Journal of Neurogastroenterology and Motility最新文献

Background/aims: Focal hypoganglionosis with adult-onset megacolon (FHAM) is marked by colon dilation proximal to a narrowed segment, with unaffected small bowel motility. Despite similar initial symptoms, FHAM may be more amenable to surgical intervention without recurrence, unlike chronic intestinal pseudo-obstruction (CIPO). The long-term outcomes of FHAM remain underexplored, prompting a comparison of its clinical features and prognosis with CIPO.

Methods: We conducted a retrospective analysis of patients presenting with chronic constipation and megacolon, prospectively recruited between January 2017 and December 2023. Within this cohort, 87 patients were diagnosed with FHAM and 13 with CIPO, all of whom were included in the study. The median follow-up period was 3.0 years for patients with FHAM and 2.8 years for those with CIPO.

Results: The proportion of females was greater in both groups (FHAM, 67.8%; CIPO, 53.8%). The median age at diagnosis was similar between the groups (FHAM, 54.5 years; CIPO, 45.3 years). Surgery was performed in 46.0% of patients with FHAM and 69.2% of those with CIPO. Unplanned postoperative hospitalizations and the need for reoperation due to disease recurrence were notably lower in patients with FHAM. None of the patients with FHAM required long-term total parenteral nutrition, in contrast to 46.2% of patients with CIPO. Significant inter-group differences were observed in body mass index at the last follow-up.

Conclusions: Patients with FHAM exhibit a more favorable long-term prognosis and lower postoperative recurrence rates than patients with CIPO. This study underscores the importance of differentiating between these conditions and precisely selecting surgical candidates.

Background/aims: In Hong Kong, Taiwan and Vietnam, the burden of irritable bowel syndrome (IBS) is poorly documented, with limited evidence-based treatments and outdated guidelines. We used a modified Delphi method to reach expert consensus on different aspects of disease management and gain insights into the current clinical practice for IBS in these 3 countries, focusing on treatment with antispasmolytics.

Methods: Evidence from a targeted literature review was used to draft consensus statements for a multidisciplinary 3-round Delphi survey. Consensus was defined as ≥ 70% agreement among experts from the same country (qualitative data) or a SD < 5% on rate estimates (quantitative data). Data were grouped and analyzed by expert specialty and country.

Results: Thirty-six experts (12 per country; primary care physicians, n = 6; gastroenterologists, n = 4; and pharmacists, n = 2) participated in the 3 voting rounds. Consensus was reached for 17/25 (68.0%) statements. Respondents agreed that IBS diagnosis relies on symptoms and guidelines. Regarding antispasmolytics, most experts were highly satisfied with the available medications, particularly hyoscine and otilonium bromide, and agreed on a short (< 2 weeks) treatment duration. Mean 1-year relapse rate was 38.3-48.0% with antispasmolytics overall and 20.5-26.5% with otilonium bromide. In all 3 countries, consensus was reached that frequent IBS relapses affect patients' daily routine and quality of life frequently and that long-term treatment strategies addressing relapse represent a key unmet need in IBS management.

Conclusions: Although antispasmolytics provide immediate symptom relief, their long-term effectiveness needs further investigations in Asian populations. Our findings may inform clinical decision-making and guideline updates.

Background/aims: We aim to investigate the effectiveness, safety, and predictors of treatment response to fecal microbiota transplantation (FMT) in Korean irritable bowel syndrome (IBS) patients.

Methods: Patients with moderate to severe diarrhea-predominant IBS (IBS-D) or mixed-type IBS (IBS-M) received FMT from one healthy donor via esophagogastroduodenoscopy. IBS-symptom severity score (IBS-SSS), Bristol stool form scale (BSFS), IBS Quality of Life (IBS-QoL) questionnaires, Hospital Anxiety and Depression Scale (HADS), and gut microbiome profiles were assessed at baseline, 4 weeks and 12 weeks post-FMT.

Results: Among the 46 enrolled IBS patients, 37 patients (IBS-D:IBS-M = 28:9) completed a 12-week follow-up. Significant improvements were observed in IBS-SSS, IBS-QoL, and BSFS after 12 weeks. FMT led to increased microbial diversity and a sustained increase in beneficial bacterial genera, including Holdemanella, Ruminococcus, and Faecalibacterium. In terms of β-diversity, the distance between the patient's gut microbiome and that of the donor decreased after FMT; greater reduction in distance to donor microbiota was associated with greater symptom improvement (Unweighted UniFrac distance, P < 0.05). Responders (IBS-SSS reduction > 50 points) exhibited lower baseline relative abundances of Roseburia and Subdoligranulum, and more profound microbiome shifts toward the donor profile after FMT.

Conclusions: FMT appears to be a potentially effective treatment for moderate to severe IBS, with significant symptom relief and gut microbiota changes. Lower baseline abundances of Roseburia and Subdoligranulum and greater shifts of gut microbiome profile toward donor microbiota after FMT may predict favorable FMT response. Long-term follow-up is on the way to assessing the durability of these effects.

Background/aims: The liver and small bowel are closely interrelated, and their diet-induced metabolic dysfunction-associated steatotic liver disease (MASLD) may also be influenced by age and sex. Therefore, this study aims to investigate the effects of age and sex on hepatic steatosis and small bowel inflammation induced by a high-fructose and high-fat diet (HFHFD) in rats.

Methods: Male and female rats, aged 6 weeks (young) and 2 years (aged), were used. The HFHFD groups were provided with a high-fat diet and high-fructose water for 8 weeks. Liver and small bowel tissues were histologically analyzed. Tight junction protein expression in jejunal mucosa was analyzed, and immunohistochemistry was performed to detect claudin-2 (Cldn-2).

Results: The histological inflammation scores of the old control groups were higher than those of the young control groups, regardless of sex. The jejunal villus/crypt ratio in the young rats was decreased in the male HFHFD group (P = 0.045). In contrast, in aged rats, the villus/crypt ratio decreased in the female HFHFD group (P = 0.076). Hepatic steatosis was higher for the male HFHFD groups (young, P = 0.003; aged, P = 0.005) and in the aged female HFHFD groups (P = 0.003). The correlation of jejunal inflammation scores with hepatic steatosis (P < 0.001) and Cldn-2 mRNA expression (P = 0.047) was significant, with the highest expression observed in aged female HFHFD rats.

Conclusion: MASLD may be associated with HFHFD-induced jejunal damage. In addition, the upregulation of Cldn-2 may contribute to MASLD in aged female rats.

Background/aims: This study aims to assess whether specific symptoms from the Gastroparesis Cardinal Symptom Index (GCSI) could predict delayed gastric emptying and to establish the prevalence of gastroparesis (GP).

Methods: Diabetic patients were recruited from a multicenter cross-sectional cohort. Each participant underwent esophagogastroduodenoscopy, symptom assessment by GCSI, and solid-meal gastric emptying scintigraphy (GES). GP was defined by GES data showing a T_1/2 > 85 minutes and/or gastric retention > 8% at 3 hours.

Results: Among 138 patients, those with delayed GES (21.01%) had a higher incidence of nephropathy (51.72% vs 22.02%, P = 0.002) and lower albumin levels (3.91 g/dL vs 4.18 g/dL, P = 0.003). Cardinal symptoms such as nausea (P = 0.011), retching (P = 0.040), vomiting (P = 0.010), stomach fullness (P = 0.001), fullness after eating (P = 0.025), and loss of appetite (P = 0.039) were more prevalent in patients with abnormal GES. A higher overall GCSI score was found to independently predict delayed gastric emptying (P = 0.028) in multivariate analysis. The area under the receiver operating characteristic curve for the GCSI in predicting GP was 0.672, with an optimal cutoff value of 1.78 (sensitivity 79.31%, specificity 49.54%). The prevalence of GP, defined by both GCSI ≥ 1.78 and abnormal GES, was 16.67% among diabetic patients. Notably, 16 (11.59%) patients had rapid emptying.

Conclusion: Diabetic patients exhibiting specific cardinal symptoms should be considered for GES evaluation, as the overall GCSI score independently predicts delayed gastric emptying. This study suggests that the GCSI may be useful as a screening tool rather than a diagnostic method for diabetic gastroparesis.

Background/aims: Evidence regarding the diagnostic value of non-to-minimally invasive investigations for identifying sliding hiatal hernia (HH) in patients with morbid obesity is limited. Herein, we aimed to evaluate the diagnostic performance of preoperative high-resolution esophageal manometry (HREM) compared with that of upper gastrointestinal (UGI) series in this patient population.

Methods: In this retrospective comparative-paired design study at a university hospital, we analyzed data from 149 consecutive patients with morbid obesity who underwent bariatric surgery (BS) between 2020 and 2024. All patients underwent preoperative workup, including HREM, UGI series, and esophagogastroduodenoscopy. Diagnostic performance was evaluated and compared between the diagnostic tests using intraoperative HH diagnosis as a reference standard.

Results: After excluding 12 patients, BS confirmed sliding HHs in 26 of 137 patients (19.0%). HREM showed a superior predictive capacity for identifying intraoperative HH than UGI series, showing area under the receiver operating characteristic curves of 0.93 (95% confidence interval [CI], 0.87-0.99; P < 0.01) and 0.63 (95% CI, 0.53-0.73; P < 0.01), respectively. Furthermore, HREM demonstrated significantly higher sensitivity (92.31% vs 42.31%), specificity (93.70% vs 83.78%), positive likelihood ratio (14.64; 95% CI, 7.09-30.24 vs 2.61; 95% CI, 1.41-4.83), and diagnostic accuracy (93.43% vs 75.91%) than UGI series (all P < 0.05). HREM identified a major esophageal motility disorder in 3/137 (2.2%) patients, which guided specific treatment before undergoing BS. No serious procedure-related complications occurred.

Conclusion: HREM has high diagnostic performance in detecting sliding HH; thus, HREM should be considered as an important part of the preoperative work-up for patients with morbid obesity.

Functional dyspepsia and gastroparesis are common gastrointestinal conditions that can significantly impact a patient's quality of life. Management of these conditions can be challenging for the treating physician due to overlap in symptomatology and incomplete response to conventional medications such as proton pump inhibitors and prokinetics. There is a growing trend in the use of management strategies such as neuromodulators, psycho-behavioral therapy, and other alternative treatments including acupuncture. Notably, differences exist in the epidemiology, symptom expression, and disease management in Western versus Asian patients. These differences stem from varying accessibility to investigation tests and medications, dietary habits and cultural beliefs. This review article comprehensively summarizes the latest knowledge on the approach to the evaluation and management of functional dyspepsia and gastroparesis, and explores the different factors influencing management practices in the West as compared to in Asia.

The low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet is an evidence-based diet therapy for irritable bowel syndrome that is recommended in multiple clinical guidelines worldwide. While in Western countries, this diet is well accepted among health professionals and widely applied in clinical practice, uptake of the diet is more limited in Asian countries, likely due to research, clinical, practical, and cultural barriers. This review explores the challenges of implementing a FODMAP diet in Asian countries, including the lack of local efficacy studies, the limited availability of specialist dietitians, the lack of FODMAP composition data for local foods, language barriers and traditional dietary practices that are at odds with the principles of the FODMAP diet. Potential solutions include building local capacity in dietary research and clinical practice; expanding the analysis of Asian foods for FODMAP content; fostering interdisciplinary training opportunities for health professionals using a train-the-trainer approach; adapting educational resources so they are linguistically and culturally appropriate; and developing practical resources for patients to facilitate recipe adaptation and meal planning. Addressing these barriers will improve access to the FODMAP diet for patients in Asia and may provide a framework to adapt other dietary therapies to suit culturally diverse groups.

Background/aims: Gastroesophageal reflux disease (GERD) is a chronic, heterogeneous condition that impairs quality of life. Extra-esophageal symptoms (eg, globus sensation, chronic cough, hoarseness, wheezing) often persist despite proton pump inhibitor (PPI) therapy. Tricyclic antidepressants are recommended for such refractory cases, but supporting evidence is limited. This study aims to evaluate the efficacy of low-dose amitriptyline in treating extra-esophageal GERD symptoms.

Methods: We conducted a single-center, single-blind, randomized, controlled crossover pilot trial. Forty patients with both typical GERD symptoms and one or more atypical symptom unresponsive to ≥ 4 weeks of PPI therapy were randomized to receive either lansoprazole 30 mg daily plus amitriptyline 10 mg at bedtime or lansoprazole alone for 4 weeks, followed by crossover to the alternate regimen. The primary outcome was symptom improvement assessed by numeric rating scale. Secondary outcome included changes in quality of life (QoL) measured by the 36-item Short Form survey.

Results: All 40 patients completed the trial. Overall, 75% reported symptom improvement: 65% in the amitriptyline group vs 85% in the PPI group (P = 0.273). Both groups showed significant reductions in symptom severity (between-group P = 0.904) and improvements in QoL (physical and mental summary scores; P = 0.600 and 0.410, respectively). These improvements persisted post-crossover.

Conclusions: Adding low-dose amitriptyline to PPI therapy did not offer a short-term advantage over PPI alone. Both treatments improved symptoms and QoL. Given the challenging nature of GERD's extra-esophageal manifestations and mixed evidence for neuromodulator therapy, further studies are needed to identify patient subgroups that may benefit from adjunctive neuromodulator therapy.