Neurogastroenterology and Motility最新文献

Objective: To elucidate the effect of internal anal sphincter (IAS) botox as an adjunct to standard treatment for disordered defecation (DD), defined by the inability to effectively evacuate stool from the rectum resulting in constipation, on patient/caregiver quality of life (QoL) metrics in association with corresponding clinical outcomes.

Methods: Consecutive children undergoing IAS botox for DD completed surveys at baseline, two weeks, and three months post-procedure. Time points included assessment of clinical symptoms (Rome IV Questionnaire), QoL (Pediatric Quality of Life Inventory [PedsQL]), and caregiver well-being/family functioning (PedsQL-Family Impact Module [PedsQL-FIM]).

Results: Of 60 participants, the median age was 7 years (IQR 4-10), with 34 (56.7%) males and 32 (53.3%) first-time Botox recipients. The median onset of positive effect after Botox was 6 days (IQR 3-14), while the median loss of effect was 70 days (IQR 39-83). Compared to baseline, by 3 months there was a lower chance of meeting Rome IV criteria for functional constipation in first-time recipients (RR 0.73, 95% CI: 0.58-0.91; p = 0.005). This remained significant after adjusting for any bowel regimen change during the 3-month period following Botox (OR 0.33, 95% CI: 0.13-0.74; p = 0.012). Regarding QoL, there was significant improvement in total PedsQL score at both 2-weeks (11.79 point improvement, 95% CI: 6.36-17.22; p < 0.0001) and 3 months (13.97 point improvement, 95% CI: 8.47-19.47; p < 0.0001) from baseline for first-time recipients, while improvement was only observed at 2 weeks for prior recipients (6.67 point improvement, 95% CI: 0.65-12.69; p = 0.030). First-time recipients demonstrated significant improvements in total PedsQL-FIM score at both 2 weeks (9.33 point improvement, 95% CI: 3.77-14.89; p = 0.001) and 3 months (11.57 point improvement, 95% CI: 5.94-17.20; p < 0.0001) from baseline.

Conclusion: Our findings establish far-reaching benefits of IAS botox primarily for first-time recipients, both clinically and psychosocially, suggesting that appropriate incorporation into the treatment paradigm may globally enhance outcomes in children with DD.

Background: The number of studies exploring esophageal motility disorders using high-resolution manometry (HRM) in patients with esophageal diverticula (ED) is limited. The goal of this study was to describe motility disorders using HRM in patients with ED and assess the added value of provocative testing in these patients.

Methods: Patients with ED who underwent HRM between 2010 and 2022 were retrospectively included. HRM findings were compared based on single water swallows (SWS), and provocative testing with solid food swallows in the upright seated position, using both ManoView and Medical Measurement Systems software. We also calculated median pressure slopes during the compartmentalization phase.

Key results: Sixteen of the 39 included patients had mid-ED and 23 had lower ED. Twenty (51.3%) patients had motility disorders based on SWS, including 7 (18%) with achalasia and 3 (7.7%) with esophagogastric junction obstruction. No significant differences in esophageal motility disorders were observed in relation to the location of the ED. Solid food swallows were performed in 29 (74%) patients leading to a change in the HRM diagnosis in 7 (24.1%), all of whom showed elevated IRP. Median pressure slopes during the compartmentalization phase (n = 30) were elevated in patients both with and without motility disorders.

Conclusion and inferences: Half of the patients with mid- or lower ED had motility disorders on HRM. Adding solid food swallows during HRM in patients with ED improves the manometric diagnosis. Results suggest abnormal distensibility in these patients, indicated by elevated pressure slope, regardless of the presence of associated motility disorders.

Introduction: Neuromodulation of cortical brain regions associated with the gut-brain axis may have the potential to modulate gastric function. Previous studies have shown phase-amplitude coupling between the electroencephalogram (EEG) alpha band frequency of the insula (Ins) and gastric slow wave (GSW) activity. This study investigated the first evidence of alpha band EEG-neurofeedback (EEG-NF) training to explore its effects on GSW activity and heart rate variability (HRV).

Methods: A randomized crossover design was employed with 20 healthy participants attending two separate sessions [active-training: uptraining left posterior Insula (LPIns) and active-control: uptraining primary visual cortex (PVC Brodmann area 17)] following the baseline recording period. A 5-min water loading test (5WLT) was conducted following the EEG-NF sessions. Finally, a post EEG-NF/5WL period was also recorded. Participants were blinded to the training program, and the sessions were randomized and conducted at least 48 h apart. Electrocardiogram (ECG), EEG, and electrogastrogram (EGG) data were recorded throughout theexperiment. In addition, the duration of successful NF training was also extracted. Correlation analysis was performed to assess the relationships between outcome variables.

Results: Pearson correlation coefficient analysis revealed a significant relationship between the duration of successful NF training and HRV metrics (RMSSD: r = 0.59; p = 0.005, SI: r = -0.59; p = 0.006) in the LPIns training group and EGG-gastric rhythm index (r = -0.40; p = 0.028) in the PVC training group. Moreover, the duration of successful LPIns NF correlated with EEG activity of the infraslow band over the left anterior Ins (r = 0.45; p = 0.043), slow band over the right posterior Ins (r = -0.5; p = 0.022), and beta band over the left (r = 0.44; p = 0.04) and right anterior Ins (r = 0.45; p = 0.04). Significant correlations were also observed between LPIns NF duration and connectivity in the beta and gamma bands between cortical regions of interest.

Conclusion: The alpha band EEG-NF training of LPIns demonstrated significant association with HRV, and EEG (activity and functional connectivity)measures and did not show a negative correlation with Gastric Alimetry Rhythm Index (GA-RI) following the 5WLT as in the PVC training group. These findings underscore the importance of considering the duration of successful NF as an important variable when evaluating NF training efficacy in future studies.

Background: This study emphasizes evaluating the antiemetic efficacy of the natural food component caffeic acid (CAF) using a copper sulfate pentahydrate (CuSO₄.5H₂O)-induced emetic model on chicks, and an in silico approach was also adopted to estimate the possible underlying mechanisms.

Methods: Two doses (25 and 50 mg/kg b.w.) of CAF and several referral drugs considered positive controls (PCs), including domperidone (6 mg/kg), hyoscine (21 mg/kg), aprepitant (16 mg/kg), diphenhydramine (10 mg/kg), and ondansetron (5 mg/kg), were orally administered to chicks. The vehicle served as the control group. Co-treatments of CAF with referral drugs were also provided to chicks to evaluate the modulatory action of the test compound.

Results: According to the results, CAF delayed the emetic onset and decreased the frequency of retches in a dose-dependent manner compared to the vehicle group. CAF (40 mg/kg) represented a notable delayed latency period (60.17 ± 3.16 s) and a diminished number of retchings (18.33 ± 1.74 times) compared to the control group. Further, in the co-treatments, CAF increased the latency period and reduced the number of retches, except for domperidone. In the in silico investigation, CAF showed notable binding affinity toward the D₂ (-7.3 kcal/mol), 5HT₃ (-7.1 kcal/mol), and M₅ (-7 kcal/mol) receptors in the same binding site as the referral ligand.

Conclusion: This research indicated that CAF has mild antiemetic properties by interacting with the D₂, 5TH₃, and M₅ receptors. Therefore, several preclinical and clinical studies are necessary to assess the effectiveness and safety profile of this food ingredient.

Background: In patients with chronic disorders of the gastrointestinal (GI) system, integral health is disturbed in all dimensions: physical, mental, quality of life, participation, meaningfulness, and daily functioning. In this group, three large subgroups are distinguished: Inflammatory Bowel Diseases (IBD), Hepato-Pancreatico-Biliary diseases (HPB), and NeuroGastroenterology and Motility (NGM) disorders. Our aim was to compare integral health status between these three subgroups. For the NGM group, we focused on patients with documented motility disorders, not on patients with functional GI-disorders. We hypothesized that the NGM group will have lower scores for integral health status compared to the IBD and HPB groups.

Methods: A prospective, observational, questionnaire study was performed in patients with chronic GI-system disorders (IBD, HPB, and NGM) attending the Maastricht University Medical Center outpatient department. Validated questionnaires and patient file data were used to quantify six health dimensions.

Key results: Data from 416 patients were collected. In all domains, apart from meaningfulness, the NGM group (n = 93) had significantly (0.001 ≤ p ≤ 0.033) lower scores compared to the IBD (n = 174) and HPB (n = 149) groups. From the NGM group, 66% were malnourished, had symptoms of depression (36%) and anxiety (19%), and work participation was lowest (32%). Correlations between intra- and interdimensional parameters were moderate to strong apart from meaningfulness.

Conclusions & inferences: Compared to patients with chronic IBD and HPB disorders, patients with NGM disorders have significantly lower scores in five of six dimensions of health: physical and mental well-being, quality of life, daily functioning, and participation.

Background: Whether uncomplicated diverticulosis gives rise to symptoms is controversial. Diary-based studies of abdominal pain and stool habits in general populations are scarce, and we therefore investigated symptom patterns in diverticulosis from prospectively collected symptom diaries in a random sample of the general population who completed a research colonoscopy.

Methods: In the Swedish population-based colonoscopy (PopCol) study, 745 individuals from the general population underwent a colonoscopy of which 130 had diverticulosis, and none had diverticulitis. Seven-day symptom diaries were completed by 258 participants (age 54, women 64%) of which 50 had diverticulosis. The frequency and location of abdominal pain, bowel habit and other gastrointestinal symptoms were compared between individuals with and without diverticulosis using logistic regression.

Key results: Diverticulosis was not associated with abdominal pain (OR 1.24, CI 0.61-2.55) or left lower quadrant (LLQ) abdominal pain (OR 1.59, CI 0.73-3.49). Pain duration and severity were not associated with diverticulosis. When individuals with diverticulosis had pain, it was more often in the LLQ (OR 2.45, CI 1.02-5.86) compared with those without diverticulosis. Diverticulosis was not linked to altered bowel habits. Irritable bowel syndrome prevalence was 16% in the diverticulosis group and 19% in the non-diverticulosis group.

Conclusions and inferences: Participants with diverticulosis did not report more abdominal pain or more LLQ abdominal pain than participants without diverticulosis. Bowel habit was not abnormal in diverticulosis. Our results do not support that uncomplicated diverticulosis cause symptoms in individuals without a history of acute diverticulitis.

Background: The scales used to assess disordered eating are often not validated in adults living with gastrointestinal conditions (i.e., gastrointestinal populations). This systematic review and meta-analysis aimed to examine the psychometric evaluations (i.e., assessments of reliability and validity) of disordered eating scales in adult gastrointestinal populations and quantify the prevalence of disordered eating in both gastrointestinal and non-gastrointestinal populations.

Methods: We conducted a search of observational studies up to May 2024 that measured disordered eating using a scale in adults with a gastrointestinal condition. Psychometric evaluations of the scales were narratively reviewed. Prevalence rates of disordered eating were pooled using a random-effects meta-analysis, and risk of bias was assessed using an adapted Newcastle Ottawa Scale.

Key results: Among 29 studies (overall medium risk of bias), 23 reported prevalences of disordered eating in gastrointestinal populations, and eight of these studies also reported prevalences in non-gastrointestinal populations. Only one out of 10 scales was developed and psychometrically evaluated in gastrointestinal populations, and 11 studies reported internal consistency (range α = 0.63 to α = 0.95). The prevalence of disordered eating was 33.2% (p < 0.001; 95% confidence interval: 0.25-0.41; I² = 97.34%) in gastrointestinal populations and 21.0% (p < 0.001; 95% confidence interval: 0.09-0.32; I² = 97.41%) in non-gastrointestinal populations. Subgroup analyses showed consistently high heterogeneity.

Conclusions and inferences: The utilisation of current disordered eating scales for adults living with gastrointestinal conditions should be undertaken with caution, and there is a need for disordered eating scales to be developed and validated in this population.

Background: Functional anorectal pain (FAP) is classified as one of the disorders of gut-brain interaction (DGBI). It involves the impairments of anorectal afferents and disrupted gut-brain communication. However, neuroimaging studies focused on FAP are lacking.

Methods: A total of 25 FAP patients and 18 healthy controls (HC) underwent structural magnetic resonance imaging (MRI), diffusion tensor imaging (DTI), resting-state functional MRI (rs-fMRI) scans, and collection of demographic data, mental health assessment scales and pain assessment questionnaires. Voxel-based morphometry (VBM), tract-based spatial statistics (TBSS), regional homogeneity (ReHo), and amplitude of low-frequency fluctuations (ALFF) were utilized to analyze the imaging data. Correlation analyses were conducted to explore the relationships between the neuroimaging findings and clinical symptoms.

Key results: Functional anorectal pain (FAP) patients exhibited higher levels of anxiety, depression scores and lower sleep quality compared to HC. VBM analysis revealed increased gray matter volume (GMV) in the bilateral fusiform, right parahippocampal, bilateral inferior temporal gyrus (ITG), and decreased GMV in the right superior frontal gyrus (SFG), left middle frontal gyrus (MFG), bilateral inferior frontal gyrus (IFG), left Calcarine, bilateral middle occipital gyrus (MOG), left middle temporal gyrus (MTG) in FAP patients. TBSS analysis showed decreased fractional anisotropy (FA) in the superior longitudinal fasciculus (SLF), anterior thalamic radiation (ATR), and forceps minor in the FAP patients. Additionally, increased ALFF in the right cerebellum and increased ReHo in the right MFG were observed in the FAP patients.

Conclusions and inferences: These findings showed a worse psychological condition and suggested neuroanatomical and neurofunctional alterations associated with pain processing, emotion regulation, and cognitive control in FAP patients.