gyrus and cerebellum may be involved in the occurrence of constipation in PD patients.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":" ","pages":"e15005"},"PeriodicalIF":3.5,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008796","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":"Primary Peristalsis Is the Dominant Mechanism of Refluxate Clearance Following Gastroesophageal Reflux.","authors":"Lorenzo Marchetti, Benjamin D Rogers, Amit Patel, Daniel Sifrim, C Prakash Gyawali","doi":"10.1111/nmo.15001","DOIUrl":"https://doi.org/10.1111/nmo.15001","url":null,"abstract":"<p><strong>Background: </strong>Refluxate volume and pH drop following gastroesophageal reflux are mostly cleared by peristalsis. We evaluated the roles of primary volume clearing peristaltic wave (VCPW), secondary VCPW, post-reflux swallow-induced peristaltic wave (PSPW), and late primary peristaltic wave (LPPW) in refluxate clearance.</p><p><strong>Methods: </strong>We retrospectively analyzed pH-impedance studies performed off therapy in 40 patients with typical esophageal symptoms. Mechanism of refluxate clearance was evaluated for each reflux episode (primary VCPW vs. secondary VCPW vs. none), as well as presence of PSPW, LPPW when PSPW was absent, and pH recovery with each mechanism. Per-episode and per-patient analyses determined the dominant mechanism of refluxate clearance and pH recovery.</p><p><strong>Results: </strong>Of 958 reflux episodes, 88% were acidic. A primary VCPW was the dominant mechanism for volume clearance (48.4% acid, 47.8% non-acid reflux episodes), and ≥ 50% pH recovery (58.7%). Of reflux episodes lacking pH recovery, PSPW resulted in ≥ 50% pH recovery in 40.2%, and LPPW in 60.9%. In logistic regression models, primary peristaltic wave (primary VCPW, PSPW, or LPPW) had the highest likelihood of pH recovery in per-episode analysis (OR 2.1, CI 1.3-3.0, p < 0.001), and in per-patient analysis (OR 11.0, CI 1.5-20.5, p = 0.025), among which primary VCPW was the most effective (OR 3.4, CI 1.5-7.7, p = 0.003).</p><p><strong>Conclusions: </strong>A primary peristaltic wave from a swallow, either in the form of a VCPW, PSPW, or LPPW, is the dominant mechanism of pH recovery after gastroesophageal reflux. When a primary VCPW does not correct pH drop, PSPW, and LPPW are equivalent salvage mechanisms for pH recovery.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":" ","pages":"e15001"},"PeriodicalIF":3.5,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952400","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":"Assessing Water Content of the Human Colonic Chyme Using the MRI Parameter T1: A Key Biomarker of Colonic Function.","authors":"Neele Dellschaft, Kathryn Murray, Yi Ren, Luca Marciani, Penny Gowland, Robin Spiller, Caroline Hoad","doi":"10.1111/nmo.14999","DOIUrl":"https://doi.org/10.1111/nmo.14999","url":null,"abstract":"<p><strong>Background: </strong>The human colon receives 2 L of fluid daily. Small changes in the efficacy of absorption can lead to altered stool consistency with diarrhea or constipation. Drugs and formulations can also alter colonic water, which can be assessed using the magnetic resonance imaging (MRI) longitudinal relaxation time constant, T1. We explore the use of regional T1 assessment in evaluating disorders of colonic function.</p><p><strong>Methods: </strong>Individual participant data analysis of data from 12 studies from a single center of patients with constipation, irritable bowel syndrome with diarrhea (IBS-D), and healthy volunteers (HV). T1 was quantified by measuring the signal from the tissue at different times after a pulse which inverts the magnetization.</p><p><strong>Key results: </strong>When diarrhea was induced by a macrogol laxative T1 in the ascending colon, T1AC was negatively correlated with stool bacterial content, r² = 0.78, p < 0.001. T1AC was increased by another laxative, rhubarb. Patients with IBS-D had elevated fasting T1AC (0.78 ± 0.28 s, N = 67) compared to HV (0.62 ± 0.21 s, N = 92) while those with constipation lay within the normal range (HV 10-90th centiles 0.33-0.91 s). Fasting T1AC in IBS-D was reduced by mesalazine treatment. T1 in the descending colon was consistently lower than T1AC, with a bigger reduction in patients with constipation than HV. Pre-feeding dietary fiber (bran, nopal, and psyllium) was associated with fasting T1AC at or above the normal 90th centile.</p><p><strong>Conclusions and inferences: </strong>T1 is an MRI parameter which could be used to monitor effectiveness of novel agents designed to alter colonic water content and stool consistency.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":" ","pages":"e14999"},"PeriodicalIF":3.5,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952395","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":"Complex and Bidirectional Interplay Between Marital Quality, Catastrophizing, Psychological Dysfunction, and Quality of Life in Married Malay Women With Disorder of Gut-Brain Interactions.","authors":"Nurhazwani Hamid, Yee Cheng Kueh, Rosediani Muhamad, Zalina Zahari, Miranda A L van Tilburg, Olafur S Palsson, William E Whitehead, Zheng Feei Ma, Nashrulhaq Tagiling, Yeong Yeh Lee","doi":"10.1111/nmo.15000","DOIUrl":"https://doi.org/10.1111/nmo.15000","url":null,"abstract":"<p><strong>Background: </strong>Disorders of gut-brain interactions (DGBI) affect more women, and marital quality may have been a factor that explains clinical manifestations of DGBI-however, the mechanism is unclear. This study aimed to elucidate supported relationships between DGBI with marital quality and clinical attributes in married Malay women.</p><p><strong>Methods: </strong>This cross-sectional study involved married Malay women with functional dyspepsia (FD), irritable bowel syndrome (IBS), and FD-IBS overlap per Rome IV criteria. Multivariate analysis of variance (MANOVA) and Pearson correlation analysis were performed to determine the association between DGBI, marital quality, and clinical attributes of catastrophizing, psychological dysfunction, and quality of life. Path analysis models were developed, tested, and fitted to elucidate relationships that satisfied significance testing and fit indices (termed supported relationship).</p><p><strong>Key results: </strong>Of 1130 screened participants, 513 were analyzed. The prevalence of FD, IBS, and FD-IBS overlap was 33.9% (n = 174), 29.5% (n = 151), and 36.6% (n = 188), respectively. Of 17 variables in MANOVA, significant differences in variables were observed for FD vs. FD-IBS overlap (10), IBS versus FD (10), and IBS versus FD-IBS overlap (5). Pearson correlation matrices found significant correlations for 15 of 17 variables. After testing and fitting, the third path model (Model 3) was deemed the final model. Model 3 suggested that relationships between DGBI and marital and clinical attributes were complex and bidirectional. The number of supported relationships were 50, 43, and 39 for FD-IBS overlap, FD, and IBS, respectively.</p><p><strong>Conclusions and inferences: </strong>Relationships between DGBI, marital quality, and clinical attributes among married Malay women are complex and bidirectional.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":" ","pages":"e15000"},"PeriodicalIF":3.5,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952396","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":"Utility of Monitoring Fasting Phase During Pediatric Colonic Manometry Studies.","authors":"Lev Dorfman, Khalil El-Chammas, Sahana Khanna, Lin Fei, Ajay Kaul","doi":"10.1111/nmo.14998","DOIUrl":"https://doi.org/10.1111/nmo.14998","url":null,"abstract":"<p><strong>Introduction: </strong>Colonic manometry (CM) is a diagnostic procedure used to evaluate pediatric patients with refractory constipation, fecal incontinence, Hirschsprung disease, and pediatric intestinal pseudo-obstruction. Pan-colonic high-amplitude propagated contractions (HAPCs), measured by CM, reflect an intact neuromuscular function of the colon. Current guidelines recommend starting CM with fasting recording for 1-2 h, but no prior evaluation has determined the diagnostic yield of the fasting phase. We aimed to determine the utility of the fasting phase during CM studies.</p><p><strong>Methods: </strong>We evaluated CM studies conducted at a tertiary pediatric center (2018-2022). Fasting phases of normal CM studies were evaluated.</p><p><strong>Key results: </strong>In 433 included studies 241 (55.7%) females, median age (9.7 years), the average fasting recording lasted 126 min. A total of 193 (44.6%) studies exhibited fasting HAPCs, with 123 (28.4%) being pan-colonic. The presence of pan-colonic HAPCs was based solely on the fasting phase in 11 (2.5%) studies. Patients with fasting pan-colonic HAPCs were younger (median age of 6.9 vs. 9.8 years, p = 0.0001) and had a higher rate of postprandial HAPCs (69.1% vs. 25.2%, p < 0.0001). Most fasting pan-colonic HAPCs presented during the first 60 min (94/123, 76.4%). All studies demonstrated HAPCs after stimulation with bisacodyl. In analyzing just the initial 30 min of fasting on CM, only 2 (0.5%) studies would have been misclassified as abnormal, with no bisacodyl administration in these studies.</p><p><strong>Conclusions & inferences: </strong>Shortening the fasting phase minimally affects next-day CM results and could reduce patient inconvenience, hospital-related costs, and potential side effects.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":" ","pages":"e14998"},"PeriodicalIF":3.5,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952401","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":"Large Peritoneal Macrophages Play No Role in the Pathogenesis of Postoperative Ileus Induced by Intestinal Manipulation.","authors":"Zheng Wang, Elodie Modave, Marcello Delfini, Iris Appeltans, Guy Boeckxstaens, Nathalie Stakenborg","doi":"10.1111/nmo.14997","DOIUrl":"https://doi.org/10.1111/nmo.14997","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative ileus (POI) is an iatrogenic disorder marked by temporary impaired gastrointestinal (GI) motility post-abdominal surgery. Surgical handling of the intestine activates resident macrophages (Mfs), leading to inflammatory cytokine release and leukocyte recruitment into the muscularis, which compromises intestinal contractility. The mechanisms behind this activation are unclear. Recent studies suggest peritoneal Mfs, particularly large peritoneal macrophages (LPMs), might play a role in sterile intestinal inflammation by rapidly recruiting to the serosal layer of the gut and aiding in tissue damage resolution.</p><p><strong>Methods: </strong>To identify immune cells involved in the early phase of POI, single-cell RNA sequencing (scRNA-seq) was conducted. The migration of LPMs post-surgery was studied using adoptive transfer techniques. LPMs were depleted via intraperitoneal injection of clodronate liposomes. Subsequently, flow cytometry, quantitative PCR (qPCR), and immunofluorescence were performed to assess the impact of LPM depletion and analyze cell populations and inflammatory effects.</p><p><strong>Results: </strong>(1) Intestinal manipulation (IM) leads to the accumulation of monocytes, neutrophils, mature Mfs, CD8+ T cells, and LPMs within 2 h post-surgery. (2) Heparin treatment does not affect gut transit or reduce IL-6, IL-1a, and IL-1b expression in the early phase of POI. (3) Depletion of LPMs via clodronate liposome does not prevent monocyte, neutrophil, and Mfs infiltration in the muscularis externa, nor does it improve gut transit or reduce cytokine expression. (4) LPMs migrate to the serosa after IM but do not enter the muscularis externa.</p><p><strong>Conclusion and inferences: </strong>LPMs adhere to the intestinal serosa following intestinal manipulation but do not migrate into the intestinal muscularis or participate in the inflammatory response and delayed transit. Consequently, LPMs are not involved in the pathogenesis of POI.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":" ","pages":"e14997"},"PeriodicalIF":3.5,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952399","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}