Neurogastroenterology and Motility最新文献

Background: During pre-bariatric surgery evaluation, we routinely perform objective testing for GERD (endoscopy, pH monitoring if no reflux esophagitis found) with high-resolution manometry (HRM) and functional lumen imaging probe (FLIP) to evaluate esophageal motility. In this study, we aimed to identify differences in FLIP metrics between obese patients with and without GERD.

Methods: We reviewed our clinical database of obese patients evaluated for bariatric surgery, including surgery-naïve patients and patients who had sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) that resulted in inadequate weight loss. We recorded GERD symptoms, HRM findings, and FLIP metrics (EGJ-diameter, distensibility index, and contractile response patterns). Patients with reflux esophagitis or acid exposure time (AET) > 6% were considered GERD+; those with AET ≤ 6% were deemed GERD.

Key results: We included 160 patients (mean age 50.2 ± 12.4 years; 79% women; 66 surgery-naïve) (29 GERD-, 37 GERD+), 70 SG (20 GERD-, 50 GERD+), 24 RYGB (16 GERD-, 8 GERD+). FLIP abnormalities were frequent, including reduced EGJ opening (REO) (12.1% surgery-naïve, 14.3% SG, 12.5% RYGB) and abnormal contractile response (59.1% surgery-naïve, 71.4% SG, 62.5% RYGB). FLIP differences were found between GERD+ and GERD- patients: REO (8.0% vs. 30.0%, p = 0.02) and BCR (2.0% vs. 15.0%, p = 0.02) were both less frequent in GERD+ than in GERD- SG patients. SRCR was more frequent in GERD- than in GERD+ surgery-naïve patients (31.0% vs. 5.4%, p = 0.01).

Conclusions: While FLIP differences between GERD- and GERD+ patients exist, there were no FLIP metrics that clearly predicted GERD in obese patients either before or after bariatric surgery.

Background: Neurogenic fecal incontinence (NFI) is a disorder of anal dysfunction caused by nerve damage. Electroacupuncture (EA), grounded in Traditional Chinese Medicine (TCM) theory, has demonstrated efficacy in treating various degenerative disorders and is extensively utilized in the clinical management of neurogenic FI. The proliferation and differentiation of muscle satellite cells (SCs) are crucial in the onset and progression of this condition. However, the specific mechanism of electroacupuncture in treating neurogenic fecal incontinence is not yet clear. This study sought to determine whether EA could enhance anal function in rats with neurogenic FI and to elucidate its mechanisms of action.

Methods: We observed the effect of electroacupuncture on anorectal function in rats with neurogenic fecal incontinence and its mechanism of action.

Key results: The morphology and arrangement of anal sphincter muscle fibers were altered due to pudendal nerve injury. The expression levels of two atrophy markers, Muscle-specific RING finger protein 1 (MuRF-1) and Atrogin-1, were elevated in the anal sphincter muscles, and shifts were seen from slow-twitch to fast-twitch muscle fibers. Post EA treatment, the expression levels of atrophy markers were reversed; the proportion of slow-twitch fibers in the muscles increased, and the expressions of Pax3 and Myod1, which had decreased 3 weeks post-injury, significantly increased and gradually normalized.

Conclusions & inferences: These results indicate that EA effectively ameliorates anal function in rats with neurogenic FI, primarily through mechanisms that involve the activation of muscle SCs.

Backgrounds: Diverticular disease, particularly symptomatic uncomplicated diverticular disease (SUDD), significantly impacts patient quality of life and is increasing in prevalence, especially in Western countries. While its pathophysiology is multifactorial, diet-specifically low fiber intake-has been implicated as a key modifiable factor in disease development and progression. Fibers influence colonic motility and stool composition, potentially reducing the formation of diverticula and symptom severity. Polyphenols, bioactive compounds with antioxidant and anti-inflammatory properties, may further protect intestinal integrity and modulate gut microbiota.

Purpose: This narrative review explores emerging evidence on the role of dietary fiber and polyphenols in SUDD management. Despite promising mechanistic insights, current studies are limited by heterogeneity and methodological constraints. Personalized nutritional strategies focusing on fiber and polyphenol-rich foods warrant further investigation to optimize therapeutic outcomes in SUDD.

Fennel tea has a region-specific effect on the stomach motility. It relaxes the fundus and the corpus and acts pro-motility in the antrum. The store operated Ca2+ entry blocker SKF-96365 hampers the spasmolytic effect of fennel tea in the fundus and corpus. The image was created using Biorender.

Background: Disorders of gut-brain interaction (DGBI) are associated with reduced health-related quality of life (HRQoL) and psychological disorders. Among individuals with DGBI, abdominal pain correlates with increased healthcare-seeking and analgesic use. This study aimed to evaluate the influence of pain as a cardinal symptom on HRQoL and psychological disorders.

Methods: This is a sub-analysis of data from four Latin American countries included in the Rome Foundation Global Epidemiology Study (RFGES). DGBI were classified into (1) painful DGBI, including individuals with diagnoses characterized by pain as a primary symptom, and (2) non-painful DGBI, including individuals with only non-painful diagnoses. Prevalence rates, healthcare-seeking behavior, HRQoL (Patient-Reported Outcomes Measurement Information System Global-10 [PROMIS Global-10]), anxiety and depression (Patient Health Questionnaire-4 [PHQ-4]) and somatization (Patient Health Questionnaire-12 [PHQ-12]) were compared.

Key results: A total of 8069 participants from the four countries completed the RFGES online survey, including 1132 in the painful group and 1720 in the non-painful group. Participants with painful DGBI more commonly sought healthcare at least monthly compared to those with non-painful disorders (18.6% vs. 14.9%). Painful disorders were associated with significantly lower HRQoL scores and higher PHQ-4 and PHQ-12 scores, both in unadjusted and adjusted analyses (sex, age, education, and community size).

Conclusion and inferences: In four Latin American countries, individuals with painful DGBI were more likely to seek healthcare, had worse HRQoL and exhibited greater psychological distress compared to those with non-painful DGBI. These findings highlight the need for targeted interventions for individuals with painful DGBI symptoms.

Background: The circadian rhythm regulates gastrointestinal motility. In humans and preclinical models, such as rodents, whole gut transit (WGT) is slower during the rest phase compared to the active phase. Investigators typically study GI transit in rodents during the day, which is their rest phase, rather than during the night, which is their active phase. A circadian rhythm reversal in which mice are in a dark room during the working day (reverse light) allows studies on nocturnal animals during their active phase and has been previously shown to reduce WGT time. GI motility is often disrupted in individuals with disorders of gut-brain interaction (DGBI), which are female predominant. However, the effect of circadian rhythm on regional transit and sex dependence of the differences is not known, as most motility studies looking at circadian rhythm reversal are done in male mice.

Methods: We tested C57BL/6 wild-type male and female mice in rest (12 h of light during the day) and active (reverse cycle for 2 weeks: 12 h of dark during the day) phases. We noted female estrous cycle by visual inspection. We performed carmine WGT by monitoring time-lapse videos of pellet production. We performed fluorescence imaging of excised intestines 30 min after gavage to assess percent fluorescence for each GI region and then examined small intestinal transit (SIT) by measuring geometric center and leading edge. For colonic transit, we monitored bead expulsion time from distal colon to anus.

Key results: Compared to rest phase, in the active phase, like male mice, female mice had (1) faster WGT, (2) increased frequency of pellet expulsion in the first 3 h of transit, (3) and greater total pellet production. Both male and female mice in their active phase exhibited (4) more contrast emptied from the stomach and they had (5) further leading edge of fluorescence and (6) geometric center, in SIT, and (7) faster colonic bead expulsion times. There were no significant sex differences in the active phase of WGT. In SIT, male mice had further leading edge in the rest phase than female mice, but this difference was not seen in the active phase, and in colonic transit, male mice in both the active and rest phases had faster bead expulsion than female mice.

Conclusions: Mice in the active phase have faster regional transit in small and large bowel than mice in the rest phase that collectively contributes to faster WGT times in the active phase of both male and female mice. These findings highlight the importance of circadian biology in sex-dependent rodent GI transit.

Background: Diaphragmatic breathing training (DBT) improves symptoms in patients with gastroesophageal reflux disease; however, the effect of DBT on the anti-reflux barrier and esophageal motility is unclear. This study aimed to evaluate the changes in specific parameters of EGJ function and esophageal motility before and after DBT using high-resolution manometry (HRM) in patients with reflux symptoms.

Methods: Prospectively collected data from adult patients with persistent reflux symptoms who underwent initial and follow-up HRM after at least 3 months of DBT were analyzed. Esophagogastric junction (EGJ) function was assessed using basal lower esophageal sphincter (LES) pressure (LESP), the EGJ contractile integral (EGJ-CI), and integrated relaxation pressure (IRP). Esophageal motility was assessed using the distal contractile integral (DCI) and percentage of ineffective esophageal motility (IEM).

Key results: Data from 53 patients with a median age of 45 years (range 25-77) were analyzed. LES pressure increased after DBT (mean LES pressure 25.6 [SE 1.3] vs. 29.1 [SE 1.4] mmHg after DBT; p = 0.02). This effect was also observed in patients with an initially hypotensive LES, but no effect was found on the size of hiatus hernia. There was a trend to increased EGJ-CI (mean EGJ-CI 52.8 [SE 3.7] vs. 59.9 [SE 4.3] mmHg·cm after DBT, p = 0.07). Esophageal contractility improved (mean DCI 1046.6 [SE 112] vs. 1264.1 [SE 137] mmHg·s·cm after DBT; p < 0.01) with the prevalence of IEM reduced from 38.0% [SE 5] to 29.2% [SE 4] after DBT; p = 0.03.

Conclusion and inferences: Diaphragmatic breathing training increased LES pressure and esophageal peristaltic vigor in patients with reflux symptoms.

Background: Apart from disorders of gut-brain interaction (DGBI), little data exist on the magnitude of the brain-to-gut pathway in other chronic gastrointestinal conditions such as gastroesophageal reflux disease (GERD) or inflammatory bowel disease (IBD) and what factors modify order of diagnosis. We aimed to determine the proportion of patients who received a diagnosis of a DGBI, GERD, or IBD prior to a new psychological diagnosis (gut-to-brain), and vice versa (brain-to-gut), and whether specific factors moderate the order of diagnosis.

Method: Data was collected from a retrospective study of 1,129,104 patients attending general practices in the United Kingdom. Patients diagnosed with DGBI, GERD, or IBD and a psychological disorder (anxiety and/or depression) were included (excluding those with other organic GI disease). Information on which diagnosis appeared first was recorded. Multiple logistic regression was performed to compare a diagnosis of a DGBI, GERD, or IBD first versus a psychological diagnosis first on sociodemographic factors, medical conditions, and medication usage.

Key results: Just over half of patients were diagnosed with a psychological condition first versus after for IBS (53.9%) and ulcerative colitis (55.6%). This proportion was higher for FD (61.5%) and GERD (64.2%) but lower for Crohn's disease (45.7%). In a multivariate model, being female (OR = 1.37, 95% CI 1.25, 1.49), prior PPI (OR = 9.17, 95% CI 8.4, 10.0), antibiotic (OR = 2.54, 95% CI 2.29, 2.81) and NSAID use (OR = 1.29, 95% CI 1.18, 1.42), and prior gastroenteritis (OR = 2.19, 95% CI, 1.79, 2.67) were significant predictors for being diagnosed with GERD first. Similar results were found for DGBI.

Conclusions & inferences: Prior medication usage and gastroenteritis may play a role in generating gut-to-brain pathway disturbances.

Background: Small intestinal bacterial overgrowth (SIBO) and intestinal methanogen overgrowth (IMO) are commonly diagnosed using glucose (GBT) and lactulose (LBT) breath tests. Despite their widespread use, concerns remain regarding their reproducibility and reliability, especially in asymptomatic individuals. This study aimed to evaluate the diagnostic variability and test-retest reliability of GBT and LBT in healthy volunteers.

Methods: We conducted a prospective observational diagnostic concordance study in 40 healthy adults. Participants underwent both GBT (75 g glucose) and LBT (10 g lactulose) with hydrogen (H₂) and methane (CH₄) measured at 15-min intervals. Testing was repeated 2 weeks later. A positive result was defined as an increase of ≥ 20 ppm in H₂ or CH₄ level of ≥ 10 ppm at any point during the breath testing. Symptoms were recorded during the tests. Agreement and reliability were assessed using kappa statistics and intraclass correlation coefficients (ICC), respectively.

Results: At baseline, 15.0% of participants had a positive GBT and 60.0% had a positive LBT, predominantly for H₂. In the retest, 10.0% remained GBT-positive, whereas LBT results were consistent (60.0%). ICC for GBT was 0.56 for H₂ and 0.87 for CH₄; for LBT, ICCs were 0.88 and 0.85, respectively. Symptoms occurred more frequently with LBT, and the median time to symptom onset (75 min) coincided with physiological orocecal transit.

Conclusions: GBT and LBT showed good test-retest reliability in healthy individuals. However, the high rate of positive LBT results and symptom occurrence suggests limited specificity, reinforcing the need for cautious interpretation and further standardization in breath test protocols.

Background: We previously found that the fecal levels of short-chain fatty acids (SCFAs) changed in irritable bowel syndrome (IBS) patients at 1 month and 1 year after fecal microbiota transplantation (FMT). This study analyzed SCFAs at 2 and 3 years after FMT in the same IBS patients included in those previous studies.

Methods: This study randomized 113 IBS patients into placebo, 30-g, and 60-g groups, who received FMT with 30 g of their own feces and with 30 g and 60 g of the donor's feces, respectively. The patients completed four questionnaires to assess IBS symptoms, fatigue, and quality of life, and supplied fecal samples at the baseline and at 2 and 3 years after FMT. The fecal SCFA levels were measured using gas chromatography.

Results: The butyric acid level was significantly increased at 2 and 3 years after FMT in the 30-g and 60-g groups, and was significantly higher than that in the placebo group. The total SCFA and acetic acid levels decreased significantly in the 30-g and 60-g groups at 2 and 3 years after FMT, while the propionic acid level decreased in the 60-g group at both time points. The butyric acid level was inversely correlated with IBS symptoms and fatigue.

Conclusion and inferences: The increased butyric acid levels in IBS patients at 2 and 3 years after FMT and their inverse correlation with both IBS symptoms and fatigue suggest that butyric acid contributes to the long-term improvement seen after FMT (www.

Clinicaltrials: gov: NCT03822299).