Neurogastroenterology and Motility最新文献

Background: Autonomic nervous system (ANS) activity is implicated in the pathogenesis of disorders of gut-brain interaction (DGBI). Technological advances enable more accurate investigation of ANS function.

Aim: This study aimed to evaluate the clinical utility of wearable devices in monitoring autonomic and gastrointestinal (GI) function in DGBI.

Methods: A systematic search identified studies in adults with DGBI using wearables to assess heart rate variability (HRV), sleep, skin conductance, or gastric myoelectric activity as clinical readouts for ANS and GI function. The review provides an overview of available devices, while the meta-analysis evaluates consistency in detecting differences between DGBI and healthy controls (HCs). Associations between autonomic function and GI symptom severity were explored. Methodological quality was assessed using the Cochrane risk of bias tool and ROBINS-I. Meta-analyses used random-effects models with standardized mean differences (SMDs).

Results: Thirty-six studies (3 RCTs, 33 observational) involving 3986 DGBI patients were included (HRV: n = 16, sleep: n = 7, gastric myoelectric activity: n = 14, skin conductance: n = 0). Meta-analyses showed lower Root Mean Square of Successive Differences (SMD = -0.503, SE 0.189, 95% CI [-0.873, -0.132]) and percentage of successive RR intervals differing by > 50 ms (SMD = -0.430, SE 0.176, 95% CI [-0.775, -0.085]), reflecting HRV alterations in DGBI versus HCs. No consistent differences were found for other metrics, except normal gastric slow waves (SMD = -0.722, SE 0.216, 95% CI [-1.146, -0.298]). Heterogeneous ANS-symptom associations precluded definitive conclusions.

Conclusions: Wearables show potential for detecting altered ANS and GI function in DGBI, particularly via HRV. Result variability highlights need for further research to confirm accuracy and clinical utility.

Background: Spontaneous neuronal network activity is essential to the functional maturation of central and peripheral circuits, yet whether this is a feature of enteric nervous system development has yet to be established. Although enteric neurons are known exhibit electrophysiological properties early in embryonic development, no connection has been drawn between this neuronal activity and the development of gastrointestinal (GI) motility patterns.

Methods: We use ex vivo GI motility assays with newly developed unbiased computational analyses to identify GI motility patterns across mouse embryonic development.

Key results: We find a previously unknown pattern of neurogenic contractions termed "clustered ripples" that arises spontaneously at embryonic day 16.5, an age earlier than any identified mature GI motility patterns. We further show that these contractions are driven by nicotinic cholinergic signaling.

Conclusions & inferences: Clustered ripples are neurogenic contractile activity that arise from spontaneous ENS activity and precede all known forms of neurogenic GI motility. This earliest motility pattern requires nicotinic cholinergic signaling, which may inform pharmacology for enhancing GI motility in preterm infants.

Cyclic vomiting is a disorder of gut brain interaction (DGBI) emphasizing the need for treatment of both the brain and the gut. Despite clinical success of psychological therapies for CVS, also called brain-gut treatments, an evidence-base is lacking and these treatments are available in few GI practices. This has resulted in an "all guts no brain" approach to CVS. The current paper is a call to action to develop more evidence and use of brain-gut therapies in CVS.

Background: Colorectal cancer (CRC) is a leading cause of cancer-related deaths, significantly disrupting enteric neurotransmission within the colon. While the effects of CRC on the enteric nervous system (ENS) of the colon are well documented, its impact on the small intestine remains underexplored. This study aims to investigate the influence of colorectal carcinogenesis on the small intestine's ENS and evaluate the individual neuroprotective effects of microencapsulated quercetin and Bifidobacterium animalis.

Methods: Wistar rats were subjected to chemically induced colorectal carcinogenesis, followed by 14 weeks of treatment with microencapsulated quercetin and B. animalis. Gastrointestinal transit times were assessed, and colonic and jejunal samples underwent histopathological and immunohistochemical analyses to evaluate neuronal markers (HuC/D, nNOS, VIP). Cholinergic neurons were not directly assessed.

Results: Aberrant crypt foci confirmed the effectiveness of the colorectal carcinogenesis induction model. The mean gastric emptying time (MGET) was notably shorter in the B. animalis-treated group. Colorectal carcinogenesis significantly reduced the density and size of HuC/D+ neurons in the myenteric and submucosal plexuses of the jejunum. Treatments with either microencapsulated quercetin or B. animalis significantly enhanced neuronal density and size in the jejunum and improved nitrergic neuronal density (nNOS-IR). Additionally, VIPergic neuron density increased in the submucosal plexus, and varicosity size increased in the myenteric plexus in the CR group; treatments reduced this varicosity size.

Conclusion: This study provides the first evidence that colorectal carcinogenesis damages jejunal neurons. Treatments with microencapsulated quercetin or B. animalis independently preserved neuronal density and modulated gastrointestinal function. However, their combined administration did not enhance these effects, highlighting the need for further research into therapeutic interventions for preserving ENS integrity during colorectal carcinogenesis.

Background: Current treatment options for irritable bowel syndrome (IBS) mainly focus on restoring abnormal stool patterns but are less effective in relieving abdominal pain. Recent studies have identified mast cells as key players in visceral hypersensitivity (VHS) via histamine acting on histamine 1 receptor (H1R) activation. Our previous multicenter clinical trial showed clinical improvement of non-constipated IBS patients during treatment with 20 mg of the H1R-antagonist ebastine. Based on urticaria clinical trials showing increased symptom control with increased antihistamine dosage, we compared the effect of ebastine 20 mg vs. 40 mg in an open label study.

Methods: The effect of treatment of non-constipated IBS patients with ebastine 20 mg (n = 92) or 40 mg (n = 73) for 12 weeks was compared. Abdominal pain was assessed at baseline and at week 12 using a 10-point Visual Analogue Scale. Abdominal pain responders were defined as patients with at least 30% decrease in score compared to baseline, substantial abdominal pain responders with at least 50% reduction. Common gastrointestinal symptoms were evaluated using the GSRS questionnaire.

Key results: The percentage of abdominal pain responders and substantial abdominal pain responders was significantly increased with ebastine 40 mg compared to 20 mg (62% vs. 32%; p = 0.0014 and 40% vs. 12%; p = 0.0010, respectively). Moreover, the severity of diarrhea was significantly reduced with ebastine 40 mg (-1.0 (2.0) vs. 0.4 (1.8); p = 0.0334).

Conclusions: Our study shows that ebastine 40 mg is more effective than 20 mg, resulting in increased symptom control, in particular reduction in abdominal pain, and supports further evaluation of ebastine as treatment of non-constipated IBS.

Background: Diabetic gastroenteropathy can cause significant diagnostic challenges. Still, it remains unknown if measures of extraintestinal autonomic function reflect diabetic gastroenteropathy. We aimed to assess the associations between (1) gastrointestinal symptoms and motility measures and (2) gastrointestinal symptoms/motility measures and extraintestinal autonomic markers.

Methods: We included 81 persons with type 1 or type 2 diabetes (65% female, mean age 54) with gastrointestinal symptoms and autonomic neuropathy. The Gastroparesis Cardinal Symptom Index (GCSI) and the Gastrointestinal Symptom Rating Scale (GSRS) assessed gastrointestinal symptoms. The wireless motility capsule (Smartpill™) assessed panenteric transit times and motility indices. Cardiovascular reflex tests (VAGUS™) and cardiac vagal tone (eMotion Faros) estimated cardiovascular autonomic neuropathy, while the SUDOSCAN™ evaluated sudomotor function.

Key results: Proximal gastrointestinal symptoms were positively associated with the gastric motility index (GCSI: 1.18 (1.04-1.35), p = 0.01; GSRS: 1.15 (1.03-1.29), p = 0.02; median ratio (95% CI)), while only satiety correlated with gastric emptying time (1.24 (1.03-1.49), p = 0.02). Diarrhea was associated with decreased small bowel transit time (0.93 (0.89-0.98), p = 0.005), while constipation were associated with prolonged colonic transit time (1.16 (1.03-1.31), p = 0.02). Gastrointestinal symptoms increased with the degree of abnormal cardiovascular reflex tests (GCSI: 0.67 (0.16-1.19), p = 0.03; GSRS: 0.87 (0.30-1.45), p = 0.01; mean difference (95% CI)) but not with motility measures. Cardiac vagal tone and sudomotor function were not associated with gastrointestinal markers.

Conclusions & inferences: Gastrointestinal and extraintestinal autonomic measures were not associated. However, proximal gastrointestinal symptoms were associated with the gastric motility index and cardiovascular reflex tests. Hence, the latter may contribute to evaluating whether proximal gastrointestinal symptoms are autonomically derived.

Introduction: Functional lumen imaging probe (FLIP) planimetry performed during peroral endoscopic myotomy (POEM) evaluates esophagogastric junction (EGJ) metrics. The 16 cm FLIP catheter allows for topographical assessment of the esophageal body, and previous intraoperative studies have only utilized the 8 cm catheter or combined data from both catheters. Our aim was to characterize the utility of the 16 cm catheter during POEM with respect to intraoperative tailoring of the myotomy length and intermediate outcomes after POEM.

Methods: We conducted a retrospective review of procedural and follow-up information of consecutive patients who underwent POEM with an intraoperative 16 cm catheter between January 2020 and September 2023.

Results: In 100 patients with intraoperative FLIP, the mean myotomy length was 8.2 cm. A tailored short myotomy (≤ 4 cm) using FLIP was performed in 10% of cases with comparable outcomes in LES obstruction and GERD metrics compared to > 4 cm myotomy length. On the basis of topographical FLIP findings, the myotomy was extended to capture spastic body features in 32% of cases including Type 2 achalasia (5), epiphrenic diverticulum (3) and prior myotomy (10). In intervention-naive patients, 70.5% achieved clinical success (Eckardt ≤ 3) at median follow-up of 30.9 months (IQR 6.5-40.9 months) with improvement in LES obstruction and GERD metrics among the intermediate follow-up cohort. An intraoperative post-myotomy EGJ diameter of ≥ 16 mm was associated with a lower rate of repeat intervention (2 vs. 5 patients, p = 0.038) and not associated with increased reflux outcomes.

Conclusion: Intraoperative FLIP using the 16 cm catheter during POEM enables a tailored myotomy guided by both EGJ metrics and topographical assessment.

Background: Functional dyspepsia (FD) and irritable bowel syndrome (IBS) are disorders of gut-brain interaction (DGBIs). Patients with these disorders experience abdominal symptoms, frequently in relation to meal intake, and often are treated using pharmacological approaches that offer limited symptom relief. In addition to various pharmacotherapies, established treatment options include lifestyle modifications (such as diet) and, in certain patients, psychological interventions. Because of the limitations of the currently available treatments, many patients look for alternative options, including herbal preparations.

Purpose: In this review, we summarize the preclinical and clinical evidence informing the use of the herbal preparation, STW 5-II, for the treatment of patients with FD and IBS. Data from clinical trials provide evidence that STW 5-II is superior to placebo in offering symptom relief. Moreover, a substantial body of preclinical data on the mechanisms of action of STW 5-II suggests that its ingredients target multiple mechanisms relevant to pathophysiology and symptom generation that may underlie its beneficial clinical effects in patients with DGBIs.

Background and aims: Gastroparesis and functional dyspepsia often share overlapping upper gastrointestinal symptoms but may differ in symptom patterns, treatment, and health care utilization. We assessed their clinical similarities and distinctions in the largest national cohort study to date.

Methods: We performed a retrospective cohort study using the TriNetX database, identifying patients through administrative codes. Individuals with structural gastric or small bowel abnormalities or prior gastric surgery were excluded. Gastroparesis required a diagnosis within three months of a gastric emptying study, at least one typical symptom, and an upper endoscopy within 12 months prior. Functional dyspepsia required a diagnosis with prior endoscopy (1-12 months) and symptoms 6-12 months before diagnosis. Primary outcomes were medication use and healthcare utilization; secondary outcomes included symptom burden and coexisting disorders of gut-brain interaction. Propensity score matching (1:1) adjusted for demographics and comorbidities. Relative risks with 95% confidence intervals were calculated.

Results: We identified 2488 patients with gastroparesis and 3676 with functional dyspepsia; after matching, 1914 per group remained. Gastroparesis showed greater use of prokinetics (52.7% vs. 19.6%; p < 0.0001) and antiemetics, and higher rates of endoscopy (41.4% vs. 21.2%), emergency visits (45.3% vs. 40.2%), and hospitalization (28.2% vs. 21.6%) (all p < 0.01). Nausea, vomiting, and distension were more frequent in gastroparesis, while epigastric pain predominated in functional dyspepsia (p < 0.0001).

Conclusion: Gastroparesis and functional dyspepsia show distinct symptom distributions and treatment patterns, with higher health care utilization in gastroparesis, supporting mechanism-based individualized management.