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Treatment principles in adults and development of patient-reported outcomes in cyclic vomiting syndrome. 成人治疗原则和周期性呕吐综合征患者报告结果的制定。
IF 3.5 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-18 DOI: 10.1111/nmo.14910
Yaozhu J Chen, Milan Patel, Thangam Venkatesan

Background: Cyclic vomiting syndrome is a chronic disorder of gut-brain interaction that is present in both adults and children. It is characterized by severe nausea, vomiting, abdominal pain, and several non-GI symptoms. It is also associated with several comorbid conditions such as anxiety and depression, which affect overall health care outcomes.

Methods: This article delineates treatment principles, encompassing both abortive interventions and prophylactic regimens currently recommended for CVS. However, it underscores a critical concern: the absence of FDA-approved medications for CVS treatment, with existing therapies relying on retrospective and open-labeled trials.

Key results: This article emphasizes the pressing need for the development of CVS-specific outcome assessment tools to facilitate more accurate evaluation and robust data collection for the future studies. In exploring this deficiency, the manuscript also presents the up-to-date data and development that enhances our comprehension of patient-centric concepts, and the challenges faced in creating CVS-specific tools, and presents a roadmap for their development. Addressing this gap is crucial for advancing our understanding of CVS and optimizing patient care.

Conclusions and inferences: This elucidates the current state of CVS management but also advocates for a future where tailored tools enhance our ability to measure and improve the outcomes for individuals with this debilitating disorder.

背景介绍周期性呕吐综合征是一种肠道与大脑相互作用的慢性疾病,成人和儿童均可患病。其特征是严重恶心、呕吐、腹痛和一些非肠道感染症状。它还与焦虑和抑郁等几种合并症有关,影响整体医疗效果:本文阐述了治疗原则,包括目前针对 CVS 推荐的中止干预和预防方案。然而,文章强调了一个关键问题:美国食品及药物管理局(FDA)没有批准用于 CVS 治疗的药物,现有疗法依赖于回顾性和开放标签试验:本文强调,迫切需要开发针对 CVS 的结果评估工具,以便为今后的研究提供更准确的评估和更有力的数据收集。在探讨这一不足的过程中,手稿还介绍了最新的数据和发展情况,这些数据和发展情况增强了我们对以患者为中心的概念的理解,以及在开发 CVS 专属工具时所面临的挑战,并提出了开发这些工具的路线图。弥补这一不足对于增进我们对 CVS 的了解和优化患者护理至关重要:本文阐明了 CVS 管理的现状,同时也为未来提出了建议,即量身定制的工具将提高我们衡量和改善这种使人衰弱的疾病患者的治疗效果的能力。
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引用次数: 0
Authors' Reply to Letter-Role of Prokinetics in Ineffective Esophageal Motility: A Call for Broader Consideration and Future Innovations. 作者回信--促动力药在无效食管运动中的作用:呼吁更广泛的考虑和未来的创新。
IF 3.5 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-14 DOI: 10.1111/nmo.14964
Amrit K Kamboj, David A Katzka, Marcelo F Vela, Rena Yadlapati, Karthik Ravi
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引用次数: 0
A machine learning approach to stratify patients with hypermobile Ehlers-Danlos syndrome/hypermobility spectrum disorders according to disorders of gut brain interaction, comorbidities and quality of life. 根据肠脑相互作用紊乱、合并症和生活质量对活动过度埃勒斯-丹洛斯综合征/活动过度谱系障碍患者进行分层的机器学习方法。
IF 3.5 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-14 DOI: 10.1111/nmo.14957
Anisa Choudhary, Asma Fikree, James K Ruffle, Kazuya Takahashi, Olafur S Palsson, Imran Aziz, Qasim Aziz

Background: A high prevalence of disorders of gut-brain interaction (DGBI) exist in patients with hypermobile Ehlers-Danlos Syndrome (hEDS) and hypermobility spectrum disorders (HSD). However, it is unknown if clusters of hEDS/HSD patients exist which overlap with different DGBIs and whether this overlap influences presence of comorbidities and quality of life. We aimed to study these knowledge gaps.

Methods: A prospectively collected hEDS/HSD cohort of 1044 individuals were studied. We undertook Uniform Manifold Approximation and Projection-enabled (UMAP) dimension reduction to create a representation of nonlinear interactions between hEDS/HSD and DGBIs, from which individuals were stratified into clusters. Somatization, Postural Tachycardia Syndrome (PoTS), autonomic symptoms, psychological factors and quality of life were statistically compared between clusters.

Key results: The mean age of patients was 40 ± 13.2 years; 87.8% were female. Patients segregated into three clusters: Cluster 0 (n = 466): hEDS/HSD+ functional foregut disorders (FFD) + irritable bowel syndrome (IBS); Cluster 1 (n = 180): hEDS/HSD+ IBS and Cluster 2 (n = 337): hEDS/HSD alone. In cluster 0, we demonstrated increased somatization (p <0.0001), anxiety (p <0.0001), depression (p <0.0001), PoTS prevalence (p = 0.003), autonomic symptoms (p <0.0001) and reduced quality of life (p <0.0001) compared to cluster 2. Cluster 0 had greater comorbidity burden than cluster 1.

Conclusions: Within hEDS/HSD, subgroups exist with a high prevalence of FFD and IBS. These subgroups have a higher prevalence of psychological disorders, dysautonomia and poorer quality of life compared with hEDS/HSD alone. Further research should focus on healthcare utilization, management and prognosis in hEDS/HSD and DGBI overlap.

背景:在活动过度埃勒斯-丹洛斯综合征(hEDS)和活动过度谱系障碍(HSD)患者中,肠脑交互障碍(DGBI)的发病率很高。然而,目前尚不清楚高运动性埃勒斯-丹洛斯综合征(hEDS)/高运动性频谱障碍(HSD)患者是否存在与不同DGBI重叠的集群,也不清楚这种重叠是否会影响合并症的存在和生活质量。我们旨在研究这些知识空白:我们对前瞻性收集的 1044 名 hEDS/HSD 患者进行了研究。我们进行了统一模形逼近和投影(UMAP)降维,以创建 hEDS/HSD 和 DGBIs 之间非线性相互作用的表征,并从中将个体分层成群。对不同群组之间的躯体化、体位性心动过速综合征(PoTS)、自律神经症状、心理因素和生活质量进行了统计比较:患者的平均年龄为 40 ± 13.2 岁,87.8% 为女性。患者分为三个群组:第0组(n = 466):hEDS/HSD+前肠功能紊乱(FFD)+肠易激综合征(IBS);第1组(n = 180):hEDS/HSD+ IBS;第2组(n = 337):仅有hEDS/HSD。在第 0 组中,我们发现躯体化程度有所提高(P 结论):在 hEDS/HSD 中,存在着 FFD 和肠易激综合征高发的亚组。与单纯的 hEDS/HSD 相比,这些亚群的心理障碍、自律神经失调和生活质量较差的发病率更高。进一步的研究应关注 hEDS/HSD 和 DGBI 重叠症的医疗保健利用、管理和预后。
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引用次数: 0
Do children with dysphagia and normal esophageal motility according to Chicago Classification always have "normal" esophageal motility? 根据芝加哥分类法,吞咽困难且食管运动正常的儿童是否总是食管运动 "正常"?
IF 3.5 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-11 DOI: 10.1111/nmo.14963
Karlo Kovacic, Mark Kern, B U K Li, Mychoua Vang, Joshua Noe, Reza Shaker

Background: Internationally adopted Chicago Classification (CC) criteria based on adult normative data have been used to diagnose children with esophageal motility disorders undergoing high-resolution esophageal manometry (HREM). The aim of this study was to compare HREM parameters of children without dysphagia and children with dysphagia and normal findings according to CC.

Methods: HREM metrics of 41 children (13.2 (9-18) years; 20 female) without dysphagia and 41 children (13.7 (8-18) years; 30 female) with dysphagia and normal diagnosis according to CC were compared. Analyzed data included resting and integrated relaxation pressures (IRP) of upper (UES) and lower (LES) esophageal sphincters, esophageal peristaltic contractile integrals, transition zone (TZ) gaps, distal latency (DL), and manometric esophageal length to height ratio (MELH). 95%ile normative cutoffs were calculated from the cohort without dysphagia.

Key results: Proximal contractile integral (PCI), UES and LES mean resting and IRP were not significantly different between the cohorts (p > 0.3). On the contrary, distal contractile integral (DCI), TZ gap and MELH were notably different with p = 0.0002, p = 0.027, and p = 0.033 respectively. According to 95%ile normative cutoffs of DCI, TZ gap and MELH, in cohort with dysphagia 27%, 15%, and 22% of patients respectively were not normal.

Conclusion & inferences: First study ever to compare HREM parameters of children without dysphagia to children with dysphagia. Considerable proportion of children with dysphagia may be underdiagnosed according to the adult criteria. This emphasizes the need for universally accepted child-specific diagnostic protocols and norms.

背景:国际上采用的芝加哥分类(CC)标准以成人常模数据为基础,用于诊断接受高分辨率食管测压(HREM)检查的食管运动障碍儿童。方法:比较 41 名无吞咽困难的儿童(13.2(9-18)岁;20 名女性)和 41 名有吞咽困难且根据 CC 诊断正常的儿童(13.7(8-18)岁;30 名女性)的 HREM 指标。分析数据包括食管上括约肌(UES)和食管下括约肌(LES)的静息压和综合松弛压(IRP)、食管蠕动收缩积分、过渡区(TZ)间隙、远端潜伏期(DL)和人工测量食管长高比(MELH)。根据无吞咽困难队列计算出 95%ile 常模临界值:主要结果:各组间的近端收缩力积分(PCI)、UES 和 LES 平均静息值及 IRP 无明显差异(P > 0.3)。相反,远端收缩力积分(DCI)、TZ间隙和MELH则有明显差异,分别为p = 0.0002、p = 0.027和p = 0.033。根据DCI、TZ间隙和MELH的95%ile常模临界值,吞咽困难队列中分别有27%、15%和22%的患者不正常:这是首次将无吞咽困难儿童的 HREM 参数与吞咽困难儿童的 HREM 参数进行比较的研究。根据成人标准,相当一部分吞咽困难儿童可能诊断不足。这强调了制定普遍接受的儿童特异性诊断方案和规范的必要性。
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引用次数: 0
Dumping syndrome: Update on pathophysiology, diagnosis, and management. 倾倒综合征:病理生理学、诊断和管理的最新进展。
IF 3.5 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-11 DOI: 10.1111/nmo.14962
Jan Tack, Karlien Raymenants, Cedric Van de Bruaene, Emidio Scarpellini

Background: Dumping syndrome is a complex of gastrointestinal symptoms originally studied in peptic ulcer surgery patients. At present, it is most prevalent in patients who underwent bariatric, upper gastrointestinal cancer or anti-reflux surgery. The symptom pattern comprises early and late dumping symptoms. Several management options have been reported including nutritional, pharmacological and surgical approaches.

Aims and methods: In this study, we aimed to review the current evidence on dumping syndrome definition, diagnosis and treatment, including preliminary data from newer pharmacological studies.

Results: Current pathophysiological concepts and analyses of provocative tests has led to a clear definition of dumping syndrome, including both early and late dumping symptoms. The term postbariatric hypoglycemia represents a limited focus on late dumping only. The diagnosis relies on recognition of symptoms and signs in a patient with appropriate surgical history; and can be confirmed by provocative testing or registration of spontaneous hypoglycemia. The initial treatment focuses on dietary intervention, to which meal viscosity enhancers and/or the glycosidase inhibitor acarbose can be added. The most effective therapy is the use of short- or long-acting somatostatin analogues, which is however expensive and entails side effect issues. In case of refractory hypoglycemia, diazoxide or SGLT2 inhibitors can be considered, based on limited evidence. In refractory patients, continuous enteral feeding or (rarely) surgical reinterventions have been advocated, although not supported by solid evidence. Therapies under current evaluation include the broad-spectrum somatostatin analogue pasireotide, GLP-1 receptor antagonists, GLP-1 receptor agonists and administration of stable forms of glucagon are currently under study.

Conclusions: Dumping syndrome is a well-defined but probably under-diagnosed complication of upper gastrointestinal, especially bariatric, and surgeries. Diagnosis is confirmed by a provocative test and incremental therapies starting with diet, adding meal viscosity enhancers or glycosidase inhibitors and adding somatostatin analogues in refractory cases. A number of emerging therapies targeting intestinal propulsion, peptide hormone effects and hypoglycemic events are under evaluation.

背景:倾倒综合征是一种复杂的胃肠道症状,最初研究对象是消化性溃疡手术患者。目前,它在接受减肥、上消化道癌症或抗反流手术的患者中最为常见。症状模式包括早期和晚期倾倒症状。目前已有多种治疗方案,包括营养、药物和手术方法:在这项研究中,我们旨在回顾有关倾倒综合征定义、诊断和治疗的现有证据,包括最新药理学研究的初步数据:结果:目前的病理生理学概念和诱导试验分析已对倾倒综合征做出了明确的定义,包括早期和晚期倾倒症状。减肥后低血糖症一词仅代表了对晚期倾倒的有限关注。诊断依赖于对具有适当手术史的患者的症状和体征的识别,并可通过诱导试验或自发性低血糖的登记加以确认。最初的治疗重点是饮食干预,可添加膳食增粘剂和/或糖苷酶抑制剂阿卡波糖。最有效的治疗方法是使用短效或长效的体生长抑素类似物,但价格昂贵,且存在副作用问题。如果出现难治性低血糖,根据有限的证据,可以考虑使用地亚佐醇或 SGLT2 抑制剂。对于难治性患者,尽管没有确凿证据支持,但也有人主张持续肠内喂养或(极少)手术再干预。目前正在评估的治疗方法包括广谱体生长抑素类似物帕西洛肽、GLP-1 受体拮抗剂、GLP-1 受体激动剂,以及目前正在研究的稳定型胰高血糖素:倾倒综合征是一种定义明确的上消化道并发症,但可能诊断不足,尤其是减肥手术。诊断需要通过诱导试验和渐进疗法来确认,首先是饮食,然后添加膳食粘度增强剂或糖苷酶抑制剂,在难治性病例中添加体生长抑素类似物。一些针对肠道推进力、肽类激素效应和低血糖事件的新兴疗法正在接受评估。
{"title":"Dumping syndrome: Update on pathophysiology, diagnosis, and management.","authors":"Jan Tack, Karlien Raymenants, Cedric Van de Bruaene, Emidio Scarpellini","doi":"10.1111/nmo.14962","DOIUrl":"https://doi.org/10.1111/nmo.14962","url":null,"abstract":"<p><strong>Background: </strong>Dumping syndrome is a complex of gastrointestinal symptoms originally studied in peptic ulcer surgery patients. At present, it is most prevalent in patients who underwent bariatric, upper gastrointestinal cancer or anti-reflux surgery. The symptom pattern comprises early and late dumping symptoms. Several management options have been reported including nutritional, pharmacological and surgical approaches.</p><p><strong>Aims and methods: </strong>In this study, we aimed to review the current evidence on dumping syndrome definition, diagnosis and treatment, including preliminary data from newer pharmacological studies.</p><p><strong>Results: </strong>Current pathophysiological concepts and analyses of provocative tests has led to a clear definition of dumping syndrome, including both early and late dumping symptoms. The term postbariatric hypoglycemia represents a limited focus on late dumping only. The diagnosis relies on recognition of symptoms and signs in a patient with appropriate surgical history; and can be confirmed by provocative testing or registration of spontaneous hypoglycemia. The initial treatment focuses on dietary intervention, to which meal viscosity enhancers and/or the glycosidase inhibitor acarbose can be added. The most effective therapy is the use of short- or long-acting somatostatin analogues, which is however expensive and entails side effect issues. In case of refractory hypoglycemia, diazoxide or SGLT2 inhibitors can be considered, based on limited evidence. In refractory patients, continuous enteral feeding or (rarely) surgical reinterventions have been advocated, although not supported by solid evidence. Therapies under current evaluation include the broad-spectrum somatostatin analogue pasireotide, GLP-1 receptor antagonists, GLP-1 receptor agonists and administration of stable forms of glucagon are currently under study.</p><p><strong>Conclusions: </strong>Dumping syndrome is a well-defined but probably under-diagnosed complication of upper gastrointestinal, especially bariatric, and surgeries. Diagnosis is confirmed by a provocative test and incremental therapies starting with diet, adding meal viscosity enhancers or glycosidase inhibitors and adding somatostatin analogues in refractory cases. A number of emerging therapies targeting intestinal propulsion, peptide hormone effects and hypoglycemic events are under evaluation.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":" ","pages":"e14962"},"PeriodicalIF":3.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624776","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 American Neurogastroenterology and Motility Society Gastroparesis Cardinal Symptom Index-Daily Diary (ANMS GCSI-DD): Psychometric validation and meaningful change threshold in patients with idiopathic or diabetic gastroparesis. 美国神经胃肠病学与胃动力学会胃痉挛症状指数--每日日记(ANMS GCSI-DD):特发性或糖尿病胃瘫患者的心理计量验证和有意义变化阈值。
IF 3.5 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-11 DOI: 10.1111/nmo.14960
Yaozhu J Chen, Karin S Coyne, Danielle Rodriguez, Andrea Schulz, Susanna Y Huh, Braden Kuo, Michael Camilleri, Jan Tack, Henry P Parkman

Introduction: The American Neurogastroenterology and Motility Society Gastroparesis Cardinal Symptom Index-Daily Diary (ANMS GCSI-DD) is a patient-reported outcome (PRO) instrument for gastroparesis. This study evaluated the psychometric properties of the ANMS GCSI-DD and determined a meaningful change threshold using the data from a phase 2b trial in adults with moderate-to-severe idiopathic or diabetic gastroparesis (DG).

Methods: The psychometric properties of ANMS GCSI-DD were analyzed using other clinician- and patient-reported outcomes from 242 patients during the 12-week trial. Trial exit interviews were conducted in a cohort of 32 patients to capture their perspectives on meaningful change from the trial.

Results: ANMS GCSI-DD demonstrated good performance: unidimensionality scores exhibited good fit; internal consistency reliability was >0.70; test-retest reliability was above 0.90, and convergent validity showed strong correlations (0.70-0.90) with overall severity rating and moderate correlations (0.30-0.70) with other outcomes. ANMS GCSI-DD scores discriminated among groups with varying severity of gastroparesis symptoms in known-groups validity (p < 0.001) and were responsive to symptom improvement. Triangulation of the quantitative anchor-based estimates of 0.9-1.4 category points as a meaningful change in the ANMS GCSI-DD composite score, and the qualitative exit interview findings of 0.5-1.5 as meaningful change, supports a one-point change on a five-point scale (0-4) as the meaningful change threshold.

Conclusion: The ANMS GCSI-DD is a reliable and valid PRO instrument to employ in clinical development for patients with moderate-to-severe idiopathic or DG, and a one-point score change in the ANMS GCSI-DD composite score is recommended as a meaningful change threshold of symptom change.

简介:美国神经胃肠病学与胃动力学会胃瘫卡迪纳尔症状指数-每日日记(ANMS GCSI-DD)是一种针对胃瘫的患者报告结果(PRO)工具。本研究评估了 ANMS GCSI-DD 的心理测量学特性,并利用中重度特发性或糖尿病胃轻瘫(DG)成人 2b 期试验的数据确定了有意义变化阈值:在为期 12 周的试验中,利用 242 名患者提供的其他临床医生和患者报告结果分析了 ANMS GCSI-DD 的心理测量特性。对 32 名患者进行了试验退出访谈,以了解他们对试验带来的有意义变化的看法:ANMS GCSI-DD表现良好:单维度得分显示出良好的拟合性;内部一致性信度大于0.70;测试-再测信度高于0.90,收敛效度显示出与总体严重程度评级的强相关性(0.70-0.90)和与其他结果的中等相关性(0.30-0.70)。ANMS GCSI-DD 评分在胃痉挛症状严重程度不同的组别之间具有已知组有效性(p 结论:ANMS GCSI-DD 评分在胃痉挛症状严重程度不同的组别之间具有区分性:ANMS GCSI-DD 是一种可靠有效的 PRO 工具,可用于中重度特发性或 DG 患者的临床开发,建议将 ANMS GCSI-DD 综合评分的一分变化作为症状变化的有意义的变化阈值。
{"title":"The American Neurogastroenterology and Motility Society Gastroparesis Cardinal Symptom Index-Daily Diary (ANMS GCSI-DD): Psychometric validation and meaningful change threshold in patients with idiopathic or diabetic gastroparesis.","authors":"Yaozhu J Chen, Karin S Coyne, Danielle Rodriguez, Andrea Schulz, Susanna Y Huh, Braden Kuo, Michael Camilleri, Jan Tack, Henry P Parkman","doi":"10.1111/nmo.14960","DOIUrl":"https://doi.org/10.1111/nmo.14960","url":null,"abstract":"<p><strong>Introduction: </strong>The American Neurogastroenterology and Motility Society Gastroparesis Cardinal Symptom Index-Daily Diary (ANMS GCSI-DD) is a patient-reported outcome (PRO) instrument for gastroparesis. This study evaluated the psychometric properties of the ANMS GCSI-DD and determined a meaningful change threshold using the data from a phase 2b trial in adults with moderate-to-severe idiopathic or diabetic gastroparesis (DG).</p><p><strong>Methods: </strong>The psychometric properties of ANMS GCSI-DD were analyzed using other clinician- and patient-reported outcomes from 242 patients during the 12-week trial. Trial exit interviews were conducted in a cohort of 32 patients to capture their perspectives on meaningful change from the trial.</p><p><strong>Results: </strong>ANMS GCSI-DD demonstrated good performance: unidimensionality scores exhibited good fit; internal consistency reliability was >0.70; test-retest reliability was above 0.90, and convergent validity showed strong correlations (0.70-0.90) with overall severity rating and moderate correlations (0.30-0.70) with other outcomes. ANMS GCSI-DD scores discriminated among groups with varying severity of gastroparesis symptoms in known-groups validity (p < 0.001) and were responsive to symptom improvement. Triangulation of the quantitative anchor-based estimates of 0.9-1.4 category points as a meaningful change in the ANMS GCSI-DD composite score, and the qualitative exit interview findings of 0.5-1.5 as meaningful change, supports a one-point change on a five-point scale (0-4) as the meaningful change threshold.</p><p><strong>Conclusion: </strong>The ANMS GCSI-DD is a reliable and valid PRO instrument to employ in clinical development for patients with moderate-to-severe idiopathic or DG, and a one-point score change in the ANMS GCSI-DD composite score is recommended as a meaningful change threshold of symptom change.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":" ","pages":"e14960"},"PeriodicalIF":3.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624779","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
Role of prokinetics in ineffective esophageal motility: A call for broader consideration and future innovations. 促胃肠动力剂在食管无效蠕动中的作用:呼吁更广泛的考虑和未来的创新。
IF 3.5 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-04 DOI: 10.1111/nmo.14961
Andrea Pasta, Francesco Calabrese, Edoardo Vincenzo Savarino, Edoardo Giovanni Giannini, Elisa Marabotto
{"title":"Role of prokinetics in ineffective esophageal motility: A call for broader consideration and future innovations.","authors":"Andrea Pasta, Francesco Calabrese, Edoardo Vincenzo Savarino, Edoardo Giovanni Giannini, Elisa Marabotto","doi":"10.1111/nmo.14961","DOIUrl":"https://doi.org/10.1111/nmo.14961","url":null,"abstract":"","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":" ","pages":"e14961"},"PeriodicalIF":3.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576567","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
Cyclic vomiting syndrome: A patient/parent perspective. 周期性呕吐综合征:患者/家长的视角。
IF 3.5 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-04 DOI: 10.1111/nmo.14952
Kathleen Adams
{"title":"Cyclic vomiting syndrome: A patient/parent perspective.","authors":"Kathleen Adams","doi":"10.1111/nmo.14952","DOIUrl":"https://doi.org/10.1111/nmo.14952","url":null,"abstract":"","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":" ","pages":"e14952"},"PeriodicalIF":3.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576558","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
Third generation sequencing analysis detects significant differences in duodenal microbiome composition between functional dyspepsia patients and control subjects. 第三代测序分析检测出功能性消化不良患者和对照组之间十二指肠微生物组组成的显著差异。
IF 3.5 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-03 DOI: 10.1111/nmo.14955
Georgios Tziatzios, Emmanouil Stylianakis, Georgia Damoraki, Paraskevas Gkolfakis, Gabriela Leite, Ruchi Mathur, Mark Pimentel, Evangelos J Giamarellos-Bourboulis, Konstantinos Triantafyllou
<p><strong>Background: </strong>Functional dyspepsia (FD) is a multifactorial disorder as its development may be based on several different pathophysiological mechanisms. Interaction of gut microbiome with the host has been proposed as a potential mechanism involved in the disease's pathogenesis.</p><p><strong>Aim/methods: </strong>We aimed to characterize microbiome profiling on duodenal luminal content (DLC) of FD patients and compare it to that of controls (CG) and patients with irritable bowel syndrome (IBS). Outpatients fulfilling Rome IV criteria for FD, IBS, and control group (CG) underwent upper gastrointestinal endoscopy and 2 cc of duodenal aspirate (3rd - 4th part) was aspirated in sterile traps. Duodenal microbiome was assessed after DNA extraction and 16S gene-based sequencing on Oxford Nanopore MinION followed by EPI2ME analysis (ONT/Metrich-ore Ltd). Bioanalysis of the microbiome (alpha-, beta-diversity, comparisons of relative abundances for all taxonomic ranks) was implemented in Python. Multiple group means comparisons were performed with one-way Analysis of Variance (ANOVA) and Kruskal-Wallis test with Tuckey's and Dunn's post hoc tests respectively, in case of significance (P-value <0.05).</p><p><strong>Results: </strong>20 subjects with FD (8 females; age 49.9 ± 13.5 yrs.), 20 with IBS (14 females; age 57.6 ± 14.8 yrs.) and 10 CG (6 females; age 49.2 ± 13.8 yrs.) had their DLC analyzed. The α-diversity index of subjects with FD was significantly lower compared to controls (Shannon's index, p = 0.0218) and similar to that of patients with IBS. Principal Coordinate Analysis (PCoA) generated from species relative abundances (beta-diversity) showed no difference in the DLC profile of subjects with FD and IBS when compared to controls (p = 0.513). Compared to controls, the relative abundance (RA) of Chloroflexota phylum was lower in subjects with FD (p = 0.017) and IBS (p = 0.026), respectively. Additionally, the RA of the Rhodothermota and Thermotogota phyla was lower in FD (p = 0.017 and p = 0.018, respectively) but not in IBS patients (p = 0.15 and p = 0.06, respectively) compared to controls. Interestingly, the RA of specific taxa from Chloroflexota, Rhodothermota and Thermotogota phyla were consistently lower in subjects with FD when compared to CG but similar to IBS, during analysis of all the subsequent major ranks of taxonomy. At the class level, there were significant differences in Syntrophobacteria, Acidithiobacillia, Cytophagia and Flavobacteriia between the FD and CG groups (p < 0.05), but no such difference between FD and IBS was found. Finally, multiple significant differences at the order, family, genus and species level between the FD and CG groups were also detected. A positive relationship between the RA of Streptococcus and those from genus Granulicatella was observed both in FD (p = 0.014) and IBS (p = 0.014) patients.</p><p><strong>Conclusion & inferences: </strong>The microbiome profiling from duodenal lumin
背景:功能性消化不良(FD)是一种多因素疾病,其发病可能基于几种不同的病理生理机制。肠道微生物组与宿主的相互作用被认为是该疾病发病机制中的一个潜在机制:我们旨在分析 FD 患者十二指肠管腔内容物(DLC)的微生物组特征,并将其与对照组(CG)和肠易激综合征(IBS)患者进行比较。符合罗马IV标准的FD、肠易激综合征和对照组(CG)门诊患者接受上消化道内窥镜检查,并在无菌收集器中吸取2毫升十二指肠吸出物(第3-4部分)。在牛津纳米孔 MinION 上进行 DNA 提取和 16S 基因测序,然后进行 EPI2ME 分析(ONT/Metrich-ore Ltd)后,对十二指肠微生物组进行评估。微生物组的生物分析(α-、β-多样性、所有分类等级的相对丰度比较)由 Python 实现。多组均值比较采用单因子方差分析(ANOVA)和 Kruskal-Wallis 检验,并分别采用 Tuckey's 和 Dunn's post hoc 检验进行显著性检验(P-value 结果:对 20 名 FD 受试者(8 名女性;年龄 49.9 ± 13.5 岁)、20 名 IBS 受试者(14 名女性;年龄 57.6 ± 14.8 岁)和 10 名 CG 受试者(6 名女性;年龄 49.2 ± 13.8 岁)的 DLC 进行了分析。与对照组相比,FD 受试者的 α 多样性指数明显较低(香农指数,p = 0.0218),与肠易激综合征患者相似。根据物种相对丰度(β-多样性)生成的主坐标分析(PCoA)显示,与对照组相比,FD 和 IBS 患者的 DLC 特征没有差异(p = 0.513)。与对照组相比,FD(p = 0.017)和 IBS(p = 0.026)受试者绿藻门的相对丰度(RA)分别较低。此外,与对照组相比,FD(分别为 p = 0.017 和 p = 0.018)和 IBS(分别为 p = 0.15 和 p = 0.06)患者的红热菌门(Rhodothermota)和热菌门(Thermotogota)的丰度较低。有趣的是,在随后所有主要分类级别的分析中,与对照组相比,FD 受试者的绿藻门(Chloroflexota)、红藻门(Rhodothermota)和热藻门(Thermotogota)特定类群的RA值一直较低,但与 IBS 相似。在类别水平上,FD 组和 CG 组之间在合成细菌、酸性硫杆菌、嗜胞杆菌和黄杆菌方面存在显著差异(p 结论与推论:FD患者十二指肠腔内容物的微生物组图谱与对照组有显著差异,包括微生物区系多样性较低、微生物区系结构/组成和特定分类群不同。胃食管反流患者和肠易激综合征患者的 DLC 没有明显的类似差异。
{"title":"Third generation sequencing analysis detects significant differences in duodenal microbiome composition between functional dyspepsia patients and control subjects.","authors":"Georgios Tziatzios, Emmanouil Stylianakis, Georgia Damoraki, Paraskevas Gkolfakis, Gabriela Leite, Ruchi Mathur, Mark Pimentel, Evangelos J Giamarellos-Bourboulis, Konstantinos Triantafyllou","doi":"10.1111/nmo.14955","DOIUrl":"https://doi.org/10.1111/nmo.14955","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Functional dyspepsia (FD) is a multifactorial disorder as its development may be based on several different pathophysiological mechanisms. Interaction of gut microbiome with the host has been proposed as a potential mechanism involved in the disease's pathogenesis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim/methods: &lt;/strong&gt;We aimed to characterize microbiome profiling on duodenal luminal content (DLC) of FD patients and compare it to that of controls (CG) and patients with irritable bowel syndrome (IBS). Outpatients fulfilling Rome IV criteria for FD, IBS, and control group (CG) underwent upper gastrointestinal endoscopy and 2 cc of duodenal aspirate (3rd - 4th part) was aspirated in sterile traps. Duodenal microbiome was assessed after DNA extraction and 16S gene-based sequencing on Oxford Nanopore MinION followed by EPI2ME analysis (ONT/Metrich-ore Ltd). Bioanalysis of the microbiome (alpha-, beta-diversity, comparisons of relative abundances for all taxonomic ranks) was implemented in Python. Multiple group means comparisons were performed with one-way Analysis of Variance (ANOVA) and Kruskal-Wallis test with Tuckey's and Dunn's post hoc tests respectively, in case of significance (P-value &lt;0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;20 subjects with FD (8 females; age 49.9 ± 13.5 yrs.), 20 with IBS (14 females; age 57.6 ± 14.8 yrs.) and 10 CG (6 females; age 49.2 ± 13.8 yrs.) had their DLC analyzed. The α-diversity index of subjects with FD was significantly lower compared to controls (Shannon's index, p = 0.0218) and similar to that of patients with IBS. Principal Coordinate Analysis (PCoA) generated from species relative abundances (beta-diversity) showed no difference in the DLC profile of subjects with FD and IBS when compared to controls (p = 0.513). Compared to controls, the relative abundance (RA) of Chloroflexota phylum was lower in subjects with FD (p = 0.017) and IBS (p = 0.026), respectively. Additionally, the RA of the Rhodothermota and Thermotogota phyla was lower in FD (p = 0.017 and p = 0.018, respectively) but not in IBS patients (p = 0.15 and p = 0.06, respectively) compared to controls. Interestingly, the RA of specific taxa from Chloroflexota, Rhodothermota and Thermotogota phyla were consistently lower in subjects with FD when compared to CG but similar to IBS, during analysis of all the subsequent major ranks of taxonomy. At the class level, there were significant differences in Syntrophobacteria, Acidithiobacillia, Cytophagia and Flavobacteriia between the FD and CG groups (p &lt; 0.05), but no such difference between FD and IBS was found. Finally, multiple significant differences at the order, family, genus and species level between the FD and CG groups were also detected. A positive relationship between the RA of Streptococcus and those from genus Granulicatella was observed both in FD (p = 0.014) and IBS (p = 0.014) patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion & inferences: &lt;/strong&gt;The microbiome profiling from duodenal lumin","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":" ","pages":"e14955"},"PeriodicalIF":3.5,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569329","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
Respiratory-swallow patterning and oropharyngeal swallowing impairment in patients undergoing evaluation for lung transplant. 接受肺移植评估的患者的呼吸-吞咽模式和口咽吞咽功能障碍。
IF 3.5 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-11-01 Epub Date: 2024-09-02 DOI: 10.1111/nmo.14912
Kahla Graham, Erin L Reedy, Jungwha Julia Lee, Elizabeth Spencer Norton, Ambalavanan Arunachalam, Rade Tomic, Bonnie Martin-Harris

Background: Although swallowing impairment is prevalent following lung transplantation, baseline respiratory and swallowing characteristics are often overlooked. Respiratory disease processes may predispose lung transplant candidates to altered respiratory-swallow patterning and swallowing impairment.

Methods: This cross-sectional study included patients referred for a Modified Barium Swallow Study during lung transplant evaluation. Swallowing impairment was measured using the Modified Barium Swallow Impairment Profile and Penetration-Aspiration Scale. Respiratory plethysmographic signals synchronized with videofluoroscopy were analyzed to determine phase patterning, pause duration, and rate. Mixed-effects logistic regression was used to identify linkages between respiratory and swallowing measures.

Key results: Fifty patients were included and demonstrated delayed swallow initiation (49/50), oral residue (37/50), incomplete pharyngoesophageal segment opening (35/50), and esophageal retention (43/50). Airway invasion occurred infrequently (10/50). Atypical respiratory patterning was significantly associated with impairment in pharyngeal swallow initiation (OR [95% CI] = 1.76 [1.16, 2.68], p = 0.009), laryngeal elevation (OR [95% CI] = 1.45 [1.01, 2.07], p = 0.044), and laryngeal vestibular closure (OR [95% CI] = 2.57 [1.48, 4.46], p < 0.001). Increased pause duration was associated with impaired initiation (OR [95% CI] = 2.24 [1.20, 4.16], p = 0.011), laryngeal elevation (OR [95% CI] = 1.18 [1.03, 1.36], p = 0.018), laryngeal closure (OR [95% CI] = 1.28 [1.9, 1.50], p = 0.003), and tongue base retraction (OR [95% CI] = 1.33 [1.13, 1.56], p < 0.001).

Conclusions & inferences: Patients undergoing evaluation for lung transplant demonstrated impaired swallowing and phase patterning. Preliminary findings implicate the need for further evaluation of respiratory-swallow coordination and its potential role in swallowing impairment before and after lung transplantation.

背景:虽然肺移植后普遍存在吞咽障碍,但呼吸和吞咽的基线特征往往被忽视。呼吸系统疾病过程可能导致肺移植候选者的呼吸-吞咽模式改变和吞咽功能障碍:这项横断面研究包括在肺移植评估期间转诊进行改良吞咽钡检查的患者。采用改良钡吞咽功能障碍档案和穿透-吞咽量表测量吞咽功能障碍。分析了与视频荧光镜同步的呼吸胸透信号,以确定相位模式、停顿时间和速率。混合效应逻辑回归用于确定呼吸和吞咽测量之间的联系:共纳入了 50 名患者,他们的吞咽开始延迟(49/50)、口腔残留(37/50)、咽喉食管段开放不全(35/50)和食管滞留(43/50)。侵犯气道的情况很少发生(10/50)。非典型呼吸模式与咽吞咽启动障碍(OR [95% CI] = 1.76 [1.16, 2.68],p = 0.009)、喉头抬高(OR [95% CI] = 1.45 [1.01, 2.07],p = 0.044)和喉头前庭闭合(OR [95% CI] = 2.57 [1.48, 4.46],p 结论和推论:接受肺移植评估的患者显示出吞咽和相位模式受损。初步研究结果表明,有必要进一步评估呼吸-吞咽协调性及其在肺移植前后吞咽障碍中的潜在作用。
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Neurogastroenterology and Motility
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