Neurogastroenterology and Motility最新文献

Background: Body surface gastric mapping (BSGM) non-invasively assesses gastric myoelectrical activity along with real-time symptom reporting. In adults, the development of normative intervals has underpinned new explanatory phenotypes, aiding clinical decision-making. This study established normative reference intervals for adolescent BSGM metrics.

Methods: Healthy adolescents aged 12-17 years with a BMI ≤ 35 kg/m² were recruited from New Zealand, Australia, and the United States. BSGM using Gastric Alimetry (Alimetry, New Zealand) involved a 30-min fast, followed by a 480-kcal meal, and a 4-h postprandial recording. Reference intervals were calculated for four validated metrics: Principal Gastric Frequency (PGF), body mass index (BMI)-adjusted amplitude, Gastric Alimetry Rhythm Index (GA-RI, indicating rhythm stability), and the fed: fasted amplitude ratio (ff-AR). Results were reported at the median and 5th and/or 95th percentiles as appropriate.

Key results: A total of 107 participants (52.8% female, median age 14 [IQR 13-16], median BMI 20.1 [IQR 18.75-22.40]) with mixed ethnicities were included. No substantive correlations were observed between BSGM metrics and demographics or anthropometric data. Therefore, a single set of normative reference intervals was established. Median PGF was 3.06 cycles per minute; reference interval 2.72-3.37. Median BMI-adjusted amplitude was 37.80 μV; reference interval 20.0-72.0. Median GA-RI was 0.51; reference interval ≥ 0.22. Median ff-AR was 2.12; reference interval ≥ 1.0.

Conclusions and inferences: This study presents normative reference intervals for BSGM spectral metrics in adolescent populations, informing the interpretation of tests in research and clinical practice.

Background: Children with abdominal pain-related disorders of gut-brain interaction (AP-DGBI) often experience sleep disturbances which may be linked to the autonomic nervous system. Heart rate variability (HRV) is a non-invasive measure of autonomic nervous system activity. Our aim was to examine if HRV was associated with characteristics of disturbed sleep in children with AP-DGBI in order to elucidate the underlying physiological mechanisms of disturbed sleep.

Methods: This analysis used baseline data from a randomized control trial of 156 children ages 7-12 years with AP-DGBI. HRV was measured after dinner using a Polar monitor. Sleep disturbances were evaluated using the Children's Sleep Habits Questionnaire. Associations between HRV indices and sleep characteristics were determined using partial correlations controlling for age and stratified by sex.

Key results: Among girls, higher parasympathetic activity (Ln RMSSD and Ln pNN50) was associated with longer sleep onset delay while lower heart rate was correlated with increased sleep anxiety. Among boys, lower autonomic balance (Ln LF/HF ratio) was associated with increased daytime sleepiness. In both sexes, lower low frequency HRV was associated with greater sleep-disordered breathing. Post hoc analysis of multiple indices revealed that children with sleep-disordered breathing had significantly lower HRV vs. those without disordered breathing.

Conclusions & inferences: The autonomic nervous system may be a potential mechanism which impacts sleep among children with AP-DGBI. Future longitudinal studies are needed to confirm this relationship.

Background: The rectosigmoid brake (RSB) regulates rectal filling via retrograde cyclic motor patterns in the distal colon. Disruption has been linked to postoperative ileus (POI), low anterior resection syndrome (LARS), fecal incontinence (FI), and acute colonic pseudo-obstruction (ACPO). We synthesized manometric evidence to clarify the RSB's clinical relevance.

Methods: A systematic search of Ovid MEDLINE and Embase (March 2025) for studies assessing distal colonic motility in adults with surgical or functional colorectal conditions. Thirty-four studies met the inclusion criteria, including nine using high-resolution manometry. Data were qualitatively synthesized by condition.

Key results: Altered RSB activity was a consistent finding. In POI (7 studies; 2 HRM), the HRM studies showed immediate postoperative hyperactive distal cyclic activity (~2-4 cycles/min) correlating with delayed return of bowel function, contradicting older low-resolution reports of quiescence. In LARS (4 studies; 3 HRM), post-prandial cyclic patterns and propagating sequences were blunted after rectosigmoid resection. In FI (5 studies; 2 HRM), the brake was suppressed; sacral nerve stimulation increased distal retrograde contractions with parallel symptom gains. In ACPO (1 HRM case study), recordings showed disordered, non-propagating hyperactive activity consistent with distal functional obstruction rather than hypoactivity.

Conclusions: Across POI, LARS, FI, and ACPO, the RSB appears to be a unifying physiological mechanism and a promising physiological biomarker with diagnostic and therapeutic potential. Priorities include standardizing manometric definitions, establishing normative reference metrics, and advancing non-invasive assessment (e.g., body-surface colonic mapping) to enable RSB-guided care and translation to practice.

Background and aims: Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by the loss of dopaminergic neurons and neurological dysfunctions. The aggregation of abnormal α-synuclein (α-Syn) is closely associated with neuronal damage and acts as the major pathogenic driver mediating neurotoxicity. As critical intermediates in the aggregation cascade, α-Syn oligomers are regarded as the most neurotoxic species, which are widely distributed in both the central and peripheral nervous systems and contribute to the initiation and progression of PD. The gut-brain axis has attracted increasing attention, with a focus on the generation and propagation of gut-derived α-Syn oligomers, which can be promoted by chronic gut inflammation, gut microbiota dysbiosis, genetic mutations, and environmental factors. In this paper, we systematically elaborate on the formation of α-Syn oligomers and their transmission into the central nervous system, discuss existing therapeutic strategies targeting α-Syn oligomers, and analyze emerging prospects for future interventions.

Results: This review integrates and analyzes available evidence regarding the biogenesis, gut-to-brain propagation, and pathogenic roles of α-Syn oligomers in PD. It also summarizes the current progress of therapeutic approaches targeting α-Syn oligomers and evaluates their potential value.

Conclusion: This review not only provides novel insights into pathogenetic mechanisms of PD but also highlights the therapeutic feasibility of targeting gut-derived α-Syn oligomers as a potential strategy for PD treatment.

Background: Wireless motility capsule (WMC) measures antroduodenal contractility and may help identify gastroparesis (GP) patients most likely to respond to gastric per-oral endoscopic myotomy (G-POEM). Contractile predictors of G-POEM success remain elusive, and WMC contractility data have not previously been studied for this purpose.

Methods: Refractory gastroparesis patients with WMC testing prior to G-POEM were retrospectively analyzed. Gastroparesis Cardinal Symptom Index (GCSI) before and after G-POEM, contraction count (Ct) and area under the pressure curve (AUC) from WMC were collected 1 h before and after gastric emptying time (GET). Decrease in GCSI ≥ 1 defined G-POEM response. Antral Ct < 29/h, AUC < 1358 and duodenal Ct < 36/h, AUC < 1456 defined diminished contractions. Contractility between responders and non-responders was compared using Pearson chi-square.

Results: Eighty-five patients were analyzed (mean age 45, 88% female); 41 (48.2%) responded to G-POEM. Among all patients, antroduodenal contraction parameters were not associated with G-POEM response. Among idiopathic GP patients, those with preserved antral contractions by AUC were more likely to be non-responders (70% vs. 30%, p = 0.028), particularly in those with severely delayed GET (74% vs. 26%, p = 0.007). Conversely, idiopathic GP patients with diminished antral contractions by AUC were more likely to be responders (67% vs. 33%, p = 0.028).

Conclusion: In idiopathic gastroparesis, preserved antral contractions were associated with G-POEM non-response, while diminished antral contractions were associated with response. Diminished antral contractions may represent a phenotype of severe motor delay responsive to "passive" gastric emptying by G-POEM, whereas preserved antral contractility may indicate sensory neuroenteric dysfunction less amenable to pyloric intervention.

Introduction: Systemic sclerosis (SSc) is a rare autoimmune disease with near-universal symptoms of gastrointestinal dysmotility. The contribution of disruption of the gut-brain axis to SSc gastrointestinal symptoms is unknown. We aimed to quantify the frequency of SSc patients meeting diagnostic criteria for DGBI-like symptoms.

Methods: In a cross-sectional survey study, the frequency of irritable bowel syndrome (IBS), functional dyspepsia (FD), functional dysphagia and post prandial distress syndrome (PPDS) was assessed using the Rome-IV-Questionnaire. Participants completed a Short Form-36, Health Assessment Questionnaire Disability Index, UCLA Gastrointestinal 2.0 Questionnaire (GIT 2.0), and ScleroID to assess quality of life, daily function, SSc gastrointestinal disease severity, and overall impact of SSc, respectively. The associations between IBS, FD, functional dysphagia, PPDS, and SSc severity, daily function, and quality of life were assessed using linear regression analysis.

Results: Out of 101 participants, 21 met FD criteria, and 18 met IBS criteria. These patients had more severe SSc gastrointestinal disease, measured by total GIT-2.0 scores (IBS coef: 0.69 (0.44-0.95, p < 0.01); FD coef: 0.64 (0.41-0.86, p < 0.01)). FD was associated with poorer physical health-related quality of life (SF-36 PCS coef: 38.70 (28.54-48.66)), and both IBS and FD were associated with a greater overall impact of SSc as measured by the ScleroID (IBS coef: 1.55 (0.35-2.75), p < coef: 1.94 (0.89-2.98, p < 0.001)).

Conclusion: One-fifth of SSc patients surveyed met DGBI diagnostic criteria, suggesting that the presence of disorders of gut-brain interaction should be considered when assessing SSc gastrointestinal disease. Our results indicate that there may be a subgroup of SSc patients who have co-existing DGBI-like symptoms contributing to their clinical presentation of SSc-associated gastrointestinal disease.