Neurogastroenterology and Motility最新文献

Mind-body approaches aim to improve gut symptoms and quality of life by targeting the interaction between the central nervous system and the enteric nervous system. These include treatments such as hypnotherapy, mindfulness, meditation, and yoga. Although evidence is building on efficacy of mind-body approaches, we generally lack a thorough understanding of how they work. Despite being presented as separate treatment modalities, mind-body approaches often use overlapping treatment aspects with the same mechanism of action. There is evidence that yoga, meditation, and hypnotherapy may partly draw their benefit from creating an absorbed state of attention combined with suggestions for change. This has implications for clinical application of these treatments in patients with GI disease. We propose studies on mechanisms of mind-body approaches to develop more efficacious and more precise treatments for GI diseases.

Introduction: The gold-standard diagnostic test for gastroparesis is gastric emptying scintigraphy (GES). Although a 4-h GES is recommended in adult guidelines, no similar guidelines exist in the pediatric population, with many hospitals utilizing a 2-h scan to reduce radiation exposure and save time.

Methods: We performed a systematic review and meta-analysis to evaluate differences in the diagnosis of gastroparesis during 2-h versus 4-h GES. Four databases were systematically searched for articles reporting results of GES at both the 2- and 4-h time points in a pediatric population. Outcomes included the proportion of patients with gastroparesis at 2- and 4-h and the number of patients with differing transit status (normal or abnormal) from 2- to 4-h. Meta-analyses were conducted utilizing a random effects model. Heterogeneity among studies was assessed utilizing the I² statistic.

Key results: A total of 344 records were identified, of which 9 articles met inclusion criteria. Of these, six articles were included in the meta-analysis. The pooled proportion of patients with alterations in gastric transit between 2 and 4 h was 0.2 (95% CI: 0.11 to 0.30). Overall, the extended 4-h scan captured an additional 10% of patients with gastroparesis. There was significant heterogeneity among the studies (I² = 91.8%, p < 0.001), likely due to differences in GES protocol and patient samples.

Conclusions and inferences: The 4-h GES offers a higher diagnostic yield in pediatric patients compared to a 2-h study, despite heterogeneity in existing research. Further prospective studies are necessary to further quantify this advantage.

Background: Multidisciplinary integrated models of care show promise for improving symptoms and quality of life (QoL) in adults with irritable bowel syndrome (IBS).

Aims: To describe and evaluate the characteristics of integrated models of care for IBS and identify how digital health is being used in these models of care.

Methods: Four databases were searched to March 2024 for studies that included adults with IBS who participated in multidisciplinary integrated models of care that delivered non-pharmacological therapies. The template for intervention description and replication (TIDieR) checklist was used to appraise study quality and extract model of care characteristics, which were mapped against the Project INTEGRATE framework to establish topics.

Results: Sixteen studies (6 randomized controlled trials, 2 quasi-experimental, 8 cohort studies) reported 14 integrated models of care including 2165 patients of which 918 were IBS patients. Integrated models of care led to improved IBS symptoms (n = 11/13 models of care) and QoL (n = 6/9 models of care). Studies showed moderate compliance with the TIDieR checklist. Five topics were established: clinicians involved, therapies provided, location and mode of delivery, coordinating clinical partnerships, and sharing visions and values of integrated care. Most commonly, a gastroenterologist coordinated care with a psychologist, dietitian, and/or nurse in tertiary care. Psychological, dietary, and physical therapies were provided by n = 11, n = 8, and n = 3 integrated models of care, respectively. Six models of care provided joint consultations or group sessions. Four models of care used digital health such as telephone coaching or online modules.

Conclusions: Integrated models of care for IBS exhibited diverse characteristics including the clinicians involved, the therapies provided and the mode of delivery of each therapy. There is a need to evaluate the use of digital health and the delivery of integrated models of care in primary care settings.

Background: Data are limited on the natural history and symptom patterns of cyclic vomiting syndrome (CVS), a disorder of gut-brain interaction characterized by recurrent stereotypical vomiting, retching, and nausea episodes.

Methods: A 6-month, observational, remote study prospectively assessed symptom patterns in adults with CVS using an electronic daily diary. Patients recorded their disease experience, including CVS symptoms and associated severity, in the daily diary. The study defined a CVS episode start as the first day of 5 or more vomiting and/or retching (V + R) events. Episode end was defined as the first day of ≥ 7 (prespecified main analysis) or ≥ 4 (sensitivity analysis) days without any diary V + R events.

Key results: Eighty-eight of 93 (94.6%) enrolled patients (62 female; mean age, 37.7 years) had daily diary data recorded during the study; 61 (69.3%) patients had at least one episode. In the prespecified main analysis, 191 episodes (median, 0.6 per 30 diary days) were reported (median duration, 3.0 days); 17.8% of the episodes lasted > 10 days. In the sensitivity analysis, 248 episodes (median, 0.7 per 30 diary days) were reported (median duration, 2.0 days). Thirteen of 88 (14.8%) patients with diary data had interepisodic V + R (reported V + R events without meeting the threshold for study-defined episode). Other CVS-related (non-V + R) symptoms (most frequently nausea, abdominal pain, and sweating) were reported more frequently during the episode versus the interepisodic period.

Conclusions and inferences: This prospective longitudinal study shows marked heterogeneity of CVS episodes and highlights the need to better define and characterize episodes in these patients.

Background: Accumulating evidence has suggested that neuropeptides such as orexin, ghrelin, or oxytocin act centrally in the brain to regulate intestinal barrier function through the vagus nerve. It has been reported that the vagal cholinergic anti-inflammatory pathway was blocked by splenectomy. In the present study, we therefore examined the effect of splenectomy on neuropeptides-induced improvement of increased intestinal permeability.

Methods: Colonic permeability was determined in vivo by quantifying the absorbed Evans blue in colonic tissue for 15 min spectrophotometrically in rats.

Results: Splenectomy increased colonic permeability. The increased permeability by splenectomy was significantly blocked by vagal activation induced by carbachol or 2-deoxy-d-glucose which was prevented by atropine, suggesting vagal activation could prevent colonic hyperpermeability in splenectomized rats. In the splenectomized rats, intracisternal injection of orexin, ghrelin, oxytocin, or butyrate failed to inhibit increased colonic permeability while intracisternal glucagon-like peptide-1 (GLP-1) analogue, liraglutide, potently blocked the increased colonic permeability in a dose-dependent manner. The liraglutide-induced improvement of increased colonic permeability was blocked by atropine in splenectomized rats. Intracisternal injection of GLP-1 receptor antagonist attenuated 2-deoxy-d-glucose-induced improvement of colonic hyperpermeability in splenectomized rats.

Conclusion: The present results suggested that the spleen is important in the improvement of intestinal barrier function by brain orexin, ghrelin or oxytocin, and butyrate. On the other hand, GLP-1 acts centrally in the brain to improve colonic hyperpermeability in a spleen-independent manner. All these results suggest that dual mechanisms (spleen dependent or independent) may exist for the brain-gut regulation in intestinal barrier function.

Background: There is a large unmet need for alternative, non-invasive, and accurate diagnosis of small intestinal bacterial overgrowth (SIBO). The smart capsule bacterial detection system (SCBDS) device contains a targeted sampling technology and an onboard SCBDS assay to detect metabolically active bacteria in the small intestine. Here, we evaluated the agreement of SCBDS assay with duodenal aspiration/culture ex vivo in a multicenter clinical study.

Methods: Duodenal aspiration was performed in subjects with gastrointestinal symptoms suggestive of SIBO. Aspirated fluid was sent to local and central microbiology labs to evaluate the agreement for detecting bacteria with SCBDS assay compared to the total bacterial count (TBC) reference standard. The performance of SCBDS assay was evaluated using a receiver operator curve, sensitivities, and specificities.

Key results: Aspirates from 66 patients were collected and analyzed for TBC and SCDBS assay. The overall agreement between the two assays was 82%-92% across 3 clinical sites. The SCBDS assay had a sensitivity of 67%-100% and a specificity of 90%-97% using either ≥ 10³ or 10⁵ CFU mL^-1 cutoff. Additionally, there was a good correlation (r = 0.82) for the TBC culture between the local and central labs.

Conclusions and inferences: The SCBDS assay showed a high level of agreement with TBC and improved performance compared to other non-invasive tests. These results demonstrate the potential utility of SCBDS device to aid SIBO diagnosis as a simple and non-invasive tool that merits further clinical validation.

Background: The functional lumen imaging probe (FLIP) has proven to be a versatile device for diagnosing esophageal motility disorders and estimating esophageal wall compliance, but there is a lack of viable software for quantitative assessment of FLIP measurements.

Methods: A Python-based web framework was developed for a unified assessment of FLIP measurements including clinical metrics such as esophagogastric junction (EGJ) distensibility index (DI), maximum EGJ opening diameter, mechanics-based metrics for estimating strength, and effectiveness of contractions, such as contraction power and displaced volume, and machine learning-based clustering and predictive algorithms such as the virtual disease landscape (VDL) and EGJ obstruction probability. The clinical and VDL probability metrics were then validated using FLIP data from 121 subjects constituting different categories of EGJ opening which were diagnosed by expert clinicians.

Results: The clinical metrics estimated by the framework matched the manual diagnosis of the clinicians. Misclassifications were minimal and were mostly between neighboring groups, that is, normal and borderline normal or borderline normal and borderline reduced EGJ opening. Similar results were also obtained for the VDL probability metrics. The misclassifications were further analyzed by clinicians and approved.

Conclusion: The FLIP web framework was developed and validated to reliably estimate various clinical, mechanical, and machine learning-based metrics for diagnosing esophageal motility disorders.