Journal of Neurogastroenterology and Motility最新文献

The gut-brain axis describes the bidirectional communication between the gut, the enteric nervous system, and the central nervous system. The gut-brain axis has attracted increasing attention owing to its regulatory effect on dysbiosis and a wide range of related diseases. Several types of nutrients, such as curcumin, have been proposed as regulators of the dysbiotic state, and preclinical experiments have suggested that curcumin is not only beneficial but also safe. This review focuses on the interplay between curcumin and the gut microbiota. Moreover, it provides a comprehensive review of the crosstalk between the gut-brain axis and disease, whilst also discussing curcumin-mediated gut-brain axis-dependent and -independent signaling about modulation of gut microbiota dysbiosis. This will help to define the utility of curcumin as a novel therapeutic agent to regulate intestinal microflora dysbiosis.

Background/aims: Extended wireless pH monitoring (WPM) is used to investigate gastroesophageal reflux disease (GERD) as subsequent or alternative investigation to 24-hour catheter-based studies. However, false negative catheter studies may occur in patients with intermittent reflux or due to catheter-induced discomfort or altered behavior. We aim to investigate the diagnostic yield of WPM after a negative 24-hour multichannel intraluminal impedance pH (MII-pH) monitoring study and to determine predictors of GERD on WPM given a negative MII-pH.

Methods: Consecutive adult patients (> 18 years) who underwent WPM for further investigation of suspected GERD following a negative 24-hour MII-pH and upper endoscopy between January 2010 and December 2019 were retrospectively included. Clinical data, endoscopy, MII-pH, and WPM results were retrieved. Fisher's exact test, Wilcoxon rank sum test, or Student's t test were used to compare data. Logistic regression analysis was used to investigate predictors of positive WMP.

Results: One hundred and eighty-one consecutive patients underwent WPM following a negative MII-pH study. On average and worst day analysis, 33.7% (61/181) and 34.2% (62/181) of the patients negative for GERD on MII-pH were given a diagnosis of GERD following WPM, respectively. On a stepwise multiple logistic regression analysis, the basal respiratory minimum pressure of the lower esophageal sphincter was a significant predictor of GERD with OR = 0.95 (0.90-1.00, P = 0.041).

Conclusions: WPM increases GERD diagnostic yield in patients with a negative MII-pH selected for further testing based on clinical suspicion. Further studies are needed to assess the role of WPM as a first line investigation in patients with GERD symptoms.

Background/aims: A high prevalence of GERD has been reported in patients with supragastric belching. We aim to evaluate reflux characteristics and explore the temporal relationship between supragastric belches (SGBs) and reflux episodes in GERD patients with excessive belching.

Methods: Twenty-four hour esophageal pH-impedance monitoring was analyzed. Reflux episodes were classified into: refluxes preceded by SGBs, followed by SGBs, and lone refluxes. Reflux characteristics were compared between patients with pH-positive (pH+) and pH-negative(pH-).

Results: Forty-six patients (34 Female, age 47 ± 13 years) were included. Fifteen patients (32.6%) had pH+. Almost half (48.1 ± 21.0%) of refluxes were preceded by SGBs. The number of SGBs significantly correlated with the number of reflux episodes preceded by SGBs (r = 0.43, P < 0.05) and % time pH < 4 at the distal esophagus (r = 0.41, P < 0.05). Patients with pH+ had significantly more SGBs and reflux episodes preceded by SGBs/day than pH- patients (P < 0.05). The difference in the number of refluxes between pH+ and pH- patients was caused by reflux episodes preceded by SGBs, but not lone refluxes and refluxes followed by SGBs. The proportion of SGBs followed by reflux/total SGBs was similar between patients with pH+ and pH- (P > 0.05). Reflux episodes preceded by SGBs and followed by SGBs extended more proximal and had longer bolus and acid contact time than lone refluxes (P < 0.05).

Conclusions: In patients with GERD and SGB, the number of SGBs positively correlates with the number of reflux episodes preceded by SGBs. Identifying and managing SGB may be beneficial and more likely to improve GERD.

Background/aims: There is growing interest in whether Helicobacter pylori eradication (HPE) can affect body weight.

Methods: Data from 5 universities between January 2013 and December 2019 were analyzed retrospectively. H. pylori-positive subjects who had body weight measurements taken at least twice at intervals of 3 months or longer were included. Using propensity score (PS)-matched data, changes in body mass index (BMI) and the lipid profile after HPE were compared with the non-HPE group.

Results: Among 363 eligible patients, 131 HPE patients were PS-matched to 131 non-HPE patients. The median intervals between the measurements were 610 (range, 154-1250) days and 606 (range, 154-1648) days in the HPE and non-HPE groups, respectively. In both groups, the mean BMI increased (from 24.5 kg/m² to 24.7 kg/m² in the HPE group, and from 24.4 kg/m² to 24.5 kg/m² in the non-HPE group). The 2 groups did not show significantly different changes (P = 0.921). In the lowest baseline BMI quartile, the BMI increased after HPE by 1.23 (standard deviation [SD], 3.72) kg/m² (P = 0.060), and the non-HPE group showed a decreased BMI at the time of follow-up (by -0.24 [SD, 5.25] kg/m²; P = 0.937) (between-group P = 0.214). Triglyceride levels increased after HPE (mean: 135 [SD, 78] to 153 [SD, 100] mg/dL; between-group P = 0.053).

Conclusion: The overall BMI change was not significantly different between the HPE and non-HPE groups, but patients with low BMI showed a tendency to gain weight after HPE. Triglyceride levels increased after HPE with marginal significance.

Background/aims: Clinical rates of fecal incontinence (FI) are known to vary based on race and ethnicity. It is unclear if anorectal manometry (ARM) findings in patients with FI differ based on ethnicity.

Methods: High-resolution ARM studies performed between 2014-2021 due to FI at 2 hospitals with multiethnic populations were retrospectively reviewed.

Results: Four hundred and seventy-nine subjects were included--87 (18.2%) Arab Israelis, 76 (15.9%) immigrants from the former Soviet Union, and 316 (66.0%) Jewish Israelis. Median age was 67 years old (76.0% women: 90.4% were parous). The Arab Israeli group had higher rates of smoking, diabetes, and obesity. Over 95% of ARM's were abnormal per the London classification including 23% with "combined anal hypotension and hypocontractility," 36% with "anal normotension with anal hypocontractility," 67% with "dyssynergia," and 65% with either "rectal hyposensation" or "borderline rectal hyposensation." On univariate analyses, significant differences between the ethnic groups were noted in the rates of "anal hypotension with normal contractility," "combined anal hypotension with anal hypocontractility," and "dyssynergia." In multivariate logistic regression analyses controlling for age, gender, parity, smoking, diabetes, and obesity, the Arab Israeli group remained several times more likely to have "combined anal hypotension and hypocontractibility" compared to the other groups.

Conclusions: Ethnicity impacts ARM findings in patients with FI. The reason for this is unclear and future studies on ethnically diverse populations evaluating the clinical relevance of these findings are warranted.

Background/aims: Natural history of chronic intestinal pseudo-obstruction (CIPO), a rare disease characterized by episodes of non-mechanical obstruction, is unclear in adults. This study evaluates the clinical course of CIPO and palliative care needs of patients.

Methods: From October 2010 to September 2021, 74 patients who underwent cine MRI and had a definitive diagnosis of CIPO were prospectively included. We investigated disease etiology and outcomes, age at onset, nutritional status at consultation (body mass index and serum albumin), hydrogen breath test results, and total parenteral nutrition (TPN) during the disease course.

Results: Forty-seven patients (64%) were women, with a mean age of 44 years at onset and 49 years at diagnosis. Primary CIPO was observed in 48 patients (65%). Secondary CIPO was observed in 26 cases (35%), of whom 18 (69%) had scleroderma. The mean body mass index, serum albumin level, and hydrogen breath test positivity rate were 17 kg/m², 3.8 mg/dL, and 60%, respectively. TPN and invasive decompression therapy were required by 23 (31%) and 18 (24%) patients, respectively. Intestinal sterilization was performed in 51 (69%) patients and was effective in 33 (65%); of these, 28 (85%) were taking metronidazole. Seven (9%) patients used opioids. There were 9 deaths (12%), including 5 (56%) from infection and 2 (22%) from suicide. Of the deaths, 6 (67%) and 4 (44%) underwent TPN management and decompression therapy, respectively. Fifty-one patients (69%) wanted palliative care.

Conclusion: CIPO is a rare, severe, and under-recognized disease. Standardization of treatment strategies, including palliative care and psychiatric interventions, is desired.

Chronic constipation is one of the most common digestive diseases encountered in clinical practice. Constipation manifests as a variety of symptoms, such as infrequent bowel movements, hard stools, feeling of incomplete evacuation, straining at defecation, a sense of anorectal blockage during defecation, and use of digital maneuvers to assist defecation. During the diagnosis of chronic constipation, the Bristol Stool Form Scale, colonoscopy, and a digital rectal examination are useful for objective symptom evaluation and differential diagnosis of secondary constipation. Physiological tests for functional constipation have complementary roles and are recommended for patients who have failed to respond to treatment with available laxatives and those who are strongly suspected of having a defecatory disorder. As new evidence on the diagnosis and management of functional constipation emerged, the need to revise the previous guideline was suggested. Therefore, these evidence-based guidelines have proposed recommendations developed using a systematic review and meta-analysis of the treatment options available for functional constipation. The benefits and cautions of new pharmacological agents (such as lubiprostone and linaclotide) and conventional laxatives have been described through a meta-analysis. The guidelines consist of 34 recommendations, including 3 concerning the definition and epidemiology of functional constipation, 9 regarding diagnoses, and 22 regarding managements. Clinicians (including primary physicians, general health professionals, medical students, residents, and other healthcare professionals) and patients can refer to these guidelines to make informed decisions regarding the management of functional constipation.

Background/aims: The efficacy and safety of anti-reflux mucosectomy (ARMS) or radiofrequency energy delivery in the treatment of gastroesophageal reflux disease (GERD) have been reported, but the difference between the 2 remains unclear.

Methods: This was a single center, randomized, comparative clinical study. Patients with symptoms of heartburn and/or regurgitation despite proton pump inhibitor treatment were randomly assigned to either ARMS group (n = 20) or radiofrequency group (n = 20). Primary outcome was the standardized GERD questionnaire (GERDQ) at 2 years after the procedures. Secondary outcomes were the proportions of patients with complete proton pump inhibitor (PPI) cessation and patients satisfied with the treatment.

Results: A total of 18 patients randomized to ARMS and 16 to radiofrequency were analyzed in this study. The operation success rate of the 2 groups was 100%. In both ARMS and radiofrequency groups, GERDQ scores at 2 years after the procedures were significantly lower than that before operation (P = 0.044 and P = 0.046). At 2 years postoperatively, the scores of GERDQ did not differ between the 2 groups (P = 0.755). There was no significant difference in the rate of discontinuation of PPIs and patient satisfaction in the ARMS and radiofrequency groups (P = 0.642 and P = 0.934).

Conclusions: The clinical efficacy of ARMS and radiofrequency for the PPI-refractory GERD is equivalent. ARMS, the efficacy of which could be maintained for at least 2 years, is promising endoscopic management for the treatment of refractory GERD.