Journal of Neurogastroenterology and Motility最新文献

Background/aims: Proton pump inhibitors (PPIs) are widely used for gastric acid suppression but are associated with adverse effects such as hypergastrinemia and delayed gastric emptying (GE). Potassium-competitive acid blockers (P-CABs), a new class of acid suppressants, rapidly and sustainably inhibit gastric acid secretion. We compared the long-term effects of different P-CABs and PPIs on gastric pH, serum gastrin levels, GE, and small intestinal microbiota in a rat model.

Methods: Seventy-two male Sprague-Dawley rats were assigned to receive control, esomeprazole, tegoprazan, or vonoprazan by oral gavage for 1, 2, or 4 weeks. After sacrifice, gastric pH, serum gastrin levels, and GE were measured, and the small intestinal microbiota were analyzed using 16S ribosomal RNA sequencing.

Results: All drug-treated groups exhibited significantly higher gastric pH than the control group. Tegoprazan achieved the highest pH at week 2, surpassing those of esomeprazole and vonoprazan. Serum gastrin levels were significantly elevated in all drug-treated groups but remained stable from weeks 1 to 4, indicating a plateau effect. GE was transiently delayed at week 2 but returned to baseline by week 4 in all drug-treated groups. Long-term administration of both P-CABs and PPI led to reduced microbial diversity and distinct taxonomic shifts with changes in the abundance of Prevotella and Acetatifactor in the small intestine. However, with prolonged administration, these differences in microbiota composition gradually diminished.

Conclusions: Long-term administration of P-CABs and PPIs altered gastrin levels, GE, and gut microbiota. Therefore, the acid suppression-related adverse effects of P-CABs and PPIs are expected to be similar.

Background/aims: Cyclic vomiting syndrome (CVS) and cannabinoid hyperemesis syndrome (CHS) are emerging gastroduodenal disorders with a growing prevalence. However, little is known about their prevalence and clinical characteristics in Latin American populations, particularly in Mexico. This study aims to explore the clinical presentation of CVS and CHS in Mexico.

Methods: A cross-sectional study was conducted in 5 medical centers across Mexico, involving patients diagnosed with CVS or CHS based on the Rome IV criteria. Data collected included sociodemographic variables, substance use, comorbidities, and clinical characteristics, with a specific focus on the relationship between substance use, particularly cannabis, and symptomatology.

Results: The study included 46 patients, with 30 diagnosed with CVS and 16 with CHS. CVS patients were younger (median age 23 years) compared to CHS patients (median age 27 years; P = 0.043). CHS patients exhibited higher tobacco consumption (50.0% vs 26.7%; P = 0.019) and risky alcohol use (31.3% vs 0.0%; P = 0.003). Cannabis use was reported by 13.3% of CVS patients. The time to diagnosis was longer for CVS (35.4 ± 9.8 months) compared to CHS (26.5 ± 16.0 months; P = 0.016). No significant differences were found in the number of hospital admissions, as well as length of stay between patients with CVS and CHS.

Conclusions: This study presents the first detailed analysis of CVS and CHS in the Mexican population, revealing some demographic and clinical differences from global data. These findings highlight the importance of developing region-specific guidelines for diagnosing and managing these conditions, especially given Mexico's changing cannabis policies.

Background/aims: Adult idiopathic gastroparesis, characterized by delayed gastric emptying without mechanical obstruction, presents with symptoms such as nausea, vomiting, early satiety, and postprandial fullness. Diagnostic criteria vary across studies, leading to inconsistencies in diagnosis and management. This systematic review explores the diagnostic criteria and categorization of definite, probable, and possible idiopathic gastroparesis in the literature.

Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, we searched Medline, EMBASE, and Cochrane Library databases for relevant articles published in English up to January 2024. Observational studies (cross-sectional, case-control, and cohort designs) that provided diagnostic criteria for idiopathic gastroparesis were included. Data were extracted on demographics, co-existing conditions, symptoms, and diagnostic approaches. Quality was assessed using Joanna Briggs Institute checklists.

Results: Of 2235 initial results, 11 studies met our inclusion criteria. Most studies were of high quality, exclusively from Western research centers, and had a preponderance of female patients (61.7% to 85.9%) with mean ages ranging from 40.0 years to 58.9 years. Diagnostic variability was noted. A definite diagnosis was most often based on clinical symptoms and positive gastric emptying scintigraphy, while probable gastroparesis was identified by suggestive symptoms with normal upper endoscopy findings. Nausea and upper abdominal pain were frequently reported symptoms. Significant overlaps were observed between idiopathic gastroparesis and functional dyspepsia.

Conclusions: The findings highlight the inherent diagnostic challenges and underscores the need for confirming delayed gastric emptying to clinch an accurate diagnosis of gastroparesis. Future research should focus on developing consistent diagnostic criteria across diverse populations to improve the diagnosis and management of idiopathic gastroparesis.

Background/aims: Obesity is associated with several gastrointestinal (GI) disorders and has been identified as a potential risk factor for various GI symptoms. Bowel frequency is an important indicator of bowel function. However, the causal link between obesity and gastrointestinal motility remains uncertain. This study aims to determine the causal effect of overall and central obesity on stool frequency.

Methods: Four obesity-related anthropometric indicators-body mass index, body fat percentage, waist circumference (WC), and waist-to-hip ratio (WHR)-were investigated. Individual-level baseline information from the UK Biobank was used to explore observational associations between obesity and stool frequency. Additionally, summary-level data from published genome-wide association studies were subjected to two-sample Mendelian randomization (MR) analyses to examine causal associations.

Results: For all 4 indicators of obesity, higher levels of obesity were associated with more frequent bowel movements after adjusting for demographic characteristics, lifestyle, and dietary factors. After rigorous screening, 482 body mass index single nucleotide polymorphisms (SNPs), 7 body fat percentage SNPs, 48 WC SNPs, and 287 WHR SNPs were identified as instrument variables for MR analysis. The MR results were generally consistent with observational findings, proving that the associations observed in the overall obesity indicators were causal. For central obesity, the association between WHR and stool frequency remained consistent in both analysis phases, whereas WC showed a multidirectional association.

Conclusions: Obesity-related anthropometric indicators were causally associated with increased stool frequency in the overall and central obesity groups. Weight loss could be a potential approach to improve gastrointestinal regularity in individuals with obesity.

Background/aims: The association between caffeine intake and constipation remains inconclusive. This study aims to investigate whether caffeine intake is associated with constipation.

Methods: This cross-sectional study included 13 941 adults from the 2005-2010 National Health and Nutrition Examination Survey. The weighted logistic regression analyses were exerted to evaluate the association between caffeine intake and constipation. Besides, stratified analyses and interaction tests were conducted to determine the potential modifying factors.

Results: After adjusting for confounders, increased caffeine intake by 100 mg was not associated with constipation, as defined by stool frequency (OR, 1.01; 95% CI, 0.94-1.10) or stool consistency (OR, 1.01; 95% CI, 0.98-1.05). Subgroup analyses showed that cholesterol intake modified the relationship between increased caffeine by 100 mg and stool frequency-defined constipation (P for interaction = 0.037). Each 100 mg increase in caffeine intake was associated with a 20% decreased risk of constipation defined by stool frequency in participants who consumed high cholesterol (OR, 0.80; 95% CI, 0.64-1.00), but no association in the other 2 cholesterol level groups. Furthermore, the association between caffeine intake and stool consistency-defined constipation was not found in different cholesterol groups.

Conclusions: Caffeine consumption is not associated with stool frequency or consistency-defined constipation. Nevertheless, increased caffeine intake may decrease the risk of constipation (defined by stool frequency) among participants in the high-cholesterol intake group.

Background/aims: Panenteric gastrointestinal dysmotility in diabetic gastroenteropathy remains incompletely understood. We aim to (1) compare gastrointestinal transit times, contractile activity, and pH levels between individuals with and without diabetic gastroenteropathy and (2) investigate associations between symptoms and contractile activity.

Methods: We compared 37 healthy individuals to 68 individuals with diabetic gastroenteropathy. Gastrointestinal segmental transit times, contractile activity, and pH were measured with SmartPill. The Gastroparesis Cardinal Symptom Index and the Gastrointestinal Symptom Rating Scale were used to evaluate symptoms.

Results: Compared to controls, individuals with diabetic gastroenteropathy had prolonged median gastric emptying time (3.3 [IQR, 2.5-4.4] vs 2.5 [IQR, 1.9-3.6] hours, P = 0.023), antroduodenal transition time (23 [IQR, 8-52] vs 11 [IQR, 2-25] minutes, P = 0.015), colonic transit times (36.0 [IQR, 17.3-53.5) vs 20.8 [IQR, 14.0-28.8] hours, P = 0.004), and whole-gut transit time (46.1 [IQR, 24.3-72.9] vs 28.7 [IQR, 22.0-42.7] hours, P = 0.002). The diabetes group had lower antral contraction frequency (1.5 [IQR, 0.9-2.1] vs 2.5 [IQR, 1.5-3.9] contractions per minute, P = 0.004) and sum of amplitudes (1941 [1377-2763] vs 2975 [1734-5337] mmHg, P = 0.004). In contrast, the diabetes group had higher colonic sum of amplitudes and area under the contraction curve. The antral contraction frequency was unassociated with gastrointestinal symptoms. Still, the overall stomach contraction frequency increased by 30% (P < 0.001) and 15% (P = 0.003) in individuals with diabetes for each incremental increase in nausea and reflux scores, respectively.

Conclusions: Gastrointestinal transit times, as well as antral and colonic contractile activity, differed between individuals with diabetic gastroenteropathy and controls. The overall gastric contraction frequency was associated with symptom severity.

Background/aims: Rectal hyposensitivity (RH), as defined by the London Classification, has been linked to sensory dysfunction caused by diabetes mellitus and Parkinson's disease (PD); however, its clinical interpretation has not been sufficiently validated. In this study, we aim to explore the correlations between rectal sensory thresholds and the clinical characteristics of patients with functional defecatory disorders.

Methods: We reviewed data from patients who underwent high-resolution anorectal manometry and acquired their clinical characteristics using a standardized questionnaire. The associations between RH based on either 1 (borderline RH) or 2 (RH) abnormal rectal sensory thresholds and patients' clinical and demographic characteristics were analyzed using linear and logistic regression models in the overall sex-stratified populations.

Results: We enrolled 2540 patients, of whom 1046 (41.2%) were men. Overall, 150 (5.9%) patients were diagnosed with RH, whereas 422 (16.6%) had borderline RH. Multivariate linear regression analysis revealed that the Cleveland Clinic Constipation Score (CCCS) increased linearly with the increase in the number of abnormal rectal sensory thresholds (effect per threshold: 0.900 [standard deviation: 0.188]). Upon stratification by sex, borderline RH was positively associated with diabetes mellitus, PD, and CCCS (adjusted odds ratio [aOR] = 2.11, 95% confidence interval [1.08, 4.15]; aOR = 1.49 [1.03, 2.14]; aOR = 1.03 [1.01, 1.05], respectively) in women. However, RH was positively associated with only the CCCS.

Conclusions: Defining RH based on 1 or more abnormal sensory thresholds showed better clinical correlation with patient characteristics. However, further prospective studies are needed to validate these findings before proposing revisions to the current London classification criteria.