Journal of Neurogastroenterology and Motility最新文献

Background/aims: : The pathophysiology of refractory gastroesophageal reflux disease (RGERD), which differs from proton pump inhibitor dependent gastroesophageal reflux disease (DGERD), remains incompletely elucidated. This study aims to compare esophageal motility patterns, transdiaphragmatic pressure gradients (TPG), and reflux profiles between RGERD and DGERD patients, and to delineate dynamic pressure gradient-esophagogastric junction (EGJ) interactions in these patients.

Methods: : In this retrospective study, 274 patients who underwent 24-hour impedance-pH monitoring and high-resolution manometry, along with an assessment of proton pump inhibitor responsiveness, were classified as RGERD (32.5%), DGERD (54.4%), or non-GERD (13.1%). Clinical characteristics, TPG, esophageal motility, and reflux metrics were compared between RGERD and DGERD patients. Subgroup analysis excluding hiatal hernia (HH) was conducted to investigate the pathophysiology of RGERD.

Results: : The RGERD group exhibited a significantly higher proportion of chest pain compared to the DGERD group. Regarding reflux profiles, RGERD patients without HH (RGERD^HH- group) experienced increased weakly acidic reflux (P < 0.001) and prolonged bolus exposure (P = 0.006) compared to their counterparts (DGERD^HH- group). Mechanistically, the RGERD^HH- group showed reduced lower esophageal sphincter basal pressure (P = 0.010) and EGJ contractile integral (P = 0.005). Notably, following a wet-swallow, the RGERD^HH- group experienced the significant elevation in gastric pressure and TPG. Correlation analyses revealed weakly acidic reflux and bolus exposure were positively correlated with gastric pressure variation, and inversely correlated with lower esophageal sphincter basal pressure.

Conclusions: : Transient gastric pressure elevation and compromised EGJ barrier function drive weakly acidic reflux and esophageal bolus exposure. This pressure gradient-barrier mismatch underpins the refractoriness of RGERD.

Background/aims: Safety data on potassium-competitive acid blockers are limited. We aim to evaluate the effect of tegoprazan on serum gastrin levels during maintenance treatment for gastroesophageal reflux disease compared to lansoprazole.

Methods: In a prospective, randomized trial, patients who underwent initial treatment with a standard dose of a proton pump inhibitor (n = 121) or tegoprazan (n = 226) were randomized to receive a half-dose of tegoprazan (n = 173) or lansoprazole (n = 174) as maintenance treatment for up to 24 weeks. Serum gastrin levels were measured immediately after initial treatment and monitored throughout the maintenance treatment period.

Results: Baseline gastrin levels were similar between the tegoprazan and lansoprazole groups (P = 0.335). During maintenance treatment, gastrin levels were significantly lower in the tegoprazan group at week 16 (P = 0.001) and week 24 (P = 0.012) compared to the lansoprazole group. Although the proportion of hypergastrinemia (> 115 pg/mL) was similar at baseline between the tegoprazan and lansoprazole groups (P = 0.114), it was significantly lower in the tegoprazan group during maintenance treatment (P = 0.003, 0.033, and 0.039 at weeks 8, 16, and 24, respectively) than in the lansoprazole group. Multivariate analysis revealed that age, sex, baseline gastrin levels, Helicobacter pylori infection, and the drug group were independently associated with final gastrin levels.

Conclusion: Tegoprazan has a smaller impact on increasing serum gastrin levels and the development of hypergastrinemia than lansoprazole, suggesting that tegoprazan may reduce safety concerns related to hypergastrinemia, particularly at half doses.

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.