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Decreases in mucosally-evoked tachykinin signaling pathways can explain age-related reductions in murine colonic motility patterns. 粘膜诱发的速激肽信号通路的减少可以解释与年龄相关的小鼠结肠运动模式的减少。
IF 3.5 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-01 Epub Date: 2024-08-18 DOI: 10.1111/nmo.14891
Mark S Yeoman, Sara Fidalgo, India Hobby, Ali Hafeez, Rachel N Ranson, M Jill Saffrey, Bhavik Anil Patel

Background: Increasing age increases the incidence of chronic constipation and fecal impaction. The contribution of the natural aging process to this phenotype is unclear. This study explored the effects of age on key motility patterns in the murine colon and determined the contribution that altered neurokinin 2 (NK2) -mediated signaling made to the aging phenotype.

Methods: Mucosal reflexes, colonic migrating motor complexes (CMMCs) and colonic motility assays were explored in isolated ex vivo colons from 3, 12-14, 18- and 24-months old mice and the NK2-mediated response determined. Electrical field stimulation (EFS) or exogenous drug application were used to explore the role of the mucosa in colonic segments.

Key results: Aging reduced the force of contraction of the distal colon mucosal reflex, the frequency and force of contraction of CMMCs and the NK2-mediated component of both motility patterns. Ondansetron, a 5-HT3 receptor antagonist, blocked a component of both motility patterns in full thickness but not in mucosa-free segments of the distal colon. 5, hydroxytryptamine (5-HT) and EFS-evoked NK2-dependent contractions were reduced with increasing age. Smooth muscle sensitivity to 5-HT or neurokinin A (NKA) was not altered with age. In isolated colon motility assays application of NKA decreased transit time in 24-months colon and the NK2 antagonist GR159897 increased transit times in both 3- and 24-months old colons.

Conclusions and inferences: Aging impairs key motility patterns in the murine colon. These changes involve a decrease in mucosally-evoked NK2-mediated signaling. Targeting NK2-mediated signaling may provide a novel approach to treating age-related motility disorders in the lower bowel.

背景:年龄的增长会增加慢性便秘和粪便嵌塞的发病率。自然衰老过程对这种表型的影响尚不清楚。本研究探讨了年龄对小鼠结肠关键运动模式的影响,并确定了神经激肽 2(NK2)介导的信号改变对衰老表型的贡献:方法:在离体的3、12-14、18-和24个月大的小鼠结肠中探讨了粘膜反射、结肠移行运动复合体(CMMCs)和结肠运动试验,并确定了NK2介导的反应。电场刺激(EFS)或外源性药物应用被用来探索粘膜在结肠节段中的作用:主要结果:衰老降低了远端结肠粘膜反射的收缩力、CMMCs 的收缩频率和收缩力以及这两种运动模式的 NK2 介导成分。5-HT3受体拮抗剂昂丹司琼(Ondansetron)能阻断远端结肠全层粘膜的两种运动模式的一部分,但不能阻断无粘膜部分的运动模式。5、羟色胺(5-HT)和 EFS 诱导的 NK2 依赖性收缩随着年龄的增长而减少。平滑肌对 5-HT 或神经激肽 A(NKA)的敏感性不会随着年龄的增长而改变。在离体结肠运动试验中,应用 NKA 会减少 24 个月结肠的转运时间,而 NK2 拮抗剂 GR159897 会增加 3 个月和 24 个月结肠的转运时间:结论和推论:衰老会损害小鼠结肠的主要运动模式。这些变化涉及粘膜诱发的 NK2 介导的信号传导的减少。针对 NK2 介导的信号传导可能为治疗与年龄相关的下肠运动障碍提供一种新方法。
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引用次数: 0
Rikkunshito improves anorexia through ghrelin- and orexin-dependent activation of the brain hypothalamus and mesolimbic dopaminergic pathway in rats. 利君实通过对大鼠大脑下丘脑和间叶多巴胺能通路的胃泌素和奥曲肽依赖性激活来改善厌食症。
IF 3.5 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-01 Epub Date: 2024-08-20 DOI: 10.1111/nmo.14900
Koji Yakabi, Naomi Yamaguchi, Kiyoshige Takayama, Eriko Hosomi, Yutaro Hori, Shoki Ro, Mitsuko Ochiai, Kosuke Maezawa, Seiichi Yakabi, Yumi Harada, Naoki Fujitsuka, Sumiko Nagoshi

Background: Rikkunshito (RKT), a traditional Japanese medicine, can relieve epigastric discomfort and anorexia in patients with functional dyspepsia. RKT enhances the orexigenic hormone, ghrelin. Ghrelin regulates food motivation by stimulating the appetite control center in the hypothalamus and the brain mesolimbic dopaminergic pathway (MDPW). However, the effect of RKT on MDPW remains unclear. Here, we aimed to investigate the central neural mechanisms underlying the orexigenic effects of RKT, focusing on the MDPW.

Methods: We examined the effects of RKT on food intake and neuronal c-Fos expression in restraint stress- and cholecystokinin octapeptide-induced anorexia in male rats.

Key results: RKT treatment significantly restored stress- and cholecystokinin octapeptide-induced decreased food intake. RKT increased c-Fos expression in the ventral tegmental area (VTA), especially in tyrosine hydroxylase-immunoreactive neurons, and nucleus accumbens (NAc). The effects of RKT were suppressed by the ghrelin receptor antagonist [D-Lys3]-GHRP-6. RKT increased the number of c-Fos/orexin-double-positive neurons in the lateral hypothalamus (LH), which project to the VTA. The orexin receptor antagonist, SB334867, suppressed RKT-induced increase in food intake and c-Fos expression in the LH, VTA, and NAc. RKT increased c-Fos expression in the arcuate nucleus and nucleus of the solitary tract of the medulla, which was inhibited by [D-Lys3]-GHRP-6.

Conclusions & inferences: RKT may restore appetite in subjects with anorexia through ghrelin- and orexin-dependent activation of neurons regulating the brain appetite control network, including the hypothalamus and MDPW.

背景:理坤师(RKT)是一种日本传统药物,可缓解功能性消化不良患者的上腹不适和厌食症状。RKT 能增强促食欲激素--胃泌素。胃泌素通过刺激下丘脑的食欲控制中心和大脑间叶多巴胺能通路(MDPW)来调节进食动机。然而,RKT 对 MDPW 的影响仍不清楚。在此,我们旨在研究 RKT 促食欲效应的中枢神经机制,重点是 MDPW:方法:我们研究了RKT对束缚应激和胆囊收缩素八肽诱导的雄性大鼠厌食症中食物摄入量和神经元c-Fos表达的影响:主要结果:RKT治疗可明显恢复应激和胆囊收缩素八肽诱导的食物摄入量下降。RKT增加了腹侧被盖区(VTA),尤其是酪氨酸羟化酶免疫反应神经元和纳氏核(NAc)中c-Fos的表达。胃泌素受体拮抗剂[D-Lys3]-GHRP-6抑制了RKT的作用。RKT 增加了外侧下丘脑(LH)中 c-Fos/orexin 双阳性神经元的数量,这些神经元投射到 VTA。奥曲肽受体拮抗剂 SB334867 可抑制 RKT 引起的食物摄入量增加以及 LH、VTA 和 NAc 中的 c-Fos 表达。RKT增加了延髓弓状核和孤束核的c-Fos表达,而[D-Lys3]-GHRP-6抑制了这种表达:RKT可通过胃泌素和奥曲肽依赖性激活调节大脑食欲控制网络的神经元(包括下丘脑和MDPW)来恢复厌食症患者的食欲。
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引用次数: 0
Intra- and interindividual variability in fasted gastric content volume. 空腹胃内容量的个体内和个体间差异。
IF 3.5 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-01 Epub Date: 2024-08-27 DOI: 10.1111/nmo.14904
Julia J M Roelofs, Guido Camps, Louise M Leenders, Luca Marciani, Robin C Spiller, Elise J M Van Eijnatten, Jaber Alyami, Ruoxuan Deng, Daniela Freitas, Michael Grimm, Leila J Karhunen, Shanthi Krishnasamy, Steven Le Feunteun, Dileep N Lobo, Alan R Mackie, Morwarid Mayar, Werner Weitschies, Paul A M Smeets

Background: Gastric fluid plays a key role in food digestion and drug dissolution, therefore, the amount of gastric fluid present in a fasted state may influence subsequent digestion and drug delivery. We aimed to describe intra- and interindividual variation in fasted gastric content volume (FGCV) and to determine the association with age, sex, and body size characteristics.

Methods: Data from 24 MRI studies measuring FGCV in healthy, mostly young individuals after an overnight fast were pooled. The analysis included 366 participants who had up to 6 repeated measurements, with a total of 870 measurements. Linear mixed model analysis was performed to calculate intra- and interindividual variability and to assess the effects of age, sex, weight, height, weight*height as a proxy for body size, and body mass index (BMI).

Results: FGCV ranged from 0 to 156 mL, with a mean (± SD) value of 33 ± 25 mL. The overall coefficient of variation within the study population was 75.6%, interindividual SD was 15 mL, and the intraindividual SD was 19 mL. Age, weight, height, weight*height, and BMI had no effect on FGCV. Women had lower volumes compared to men (MD: -6 mL), when corrected for the aforementioned factors.

Conclusion: FGCV is highly variable, with higher intraindividual compared to interindividual variability, indicating that FGCV is subject to day-to-day and within-day variation and is not a stable personal characteristic. This highlights the importance of considering FGCV when studying digestion and drug dissolution. Exact implications remain to be studied.

背景:胃液在食物消化和药物溶解过程中起着关键作用,因此,空腹状态下的胃液量可能会影响随后的消化和给药。我们旨在描述空腹胃内容量(FGCV)的个体内和个体间差异,并确定其与年龄、性别和体型特征的关联:我们汇集了 24 项磁共振成像研究的数据,这些研究测量了健康人(大多为年轻人)在一夜禁食后的空腹胃容积。分析包括366名参与者,他们最多进行了6次重复测量,共进行了870次测量。通过线性混合模型分析计算了个体内和个体间的变异性,并评估了年龄、性别、体重、身高、体重*身高(作为体型的代表)和体重指数(BMI)的影响:FGCV的范围为0至156毫升,平均值(± SD)为33±25毫升。研究人群的总体变异系数为 75.6%,个体间 SD 为 15 mL,个体内 SD 为 19 mL。年龄、体重、身高、体重*身高和体重指数对 FGCV 没有影响。在对上述因素进行校正后,女性的血容量低于男性(MD:-6 mL):结论:FGCV 的可变性很高,个体内的可变性高于个体间的可变性,这表明 FGCV 受日常和日内变化的影响,并不是一个稳定的个人特征。这突出了在研究消化和药物溶解时考虑 FGCV 的重要性。具体影响还有待研究。
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引用次数: 0
Esophageal chest pain resembles heartburn in reflux metrics and response to proton pump inhibitor therapy. 食管胸痛与反流性胃炎的胃灼热相似,以及对质子泵抑制剂治疗的反应。
IF 3.5 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-01 DOI: 10.1111/nmo.14953
Mentore Ribolsi, Lorenzo Marchetti, Lucrezia Maria Olmi, Michele Cicala, Edoardo Savarino

Background: Gastro-esophageal reflux disease (GERD) is the most common cause for noncardiac chest pain (NCCP), with an estimated prevalence rate ranging between 30% and 60%. Heartburn and NCCP may share common mechanisms.

Aims/methods: To assess whether particular patterns of impedance-pH variables characterize patients with dominant heartburn, regurgitation, or NCCP and their ability to predict proton pump inhibitor (PPI) response for each symptom, GERD patients, evaluated with high-resolution manometry (HRM) and impedance-pH, were included.

Results: In total, 109 NCCP, 68 heartburn, and 64 regurgitation patients were included. Pathological reflux episodes were observed in 28%, 19%, and 56% (p < 0.001). Pathological mean nocturnal baseline impedance (MNBI) values were observed in 55%, 53%, and 34% (p < 0.05). Hypomotility was more frequent in NCCP compared to heartburn patients (p < 0.05). When comparing NCCP with heartburn, hypomotility was associated with NCCP perception (OR: 2.34, 95% CI: 1.23-4.43; p < 0.01). When comparing NCCP with regurgitation, >80 refluxes and type 2/3 esophagogastric junction (EGJ) were associated with regurgitation perception (OR: 0.31, 95% CI: 0.16-0.59; p < 0.001, and OR: 0.5, 95% CI: 0.27-0.93; p < 0.05), while pathological MNBI was associated with NCCP perception (OR: 2.34, 95% CI: 1.23-4.43; p < 0.01). 45.5% NCCP patients, 45.6% with heartburn, and 36% with regurgitation responded to PPIs (p < 0.05). At multivariate analysis, pathological MNBI or PSPW index were associated with PPI responsiveness in patients with NCCP or heartburn, while in patients with regurgitation, pathological MNBI was associated with PPI responsiveness and a reflux number >80 to PPI refractoriness.

Conclusions: We highlight the usefulness of an accurate clinical and functional evaluation of GERD patients, allowing to discriminate particular characteristics in patients with dominant heartburn, NCCP, or regurgitation, which may benefit of distinct therapeutic strategies.

背景:胃食管反流病(GERD)是导致非心源性胸痛(NCCP)的最常见原因,估计发病率在 30% 到 60% 之间。烧心和非心源性胸痛可能具有共同的机制:为了评估阻抗-pH 变量的特定模式是否是主要烧心、反流或 NCCP 患者的特征,以及其预测质子泵抑制剂(PPI)对每种症状反应的能力,纳入了使用高分辨率测压法(HRM)和阻抗-pH 进行评估的胃食管反流病患者:结果:共纳入了 109 名 NCCP 患者、68 名烧心患者和 64 名反流患者。28%、19%和56%的患者出现病理性反流(P 80),2/3型食管胃交界处(EGJ)与反流感知相关(OR:0.31,95% CI:0.16-0.59;P 80):我们强调了对胃食管反流病患者进行准确的临床和功能评估的有用性,它可以区分具有明显烧心、NCCP 或反流症状的患者的特定特征,这些特征可能会从不同的治疗策略中获益。
{"title":"Esophageal chest pain resembles heartburn in reflux metrics and response to proton pump inhibitor therapy.","authors":"Mentore Ribolsi, Lorenzo Marchetti, Lucrezia Maria Olmi, Michele Cicala, Edoardo Savarino","doi":"10.1111/nmo.14953","DOIUrl":"https://doi.org/10.1111/nmo.14953","url":null,"abstract":"<p><strong>Background: </strong>Gastro-esophageal reflux disease (GERD) is the most common cause for noncardiac chest pain (NCCP), with an estimated prevalence rate ranging between 30% and 60%. Heartburn and NCCP may share common mechanisms.</p><p><strong>Aims/methods: </strong>To assess whether particular patterns of impedance-pH variables characterize patients with dominant heartburn, regurgitation, or NCCP and their ability to predict proton pump inhibitor (PPI) response for each symptom, GERD patients, evaluated with high-resolution manometry (HRM) and impedance-pH, were included.</p><p><strong>Results: </strong>In total, 109 NCCP, 68 heartburn, and 64 regurgitation patients were included. Pathological reflux episodes were observed in 28%, 19%, and 56% (p < 0.001). Pathological mean nocturnal baseline impedance (MNBI) values were observed in 55%, 53%, and 34% (p < 0.05). Hypomotility was more frequent in NCCP compared to heartburn patients (p < 0.05). When comparing NCCP with heartburn, hypomotility was associated with NCCP perception (OR: 2.34, 95% CI: 1.23-4.43; p < 0.01). When comparing NCCP with regurgitation, >80 refluxes and type 2/3 esophagogastric junction (EGJ) were associated with regurgitation perception (OR: 0.31, 95% CI: 0.16-0.59; p < 0.001, and OR: 0.5, 95% CI: 0.27-0.93; p < 0.05), while pathological MNBI was associated with NCCP perception (OR: 2.34, 95% CI: 1.23-4.43; p < 0.01). 45.5% NCCP patients, 45.6% with heartburn, and 36% with regurgitation responded to PPIs (p < 0.05). At multivariate analysis, pathological MNBI or PSPW index were associated with PPI responsiveness in patients with NCCP or heartburn, while in patients with regurgitation, pathological MNBI was associated with PPI responsiveness and a reflux number >80 to PPI refractoriness.</p><p><strong>Conclusions: </strong>We highlight the usefulness of an accurate clinical and functional evaluation of GERD patients, allowing to discriminate particular characteristics in patients with dominant heartburn, NCCP, or regurgitation, which may benefit of distinct therapeutic strategies.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Postoperative ileus-Immune mechanisms and potential therapeutic interventions. 术后回肠梗阻--免疫机制和潜在的治疗干预。
IF 3.5 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-27 DOI: 10.1111/nmo.14951
Zheng Wang, Nathalie Stakenborg, Guy Boeckxstaens

Background: Postoperative ileus (POI) is a condition marked by a temporary suppression of gastrointestinal motility following abdominal surgery. The mechanism of POI encompasses various factors and is characterized by two phases: the early neurogenic phase involving both adrenergic and non-adrenergic neural pathways; the later immune-mediated phase is characterized by a sterile inflammatory response that lasts several days. Activation of muscularis macrophages triggers a sterile inflammatory process that results in dysfunction of the enteric nervous system (ENS) and a reversible inhibition of gastrointestinal motility.

Purpose: In this minireview, recent insights in the pathophysiological mechanisms underlying POI and potential new therapeutic strategies are described.

背景:术后回肠梗阻(POI)是腹部手术后胃肠道蠕动暂时受抑制的一种症状。POI 的发生机制包含多种因素,并分为两个阶段:早期神经源性阶段涉及肾上腺素能和非肾上腺素能神经通路;后期免疫介导阶段的特点是持续数天的无菌炎症反应。目的:本小视图介绍了 POI 的病理生理机制和潜在的新治疗策略。
{"title":"Postoperative ileus-Immune mechanisms and potential therapeutic interventions.","authors":"Zheng Wang, Nathalie Stakenborg, Guy Boeckxstaens","doi":"10.1111/nmo.14951","DOIUrl":"https://doi.org/10.1111/nmo.14951","url":null,"abstract":"<p><strong>Background: </strong>Postoperative ileus (POI) is a condition marked by a temporary suppression of gastrointestinal motility following abdominal surgery. The mechanism of POI encompasses various factors and is characterized by two phases: the early neurogenic phase involving both adrenergic and non-adrenergic neural pathways; the later immune-mediated phase is characterized by a sterile inflammatory response that lasts several days. Activation of muscularis macrophages triggers a sterile inflammatory process that results in dysfunction of the enteric nervous system (ENS) and a reversible inhibition of gastrointestinal motility.</p><p><strong>Purpose: </strong>In this minireview, recent insights in the pathophysiological mechanisms underlying POI and potential new therapeutic strategies are described.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Splenectomy prevents brain orexin, ghrelin, or oxytocin but not GLP-1-induced improvement of intestinal barrier function in rats. 脾切除能阻止脑奥曲肽、胃泌素或催产素对大鼠肠屏障功能的改善,但不能阻止 GLP-1 诱导的改善。
IF 3.5 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-25 DOI: 10.1111/nmo.14949
Takuya Funayama, Tsukasa Nozu, Masatomo Ishioh, Sho Igarashi, Hiroki Tanaka, Chihiro Sumi, Takeshi Saito, Yasumichi Toki, Mayumi Hatayama, Masayo Yamamoto, Motohiro Shindo, Shuichiro Takahashi, Toshikatsu Okumura

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.

背景:越来越多的证据表明,神经肽(如奥曲肽、胃泌素或催产素)在大脑中枢发挥作用,通过迷走神经调节肠屏障功能。有报道称,脾切除术阻断了迷走胆碱能抗炎通路。因此,在本研究中,我们研究了脾切除对神经肽诱导的肠道通透性增加的改善作用:方法:通过分光光度法量化大鼠结肠组织中吸收的伊文思蓝15分钟,测定体内结肠通透性:结果:脾切除增加了结肠的通透性。结果:脾切除增加了大鼠结肠的通透性,而卡巴胆碱或 2-脱氧葡萄糖诱导的迷走神经激活可显著阻断脾切除增加的通透性,阿托品也可阻止这种通透性,这表明迷走神经激活可防止脾切除大鼠结肠的高通透性。在脾切除的大鼠体内注射奥曲肽,胃泌素,催产素或丁酸盐都不能抑制结肠通透性的增加,而体内注射胰高血糖素样肽-1(GLP-1)类似物利拉鲁肽能以剂量依赖的方式有效阻断结肠通透性的增加。脾切除大鼠服用阿托品后,利拉鲁肽对结肠通透性增加的改善作用被阻断。脾切除大鼠体内注射 GLP-1 受体拮抗剂可减轻 2-deoxy-d-glucose 诱导的结肠高渗透性的改善:结论:本研究结果表明,脾脏在脑奥曲肽、胃泌素或催产素和丁酸盐改善肠屏障功能方面起着重要作用。另一方面,GLP-1 在大脑中枢发挥作用,以不依赖于脾脏的方式改善结肠高渗透性。所有这些结果表明,肠屏障功能的脑-肠调节可能存在双重机制(依赖于脾脏或独立于脾脏)。
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引用次数: 0
Diagnostic classification systems for disorders of gut-brain interaction should include psychological symptoms. 肠脑交互紊乱的诊断分类系统应包括心理症状。
IF 3.5 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-25 DOI: 10.1111/nmo.14940
Michael P Jones, Gerald J Holtmann, Jan Tack, Florencia Carbonne, William Chey, Natasha Koloski, Ayesha Shah, Shrikant I Bangdiwala, Ami D Sperber, Olafur S Palsson, Nicholas J Talley

Background and aims: The group of disorders known as Disorders of Gut Brain Interaction (DGBI) were originally labeled functional GI disorders and were thought to be disorders of the gastrointestinal tract that had several psychological conditions as comorbidities. Despite mounting evidence that psychological morbidity plays an innate role in the etiology and maintenance of DGBI, none of the Rome IV criteria include any measure of psychological symptoms. This study tested the hypothesis that individuals would cluster differently if GI symptoms alone were considered versus GI symptoms combined with measures of psychological symptoms.

Methods: Data were obtained from the Rome Foundation Global Epidemiology Study measuring Rome IV GI symptoms, psychological measures and demographic characteristics. Latent profile models were used to cluster individuals based on (i) GI symptoms only (GI only) and then (ii) GI and psychological measures (GI + Psych).

Key results: Individuals clustering into the same group of individuals whether formed via GI only or GI + Psych, ranged from 96% for a 2-class solution (the most simplistic) to 76% with 6 classes (the parsimonious system) and 59% with twenty-two classes (mimicking Rome IV). The generalisability of this finding between six geographic regions was confirmed with agreement varying between 95%-97% for 2 clusters and 71-79% for 6 classes and 51%-63% for 22 classes. These findings were also consistent between DGBI (range 94% with 2 classes to 50% with 22 classes) and non-DGBI (range 97% with 2 clusters to 65% with 22 classes) groups.

Conclusions & inferences: Our data suggest that considering psychological as well as gastrointestinal symptoms would lead to a different clustering of individuals in more complex, and accurate, classification systems. For this reason, future work on DGBI classification should consider inclusion of psychological traits.

背景和目的:被称为 "肠脑互动障碍"(DGBI)的一组疾病最初被称为功能性胃肠道疾病,并被认为是胃肠道疾病合并多种心理疾病。尽管有越来越多的证据表明,心理疾病在 DGBI 的病因和维持过程中起着先天性的作用,但罗马 IV 标准中却没有任何一项包含对心理症状的测量。本研究对以下假设进行了测试:如果仅考虑消化道症状,与将消化道症状与心理症状相结合,个体的聚类会有所不同:方法:数据来自罗马基金会全球流行病学研究(Rome Foundation Global Epidemiology Study),该研究测量了罗马IV型消化道症状、心理测量和人口特征。主要结果:根据(i)仅有胃肠道症状(仅有胃肠道症状)和(ii)胃肠道症状和心理测量(胃肠道症状 + 心理),使用潜伏特征分析模型对个体进行聚类:主要结果:无论是仅根据胃肠道症状还是根据胃肠道症状+心理症状,个体聚类为同一群体的比例从两类解决方案(最简单的)的 96%到 6 类解决方案(最合理的系统)的 76%,以及 22 类解决方案(模拟罗马四)的 59%不等。这一发现在六个地理区域之间的普遍性得到了证实,2 个群组的吻合率为 95%-97%,6 个等级的吻合率为 71%-79%,22 个等级的吻合率为 51%-63%。这些结果在 DGBI(2 个班级为 94%,22 个班级为 50%)和非 DGBI(2 个班级为 97%,22 个班级为 65%)组之间也是一致的:我们的数据表明,考虑心理症状和胃肠道症状将导致在更复杂、更准确的分类系统中对个体进行不同的聚类。因此,未来的 DGBI 分类工作应考虑纳入心理特征。
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引用次数: 0
Biofeedback efficacy for outlet dysfunction constipation: Clinical outcomes and predictors of response by a limited approach. 生物反馈疗法对出口功能障碍性便秘的疗效:有限方法的临床结果和反应预测因素。
IF 3.5 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-25 DOI: 10.1111/nmo.14948
Christian Lambiase, Massimo Bellini, William E Whitehead, Stefan Lucian Popa, Riccardo Morganti, Giuseppe Chiarioni

Background: Functional defecation disorders (FDD) are a common etiology of refractory chronic constipation (CC). FDD diagnosis (dyssynergic defecation [DD] and inadequate defecatory propulsion [IDP]), requires diagnostic tests including anorectal manometry (ARM) and balloon expulsion test (BET). Biofeedback (BF) is the treatment of choice for DD. The aims of our study were to evaluate: the outcome of BF in a group of constipated patients with defecatory disorders of any etiology; the efficacy of two simple diagnostic tools in predicting BF outcome in the short-term.

Methods: One hundred and thirty-one refractory CC patients failing the BET underwent BF therapy. Before BF, all patients underwent the following: ARM. Straining questionnaire. The answers were: "belly muscles"; "anal muscles"; "both"; "Don't know/No answer." Digital rectal examination augmented by abdominal palpation on straining (augmented-DRE). The BF therapist was blinded to ARM, straining questionnaire, and augmented-DRE results.

Key results: Eighty-one patients responded to BF. Gender, age, and IBS-C showed no significant impact on BF response. Both DD and IDP responded equally to BF, while the rate of response in patients with isolated structural pelvic floor abnormalities was lower (p < 0.001). The answer "anal muscles" to straining questionnaire showed a strong association with BF response (p < 0.001). A lack in abdominal contraction and in anal relaxation on augmented-DRE were strongly associated with BF response (p < 0.01). Absence of manual maneuvers to facilitate defecation was associated with BF response (p < 0.001).

Conclusions & inferences: BF is the therapy of choice for refractory constipation due to FDD of any etiology, inducing both clinical and anorectal physiology improvement in the short term. Comorbid IBS-C did not affect outcome while symptomatic isolated pelvic floor abnormalities appeared refractory to behavior treatment. The straining questionnaire and augmented-DRE outcomes showed a strong correlation with BF response and can be implemented in clinical practice to improve the management of constipated patients by prompting early referral to BF.

背景:功能性排便障碍(FDD)是难治性慢性便秘(CC)的常见病因。诊断功能性排便障碍(排便失调 [DD] 和排便推动力不足 [IDP])需要进行诊断测试,包括肛门直肠测压 (ARM) 和气球排出试验 (BET)。生物反馈疗法(BF)是治疗排便障碍的首选方法。我们的研究目的是评估:生物反馈疗法在一组任何病因引起的排便障碍便秘患者中的疗效;两种简单诊断工具在短期内预测生物反馈疗法疗效的有效性:131名BET失败的难治性CC患者接受了BF治疗。在 BF 之前,所有患者都接受了以下检查:ARM。拉力问卷。答案为"腹部肌肉"、"肛门肌肉"、"两者"、"不知道/无答案"。通过腹部触诊增强拉力进行数字直肠检查(增强直肠检查)。BF治疗师对ARM、拉力问卷和增强直肠指诊(augmented-DRE)结果进行盲测:主要结果:81 名患者对 BF 有反应。性别、年龄和 IBS-C 对 BF 反应无明显影响。DD和IDP对BF的反应相同,而孤立的盆底结构异常患者的反应率较低(p 结论和推论:BF 是治疗任何病因的 FDD 引起的难治性便秘的首选疗法,可在短期内改善临床和肛门直肠生理功能。合并 IBS-C 不影响治疗效果,而有症状的孤立性盆底异常似乎对行为治疗无效。拉稀问卷和增强型肛门直肠指诊结果显示与盆底肌反应密切相关,可在临床实践中应用,通过促使患者尽早转诊至盆底肌治疗来改善便秘患者的管理。
{"title":"Biofeedback efficacy for outlet dysfunction constipation: Clinical outcomes and predictors of response by a limited approach.","authors":"Christian Lambiase, Massimo Bellini, William E Whitehead, Stefan Lucian Popa, Riccardo Morganti, Giuseppe Chiarioni","doi":"10.1111/nmo.14948","DOIUrl":"https://doi.org/10.1111/nmo.14948","url":null,"abstract":"<p><strong>Background: </strong>Functional defecation disorders (FDD) are a common etiology of refractory chronic constipation (CC). FDD diagnosis (dyssynergic defecation [DD] and inadequate defecatory propulsion [IDP]), requires diagnostic tests including anorectal manometry (ARM) and balloon expulsion test (BET). Biofeedback (BF) is the treatment of choice for DD. The aims of our study were to evaluate: the outcome of BF in a group of constipated patients with defecatory disorders of any etiology; the efficacy of two simple diagnostic tools in predicting BF outcome in the short-term.</p><p><strong>Methods: </strong>One hundred and thirty-one refractory CC patients failing the BET underwent BF therapy. Before BF, all patients underwent the following: ARM. Straining questionnaire. The answers were: \"belly muscles\"; \"anal muscles\"; \"both\"; \"Don't know/No answer.\" Digital rectal examination augmented by abdominal palpation on straining (augmented-DRE). The BF therapist was blinded to ARM, straining questionnaire, and augmented-DRE results.</p><p><strong>Key results: </strong>Eighty-one patients responded to BF. Gender, age, and IBS-C showed no significant impact on BF response. Both DD and IDP responded equally to BF, while the rate of response in patients with isolated structural pelvic floor abnormalities was lower (p < 0.001). The answer \"anal muscles\" to straining questionnaire showed a strong association with BF response (p < 0.001). A lack in abdominal contraction and in anal relaxation on augmented-DRE were strongly associated with BF response (p < 0.01). Absence of manual maneuvers to facilitate defecation was associated with BF response (p < 0.001).</p><p><strong>Conclusions & inferences: </strong>BF is the therapy of choice for refractory constipation due to FDD of any etiology, inducing both clinical and anorectal physiology improvement in the short term. Comorbid IBS-C did not affect outcome while symptomatic isolated pelvic floor abnormalities appeared refractory to behavior treatment. The straining questionnaire and augmented-DRE outcomes showed a strong correlation with BF response and can be implemented in clinical practice to improve the management of constipated patients by prompting early referral to BF.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Disorders of secondary peristalsis are associated with the development of esophagitis. 继发性蠕动障碍与食管炎的发生有关。
IF 3.5 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-25 DOI: 10.1111/nmo.14943
Tal David Berger, Jasmine Kung, Christopher Chalmers, Grace Nemec, Anna Wen, Samuel Nurko, Rachel Rosen

Background: Disorders of primary peristalsis are associated with a higher percent time pH <4 in the esophagus suggesting poor acid clearance. However, there are no studies of secondary peristalsis and its relationship to microscopic or erosive esophagitis. The goal of this study was to determine the relationship between secondary peristalsis using functional luminal imaging probes (EndoFLIP) and the presence or absence of esophagitis.

Methods: We reviewed the endoscopic and EndoFLIP 2.0 tracings for 103 consecutive patients including those with a history of upper gastrointestinal surgery undergoing upper endoscopy. Esophagogastric junction (EGJ) distensibility and diameter, repetitive antegrade contraction (RACs) presence and frequency, and occlusive diameters were measured. Measurements were then compared between patients with and without microscopic and/or erosive esophagitis. Means were compared using t-tests. Proportions were compared using Chi-Squared analyses.

Key results: One hundred and three patients were included (mean age: 14.4 + 6.4 years). Ten patients had erosive esophagitis and 28 patients had microscopic esophagitis. Erosive and microscopic esophagitis were associated with abnormal or absent of RACs (p < 0.001). Occlusive diameters were higher in patients with esophagitis compared to those without (p < 0.001). There was no relationship between EGJ distensibility and the presence of erosive or microscopic esophagitis (p = 0.4). The absence of RACs was the only independent predictor of esophagitis (erosive and microscopic), after controlling for age, proton pump inhibitors (PPI) use and EGJ distensibility (p < 0.001).

Conclusions & inferences: Abnormal secondary peristalsis is associated with microscopic and gross esophagitis, suggesting that EndoFLIP should be part of the diagnostic algorithm for esophagitis.

背景:原发性蠕动障碍与较高的 pH 值时间相关 方法:我们对 103 名连续接受上内镜检查的患者(包括有上消化道手术史者)的内镜和 EndoFLIP 2.0 曲线进行了复查。对食管胃交界处(EGJ)的扩张性和直径、重复性前向收缩(RAC)的存在和频率以及闭塞直径进行了测量。然后对患有和未患有显微镜下食管炎和/或侵蚀性食管炎的患者的测量结果进行比较。使用 t 检验比较平均值。主要结果:共纳入 103 名患者(平均年龄:14.4 + 6.4 岁)。10 名患者患有侵蚀性食管炎,28 名患者患有显微镜下食管炎。侵蚀性食管炎和微小食管炎与 RACs 异常或缺失有关(p 结论与推论:继发性蠕动异常与微小食管炎和粗大食管炎有关,这表明 EndoFLIP 应成为食管炎诊断算法的一部分。
{"title":"Disorders of secondary peristalsis are associated with the development of esophagitis.","authors":"Tal David Berger, Jasmine Kung, Christopher Chalmers, Grace Nemec, Anna Wen, Samuel Nurko, Rachel Rosen","doi":"10.1111/nmo.14943","DOIUrl":"https://doi.org/10.1111/nmo.14943","url":null,"abstract":"<p><strong>Background: </strong>Disorders of primary peristalsis are associated with a higher percent time pH <4 in the esophagus suggesting poor acid clearance. However, there are no studies of secondary peristalsis and its relationship to microscopic or erosive esophagitis. The goal of this study was to determine the relationship between secondary peristalsis using functional luminal imaging probes (EndoFLIP) and the presence or absence of esophagitis.</p><p><strong>Methods: </strong>We reviewed the endoscopic and EndoFLIP 2.0 tracings for 103 consecutive patients including those with a history of upper gastrointestinal surgery undergoing upper endoscopy. Esophagogastric junction (EGJ) distensibility and diameter, repetitive antegrade contraction (RACs) presence and frequency, and occlusive diameters were measured. Measurements were then compared between patients with and without microscopic and/or erosive esophagitis. Means were compared using t-tests. Proportions were compared using Chi-Squared analyses.</p><p><strong>Key results: </strong>One hundred and three patients were included (mean age: 14.4 + 6.4 years). Ten patients had erosive esophagitis and 28 patients had microscopic esophagitis. Erosive and microscopic esophagitis were associated with abnormal or absent of RACs (p < 0.001). Occlusive diameters were higher in patients with esophagitis compared to those without (p < 0.001). There was no relationship between EGJ distensibility and the presence of erosive or microscopic esophagitis (p = 0.4). The absence of RACs was the only independent predictor of esophagitis (erosive and microscopic), after controlling for age, proton pump inhibitors (PPI) use and EGJ distensibility (p < 0.001).</p><p><strong>Conclusions & inferences: </strong>Abnormal secondary peristalsis is associated with microscopic and gross esophagitis, suggesting that EndoFLIP should be part of the diagnostic algorithm for esophagitis.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The role of reactive enteric glia-macrophage interactions in acute and chronic inflammation. 反应性肠胶质细胞-巨噬细胞相互作用在急性和慢性炎症中的作用。
IF 3.5 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-20 DOI: 10.1111/nmo.14947
Schneider Reiner, Schneider Linda, Hamza Ebrahim, Leven Patrick, Wehner Sven

Enteric glia are a heterogeneous population of peripheral glia within the enteric nervous system and play pivotal roles in gut homeostasis, tissue integrity, coordination of motility, and intestinal immune responses. Under physiological conditions, they communicate with enteric neurons to control intestinal motility. In contrast, enteric glia undergo reactive changes in response to inflammatory signals during enteric neuroinflammation and participate in immune control. In this state, these glia are called reactive enteric glia, which promote cytokine and chemokine secretion and perpetuate immune cell recruitment, thereby affecting disease progression. Interestingly, reactive glia exhibit a huge plasticity and adapt to or shape the immune environment towards a resolving phenotype during inflammation and neuropathies. Recent studies revealed a bidirectional communication between enteric glia and resident and infiltrating immune cells under healthy conditions and in the context of inflammation-based intestinal disorders and neuropathies. While recent reviews give a superb general overview of enteric glial reactivity, we herein discuss the latest evidence on enteric glial reactivity in two prominent inflammatory conditions: acute postoperative inflammation, resulting in postoperative ileus, and chronic inflammation in inflammatory bowel diseases. We define their plasticity during inflammation and the interplay between reactive enteric glia and intestinal macrophages. Finally, we sketch important questions that should be addressed to clarify further the impact of enteric glial reactivity on intestinal inflammation.

肠神经胶质细胞是肠神经系统中一种异质性的外周神经胶质细胞群,在肠道稳态、组织完整性、运动协调和肠道免疫反应中发挥着关键作用。在生理条件下,它们与肠神经元沟通,控制肠道运动。相反,在肠道神经炎症期间,肠胶质细胞会根据炎症信号发生反应性变化,并参与免疫控制。在这种状态下,这些胶质细胞被称为反应性肠胶质细胞,它们会促进细胞因子和趋化因子的分泌,并使免疫细胞的招募永久化,从而影响疾病的进展。有趣的是,在炎症和神经病变期间,反应性神经胶质细胞表现出巨大的可塑性,可适应或塑造免疫环境,从而形成一种可解决的表型。最近的研究揭示了肠胶质细胞与常驻和浸润免疫细胞之间在健康条件下以及在基于炎症的肠道疾病和神经病变背景下的双向交流。最近的综述对肠神经胶质的反应性做了很好的概括,我们在此讨论了在两种主要炎症情况下肠神经胶质反应性的最新证据:急性术后炎症(导致术后回肠梗阻)和慢性炎症(炎症性肠病)。我们定义了它们在炎症期间的可塑性以及反应性肠胶质细胞和肠巨噬细胞之间的相互作用。最后,我们概述了应解决的重要问题,以进一步阐明肠胶质细胞反应性对肠道炎症的影响。
{"title":"The role of reactive enteric glia-macrophage interactions in acute and chronic inflammation.","authors":"Schneider Reiner, Schneider Linda, Hamza Ebrahim, Leven Patrick, Wehner Sven","doi":"10.1111/nmo.14947","DOIUrl":"https://doi.org/10.1111/nmo.14947","url":null,"abstract":"<p><p>Enteric glia are a heterogeneous population of peripheral glia within the enteric nervous system and play pivotal roles in gut homeostasis, tissue integrity, coordination of motility, and intestinal immune responses. Under physiological conditions, they communicate with enteric neurons to control intestinal motility. In contrast, enteric glia undergo reactive changes in response to inflammatory signals during enteric neuroinflammation and participate in immune control. In this state, these glia are called reactive enteric glia, which promote cytokine and chemokine secretion and perpetuate immune cell recruitment, thereby affecting disease progression. Interestingly, reactive glia exhibit a huge plasticity and adapt to or shape the immune environment towards a resolving phenotype during inflammation and neuropathies. Recent studies revealed a bidirectional communication between enteric glia and resident and infiltrating immune cells under healthy conditions and in the context of inflammation-based intestinal disorders and neuropathies. While recent reviews give a superb general overview of enteric glial reactivity, we herein discuss the latest evidence on enteric glial reactivity in two prominent inflammatory conditions: acute postoperative inflammation, resulting in postoperative ileus, and chronic inflammation in inflammatory bowel diseases. We define their plasticity during inflammation and the interplay between reactive enteric glia and intestinal macrophages. Finally, we sketch important questions that should be addressed to clarify further the impact of enteric glial reactivity on intestinal inflammation.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":null,"pages":null},"PeriodicalIF":3.5,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Neurogastroenterology and Motility
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