Panyavee Pitisuttithum, Eric Goudie, Isis K. Araujo, Sourav Halder, Dustin A. Carlson, John E. Pandolfino, Wenjun Kou
BackgroundThe objective measurement for esophageal bolus volume and bolus clearance could classify abnormal high‐resolution manometry (HRM) beyond the current Chicago classification. We aimed to compare the novel four‐dimensional impedance manometry (4D HRM) volume metrics with timed barium esophagram (TBE).MethodsAdults with esophageal symptoms undergoing HRM and TBE were included. A custom‐built program for 4D HRM analysis measured esophageal luminal cross‐sectional area (CSA) from impedance and subsequently derived esophageal bolus volume and clearance. 4D HRM volume metrics included pre‐swallow residual volume, maximal volume, retention volume, and clearance ratio defined as 1.0—retention volume divided by the maximal volume. An abnormal TBE was defined as a column height >5 cm at 1 min or 5 min.Key ResultsA total of 95 patients (normal motility: 33%; ineffective esophageal motility: 12%; absent contractility: 10%; esophagogastric junction outflow obstruction: 30%; type I achalasia: 5%; type II achalasia: 12%) were categorized into normal TBE (58%), abnormal TBE at 1 min (17%), and abnormal TBE at 5 min (25%). The AUROC demonstrated that, among all 4D HRM volume metrics, the clearance ratio had the best performance in predicting abnormal TBE at 5 min (AUROC, 95% confidence interval: 0.89, 0.82–0.96), and exhibited a strong negative correlation with TBE at 5 min (r = −0.65; p < 0.001).Conclusions & InferencesNovel 4D HRM volume metrics provide objective measurement of esophageal bolus volume and bolus clearance. The clearance ratio has a strong correlation with TBE and could potentially serve as a substitute for TBE to measure esophageal retention.
{"title":"Four‐dimensional impedance manometry volume metrics for predicting abnormal bolus retention","authors":"Panyavee Pitisuttithum, Eric Goudie, Isis K. Araujo, Sourav Halder, Dustin A. Carlson, John E. Pandolfino, Wenjun Kou","doi":"10.1111/nmo.14803","DOIUrl":"https://doi.org/10.1111/nmo.14803","url":null,"abstract":"BackgroundThe objective measurement for esophageal bolus volume and bolus clearance could classify abnormal high‐resolution manometry (HRM) beyond the current Chicago classification. We aimed to compare the novel four‐dimensional impedance manometry (4D HRM) volume metrics with timed barium esophagram (TBE).MethodsAdults with esophageal symptoms undergoing HRM and TBE were included. A custom‐built program for 4D HRM analysis measured esophageal luminal cross‐sectional area (CSA) from impedance and subsequently derived esophageal bolus volume and clearance. 4D HRM volume metrics included pre‐swallow residual volume, maximal volume, retention volume, and clearance ratio defined as 1.0—retention volume divided by the maximal volume. An abnormal TBE was defined as a column height >5 cm at 1 min or 5 min.Key ResultsA total of 95 patients (normal motility: 33%; ineffective esophageal motility: 12%; absent contractility: 10%; esophagogastric junction outflow obstruction: 30%; type I achalasia: 5%; type II achalasia: 12%) were categorized into normal TBE (58%), abnormal TBE at 1 min (17%), and abnormal TBE at 5 min (25%). The AUROC demonstrated that, among all 4D HRM volume metrics, the clearance ratio had the best performance in predicting abnormal TBE at 5 min (AUROC, 95% confidence interval: 0.89, 0.82–0.96), and exhibited a strong negative correlation with TBE at 5 min (<jats:italic>r</jats:italic> = −0.65; <jats:italic>p</jats:italic> < 0.001).Conclusions & InferencesNovel 4D HRM volume metrics provide objective measurement of esophageal bolus volume and bolus clearance. The clearance ratio has a strong correlation with TBE and could potentially serve as a substitute for TBE to measure esophageal retention.","PeriodicalId":19104,"journal":{"name":"Neurogastroenterology & Motility","volume":"73 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140809723","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}
There is a lack of data on the epidemiology of IBS in pregnant and postpartum patients in the United States.
在美国，缺乏有关孕妇和产后患者肠易激综合征流行病学的数据。
{"title":"Psychological comorbidities are more prevalent amongst pregnant and postpartum patients with irritable bowel syndrome","authors":"Yuying Luo, Christie Lee Luo, Rachel Meislin, Eunyoung Yang, Xiaotao Zhang","doi":"10.1111/nmo.14800","DOIUrl":"https://doi.org/10.1111/nmo.14800","url":null,"abstract":"There is a lack of data on the epidemiology of IBS in pregnant and postpartum patients in the United States.","PeriodicalId":19104,"journal":{"name":"Neurogastroenterology & Motility","volume":"864 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140598848","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}
Facundo Pereyra, Luis María Bustos Fernández, Francisco Schlottmann, Rafael Zamora, Agustina Marconi, Leandro Steinberg, Lisandro Pereyra
BackgroundIrritable bowel syndrome (IBS) is a functional disorder commonly associated with extra‐intestinal symptoms. However, the prevalence of these symptoms according to IBS subtype is not well established.AimTo compare the prevalence of extra‐intestinal symptoms among patients with different subtypes of IBS.MethodsA descriptive cross‐sectional study including patients with IBS according to Rome IV criteria was performed between July 2022 and April 2023. Patients were classified according their subtype of IBS: IBS‐D (diarrhea‐predominant), IBS‐C (constipation‐predominant), and IBS‐M (mixed bowel habits). Patients completed the IBS severity scoring system questionnaire (IBS‐SSS) to determine severity of IBS symptoms and patient health questionnaire‐ 9 (PHQ‐9) to define presence and severity of depressive symptoms. The prevalence of reported extra‐intestinal symptoms was also assessed and compared between groups.Key ResultsA total of 4862 patients with IBS were included; 608 IBS‐D (12.5%), 1978 IBS‐C (40.7%), and 2276 IBS‐M (46.8%). Patients with IBS‐C had significantly lower IBS‐symptoms severity (mean IBS‐SSS 290 vs. 310 and 320 for IBS‐D and IBS‐M, respectively, p = 0.03). The prevalence of obesity was also significantly lower in these patients (17.1% vs. 30.9% IBS‐D and 27.9% IBS‐M, p = 0.0001). Patients with IBS‐D showed a significantly higher prevalence of food intolerance perception (9.5%, p = 0.03), history of cholecystectomy (17.8%, p = 0.03), and fecal incontinence (36.2%, p = 0.0001) as compared to the other groups. Patients with IBS‐M had significantly higher mean PHQ‐9 score (12.7 vs. 11.1 IBS‐D and 10.5 IBS‐C, p = 0.001) and prevalence of depressive symptoms (80.0%, p = 0.01). Patients with IBS‐M also had higher prevalence of extra‐intestinal symptoms such as arthralgia (62.4%, p = 0.0001), extremity numbness (64.5%, p = 0.0001), atopic dermatitis (28.2%, p = 0.02), and chronic cervicalgia (81.0%, p = 0.01).Conclusions & InferencesThe prevalence of most extra‐intestinal symptoms is higher among patients with IBS‐M. Further research is needed to better characterize IBS subtypes, which could potentially help refining tailored therapeutic strategies.
{"title":"Prevalence of extra‐intestinal symptoms according to irritable bowel syndrome subtype","authors":"Facundo Pereyra, Luis María Bustos Fernández, Francisco Schlottmann, Rafael Zamora, Agustina Marconi, Leandro Steinberg, Lisandro Pereyra","doi":"10.1111/nmo.14796","DOIUrl":"https://doi.org/10.1111/nmo.14796","url":null,"abstract":"BackgroundIrritable bowel syndrome (IBS) is a functional disorder commonly associated with extra‐intestinal symptoms. However, the prevalence of these symptoms according to IBS subtype is not well established.AimTo compare the prevalence of extra‐intestinal symptoms among patients with different subtypes of IBS.MethodsA descriptive cross‐sectional study including patients with IBS according to Rome IV criteria was performed between July 2022 and April 2023. Patients were classified according their subtype of IBS: IBS‐D (diarrhea‐predominant), IBS‐C (constipation‐predominant), and IBS‐M (mixed bowel habits). Patients completed the IBS severity scoring system questionnaire (IBS‐SSS) to determine severity of IBS symptoms and patient health questionnaire‐ 9 (PHQ‐9) to define presence and severity of depressive symptoms. The prevalence of reported extra‐intestinal symptoms was also assessed and compared between groups.Key ResultsA total of 4862 patients with IBS were included; 608 IBS‐D (12.5%), 1978 IBS‐C (40.7%), and 2276 IBS‐M (46.8%). Patients with IBS‐C had significantly lower IBS‐symptoms severity (mean IBS‐SSS 290 vs. 310 and 320 for IBS‐D and IBS‐M, respectively, <jats:italic>p</jats:italic> = 0.03). The prevalence of obesity was also significantly lower in these patients (17.1% vs. 30.9% IBS‐D and 27.9% IBS‐M, <jats:italic>p</jats:italic> = 0.0001). Patients with IBS‐D showed a significantly higher prevalence of food intolerance perception (9.5%, <jats:italic>p</jats:italic> = 0.03), history of cholecystectomy (17.8%, <jats:italic>p</jats:italic> = 0.03), and fecal incontinence (36.2%, <jats:italic>p</jats:italic> = 0.0001) as compared to the other groups. Patients with IBS‐M had significantly higher mean PHQ‐9 score (12.7 vs. 11.1 IBS‐D and 10.5 IBS‐C, <jats:italic>p</jats:italic> = 0.001) and prevalence of depressive symptoms (80.0%, <jats:italic>p</jats:italic> = 0.01). Patients with IBS‐M also had higher prevalence of extra‐intestinal symptoms such as arthralgia (62.4%, <jats:italic>p</jats:italic> = 0.0001), extremity numbness (64.5%, <jats:italic>p</jats:italic> = 0.0001), atopic dermatitis (28.2%, <jats:italic>p</jats:italic> = 0.02), and chronic cervicalgia (81.0%, <jats:italic>p</jats:italic> = 0.01).Conclusions & InferencesThe prevalence of most extra‐intestinal symptoms is higher among patients with IBS‐M. Further research is needed to better characterize IBS subtypes, which could potentially help refining tailored therapeutic strategies.","PeriodicalId":19104,"journal":{"name":"Neurogastroenterology & Motility","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140598954","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}
Nessmah Sultan, Mandy Foyster, Matilda Tonkovic, Danielle Noon, Helen Burton‐Murray, Jessica R. Biesiekierski, Caroline J. Tuck
IntroductionOrthorexia, a harmful obsession with eating healthily, may develop from illnesses characterized by dietary restriction, including irritable bowel syndrome (IBS) and eating disorders (ED). Evidence of disordered eating in IBS exists, but orthorexia has not been assessed. This cross‐sectional study in adults (≥18 years) assessed presence and characteristics of disordered eating and orthorexia in IBS, compared to control subjects (CS) and ED.MethodsIBS participants met Rome IV, and ED participants met DSM‐5 criteria. Disordered eating was assessed using “sick, control, one‐stone, fat, food” (SCOFF, ≥2 indicating disordered eating), and orthorexia by the eating habits questionnaire (EHQ). Secondary measures included stress (PSS); anxiety (HADS‐A); food‐related quality of life (Fr‐QoL), and dietary intake (CNAQ).Key ResultsIn 202 IBS (192 female), 34 ED (34 female), and 109 CS (90 female), more IBS (33%) and ED (47%) scored SCOFF≥2 compared to CS (16%, p < 0.001, chi‐square). IBS and ED had higher orthorexia symptom severity compared to CS (EHQ IBS 82.9 ± 18.1, ED 90.1 ± 19.6, and CS 73.5 ± 16.9, p < 0.001, one‐way ANOVA). IBS and ED did not differ for SCOFF or EHQ (p > 0.05). Those with IBS and disordered eating had higher orthorexia symptom severity (EHQ 78.2 ± 16.6 vs. 92.4 ± 17.5, p < 0.001, independent t‐test), worse symptoms (IBS‐SSS 211.0 ± 78.4 vs. 244.4 ± 62.5, p = 0.008, Mann–Whitney U test), higher stress (p < 0.001, independent t‐test), higher anxiety (p = 0.002, independent t‐test), and worse FR‐QoL (p < 0.001, independent t‐test).Conclusions and InferencesDisordered eating and orthorexia symptoms occur frequently in IBS, particularly in those with worse gastrointestinal symptoms, higher stress, and anxiety. Clinicians could consider these characteristics when prescribing dietary therapies.
导言厌食症是一种对健康饮食有害的强迫症，可能源于以饮食限制为特征的疾病，包括肠易激综合征（IBS）和饮食失调症（ED）。有证据表明肠易激综合征患者存在饮食紊乱，但尚未对厌食症进行评估。这项横断面研究以成年人（≥18 岁）为对象，与对照组（CS）和 ED 相比，评估了 IBS 中饮食紊乱和厌食症的存在和特征。进食障碍通过 "生病、控制、一石、脂肪、食物"（SCOFF，≥2 表示进食障碍）进行评估，厌食症通过饮食习惯问卷（EHQ）进行评估。主要结果 在 202 名 IBS（192 名女性）、34 名 ED（34 名女性）和 109 名 CS（90 名女性）中，与 CS（16%，p < 0.001，chi-square）相比，更多的 IBS（33%）和 ED（47%）在 SCOFF 中得分≥2。与 CS 相比，IBS 和 ED 的厌食症状严重程度更高（EHQ IBS 82.9 ± 18.1，ED 90.1 ± 19.6，CS 73.5 ± 16.9，p < 0.001，单因素方差分析）。IBS 和 ED 在 SCOFF 或 EHQ 方面没有差异（p > 0.05）。患有肠易激综合征和进食障碍的人有较高的厌食症状严重程度（EHQ 78.2 ± 16.6 vs. 92.4 ± 17.5，p < 0.001，独立 t 检验）、较差的症状（IBS-SSS 211.0 ± 78.4 vs. 244.4 ± 62.5，p = 0.008，曼-惠特尼 U 检验）、较高的压力（p < 0.001，独立 t 检验）、更高的焦虑（p = 0.002，独立 t 检验）和更差的 FR-QoL （p < 0.001，独立 t 检验）。临床医生在开具饮食疗法处方时可考虑这些特征。
{"title":"Presence and characteristics of disordered eating and orthorexia in irritable bowel syndrome","authors":"Nessmah Sultan, Mandy Foyster, Matilda Tonkovic, Danielle Noon, Helen Burton‐Murray, Jessica R. Biesiekierski, Caroline J. Tuck","doi":"10.1111/nmo.14797","DOIUrl":"https://doi.org/10.1111/nmo.14797","url":null,"abstract":"IntroductionOrthorexia, a harmful obsession with eating healthily, may develop from illnesses characterized by dietary restriction, including irritable bowel syndrome (IBS) and eating disorders (ED). Evidence of disordered eating in IBS exists, but orthorexia has not been assessed. This cross‐sectional study in adults (≥18 years) assessed presence and characteristics of disordered eating and orthorexia in IBS, compared to control subjects (CS) and ED.MethodsIBS participants met Rome IV, and ED participants met DSM‐5 criteria. Disordered eating was assessed using “sick, control, one‐stone, fat, food” (SCOFF, ≥2 indicating disordered eating), and orthorexia by the eating habits questionnaire (EHQ). Secondary measures included stress (PSS); anxiety (HADS‐A); food‐related quality of life (Fr‐QoL), and dietary intake (CNAQ).Key ResultsIn 202 IBS (192 female), 34 ED (34 female), and 109 CS (90 female), more IBS (33%) and ED (47%) scored SCOFF≥2 compared to CS (16%, <jats:italic>p</jats:italic> < 0.001, chi‐square). IBS and ED had higher orthorexia symptom severity compared to CS (EHQ IBS 82.9 ± 18.1, ED 90.1 ± 19.6, and CS 73.5 ± 16.9, <jats:italic>p</jats:italic> < 0.001, one‐way ANOVA). IBS and ED did not differ for SCOFF or EHQ (<jats:italic>p</jats:italic> > 0.05). Those with IBS and disordered eating had higher orthorexia symptom severity (EHQ 78.2 ± 16.6 vs. 92.4 ± 17.5, <jats:italic>p</jats:italic> < 0.001, independent <jats:italic>t</jats:italic>‐test), worse symptoms (IBS‐SSS 211.0 ± 78.4 vs. 244.4 ± 62.5, <jats:italic>p</jats:italic> = 0.008, Mann–Whitney <jats:italic>U</jats:italic> test), higher stress (<jats:italic>p</jats:italic> < 0.001, independent <jats:italic>t</jats:italic>‐test), higher anxiety (<jats:italic>p</jats:italic> = 0.002, independent <jats:italic>t</jats:italic>‐test), and worse FR‐QoL (<jats:italic>p</jats:italic> < 0.001, independent <jats:italic>t</jats:italic>‐test).Conclusions and InferencesDisordered eating and orthorexia symptoms occur frequently in IBS, particularly in those with worse gastrointestinal symptoms, higher stress, and anxiety. Clinicians could consider these characteristics when prescribing dietary therapies.","PeriodicalId":19104,"journal":{"name":"Neurogastroenterology & Motility","volume":"99 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140598981","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}
Nastasia Mattio, Pierre Pradat, Christelle Machon, Anne Mialon, Sabine Roman, Charlotte Cuerq, François Mion
BackgroundGlucose breath test (GBT) is used for the diagnosis of small intestine bacterial overgrowth. A restrictive diet without fibers and/or fermentable food is recommended on the day before the test. The aim of our retrospective study was to evaluate the impact of two different restrictive diets on the results of GBT.MethodsA change of the pretest restrictive diet was applied in our lab on September 1, 2020. The recommended diet was a fiber‐free diet before this date, and a fiber‐free diet plus restriction of all fermentable food afterward. We thus compared the results of GBT performed before (group A) and after (group B) this pretest diet modification. Demographics, reasons to perform GBT, digestive symptoms, and hydrogen and methane baseline values and variations after glucose ingestion were compared between the two groups.Key Results269 patients underwent GBT in group A, and 316 patients in group B. The two groups were comparable in terms of demographics. Methane and hydrogen baseline values were significantly higher in group A (respectively 14 [18] vs. 8 [14] ppm, p < 0.01 and 11 [14] vs. 6 [8] ppm, p < 0.01). The percentage of positive tests was higher in group A for methane (43% vs. 28%, p < 0.05), and for hydrogen (18% vs. 12%, p = 0.03).Conclusion & InferencesThis retrospective study suggests the importance of the restrictive diet prior to GBT. A strict limitation of fibers and fermentable food decreased hydrogen and methane baseline values, and the prevalence of positive GBT. Thus a strict restrictive diet should be recommended on the day before the test, in order to limit the impact of food on hydrogen and methane breath levels, and possibly improve the diagnosis quality of GBT.
{"title":"Glucose breath test for the detection of small intestine bacterial overgrowth: Impact of diet prior to the test","authors":"Nastasia Mattio, Pierre Pradat, Christelle Machon, Anne Mialon, Sabine Roman, Charlotte Cuerq, François Mion","doi":"10.1111/nmo.14801","DOIUrl":"https://doi.org/10.1111/nmo.14801","url":null,"abstract":"BackgroundGlucose breath test (GBT) is used for the diagnosis of small intestine bacterial overgrowth. A restrictive diet without fibers and/or fermentable food is recommended on the day before the test. The aim of our retrospective study was to evaluate the impact of two different restrictive diets on the results of GBT.MethodsA change of the pretest restrictive diet was applied in our lab on September 1, 2020. The recommended diet was a fiber‐free diet before this date, and a fiber‐free diet plus restriction of all fermentable food afterward. We thus compared the results of GBT performed before (group A) and after (group B) this pretest diet modification. Demographics, reasons to perform GBT, digestive symptoms, and hydrogen and methane baseline values and variations after glucose ingestion were compared between the two groups.Key Results269 patients underwent GBT in group A, and 316 patients in group B. The two groups were comparable in terms of demographics. Methane and hydrogen baseline values were significantly higher in group A (respectively 14 [18] vs. 8 [14] ppm, <jats:italic>p</jats:italic> < 0.01 and 11 [14] vs. 6 [8] ppm, <jats:italic>p</jats:italic> < 0.01). The percentage of positive tests was higher in group A for methane (43% vs. 28%, <jats:italic>p</jats:italic> < 0.05), and for hydrogen (18% vs. 12%, <jats:italic>p</jats:italic> = 0.03).Conclusion & InferencesThis retrospective study suggests the importance of the restrictive diet prior to GBT. A strict limitation of fibers and fermentable food decreased hydrogen and methane baseline values, and the prevalence of positive GBT. Thus a strict restrictive diet should be recommended on the day before the test, in order to limit the impact of food on hydrogen and methane breath levels, and possibly improve the diagnosis quality of GBT.","PeriodicalId":19104,"journal":{"name":"Neurogastroenterology & Motility","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140598876","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}
Elise M. Wessels, Gwen M. C. Masclee, Barbara A. J. Bastiaansen, Paul Fockens, Albert J. Bredenoord
BackgroundPeroral endoscopic myotomy (POEM) is an effective and safe treatment for achalasia, but often leads to posttreatment gastroesophageal reflux disease. The aim of this study was to examine the incidence and severity of reflux esophagitis after POEM and to identify associated predictive factors.MethodsPatients who underwent POEM between August 2011 and December 2022 were included. Multivariate logistic regression was used to assess predictive factors for reflux esophagitis after POEM.Key ResultsIn total, 252 patients were included; of which, 46% were female and age ranged between 18 and 87 years. Reflux esophagitis within 1 year after POEM was observed in 131 patients (52%), which was severe in 29 patients (LA grade C/D, 12%). Length of full‐thickness myotomy (cm; OR 1.11, 95% CI 1.02–1.21), Eckardt scores before POEM (OR 0.84, 95% CI 0.74–0.96), previous pneumatic dilation (OR 0.51, 95% CI 0.29–0.91), and previous laparoscopic Heller myotomy (LHM; OR 0.44, 95% CI 0.23–0.86) were associated with reflux esophagitis after POEM. Alcohol use (none vs > 7 units per week; OR 3.51, 95% CI 1.35–9.11) and overweight (BMI ≥25 kg/m2; OR 2.67, 95% CI 1.17–6.09) were positive predictive factors and previous LHM (OR 0.13, 95% CI 0.02–0.95) was a negative predictive factor for severe reflux esophagitis after POEM (LA grade C/D).ConclusionAbout half of the patients develop reflux esophagitis after POEM and 12% is graded as severe. Recognizing predictive factors of reflux esophagitis after POEM treatment leads to better patient selection before POEM and provides an opportunity to take preventive measures or start preemptive treatment.
背景口腔内镜下肌切开术（POEM）是治疗贲门失弛缓症的一种有效而安全的方法，但常常导致治疗后胃食管反流病。本研究旨在探讨口内镜下肌切开术（POEM）后反流性食管炎的发生率和严重程度，并确定相关的预测因素。方法纳入2011年8月至2022年12月期间接受口内镜下肌切开术（POEM）的患者。主要结果共纳入 252 例患者，其中 46% 为女性，年龄介于 18 岁至 87 岁之间。131名患者（52%）在POEM术后1年内出现反流性食管炎，其中29名患者（LA C/D级，12%）病情严重。全厚肌切开术的长度（厘米；OR 1.11，95% CI 1.02-1.21）、POEM 前的 Eckardt 评分（OR 0.84，95% CI 0.74-0.96）、之前的气压扩张术（OR 0.51，95% CI 0.29-0.91）和之前的腹腔镜海勒肌切开术（LHM；OR 0.44，95% CI 0.23-0.86）与 POEM 后的反流性食管炎有关。饮酒（无 vs > 每周 7 单位；OR 3.51，95% CI 1.35-9.11）和超重（体重指数≥25 kg/m2；OR 2.67，95% CI 1.17-6.09）是阳性预测因素，而既往 LHM（OR 0.13，95% CI 0.结论约有一半的患者在 POEM 后发生反流性食管炎，其中 12% 的患者被评为重度反流性食管炎。识别 POEM 治疗后反流性食管炎的预测因素有助于在 POEM 治疗前更好地选择患者，并为采取预防措施或开始先期治疗提供了机会。
{"title":"Incidence and risk factors of reflux esophagitis after peroral endoscopic myotomy","authors":"Elise M. Wessels, Gwen M. C. Masclee, Barbara A. J. Bastiaansen, Paul Fockens, Albert J. Bredenoord","doi":"10.1111/nmo.14794","DOIUrl":"https://doi.org/10.1111/nmo.14794","url":null,"abstract":"BackgroundPeroral endoscopic myotomy (POEM) is an effective and safe treatment for achalasia, but often leads to posttreatment gastroesophageal reflux disease. The aim of this study was to examine the incidence and severity of reflux esophagitis after POEM and to identify associated predictive factors.MethodsPatients who underwent POEM between August 2011 and December 2022 were included. Multivariate logistic regression was used to assess predictive factors for reflux esophagitis after POEM.Key ResultsIn total, 252 patients were included; of which, 46% were female and age ranged between 18 and 87 years. Reflux esophagitis within 1 year after POEM was observed in 131 patients (52%), which was severe in 29 patients (LA grade C/D, 12%). Length of full‐thickness myotomy (cm; OR 1.11, 95% CI 1.02–1.21), Eckardt scores before POEM (OR 0.84, 95% CI 0.74–0.96), previous pneumatic dilation (OR 0.51, 95% CI 0.29–0.91), and previous laparoscopic Heller myotomy (LHM; OR 0.44, 95% CI 0.23–0.86) were associated with reflux esophagitis after POEM. Alcohol use (none vs > 7 units per week; OR 3.51, 95% CI 1.35–9.11) and overweight (BMI ≥25 kg/m<jats:sup>2</jats:sup>; OR 2.67, 95% CI 1.17–6.09) were positive predictive factors and previous LHM (OR 0.13, 95% CI 0.02–0.95) was a negative predictive factor for severe reflux esophagitis after POEM (LA grade C/D).ConclusionAbout half of the patients develop reflux esophagitis after POEM and 12% is graded as severe. Recognizing predictive factors of reflux esophagitis after POEM treatment leads to better patient selection before POEM and provides an opportunity to take preventive measures or start preemptive treatment.","PeriodicalId":19104,"journal":{"name":"Neurogastroenterology & Motility","volume":"94 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140598851","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}
Alexander O'Connor, Donghua Liao, Asbjørn Mohr Drewes, Abhiram Sharma, Dipesh H. Vasant, John McLaughlin, Edward Kiff, Karen Telford
BackgroundThe functional lumen imaging probe (FLIP) is a test of anal sphincter distensibility under evaluation by specialist centers. Two measurement protocols termed “stepwise” and “ramp” are used, risking a lack of standardization. This study aims to compare the performance of these protocols to establish if there are differences between them.MethodsPatients with fecal incontinence were recruited and underwent measurement with both protocols at a tertiary pelvic floor referral unit. Differences in minimum diameter, FLIP bag pressure, and distensibility index (DI) at rest and during squeeze were calculated at various FLIP bag volumes.Key ResultsTwenty patients (19 female, mean age 61 [range: 38–78]) were included. The resting minimum diameter at 30 and 40 mL bag volumes were less in the stepwise protocol (mean bias: −0.55 mm and −1.18 mm, p < 0.05) along with the DI at the same bag volumes (mean bias: −0.37 mm2/mmHg and −0.55 mm2/mmHg, p < 0.05). There was also a trend towards greater bag pressures at 30 mL (mean bias: +2.08 mmHg, p = 0.114) and 40 mL (mean bias: +2.81 mmHg, p = 0.129) volumes in the stepwise protocol. There were no differences between protocols in measurements of minimum diameter, maximum bag pressure, or DI during voluntary squeeze (p > 0.05).Conclusion and InferencesThere are differences between the two commonly described FLIP measurement protocols at rest, although there are no differences in the assessment of squeeze function. Consensus agreement is required to agree the most appropriate FLIP measurement protocol in assessing anal sphincter function.
{"title":"A comparison of function lumen imaging probe measurements of anal sphincter function in fecal incontinence","authors":"Alexander O'Connor, Donghua Liao, Asbjørn Mohr Drewes, Abhiram Sharma, Dipesh H. Vasant, John McLaughlin, Edward Kiff, Karen Telford","doi":"10.1111/nmo.14791","DOIUrl":"https://doi.org/10.1111/nmo.14791","url":null,"abstract":"BackgroundThe functional lumen imaging probe (FLIP) is a test of anal sphincter distensibility under evaluation by specialist centers. Two measurement protocols termed “stepwise” and “ramp” are used, risking a lack of standardization. This study aims to compare the performance of these protocols to establish if there are differences between them.MethodsPatients with fecal incontinence were recruited and underwent measurement with both protocols at a tertiary pelvic floor referral unit. Differences in minimum diameter, FLIP bag pressure, and distensibility index (DI) at rest and during squeeze were calculated at various FLIP bag volumes.Key ResultsTwenty patients (19 female, mean age 61 [range: 38–78]) were included. The resting minimum diameter at 30 and 40 mL bag volumes were less in the stepwise protocol (mean bias: −0.55 mm and −1.18 mm, <jats:italic>p</jats:italic> < 0.05) along with the DI at the same bag volumes (mean bias: −0.37 mm<jats:sup>2</jats:sup>/mmHg and −0.55 mm<jats:sup>2</jats:sup>/mmHg, <jats:italic>p</jats:italic> < 0.05). There was also a trend towards greater bag pressures at 30 mL (mean bias: +2.08 mmHg, <jats:italic>p</jats:italic> = 0.114) and 40 mL (mean bias: +2.81 mmHg, <jats:italic>p</jats:italic> = 0.129) volumes in the stepwise protocol. There were no differences between protocols in measurements of minimum diameter, maximum bag pressure, or DI during voluntary squeeze (<jats:italic>p</jats:italic> > 0.05).Conclusion and InferencesThere are differences between the two commonly described FLIP measurement protocols at rest, although there are no differences in the assessment of squeeze function. Consensus agreement is required to agree the most appropriate FLIP measurement protocol in assessing anal sphincter function.","PeriodicalId":19104,"journal":{"name":"Neurogastroenterology & Motility","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140598834","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}
Yun Yan, Karunaratne Tennekoon, Audrey Eubanks, Anam Herekar, Dhanush Shimoga, Deepak Ayyala, Colin McLeod, Julie A. Kurek, John C. Morgan, Satish S. C. Rao, Amol Sharma
Parkinson's disease (PD) is a neurodegenerative movement disorder with prodromal and highly prevalent gastrointestinal (GI) symptoms, especially constipation. Although PD models suggest gut-brain axis dysfunction, the mechanistic underpinnings and their correlation with GI symptoms are poorly understood.
{"title":"Evaluation of bidirectional gut-brain axis and anorectal function in Parkinson's disease with constipation","authors":"Yun Yan, Karunaratne Tennekoon, Audrey Eubanks, Anam Herekar, Dhanush Shimoga, Deepak Ayyala, Colin McLeod, Julie A. Kurek, John C. Morgan, Satish S. C. Rao, Amol Sharma","doi":"10.1111/nmo.14728","DOIUrl":"https://doi.org/10.1111/nmo.14728","url":null,"abstract":"Parkinson's disease (PD) is a neurodegenerative movement disorder with prodromal and highly prevalent gastrointestinal (GI) symptoms, especially constipation. Although PD models suggest gut-brain axis dysfunction, the mechanistic underpinnings and their correlation with GI symptoms are poorly understood.","PeriodicalId":19104,"journal":{"name":"Neurogastroenterology & Motility","volume":"105 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138715293","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}
Osman Sinen, İrem Akçalı, Simla Su Akkan, Mehmet Bülbül
Central Orexin-A (OXA) modulates gastrointestinal (GI) functions and stress response. This study aimed to investigate whether OXA and CRF interact at hypothalamic level.
{"title":"The role of hypothalamic Orexin-A in stress-induced gastric dysmotility: An agonistic interplay with corticotropin releasing factor","authors":"Osman Sinen, İrem Akçalı, Simla Su Akkan, Mehmet Bülbül","doi":"10.1111/nmo.14719","DOIUrl":"https://doi.org/10.1111/nmo.14719","url":null,"abstract":"Central Orexin-A (OXA) modulates gastrointestinal (GI) functions and stress response. This study aimed to investigate whether OXA and CRF interact at hypothalamic level.","PeriodicalId":19104,"journal":{"name":"Neurogastroenterology & Motility","volume":"242 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138716010","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}
Neha R. Santucci, Carlos Alberto Velasco-Benitez, Natoshia Cunningham, Jesse Li, Lin Fei, Qin Sun, Miguel Saps
Multiple psychological factors influence disorders of gut–brain interaction (DGBIs). We aimed to evaluate psychological distress in Colombian schoolchildren with and without DGBIs.
{"title":"Psychological distress and coping efficacy in children with disorders of gut–brain interaction","authors":"Neha R. Santucci, Carlos Alberto Velasco-Benitez, Natoshia Cunningham, Jesse Li, Lin Fei, Qin Sun, Miguel Saps","doi":"10.1111/nmo.14724","DOIUrl":"https://doi.org/10.1111/nmo.14724","url":null,"abstract":"Multiple psychological factors influence disorders of gut–brain interaction (DGBIs). We aimed to evaluate psychological distress in Colombian schoolchildren with and without DGBIs.","PeriodicalId":19104,"journal":{"name":"Neurogastroenterology & Motility","volume":"173 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138575443","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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