Neurogastroenterology and Motility最新文献

Background: Quantitative data on colon length in adult chronic constipation (CC) are lacking. This study aimed to measure the length of the colon in CC, in the undisturbed state and after an osmotic laxative challenge, using magnetic resonance imaging (MRI) as compared to healthy volunteers (HV) and IBS-C patients.

Methods: Segmental and total colon length were measured by manual tracing on fasting MRI scans, retrieved retrospectively for 57 HV, 17 CC, and nine patients with irritable bowel syndrome with constipation (IBS-C). In all CC patients and 22 HV, MRI scans were also performed after an oral osmotic laxative challenge. Participants' age range was 18-75 years.

Key results: CC patients showed significantly longer colons (162 ± 6 cm) than HV (127 ± 2 cm; p < 0.01), with 10/17 being longer than the upper limit of normal. Colon length in IBS-C (129 ± 6 cm) was similar to HV. The colon in HV was able to elongate from 133 ± 3 to 148 ± 4 cm (p < 0.0001) to accommodate the macrogol challenge influx, while the CC colon could not do so (from total length at baseline 162 ± 6 to 168 ± 5 cm; p = 0.0768).

Conclusion & inferences: The study provides normative values of colon length, to which CC and IBS-C are compared. CC was associated with increased colon length and reduced capacity to elongate longitudinally, rather than radially, in response to a laxative challenge. Colon length in IBS-C was similar to HV. These measurements can improve our understanding of gut disease pathophysiology and response to treatment.

Purpose: This work delves into the critical role of the human gut microbiome in health and disease, emphasizing its influence on a range of physiological processes and its connection to conditions such as irritable bowel syndrome (IBS). The microbiome is made up of a very large and complicated group of microorganisms that have big effects on metabolic and immune functions. This makes it an interesting area for researching new ways to diagnose and treat diseases. Analyzing this data introduces substantial challenges due to its high dimensionality, intricate microbial interactions, and significant inter-individual variability.

Methods: The above factors demand the application of sophisticated machine learning techniques that can efficiently manage and interpret such complex, high-dimensional data. The XGBoost, RandomForest, Logistic Regression, LightGBM, and a deep neural network (DNN) are specifically tailored for this work. Each model's implementation is meticulously designed to extract meaningful patterns from the microbiome data with the required preprocessing by focusing on achieving high accuracy, sensitivity, and specificity in disease classification. The models are implemented using Python's libraries and are evaluated through rigorous cross-validation on a comprehensive dataset of microbiome profiles to ensure robustness and reliability.

Results: A comparison study is done to find out what each model does well and what it does not do so well. The DNN's dense layered neurocomputing pattern recognition skills make it very good at dealing with the complexity of microbiome data, resulting in an accuracy of 92.79%.

Conclusion: This study not only adds to our knowledge of how the microbiome affects health, but it also pushes the limits of diagnostic methods. By using cutting-edge deep machine learning innovations in biomedical research, we may be able to improve health outcomes around the world.

Background: Irritable bowel syndrome (IBS) is a gut-brain interaction disorder that significantly impacts quality of life, with symptoms influenced by stress, anxiety, dietary habits, and gut microbiota imbalances. Alexithymia, characterized by difficulties in identifying and expressing emotions, may exacerbate IBS symptoms by impairing stress management and illness perception. Additionally, poor adaptation to chronic illness can increase psychological burden and worsen symptom severity.

Methods: This cross-sectional study examined 148 IBS patients diagnosed using Rome IV criteria at a gastroenterology outpatient clinic. Data were collected through validated scales, including the IBS Symptom Severity Score (IBS-SSS), Twenty-Item Toronto Alexithymia Scale (TAS-20), and Chronic Disease Adaptation Assessment Scale (CDAAS). Correlation and multiple regression analyses were conducted to identify key predictors of symptom severity.

Results: IBS severity was notably high (mean IBS-SSS = 380.1 ± 61.5), with low income (B = 32.337, p = 0.002) and high alexithymia levels (B = 0.991, p = 0.045) emerging as strong predictors of increased symptom burden. Marital status also showed a notable association (B = 22.005, p = 0.085). While overall disease adaptation (CDAAS) was not directly linked to symptom severity, poor physiological adaptation correlated negatively with IBS symptoms, suggesting a critical role in disease perception. A significant inverse relationship was found between meal frequency and symptom severity (r = -0.170, p = 0.039), highlighting the impact of dietary habits on symptom control. The regression model explained 14.9% of variance (adjusted R² = 0.081).

Conclusion: IBS symptom severity is partially influenced by socioeconomic status, emotional regulation, and dietary patterns. These findings underscore the need for a multidisciplinary treatment approach integrating dietary modifications, psychological interventions, and tailored patient support to enhance disease management and improve patient outcomes.

Background: Microbial overgrowth (MO) in the small intestine can cause gastrointestinal symptoms and may arise from stasis, such as dysmotility. Microtypes of MO include small intestinal bacterial overgrowth (SIBO) and intestinal methanogen overgrowth (IMO). Dyssynergic defecation (DD) is associated with constipation and slow colonic transit (STC). Our aim was to assess the relationship between DD and MO.

Methods: We retrospectively identified patients who underwent both anorectal manometry (ARM) and balloon expulsion testing (BET) for DD, and MO testing using either small intestinal aspirate culture or breath testing. SIBO was analyzed using two culture thresholds: ≥ 10⁵ CFU/mL and ≥ 10³ CFU/mL. Chi-square tests compared positive vs. negative results.

Key results: 436 patients underwent culture of SB aspirates. At the ≥ 10⁵ CFU/mL threshold, 41.7% were diagnosed with SIBO, and 87.4% at ≥ 10³ CFU/mL. At ≥ 10⁵ CFU/mL, percent anal relaxation was significantly lower in SIBO-positive patients. SIBO patients were more likely to have reduced anal relaxation (p = 0.032), but no other ARM parameters or BET > 60 s. At ≥ 10³ CFU/mL, a more negative recto-anal pressure differential (RAPD) was observed, along with a combination of RAPD < -45 mmHg and resting anal pressure > 90 mmHg. 637 patients underwent breath testing for MO, with 174 positive results, predominantly showing IMO (73%). In this group, BET was significantly longer, and anal relaxation was significantly lower. SIBO at ≥ 10³ CFU/mL was more prevalent in DD than STC (85.5% vs. 64.7%, p = 0.002). IMO was more common in DD than STC (p = 0.021).

Conclusion/inferences: DD may be a risk factor for MO, often with evidence of methanogenesis.

Background: Current clinical guidelines for chronic constipation offer limited dietary recommendations. The aim of this project was to develop the first comprehensive evidence-based dietary guidelines for the management of chronic constipation in adults.

Methods: Four systematic reviews and meta-analyses were performed to identify eligible randomized controlled trials (RCTs). The findings generated from the meta-analyses were then used to develop guideline statements using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach and a Delphi consensus survey among a multidisciplinary expert Guideline Steering Committee. Recommendation statements were produced for treatment response, stool output, gut symptoms, adverse events, and quality of life, and only based on the findings where ≥ 2 RCTs contributed to the meta-analysis. The strength of recommendation was assessed using the GRADE approach. Consensus voting among the Guideline Steering Committee was performed using a modified Delphi survey approach.

Results: The four systematic reviews included a total of 75 RCTs. Fifty-nine dietary recommendation statements were generated and accepted through the Delphi survey. For dietary supplements, 15 recommendation statements relate to fiber supplements, 20 relate to probiotics, two to synbiotics, five to magnesium oxide, two to senna, and three to kiwifruit supplements. For foods, three recommendation statements related to kiwifruits, two to prunes, and two to rye bread. For drinks, five recommendation statements related to high mineral-containing water. No recommendations were made for whole diet approaches due to lack of evidence. Twelve statements had a very low level of evidence, 39 had a low level of evidence, and eight had moderate evidence. Twenty-seven statements were strong recommendations, and 32 were qualified recommendations.

Conclusions: These are the first comprehensive evidence-based dietary guidelines for the management of constipation based upon a robust systematic review and GRADE processes. Recommendations were made for dietary supplements, foods, and drinks that have never been previously included in clinical guidelines, and can now be rapidly implemented into clinical practice, thereby improving clinical care and patient outcomes.

Thank you for your insightful comments, which have expanded our research perspective from psychology to neural mechanisms. We agree that the core challenge of refractory constipation is closely related to neurological factors, and its essence lies in being a complex disorder involving sensory and neural dysregulation. Our preliminary fMRI studies have already identified abnormal functional connectivity in the brains of patients. Clinical observations suggest that different patient subtypes may correspond to distinct pathological mechanisms, necessitating differentiated diagnostic and therapeutic strategies. Future research will integrate psychological, neural, and physiological dimensions to construct a multidimensional pathological model.

Background & aims: The straight leg raise (SLR) is a provocative maneuver used to assess the esophagogastric junction (EGJ) barrier function during high-resolution manometry (HRM) and is part of the Milan Score (MS). The Chicago Classification 4.0 (CCv4.0) protocol requires patients to perform a supine-upright transition (SUT), increasing intra-abdominal pressure (IAP). The aim of this study was to compare the SUT and SLR maneuvers for efficacy in increasing IAP and in predicting pathologic gastroesophageal reflux disease (GERD).

Methods: Consecutive adult patients with persistent GERD symptoms undergoing HRM and pH-impedance were prospectively enrolled. After completion of the supine swallows of the CCv4.0 protocol, the SLR maneuver was performed and the patients were asked to get up to the upright position (SUT). IAP and intra-esophageal pressure (IEP) were recorded at baseline and during the maneuvers. GERD was defined as acid exposure time > 6% according to Lyon 2.0.

Results: Among the 110 patients included (age 55 years; 59.1% female, BMI 25.4 kg/m²) SUT was effective in 94 and SLR in 85. SUT was more sensitive than SLR (77.4% vs. 71.0%) but less specific (63.5% vs. 79.6%) in predicting GERD. On ROC analysis, the AUC of the MS-SUT was 0.825 and MS-SLR 0.854. When both maneuvers were effective (73 patients) SUT predicted GERD in 69.9%, SLR in 76.7% (p = 0.192). When concordant (52 patients) sensitivity and specificity were 88% and 80%, and the AUC of the MS was 0.872.

Conclusions: SUT is comparable to SLR, with higher sensitivity but lower specificity. When both are concordant, the SUT can strengthen confidence in SLR and increase the accuracy of the Milan Score.

Background: Irritable bowel syndrome (IBS), a disorder of the gut-brain interaction, is associated with significant symptom burden and impaired psychosocial functioning. Evidence-based behavioral therapies are effective, but often underutilized due to accessibility barriers. Mobile health is an emerging field with the potential to bridge the gap between the needs of individuals with IBS and the limitations of the healthcare system. This study evaluated the feasibility and effectiveness of the LyfeMD app plus health coaching (HC) in improving IBS symptom severity and psychosocial wellbeing.

Methods: This 12-week interventional pilot study evaluated the effectiveness of a mobile application combined with HC in adults diagnosed with IBS. Participants were assessed at baseline, 6 weeks, and 12 weeks using validated surveys to assess symptom severity, psychosocial wellbeing, diet, physical activity, and sleep. A Fitbit was also used to track physical activity and sleep.

Results: Thirty-nine participants completed the 12-week intervention. IBS symptom severity improved significantly (p < 0.001) over the 12-week period, with 63.2% of the participants having a clinically meaningful improvement in their symptoms. In addition to symptom severity, participants improved in all measured psychosocial domains and their subjective sleep quality at 12 weeks.

Conclusion: In summary, the LyfeMD platform, in combination with HC, shows potential in improving IBS symptom severity, psychosocial well-being, and sleep quality in individuals diagnosed with IBS. These findings highlight the potential of mobile health as a complement to traditional medical care. Further research, including randomized controlled trials with extended follow-up, is needed to confirm findings and the sustainability of these outcomes.

Background: Arbutus and hawthorn fruits are commonly utilized in traditional medicine to address various gastrointestinal (GI) ailments. Our primary aim was to individually assess the effects of aqueous extracts from Arbutus unedo (AUAE) and Crataegus monogyna (CMAE) fruits on GI motility, spontaneous jejunal smooth muscle contractility, and hyperglycemia management.

Methods: Wistar rats were administered loperamide (LOP, 3 mg/kg, b.w.) along with AUAE or CMAE (at doses of 75, 150 and 300 mg/kg, b.w.) or yohimbine (YOH, 2 mg/kg, b.w.). GI transit was evaluated using the charcoal meal test. The impact of both extracts on jejunal secretion and contraction was assessed using the Ussing chamber technique and the isometric transducer. The bioactive constituents of AUAE and CMAE were analyzed via liquid chromatography-high resolution electrospray ionization mass spectrometry (LC-HRESIMS).

Results: AUAE and CMAE comprise bioactive compounds, including phenolic acids, flavonoids, and flavonols, capable of eliciting various intended physiological effects. Both extracts demonstrated a significant and dose-dependent increase in GI transit (77.33%-89.83% and 80.31%-85.54%, respectively) compared to the delayed peristalsis induced by LOP (42.77%) and the accelerated effect of YOH (90.09%). Both extracts induced an increase in the amplitude of spontaneous jejunal contraction with an EC₅₀ of 90.47 and 22.98 μg/mL, respectively. Conversely, the two extracts did not impact the electrogenic transport of intestinal fluid when compared to the action produced by forskolin (FSK, 10 μM). Additionally, both extracts significantly reduced glucose levels in hyperglycemic rats compared to control values.

Conclusion: These findings hold promise for the development of novel preventive and pharmacological treatment strategies for GI disorders and diabetes management.

Background: Functional lumen imaging probe (FLIP) utility is established in treatment-naïve achalasia but less clear following lower esophageal sphincter (LES) directed therapy.

Methods: Achalasia patients with LES directed therapy across three tertiary care centers between 2017 and 2024 with post-treatment FLIP and timed barium esophagram (TBE) were retrospectively identified. Reduced esophagogastric junction (EGJ) opening was defined by distensibility index (DI) < 2 mm²/mmHg and diameter < 12 mm. Abnormal emptying on TBE was defined as column height ≥ 5 cm at 5 min and/or retained tablet. Eckardt scores ≤ 3 defined clinical response.

Key results: The study included 222 patients (46% peroral endoscopic myotomy, 46% laparoscopic Heller myotomy, 8% pneumatic dilation) with a median of 1.4 years to post-treatment TBE/FLIP. Abnormal emptying on TBE was associated with a narrower median EGJ diameter (13.2 vs. 14.8 mm, p = 0.008), a greater frequency of EGJ diameter < 12 mm (36% vs. 21%, p = 0.012), and a smaller change in EGJ diameter (+4.6 vs. +8.6 mm, p = 0.002). Abnormal emptying on TBE occurred more frequently in patients with EGJ DI < 2 mm²/mmHg (8.5% vs. 2.6%, p = 0.052), but was not associated with median EGJ DI (4.5 vs. 5.1 mm²/mmHg, p = 0.29) nor median change in EGJ DI (+2.9 vs. +3.9 mm²/mmHg, p = 0.25). Patients with reduced EGJ DI or EGJ diameter more often had abnormal TBE (37% vs. 22%, p = 0.012). Only the change in DI (+3.8 vs. +1.5 mm²/mmHg, p = 0.012) and diameter (+8.2 vs. +1.6 mm, p = 0.002) on FLIP was associated with a clinical response based on Eckardt ≤ 3.

Conclusions and inferences: FLIP following achalasia therapy generally correlates with TBE, although discrepant findings are not uncommon. In particular, FLIP EGJ-diameter has a strong association with esophageal emptying on TBE. Both TBE and FLIP have limited association with clinical response based on Eckardt, with change in DI and diameter on FLIP most strongly associated. Consequently, FLIP as part of multimodal assessment appears useful in the longitudinal follow-up of treated achalasia.