Khanh Hoang Nicholas Le, Eric E. Low, Priya Sharma, Madeline Greytak, Rena Yadlapati
BackgroundSurgical bariatric interventions, while highly effective, can be associated with post‐operative esophageal symptoms, gastroesophageal reflux disease and esophageal dysmotility. Whether pre‐operative physiology impacts this risk is unknown, in part because expected values on esophageal manometry in patients with obesity are not well understood. This study seeks to establish normative values on esophageal high resolution manometry (HRM) and the prevalence of esophageal dysmotility in the asymptomatic patient with obesity.MethodsThis retrospective study included adult patients with body mass index (BMI) ≥35 kg m−2 without esophageal symptoms undergoing preoperative bariatric surgical evaluation, including HRM, at a single tertiary care center between February, 2019 and February, 2020.ResultsOf 104 asymptomatic patients with obesity, HRM identified normal esophageal motility in 94 (90.4%) with the remaining 10 having ineffective esophageal motility (3.8%), manometric esophagogastric junction outflow obstruction (3.8%), distal esophageal spasm (1.0%), and hypercontractile esophagus (1.0%). Mean of median lower esophageal sphincter integrated relaxation pressure (LES IRP) was 10.6 mmHg supine (95th percentile 21.5 mmHg) and 8.5 mmHg upright (95th percentile 21.3 mmHg). 86% of patients had intragastric pressure above 8 mmHg. Mean of mean distal contractile integral (DCI) was 2261.6 mmHg cm s−1 (95th percentile 5889.5 mmHg cm s−1).ConclusionThe vast majority of asymptomatic patients with obesity had normal manometry. LES IRP and DCI were higher than that observed in non‐obese cohorts. Additionally, BMI correlated to increased intragastric pressure. These data suggest that normative values in patients with obesity should be adjusted to prevent overdiagnosis of EGJOO or hypercontractile esophagus.
{"title":"Normative high resolution esophageal manometry values in asymptomatic patients with obesity","authors":"Khanh Hoang Nicholas Le, Eric E. Low, Priya Sharma, Madeline Greytak, Rena Yadlapati","doi":"10.1111/nmo.14914","DOIUrl":"https://doi.org/10.1111/nmo.14914","url":null,"abstract":"BackgroundSurgical bariatric interventions, while highly effective, can be associated with post‐operative esophageal symptoms, gastroesophageal reflux disease and esophageal dysmotility. Whether pre‐operative physiology impacts this risk is unknown, in part because expected values on esophageal manometry in patients with obesity are not well understood. This study seeks to establish normative values on esophageal high resolution manometry (HRM) and the prevalence of esophageal dysmotility in the asymptomatic patient with obesity.MethodsThis retrospective study included adult patients with body mass index (BMI) ≥35 kg m<jats:sup>−2</jats:sup> without esophageal symptoms undergoing preoperative bariatric surgical evaluation, including HRM, at a single tertiary care center between February, 2019 and February, 2020.ResultsOf 104 asymptomatic patients with obesity, HRM identified normal esophageal motility in 94 (90.4%) with the remaining 10 having ineffective esophageal motility (3.8%), manometric esophagogastric junction outflow obstruction (3.8%), distal esophageal spasm (1.0%), and hypercontractile esophagus (1.0%). Mean of median lower esophageal sphincter integrated relaxation pressure (LES IRP) was 10.6 mmHg supine (95th percentile 21.5 mmHg) and 8.5 mmHg upright (95th percentile 21.3 mmHg). 86% of patients had intragastric pressure above 8 mmHg. Mean of mean distal contractile integral (DCI) was 2261.6 mmHg cm s<jats:sup>−1</jats:sup> (95th percentile 5889.5 mmHg cm s<jats:sup>−1</jats:sup>).ConclusionThe vast majority of asymptomatic patients with obesity had normal manometry. LES IRP and DCI were higher than that observed in non‐obese cohorts. Additionally, BMI correlated to increased intragastric pressure. These data suggest that normative values in patients with obesity should be adjusted to prevent overdiagnosis of EGJOO or hypercontractile esophagus.","PeriodicalId":19104,"journal":{"name":"Neurogastroenterology & Motility","volume":"201 1","pages":"e14914"},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142253905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elyse R. Thakur, Jordan M. Shapiro, Jennifer Wellington, Stephanie J. Sohl, Suzanne C. Danhauer, Baharak Moshiree, Alexander C. Ford, Kenneth Koch
BackgroundSeveral studies have reviewed yoga for the treatment of disorders of gut‐brain interaction (DGBI) with most demonstrating a benefit for symptom reduction; however, yoga has been studied beyond DGBI.PurposeThe aim of this systematic review is to provide a comprehensive summary of yoga as treatment for gastrointestinal conditions.MethodWe conducted literature searches in PubMed and Embase and included yoga trials of adults with a diagnosis of a gastrointestinal disorders and diseases.ResultsWe identified 1275 articles; 12 studies were eligible. Most studies compared yoga to controls, for patients with different GI conditions (irritable bowel syndrome, ulcerative colitis, chronic pancreatitis, and gastrointestinal cancer). The type, method, and duration of yoga used varied. Across IBS studies, most demonstrated that yoga improved IBS symptom severity, mood‐related symptoms, and quality of life compared with controls. In one study of inflammatory bowel disease, yoga improved quality of life compared to controls. Two studies of gastrointestinal cancer demonstrated that yoga led to a reduction in sleep disturbance and mood symptoms. One study of chronic pancreatitis found that yoga led to improvements in quality of life, stress, mood changes, alcohol dependence, and appetite. Yoga was generally safe, and no serious adverse events were attributed to the intervention.ConclusionIn conclusion, yoga appears to be safe and has potential to improve functioning across a spectrum of gastrointestinal diseases; however, current studies are limited by heterogeneity and methodological weaknesses. Further research is needed to evaluate the impact of yoga on health outcomes for a broader range of gastrointestinal conditions.
{"title":"A systematic review of yoga for the treatment of gastrointestinal disorders","authors":"Elyse R. Thakur, Jordan M. Shapiro, Jennifer Wellington, Stephanie J. Sohl, Suzanne C. Danhauer, Baharak Moshiree, Alexander C. Ford, Kenneth Koch","doi":"10.1111/nmo.14915","DOIUrl":"https://doi.org/10.1111/nmo.14915","url":null,"abstract":"BackgroundSeveral studies have reviewed yoga for the treatment of disorders of gut‐brain interaction (DGBI) with most demonstrating a benefit for symptom reduction; however, yoga has been studied beyond DGBI.PurposeThe aim of this systematic review is to provide a comprehensive summary of yoga as treatment for gastrointestinal conditions.MethodWe conducted literature searches in PubMed and Embase and included yoga trials of adults with a diagnosis of a gastrointestinal disorders and diseases.ResultsWe identified 1275 articles; 12 studies were eligible. Most studies compared yoga to controls, for patients with different GI conditions (irritable bowel syndrome, ulcerative colitis, chronic pancreatitis, and gastrointestinal cancer). The type, method, and duration of yoga used varied. Across IBS studies, most demonstrated that yoga improved IBS symptom severity, mood‐related symptoms, and quality of life compared with controls. In one study of inflammatory bowel disease, yoga improved quality of life compared to controls. Two studies of gastrointestinal cancer demonstrated that yoga led to a reduction in sleep disturbance and mood symptoms. One study of chronic pancreatitis found that yoga led to improvements in quality of life, stress, mood changes, alcohol dependence, and appetite. Yoga was generally safe, and no serious adverse events were attributed to the intervention.ConclusionIn conclusion, yoga appears to be safe and has potential to improve functioning across a spectrum of gastrointestinal diseases; however, current studies are limited by heterogeneity and methodological weaknesses. Further research is needed to evaluate the impact of yoga on health outcomes for a broader range of gastrointestinal conditions.","PeriodicalId":19104,"journal":{"name":"Neurogastroenterology & Motility","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142253899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Luis C. Populin, Abigail Z. Rajala, Kristina A. Matkowskyj, Sumona Saha, Weifeng Zeng, Bradley Christian, Andrew McVea, Emmy Xue Tay, Ellie M. Mueller, Margaret E. Malone, Ingrid Brust‐Mascher, Alan B. McMillan, Kip A. Ludwig, Aaron J. Suminski, Colin Reardon, John B. Furness
BackgroundDiarrhea is commonly associated with irritable bowel syndrome, inflammatory bowel disease, microscopic colitis, and other gastrointestinal dysfunctions. Spontaneously occurring idiopathic chronic diarrhea is frequent in rhesus macaques, but has not been used as a model for the investigation of diarrhea or its treatment. We characterized this condition and present preliminary data demonstrating that left vagal nerve stimulation provides relief.MethodsStool consistency scores were followed for up to 12 years. Inflammation was assessed by plasma C‐reactive protein, [18F]fluorodeoxyglucose (FDG) uptake, measured by positron emission tomography (PET), multiplex T cell localization, endoscopy and histology. The vagus was stimulated for 9 weeks in conscious macaques, using fully implanted electrodes, under wireless control.Key ResultsMacaques exhibited recurrent periods of diarrhea for up to 12 years, and signs of inflammation: elevated plasma C‐reactive protein, increased bowel FDG uptake and increased mucosal T helper1 T‐cells. The colon and distal ileum were endoscopically normal, and histology revealed mild colonic inflammation. Application of vagal nerve stimulation to conscious macaques (10 Hz, 30 s every 3 h; 24 h a day for 9 weeks) significantly reduced severity of diarrhea and also reduced inflammation, as measured by FDG uptake and C‐reactive protein.Conclusions and InferencesThese macaques exhibit spontaneously occurring diarrhea with intestinal inflammation that can be reduced by VNS. The data demonstrate the utility of this naturally occurring primate model to study the physiology and treatments for chronic diarrhea and the neural control circuits influencing diarrhea and inflammation that are not accessible in human subjects.
背景腹泻通常与肠易激综合征、炎症性肠病、微小结肠炎和其他胃肠功能紊乱有关。猕猴经常发生自发性特发性慢性腹泻，但尚未被用作腹泻或其治疗的研究模型。我们对这种情况进行了描述，并提供了初步数据，证明刺激左侧迷走神经可缓解腹泻。炎症通过血浆 C 反应蛋白、正电子发射断层扫描（PET）测量的[18F]氟脱氧葡萄糖（FDG）摄取、多重 T 细胞定位、内窥镜检查和组织学检查进行评估。在无线控制下，使用完全植入的电极对有意识的猕猴的迷走神经进行了为期 9 周的刺激。主要结果猕猴表现出长达 12 年的反复腹泻期和炎症迹象：血浆 C 反应蛋白升高、肠道 FDG 摄取增加和粘膜 T 辅助 1 T 细胞增加。结肠和回肠远端内镜检查正常，组织学检查显示结肠有轻微炎症。对有意识的猕猴施加迷走神经刺激（10赫兹，每3小时30秒；每天24小时，持续9周）可显著减轻腹泻的严重程度，同时还能减轻炎症，这是用FDG摄取量和C反应蛋白来衡量的。这些数据证明了这种自然发生的灵长类动物模型在研究慢性腹泻的生理学和治疗方法以及影响腹泻和炎症的神经控制回路方面的实用性，而这些在人类身上是无法获得的。
{"title":"Characterization of idiopathic chronic diarrhea and associated intestinal inflammation and preliminary observations of effects of vagal nerve stimulation in a non‐human primate","authors":"Luis C. Populin, Abigail Z. Rajala, Kristina A. Matkowskyj, Sumona Saha, Weifeng Zeng, Bradley Christian, Andrew McVea, Emmy Xue Tay, Ellie M. Mueller, Margaret E. Malone, Ingrid Brust‐Mascher, Alan B. McMillan, Kip A. Ludwig, Aaron J. Suminski, Colin Reardon, John B. Furness","doi":"10.1111/nmo.14876","DOIUrl":"https://doi.org/10.1111/nmo.14876","url":null,"abstract":"BackgroundDiarrhea is commonly associated with irritable bowel syndrome, inflammatory bowel disease, microscopic colitis, and other gastrointestinal dysfunctions. Spontaneously occurring idiopathic chronic diarrhea is frequent in rhesus macaques, but has not been used as a model for the investigation of diarrhea or its treatment. We characterized this condition and present preliminary data demonstrating that left vagal nerve stimulation provides relief.MethodsStool consistency scores were followed for up to 12 years. Inflammation was assessed by plasma C‐reactive protein, [<jats:sup>18</jats:sup>F]fluorodeoxyglucose (FDG) uptake, measured by positron emission tomography (PET), multiplex T cell localization, endoscopy and histology. The vagus was stimulated for 9 weeks in conscious macaques, using fully implanted electrodes, under wireless control.Key ResultsMacaques exhibited recurrent periods of diarrhea for up to 12 years, and signs of inflammation: elevated plasma C‐reactive protein, increased bowel FDG uptake and increased mucosal T helper1 T‐cells. The colon and distal ileum were endoscopically normal, and histology revealed mild colonic inflammation. Application of vagal nerve stimulation to conscious macaques (10 Hz, 30 s every 3 h; 24 h a day for 9 weeks) significantly reduced severity of diarrhea and also reduced inflammation, as measured by FDG uptake and C‐reactive protein.Conclusions and InferencesThese macaques exhibit spontaneously occurring diarrhea with intestinal inflammation that can be reduced by VNS. The data demonstrate the utility of this naturally occurring primate model to study the physiology and treatments for chronic diarrhea and the neural control circuits influencing diarrhea and inflammation that are not accessible in human subjects.","PeriodicalId":19104,"journal":{"name":"Neurogastroenterology & Motility","volume":"135 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141780158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Manuel Besendörfer, Christian Knorr, Annemarie Kirchgatter, Hanna Müller, Patricia Reis Wolfertstetter, Klaus E. Matzel, Sonja Diez
BackgroundEven if understanding of neuronal enteropathies, such as Hirschsprung's disease and functional constipation, has been improved, specialized therapies are still missing. Sacral neuromodulation (SNM) has been established in the treatment of defecation disorders in adults. The aim of the study was to investigate effects of SNM in children and adolescents with refractory symptoms of chronic constipation.MethodsA two‐centered, prospective trial has been conducted between 2019 and 2022. SNM was applied continuously at individually set stimulation intensity. Evaluation of clinical outcomes was conducted at 3, 6, and 12 months after surgery based on the developed questionnaires and quality of life analysis (KINDLR). Primary outcome was assessed based on predefined variables of fecal incontinence and defecation frequency.Key ResultsFifteen patients enrolled in the study and underwent SNM (median age 8.0 years (range 4–17 years)): eight patients were diagnosed with Hirschsprung's disease (53%). Improvement of defecation frequency was seen in 8/15 participants (53%) and an improvement of fecal incontinence in 9/12 patients (75%). We observed stable outcome after 1 year of treatment. Surgical revision was necessary in one patient after electrode breakage. Urinary incontinence was observed as singular side effect of treatment in two patients (13%), which was manageable with the reduction of stimulation intensity.ConclusionsSNM shows promising clinical results in children and adolescents presenting with chronic constipation refractory to conservative therapy. Indications for patients with enteral neuropathies deserve further confirmation.
{"title":"Sacral neuromodulation in children and adolescents with defecation disorders","authors":"Manuel Besendörfer, Christian Knorr, Annemarie Kirchgatter, Hanna Müller, Patricia Reis Wolfertstetter, Klaus E. Matzel, Sonja Diez","doi":"10.1111/nmo.14808","DOIUrl":"https://doi.org/10.1111/nmo.14808","url":null,"abstract":"BackgroundEven if understanding of neuronal enteropathies, such as Hirschsprung's disease and functional constipation, has been improved, specialized therapies are still missing. Sacral neuromodulation (SNM) has been established in the treatment of defecation disorders in adults. The aim of the study was to investigate effects of SNM in children and adolescents with refractory symptoms of chronic constipation.MethodsA two‐centered, prospective trial has been conducted between 2019 and 2022. SNM was applied continuously at individually set stimulation intensity. Evaluation of clinical outcomes was conducted at 3, 6, and 12 months after surgery based on the developed questionnaires and quality of life analysis (KINDL<jats:sub>R</jats:sub>). Primary outcome was assessed based on predefined variables of fecal incontinence and defecation frequency.Key ResultsFifteen patients enrolled in the study and underwent SNM (median age 8.0 years (range 4–17 years)): eight patients were diagnosed with Hirschsprung's disease (53%). Improvement of defecation frequency was seen in 8/15 participants (53%) and an improvement of fecal incontinence in 9/12 patients (75%). We observed stable outcome after 1 year of treatment. Surgical revision was necessary in one patient after electrode breakage. Urinary incontinence was observed as singular side effect of treatment in two patients (13%), which was manageable with the reduction of stimulation intensity.ConclusionsSNM shows promising clinical results in children and adolescents presenting with chronic constipation refractory to conservative therapy. Indications for patients with enteral neuropathies deserve further confirmation.","PeriodicalId":19104,"journal":{"name":"Neurogastroenterology & Motility","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140837729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BackgroundThe diagnosis of disorders of gut–brain interaction (DGBI) in children is exclusively based on clinical criteria called the Rome criteria. The inter‐rater reliability (IRR) measures how well two raters agree with a diagnosis using the same diagnostic tool. Previous versions of the Rome criteria showed only fair to moderate IRR. There have been no studies assessing the IRR of the current edition of the pediatric Rome criteria (Rome IV). This study sought to investigate the IRR of the pediatric Rome IV criteria and compare its reliability with the previous versions of the Rome criteria. We hypothesized that changes made to Rome IV would result in higher IRR than previous versions.MethodsThis study used the same methodology as the previous studies on Rome II and III, including identical clinical vignettes, number of raters, and levels of expertise. Participants included 10 pediatric gastroenterology fellows and 10 pediatric gastroenterology specialists. IRR was assessed using the percentage of agreement and Cohen's kappa coefficient to account for possible agreement by chance.ResultsThe average IRR percentage of agreement using the Rome IV criteria was 55% for pediatric gastroenterologists and 48.5% for fellows, indicating moderate agreement (k = 0.54 for specialists, k = 0.47 for fellows). The results demonstrated higher percentages of agreement and kappa coefficients compared to the Rome II and III criteria.ConclusionsThe findings demonstrate improved reliability in Rome IV compared to Rome II and III, suggesting that the changes incorporated into the Rome IV criteria have enhanced diagnostic consistency. Despite the advancements, the reliability is still moderate, indicating the need for further refinement of future versions of the Rome criteria.
背景儿童肠脑互动障碍（DGBI）的诊断完全基于临床标准，即罗马标准。评定者之间的可靠性（IRR）衡量两位评定者在使用同一诊断工具进行诊断时达成一致的程度。以前版本的罗马标准只显示出一般到中等的 IRR。目前还没有研究对当前版本的儿科罗马标准（罗马IV）的内部信度进行评估。本研究旨在调查儿科罗马IV标准的内部反应率，并将其可靠性与之前版本的罗马标准进行比较。我们假设，对罗马标准 IV 所做的修改将使其 IRR 高于之前的版本。方法本研究采用了与之前罗马标准 II 和 III 相同的研究方法，包括相同的临床案例、评分者人数和专业水平。参与者包括 10 名儿科胃肠病学研究员和 10 名儿科胃肠病学专家。结果使用罗马IV标准的平均IRR一致率为：儿科胃肠病专家55%，研究员48.5%，表明一致率中等（专家k=0.54，研究员k=0.47）。结论研究结果表明，与罗马 II 和罗马 III 标准相比，罗马 IV 标准的可靠性有所提高，这表明罗马 IV 标准中的变化增强了诊断的一致性。尽管取得了进步，但可靠性仍处于中等水平，这表明需要进一步完善未来版本的罗马标准。
{"title":"Reliability of pediatric Rome IV criteria for the diagnosis of disorders of gut–brain interaction","authors":"Lee Ginton, Rasmita Budhathoki, Miguel Saps","doi":"10.1111/nmo.14813","DOIUrl":"https://doi.org/10.1111/nmo.14813","url":null,"abstract":"BackgroundThe diagnosis of disorders of gut–brain interaction (DGBI) in children is exclusively based on clinical criteria called the Rome criteria. The inter‐rater reliability (IRR) measures how well two raters agree with a diagnosis using the same diagnostic tool. Previous versions of the Rome criteria showed only fair to moderate IRR. There have been no studies assessing the IRR of the current edition of the pediatric Rome criteria (Rome IV). This study sought to investigate the IRR of the pediatric Rome IV criteria and compare its reliability with the previous versions of the Rome criteria. We hypothesized that changes made to Rome IV would result in higher IRR than previous versions.MethodsThis study used the same methodology as the previous studies on Rome II and III, including identical clinical vignettes, number of raters, and levels of expertise. Participants included 10 pediatric gastroenterology fellows and 10 pediatric gastroenterology specialists. IRR was assessed using the percentage of agreement and Cohen's kappa coefficient to account for possible agreement by chance.ResultsThe average IRR percentage of agreement using the Rome IV criteria was 55% for pediatric gastroenterologists and 48.5% for fellows, indicating moderate agreement (<jats:italic>k</jats:italic> = 0.54 for specialists, <jats:italic>k</jats:italic> = 0.47 for fellows). The results demonstrated higher percentages of agreement and kappa coefficients compared to the Rome II and III criteria.ConclusionsThe findings demonstrate improved reliability in Rome IV compared to Rome II and III, suggesting that the changes incorporated into the Rome IV criteria have enhanced diagnostic consistency. Despite the advancements, the reliability is still moderate, indicating the need for further refinement of future versions of the Rome criteria.","PeriodicalId":19104,"journal":{"name":"Neurogastroenterology & Motility","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140837600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mikaela Law, Gabriel Schamberg, Armen Gharibans, Gabrielle Sebaratnam, Daphne Foong, Chris Varghese, India Fitt, Charlotte Daker, Vincent Ho, Peng Du, Christopher N. Andrews, Greg O'Grady, Stefan Calder
BackgroundMany diagnostic tests for gastroduodenal symptoms, such as gastric emptying scintigraphy (GES), gastric emptying breath tests (GEBT), and electrogastrography (EGG) show variable intra‐individual reproducibility over time. This study investigated the short‐ and long‐term reproducibility of body surface gastric mapping (BSGM), a non‐invasive test for assessing gastric function, in controls and patients with chronic gastroduodenal disorders.MethodsParticipants completed three standardized BSGM tests using Gastric Alimetry® (Alimetry, New Zealand). The test encompassed a fasting baseline (30 min), a 482 kCal standard meal, and a 4 h postprandial recording. The first two tests were >6 months apart and the last occurred ~1 week after the second test, to evaluate long and short‐term reproducibility.ResultsFourteen patients with upper gastrointestinal symptoms and 14 healthy controls were recruited. There were no significant differences in any BSGM metrics between the tests at short and long term (all p > 0.180). Lin's concordance correlation coefficients (CCC) for the primary metrics were high, ranging from 0.58 to 0.96, with intra‐individual coefficients of variance (CVintra) ranging from 0.2% to 1.9%. Reproducibility was higher, and intra‐individual variation lower, than in previous studies of GES (CCC = 0.54–0.83, CVintra = 3%–77%), GEBT (CVintra = 8%–11%), and EGG (CVintra = 3%–78%).ConclusionsBSGM spectral metrics demonstrate high reproducibility and low intra‐individual variation at both short and long term, with superior results to comparable tests. The high reproducibility of Gastric Alimetry supports its role as a diagnostic aid for gastric dysfunction and a reliable tool for evaluating treatment outcomes and disease progression over time.
{"title":"Short‐ and long‐term reproducibility of body surface gastric mapping using the Gastric Alimetry® system","authors":"Mikaela Law, Gabriel Schamberg, Armen Gharibans, Gabrielle Sebaratnam, Daphne Foong, Chris Varghese, India Fitt, Charlotte Daker, Vincent Ho, Peng Du, Christopher N. Andrews, Greg O'Grady, Stefan Calder","doi":"10.1111/nmo.14812","DOIUrl":"https://doi.org/10.1111/nmo.14812","url":null,"abstract":"BackgroundMany diagnostic tests for gastroduodenal symptoms, such as gastric emptying scintigraphy (GES), gastric emptying breath tests (GEBT), and electrogastrography (EGG) show variable intra‐individual reproducibility over time. This study investigated the short‐ and long‐term reproducibility of body surface gastric mapping (BSGM), a non‐invasive test for assessing gastric function, in controls and patients with chronic gastroduodenal disorders.MethodsParticipants completed three standardized BSGM tests using Gastric Alimetry® (Alimetry, New Zealand). The test encompassed a fasting baseline (30 min), a 482 kCal standard meal, and a 4 h postprandial recording. The first two tests were >6 months apart and the last occurred ~1 week after the second test, to evaluate long and short‐term reproducibility.ResultsFourteen patients with upper gastrointestinal symptoms and 14 healthy controls were recruited. There were no significant differences in any BSGM metrics between the tests at short and long term (all <jats:italic>p</jats:italic> > 0.180). Lin's concordance correlation coefficients (CCC) for the primary metrics were high, ranging from 0.58 to 0.96, with intra‐individual coefficients of variance (CV<jats:sub>intra</jats:sub>) ranging from 0.2% to 1.9%. Reproducibility was higher, and intra‐individual variation lower, than in previous studies of GES (CCC = 0.54–0.83, CV<jats:sub>intra</jats:sub> = 3%–77%), GEBT (CV<jats:sub>intra</jats:sub> = 8%–11%), and EGG (CV<jats:sub>intra</jats:sub> = 3%–78%).ConclusionsBSGM spectral metrics demonstrate high reproducibility and low intra‐individual variation at both short and long term, with superior results to comparable tests. The high reproducibility of Gastric Alimetry supports its role as a diagnostic aid for gastric dysfunction and a reliable tool for evaluating treatment outcomes and disease progression over time.","PeriodicalId":19104,"journal":{"name":"Neurogastroenterology & Motility","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140837906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jessica L. Swartz, Ali Zifan, Lori J. Tuttle, Geoffrey Sheean, Rowena M. Tam, Ravinder K. Mittal
BackgroundDisruption of external anal sphincter muscle (EAS) is an important factor in the multifactorial etiology of fecal incontinence (FI).ObjectivesWe categorize FI patients into four groups based on the location of lesion in neuromuscular circuitry of EAS to determine if there are differences with regards to fecal incontinence symptoms severity (FISI) score, age, BMI, obstetrical history, and anal sphincter muscle damage.MethodsFemale patients (151) without any neurological symptoms, who had undergone high‐resolution manometry, anal sphincter EMG, and 3D ultrasound imaging of the anal sphincter were assessed. Patients were categorized into four groups: Group 1 (normal)—normal cough EMG (>10 μV), normal squeeze EMG (>10 μV), and normal anal squeeze pressure (>124 mmHg); Group 2 (cortical apraxia, i.e., poor cortical activation)—normal cough EMG, low squeeze EMG, and low anal squeeze pressure; Group 3 (muscle damage)—normal cough EMG, normal squeeze EMG, and low anal squeeze pressure; and Group 4 (pudendal nerve damage)—low cough EMG, low squeeze EMG, and low anal squeeze pressure.ResultsThe four patient groups were not different with regards to the patient's age, BMI, parity, and FISI scores. 3D ultrasound images of the anal sphincter complex revealed significant damage to the internal anal sphincter, external anal sphincter, and puborectalis muscles in all four groups.ConclusionThe FI patients are a heterogeneous group; majority of these patients have significant damage to the muscles of the anal sphincter complex. Whether biofeedback therapy response is different among different patient groups requires study.
{"title":"Fecal incontinence patients categorized based on anal pressure and electromyography: Anal sphincter damage and clinical symptoms","authors":"Jessica L. Swartz, Ali Zifan, Lori J. Tuttle, Geoffrey Sheean, Rowena M. Tam, Ravinder K. Mittal","doi":"10.1111/nmo.14810","DOIUrl":"https://doi.org/10.1111/nmo.14810","url":null,"abstract":"BackgroundDisruption of external anal sphincter muscle (EAS) is an important factor in the multifactorial etiology of fecal incontinence (FI).ObjectivesWe categorize FI patients into four groups based on the location of lesion in neuromuscular circuitry of EAS to determine if there are differences with regards to fecal incontinence symptoms severity (FISI) score, age, BMI, obstetrical history, and anal sphincter muscle damage.MethodsFemale patients (151) without any neurological symptoms, who had undergone high‐resolution manometry, anal sphincter EMG, and 3D ultrasound imaging of the anal sphincter were assessed. Patients were categorized into four groups: Group 1 (normal)—normal cough EMG (>10 μV), normal squeeze EMG (>10 μV), and normal anal squeeze pressure (>124 mmHg); Group 2 (cortical apraxia, i.e., poor cortical activation)—normal cough EMG, low squeeze EMG, and low anal squeeze pressure; Group 3 (muscle damage)—normal cough EMG, normal squeeze EMG, and low anal squeeze pressure; and Group 4 (pudendal nerve damage)—low cough EMG, low squeeze EMG, and low anal squeeze pressure.ResultsThe four patient groups were not different with regards to the patient's age, BMI, parity, and FISI scores. 3D ultrasound images of the anal sphincter complex revealed significant damage to the internal anal sphincter, external anal sphincter, and puborectalis muscles in all four groups.ConclusionThe FI patients are a heterogeneous group; majority of these patients have significant damage to the muscles of the anal sphincter complex. Whether biofeedback therapy response is different among different patient groups requires study.","PeriodicalId":19104,"journal":{"name":"Neurogastroenterology & Motility","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140837931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mythili P. Pathipati, Luisa L. Scott, Allen Cameron Griser, Kyle Staller
BackgroundMahana™ IBS is a Food and Drug Administration‐cleared prescription mobile application designed to deliver 3 months of gut‐directed cognitive behavioral therapy (CBT) to adults ≥22 years old with irritable bowel syndrome (IBS). We assessed whether gut‐directed CBT delivered digitally improved outcomes in IBS management.MethodsWe studied users who had a dispensed physician prescription for Mahana™ IBS between August 2021 and August 2023. The primary outcome was change in IBS symptom severity (IBS‐SSS) score.Key ResultsFor the 843 patients, 324 (38%) completed half of the program up to session 5, and 162 (19%) of participants completed the full program up to session 10. Median age was 41 years, median IBS‐SSS was 270 (moderate severity), IBS‐mixed subtype was most common (23%) followed by IBS‐C (20%) and IBS‐D (19%). The change in IBS‐SSS was −81.0 (p = < 0.001) after session 5 and − 104.4 (p = < 0.001) after session 10. In multivariate analyses, a higher baseline IBS‐SSS (OR 1.59; 95% CI 1.26–2.01) and high baseline Perceived Stress Scale (PSS) score predicted non‐response (OR 0.95; 95% CI 0.91–0.98) while older age (OR 1.10 per decade; 95% CI 1.01–1.20), prescription source from a healthcare provider (as opposed to third party telehealth encounter, OR 1.48; 95% CI 1.07–2.05), and payment for the app (OR 1.93; 95% CI 1.41–2.63) predicted adherence.Conclusions & InferencesUse of a digital mobile application for gut‐directed CBT improved symptoms of IBS. Digital health applications have the potential to democratize CBT and allow integrated care to scale for patients with IBS.
{"title":"Real‐world outcomes for a digital prescription mobile application for adults with irritable bowel syndrome","authors":"Mythili P. Pathipati, Luisa L. Scott, Allen Cameron Griser, Kyle Staller","doi":"10.1111/nmo.14811","DOIUrl":"https://doi.org/10.1111/nmo.14811","url":null,"abstract":"BackgroundMahana™ IBS is a Food and Drug Administration‐cleared prescription mobile application designed to deliver 3 months of gut‐directed cognitive behavioral therapy (CBT) to adults ≥22 years old with irritable bowel syndrome (IBS). We assessed whether gut‐directed CBT delivered digitally improved outcomes in IBS management.MethodsWe studied users who had a dispensed physician prescription for Mahana™ IBS between August 2021 and August 2023. The primary outcome was change in IBS symptom severity (IBS‐SSS) score.Key ResultsFor the 843 patients, 324 (38%) completed half of the program up to session 5, and 162 (19%) of participants completed the full program up to session 10. Median age was 41 years, median IBS‐SSS was 270 (moderate severity), IBS‐mixed subtype was most common (23%) followed by IBS‐C (20%) and IBS‐D (19%). The change in IBS‐SSS was −81.0 (<jats:italic>p</jats:italic> = < 0.001) after session 5 and − 104.4 (<jats:italic>p</jats:italic> = < 0.001) after session 10. In multivariate analyses, a higher baseline IBS‐SSS (OR 1.59; 95% CI 1.26–2.01) and high baseline Perceived Stress Scale (PSS) score predicted non‐response (OR 0.95; 95% CI 0.91–0.98) while older age (OR 1.10 per decade; 95% CI 1.01–1.20), prescription source from a healthcare provider (as opposed to third party telehealth encounter, OR 1.48; 95% CI 1.07–2.05), and payment for the app (OR 1.93; 95% CI 1.41–2.63) predicted adherence.Conclusions & InferencesUse of a digital mobile application for gut‐directed CBT improved symptoms of IBS. Digital health applications have the potential to democratize CBT and allow integrated care to scale for patients with IBS.","PeriodicalId":19104,"journal":{"name":"Neurogastroenterology & Motility","volume":"60 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140837595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eline Margrete Randulff Hillestad, Elisabeth Kjelsvik Steinsvik, Erica Sande Teige, Stella Hellgren Rasmussen, Ingeborg Brønstad, Arvid Lundervold, Trygve Hausken, Kurt Hanevik, Gülen Arslan Lied, Birgitte Berentsen
BackgroundA low FODMAP diet (LFD) is an established dietary treatment for patients with irritable bowel syndrome (IBS). However, knowledge on the extended effects of the restriction phase regarding nutrient intake, symptom severity, and quality of life (QoL) is sparse. Therefore, our objectives were to evaluate the safety of a dietitian‐led 12‐week strict LFD on measures of blood biochemistry, nutritional status, symptom severity, and QoL.MethodsIn this open‐label dietitian‐led 12‐week strict LFD intervention for IBS patients with predominantly diarrhea or mixed stool pattern (IBS‐D/−M), we collected data on diet intake (3‐day dietary record), overnight fasting routine blood samples, body weight, IBS symptoms (IBS Severity Scoring System (IBS‐SSS)), and IBS‐related QoL (IBS‐QoL) at baseline and after 12 weeks.Key ResultsThirty‐six participants completed the 12‐week follow‐up (mean age: 37 years, 67% women, IBS‐SSS: 242 (101)). All blood parameters measured were within established reference values at both time points. We found no change in intake of macro‐ or micronutrients, but several micronutrients were below the recommendations both before and after 12 weeks. BMI slightly decreased, primarily driven by participants with BMI >25 (p < 0.005). QoL improved among most subdomains (p ≤ 0.002), except food avoidance and social reaction.ConclusionAn extended dietitian‐guided LFD (12 weeks) is not inferior to the participants' baseline diet, since no clinically meaningful changes in nutritionally related blood samples and no changes in macro‐ or micronutrient intake were observed. However, the intake of several nutrients was below the recommendations at both time points indicating low diet quality.
{"title":"Nutritional safety and status following a 12‐week strict low FODMAP diet in patients with irritable bowel syndrome","authors":"Eline Margrete Randulff Hillestad, Elisabeth Kjelsvik Steinsvik, Erica Sande Teige, Stella Hellgren Rasmussen, Ingeborg Brønstad, Arvid Lundervold, Trygve Hausken, Kurt Hanevik, Gülen Arslan Lied, Birgitte Berentsen","doi":"10.1111/nmo.14814","DOIUrl":"https://doi.org/10.1111/nmo.14814","url":null,"abstract":"BackgroundA low FODMAP diet (LFD) is an established dietary treatment for patients with irritable bowel syndrome (IBS). However, knowledge on the extended effects of the restriction phase regarding nutrient intake, symptom severity, and quality of life (QoL) is sparse. Therefore, our objectives were to evaluate the safety of a dietitian‐led 12‐week strict LFD on measures of blood biochemistry, nutritional status, symptom severity, and QoL.MethodsIn this open‐label dietitian‐led 12‐week strict LFD intervention for IBS patients with predominantly diarrhea or mixed stool pattern (IBS‐D/−M), we collected data on diet intake (3‐day dietary record), overnight fasting routine blood samples, body weight, IBS symptoms (IBS Severity Scoring System (IBS‐SSS)), and IBS‐related QoL (IBS‐QoL) at baseline and after 12 weeks.Key ResultsThirty‐six participants completed the 12‐week follow‐up (mean age: 37 years, 67% women, IBS‐SSS: 242 (101)). All blood parameters measured were within established reference values at both time points. We found no change in intake of macro‐ or micronutrients, but several micronutrients were below the recommendations both before and after 12 weeks. BMI slightly decreased, primarily driven by participants with BMI >25 (<jats:italic>p</jats:italic> < 0.005). QoL improved among most subdomains (<jats:italic>p</jats:italic> ≤ 0.002), except <jats:italic>food avoidance</jats:italic> and <jats:italic>social reaction.</jats:italic>ConclusionAn extended dietitian‐guided LFD (12 weeks) is not inferior to the participants' baseline diet, since no clinically meaningful changes in nutritionally related blood samples and no changes in macro‐ or micronutrient intake were observed. However, the intake of several nutrients was below the recommendations at both time points indicating low diet quality.","PeriodicalId":19104,"journal":{"name":"Neurogastroenterology & Motility","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140837771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Borko Nojkov, Colin Burnett, Lydia Watts, Jieyun Yin, Khawar Ali, Tingting Zhao, Shiyuan Gong, Candice Miller, Matthew Habrowski, William D. Chey, Jiande D. Z. Chen
BackgroundTreatment options for abdominal pain in IBS are inadequate. TEA was reported effective treatment of disorders of gut–brain interaction but its mechanism of action and optimal delivery method for treating pain in IBS are unknown. This study aims to determine the most effective TEA parameter and location to treat abdominal pain in patients with IBS‐Constipation and delineate the effect of TEA on rectal sensation and autonomic function.MethodsNineteen IBS‐C patients underwent TEA at acupoints ST36 (leg), PC6 (wrist), or sham‐acupoint. Each patient was studied in five randomized sessions on separate days: (1) TEA/ST36‐100 Hz; (2) TEA/ST36‐25 Hz; (3) TEA/PC6‐100 Hz; (4) TEA/PC6‐25 Hz; (5) TEA/Sham‐25 Hz. In each session, barostat‐guided rectal distention (RD) was performed before and after TEA. Patients graded the RD‐induced pain and recorded three rectal sensation thresholds. A heart rate variability (HRV) signal was derived from the electrocardiogram for autonomic function assessment.Key ResultsStudied patients were predominantly female, young, and Caucasian. Compared with baseline, patients treated with TEA/ST36‐100 Hz had significantly decreased pain scores at RD pressure‐points 20–50 mmHg (p < 0.04). The average pain reduction was 40%. Post‐treatment scores did not change significantly with other TEA modalities except with sham‐TEA (lesser degree compared to ST36‐100 Hz, p = 0.04). TEA/ST36‐100, but not other modalities, increased the rectal sensation threshold (first sensation: p = 0.007; urge to defecate: p < 0.026). TEA/ST36‐100 Hz was the only treatment that significantly decreased sympathetic activity and increased parasympathetic activity with and without RD (p < 0.04).Conclusions & InferencesTEA at ST36‐100 Hz is superior stimulation point/parameter, compared to TEA at PC‐6/sham‐TEA, to reduce rectal distension‐induced pain in IBS‐C patients. This therapeutic effect appears to be mediated through rectal hypersensitivity reduction and autonomic function modulation.
{"title":"The impact of transcutaneous electrical acustimulation (TEA) on rectal distension‐induced pain in patients with irritable bowel syndrome (IBS)—A study to determine the optimal TEA delivery modalities and effects on rectal sensation and autonomic function","authors":"Borko Nojkov, Colin Burnett, Lydia Watts, Jieyun Yin, Khawar Ali, Tingting Zhao, Shiyuan Gong, Candice Miller, Matthew Habrowski, William D. Chey, Jiande D. Z. Chen","doi":"10.1111/nmo.14799","DOIUrl":"https://doi.org/10.1111/nmo.14799","url":null,"abstract":"BackgroundTreatment options for abdominal pain in IBS are inadequate. TEA was reported effective treatment of disorders of gut–brain interaction but its mechanism of action and optimal delivery method for treating pain in IBS are unknown. This study aims to determine the most effective TEA parameter and location to treat abdominal pain in patients with IBS‐Constipation and delineate the effect of TEA on rectal sensation and autonomic function.MethodsNineteen IBS‐C patients underwent TEA at acupoints ST36 (leg), PC6 (wrist), or sham‐acupoint. Each patient was studied in five randomized sessions on separate days: (1) TEA/ST36‐100 Hz; (2) TEA/ST36‐25 Hz; (3) TEA/PC6‐100 Hz; (4) TEA/PC6‐25 Hz; (5) TEA/Sham‐25 Hz. In each session, barostat‐guided rectal distention (RD) was performed before and after TEA. Patients graded the RD‐induced pain and recorded three rectal sensation thresholds. A heart rate variability (HRV) signal was derived from the electrocardiogram for autonomic function assessment.Key ResultsStudied patients were predominantly female, young, and Caucasian. Compared with baseline, patients treated with TEA/ST36‐100 Hz had significantly decreased pain scores at RD pressure‐points 20–50 mmHg (<jats:italic>p</jats:italic> < 0.04). The average pain reduction was 40%. Post‐treatment scores did not change significantly with other TEA modalities except with sham‐TEA (lesser degree compared to ST36‐100 Hz, <jats:italic>p</jats:italic> = 0.04). TEA/ST36‐100, but not other modalities, increased the rectal sensation threshold (first sensation: <jats:italic>p</jats:italic> = 0.007; urge to defecate: <jats:italic>p</jats:italic> < 0.026). TEA/ST36‐100 Hz was the only treatment that significantly decreased sympathetic activity and increased parasympathetic activity with and without RD (<jats:italic>p</jats:italic> < 0.04).Conclusions & InferencesTEA at ST36‐100 Hz is superior stimulation point/parameter, compared to TEA at PC‐6/sham‐TEA, to reduce rectal distension‐induced pain in IBS‐C patients. This therapeutic effect appears to be mediated through rectal hypersensitivity reduction and autonomic function modulation.","PeriodicalId":19104,"journal":{"name":"Neurogastroenterology & Motility","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140812986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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