Journal of Neurogastroenterology and Motility最新文献

Background/aims: : The pylorus muscles are known to play a vital role in the process of gastric emptying and are directly implicated in symptom associated with delayed gastric drainage. Endoluminal functional luminal imaging probe (EndoFLIP) can predict clinical response to pylorus directed therapy in symptomatic children and adults. Normal pylorus EndoFLIP values are available for adult but not in children. We aim to assess the impact of age on pediatric pyloric EndoFLIP values.

Methods: : Retrospective review of all children who underwent pylorus EndoFLIP in Evelina London Children's Hospital from July 2022 to March 2025.

Results: : One hundred and sixty-nine EndoFLIP values were collected from 29 children, 35% females. Mean age was 8.5 ± SD (± 4.1), children reported at least 1 symptom of impaired gastric emptying. EndoFLIP values appeared to cluster in age ranges 0-4, 4-8 and > 8 years with diameter significantly different. There was no correlation with weight range. At balloon volume of 40 mL, abdominal distension after feeding positively correlated with distensibility (r = 0.45, P = 0.018 and negatively with pressure (r = -0.41, P = 0.036). Intolerance to gastric feeding with pressure (r = 0.45, P = 0.019) and pain after feeding with pressure (r = 0.5, P = 0.009). High balloon pressure can lead to unwarranted dilatation.

Conclusion: : Pediatric pylorus EndoFLIP values are determined by age but not weight and they correlate with symptoms of impaired gastric emptying. Adults normal values are not applicable to children. There is a need to set up a separate pediatric protocol for pylorus EndoFLIP.

Background/aims: : The Leuven Postprandial Distress Scale (LPDS) is a validated patient reported outcome (PRO) measure for functional dyspepsia (FD)/postprandial distress syndrome (PDS) patients according to Rome III criteria. However, meal-related nausea or epigastric pain, part of PDS in Rome IV, were not addressed in this construct. Also, focus groups identified fatigue as a frequently reported complaint for which the European Medicines Agency requested further analysis. Our aim is to validate the LPDS in FD/PDS as defined by Rome IV criteria and to optimize the model by assessing the value of adding extra items to this questionnaire.

Methods: : The questionnaire was validated in 3 different Rome IV FD/PDS patient cohorts recruited for controlled clinical trials. Additional questions in the diary regarding symptom relationship to meal and fatigue were evaluated. Anchor scores were the patient assessment of gastrointestinal symptom severity index, Short-form Nepean dyspepsia index, the overall treatment evaluation and overall symptom severity questionnaires.

Results: : The LPDS Construct validity was confirmed for Rome IV-defined PDS. Psychometric analysis did not support inclusion of fatigue, nausea, meal-related or meal-unrelated, and meal-related epigastric pain, due to low loading or poor model fit.

Conclusions: : The LPDS questionnaire showed good reliability and responsiveness, and can be confidently used as a validated tool in Rome IV PDS populations. Data did not support adding accessory symptoms to the construct, due to low loading or poor model fit.

Background/aims: : Gastric emptying scintigraphy (GES) is the reference standard test for diagnosing gastroparesis. Body surface gastric mapping (BSGM) via Gastric Alimetry is a new test of gastric function that combines non-invasive assessment of gastric electrophysiology and validated symptom profiling. This randomized, prospective pilot study evaluated the impact of GES vs BSGM test results on clinical decision-making.

Methods: : Patients with chronic gastroduodenal symptoms from a tertiary center referred for GES were recruited. Subjects separately underwent baseline assessment with GES and BSGM testing. Two motility-specialists were first asked to devise a management plan after reviewing a test result (GES or BSGM, in random order). They were then asked to repeat the management plan after reviewing the other test result (BSGM or GES). Clinician-perceived certainty measures were assessed.

Results: : Sixteen patients, 13 (81.0%) female, median age 30 years, median body mass index 22.5 kg/m², were recruited. At baseline, a diagnosis was established in 2/16 (12.5%) and increased to 8/16 (50.0%) with both tests. Abnormal test results were found in 11 patients. In patients with normal results, BSGM symptom profiling phenotyped 5 additional patients. All patients received an intervention following the first unblinding, with subsequent management changes made in 75.0% (BSGM) and 62.5% (GES) of patients. The combined GES and BSGM results significantly increased diagnostic and management certainty (P < 0.05), with both tests having similar influence on management (P > 0.05).

Conclusion: : The combined GES and BSGM test results significantly enhanced diagnostic and management confidence in patients with suspected gastroparesis within a tertiary center.

Neural gastric electrical stimulation (NGES) is a multi-channel high-energy gastrointestinal stimulation technique that directly activates cholinergic motor neurons to evoke contractions that improve gastric emptying. NGES stimulation superimposes on spontaneous electromechanical activity to generate coordinated propagating contractions. In contrast, the most commonly applied form of gastric electrical stimulation (Enterra), employs paired pulses that stimulate vagal afferent pathways to reduce symptoms of nausea and vomiting, but does not enhance emptying. This review examines the evolution and implementation of NGES, focusing on its potential role as a treatment option to enhance gastric propulsion in gastroparesis and delayed gastric conduit emptying. While initial acute animal studies have shown promising results, continued development of the technology and refinement of stimulation protocols through chronic experiments remains essential for successful clinical translation.

Background/aims: : Spinal cord injury (SCI) frequently impairs defecation, severely affecting the quality of life. This study examines compensatory neural remodeling after SCI, focusing on basal colonic contractility, neural responses to electrical field stimulation, and alterations in excitatory cholinergic and inhibitory nitrergic pathways.

Methods: : Female Sprague-Dawley rats underwent either sham surgery or T10 spinal cord transection and were categorized into 3 groups: sham, 1-week post-SCI (acute), and 4-week post-SCI (chronic). Colonic contractility was assessed in an organ bath using electrical field stimulation in the presence of a nitric oxide synthase inhibitor. Neural protein expression was analyzed by immunofluorescence and Western blotting.

Results: : SCI produced region- and time-dependent impairments in colonic contractility, with distinct alterations in the proximal circular and longitudinal muscles across acute and chronic phases. Neural excitability shifted dynamically, showing enhanced excitatory activity in the proximal longitudinal muscle at 1-week and the distal circular muscle at 4-week post-SCI. Protein analysis revealed increased neuronal nitric oxide synthase in the proximal colon, decreased soluble guanylyl cyclase in the distal colon, upregulated muscarinic M₃ receptor in the proximal colon, and reduced vasoactive intestinal peptide receptor 1 in both proximal and distal regions.

Conclusion: : SCI induces spatiotemporal remodeling of excitatory and inhibitory neural pathways, contributing to colonic dysmotility and revealing potential targets for therapeutic intervention.

Background/aims: : Nocturnal acid reflux disrupts sleep and impairs quality of life. Proton pump inhibitors provide insufficient suppression of nocturnal acid secretion, whereas fexuprazan offers prolonged acid suppression. We compared the efficacy of fexuprazan and esomeprazole in controlling nocturnal reflux.

Methods: : In a randomized and crossover study, patients received fexuprazan or esomeprazole daily for 4 weeks, followed by a washout and crossover to the alternate medication for another 4 weeks, with a final washout completing the sequence. Severity (scores 0-10), frequency, sleep disturbance, and medication preferences were evaluated.

Results: : Thirty-nine patients were enrolled and randomized to receive either fexuprazan (n = 20) or esomeprazole (n = 19) first. After the first treatment, fexuprazan reduced severity from 7.5 ± 1.7 to 1.4 ± 1.7 (81.3% decrease), versus 7.8 ± 1.5 to 2.8 ± 1.9 (64.1% decrease) with esomeprazole (P = 0.012). In patients with severe symptoms (scores ≥ 7), fexuprazan led to significantly greater improvement than esomeprazole (P = 0.008). Following the first washout, the second crossover treatment resulted in greater improvement in symptom severity with fexuprazan (P = 0.001). During the second washout, nocturnal symptoms severity and frequencies were better controlled with fexuprazan than with esomeprazole (P = 0.005 and 0.019). Patients who switched from esomeprazole to fexuprazan preferred fexuprazan (P = 0.018).

Conclusions: : Fexuprazan was more effective than esomeprazole in controlling nocturnal reflux symptom, particularly in patients with severe symptoms. Fexuprazan may offer a therapeutic advantage for patients with severe and persistent nocturnal reflux despite proton pump inhibitor therapy.

Background/aims: : Gastroesophageal reflux disease (GERD) after peroral endoscopic myotomy (POEM) is a significant challenge. Disruption of the lower esophageal sphincter during POEM and dysfunction of the crural diaphragm, which contributes to esophagogastric junction pressure, may lead to GERD after POEM. We aim to identify predictors of GERD after POEM and focus on physiological parameters of esophagogastric junction pressure in patients with achalasia before POEM.

Methods: : We retrospectively analyzed a prospectively collected database of patients who underwent POEM between July 2016 and August 2023. Ninety-two patients with achalasia who underwent high-resolution manometry and endoscopy before and after POEM were included.

Results: : Forty-nine (53.3%) patients were diagnosed with GERD. Patient demographics, achalasia subtypes, prior treatments, myotomy length, and myotomy orientation were not associated with GERD after POEM. Loss of inspiratory augmentation before POEM was associated with GERD after POEM (P < 0.05). GERD occurred more frequently in patients with a shorter intra-abdominal lower esophageal sphincter length before POEM. Type III esophagogastric junction morphology in the GERD group (37.1%) was more common than that in the non-GERD group (15.8%). Loss of inspiratory augmentation occurred more frequently in patients with type III esophagogastric junction pressure morphology.

Conclusion: : Loss of inspiratory augmentation may predict GERD after POEM.

Background/aims: : Chronic constipation is prevalent yet under-diagnosed across Asia, compromising quality of life and burdening healthcare systems. Cultural stigma, varied diets, and limited access to standardized diagnostic tools delay timely care.

Methods: : The Bali Chronic Constipation Roundtable in November 2024, brought together experts from 11 Asian countries. The group reviewed epidemiological data, analyzed multinational questionnaire on clinical practice pattern, and conducted structured discussions to identify key barriers and propose region-specific recommendations.

Results: : Chronic constipation prevalence varies across Asia, ranging from 1.8% in India to 16.6% in Japan, with women and the elderly disproportionately affected. Under-reporting persists owing to cultural taboos and widespread self treatment with laxatives and traditional medications. Although the Rome IV criteria remains the global standard, they may not fully reflect Asian symptom profiles, and diagnosis is limited by scarce motility laboratories. First line therapies such as dietary-fiber optimization and osmotic laxatives are widely available, but newer pharmacotherapies (prucalopride, linaclotide, lubiprostone, and elobixibat) remain costly and unevenly accessible. Biofeedback for dyssynergic defecation is underutilized due to limited availability. Experts recommend expanded regional research on to refine diagnostic criteria, coupled with enhanced physician education and public awareness. They advocate accessibility to second-line and novel therapies that incorporate culturally attuned regional guidelines, and improved access to gastrointestinal motility testing.

Conclusions: : The Bali Chronic Constipation Roundtable highlighted Asia's need for region specific diagnostics and management. Addressing diagnostic and treatment gaps will improve outcomes, while ongoing researcher clinician policy collaboration must standardize guidelines, advance research, and ensure equitable care across Asia.