Neurogastroenterology and Motility最新文献

Background: Evaluate the impact of Spondias mombin L. juice (SM), alone and in combination with Lactobacillus acidophilus, in an experimental model of intestinal mucositis.

Methods: Swiss mice were orally administered with saline, SM, or SM combined with L. acidophilus NRRL B-4495 at 1 × 10⁹ colony-forming unit (CFU/mL) for 15 days before the induction of intestinal mucositis by a single intraperitoneal injection of 5-fluorouracil (5-FU) at 450 mg/kg. On the 18th day, following euthanasia, tissue samples were collected for histopathological examination. Jejunum tissues were analyzed for MUC-2 immunoexpression, concentrations of interleukin-1-beta (IL-1β), interleukin 6 (IL-6) and tumor necrosis factor (TNF)-α, and invertase activity.

Key results: 5-FU induced intestinal damage in all intestinal segments, and this damage involved villus blunting, flattened and vacuolated cells, crypt necrosis, inflammatory cell infiltration, and mucosa and submucosal edema compared to the control group. In contrast, SM or SM with L. acidophilus prevented these morphological alterations in all intestinal segments (p < 0.05). Both treatments reduced the intestinal concentration of IL-1 beta (p < 0.05), IL-6 (p < 0.05), and TNF-alpha (p < 0.05). Notably, the combination of SM and L. acidophilus, but not SM alone, prevented the 5-FU-induced decrease in invertase activity and mucin expression (p < 0.05). Furthermore, SM combined with L. acidophilus resulted in an increased population of lactic acid bacteria in feces on the 7th and 18th days. Combining SM with L. acidophilus also decreased fecal excretion of γ-Ergostenol and γ-sitosterol.

Conclusions and inferences: SM, alone and combined with Lactobacillus acidophilus demonstrated significant protective effects against 5-FU-induced intestinal mucositis, reducing inflammatory markers.

Objective: To observe the clinical efficacy of abdominal massage combined with moxibustion in alleviating chronic constipation in elderly patients.

Methods: A total of 74 elderly patients with constipation who visited Shijiazhuang People's Hospital between October 2022 and January 2024 were selected and randomly assigned into two groups: the abdominal massage + moxibustion (AM + M) group and the control group. The control group received usual bowel care (UBC), whereas the AM + M group received abdominal massage and moxibustion in addition to UBC, with five sessions per week for 4 weeks. Clinical efficacy was compared between the two groups following treatment. Statistical analysis was performed using GraphPad Prism, with p < 0.05 considered statistically significant.

Results: The total effective rate in the AM + M group (71.05%) was significantly higher than that in the control group (36.11%) (p < 0.05). Following treatment, both groups showed improvements in constipation symptoms (stool frequency and consistency), Constipation Severity Instrument (CSI) score, Patient Assessment of Constipation-Quality of Life (PAC-QOL) score and levels of nitric oxide (NO) and vasoactive intestinal peptide (VIP), with greater improvements in the AM + M group (CSI: p < 0.001; PAC-QOL: p < 0.001; NO: p < 0.01; VIP: p < 0.01). Additionally, the level of substance P increased significantly in the AM + M group compared with the control group (p < 0.01).

Conclusion: Four weeks of abdominal massage combined with moxibustion significantly improved stool characteristics, reduced defecation interval and duration, regulated intestinal neurotransmitter levels and enhanced quality of life in elderly patients with chronic constipation.

Background: Evacuation dysfunction affects gastrointestinal motility, yet its effect on small bowel microbiota is unknown. We aimed to compare the glucose breath test (GBT) and lactulose breath test (LBT) outcomes in patients with or without evacuation dysfunction based on high-resolution anorectal manometry (HR-ARM) and balloon expulsion test (BET).

Methods: We conducted a retrospective review of patients who received a HR-ARM and either a GBT or LBT from 2018 to 2024.

Key results: We studied 344 patients who underwent GBT and 144 who underwent LBT. Clinical characteristics between the two groups were comparable. Abnormal BET was observed in 53% of patients. Rates of abnormal breath tests were comparable among patients with or without abnormal BET. Patients with positive vs. negative breath tests had similar anorectal pressures, rectal sensory function, and BET results. There were significantly more negative breath tests in GBT (64%) versus LBT (35%), with higher rates of small intestinal bacterial overgrowth (SIBO) in LBT versus GBT (SIBO only: 20.1% vs. 7.6%; SIBO+IMO: 21.5% vs. 5.5%; p < 0.001).

Conclusions and inferences: The presence of evacuation dysfunction does not impact the results of the breath test. HR-ARM and BET demonstrate a high diagnostic yield in identifying the etiology of abdominal bloating in patients with chronic constipation or IBS without diarrhea, whereas hydrogen breath tests have a low diagnostic yield in this context. The specificity and sensitivity of LBT in this patient population remain less certain.

Background: Disorders of gut-brain interaction (DGBI) impose significant burdens worldwide, yet reliable regional prevalence estimates are lacking, limiting insight into potential geographic variation. Socio-economic status (SES) may contribute but remains underexplored.

Methods: Data were obtained from the Dutch cohort of the Rome Foundation Global Epidemiology Study, including the Rome IV Adult Diagnostic Questionnaire, sociodemographic items, and SES indicators. The Netherlands was divided into three regions (Region 1: South; Region 2: West; Region 3: North-East). Regional prevalence was calculated for any DGBI, groups, and subtypes. Associations with SES were examined using logistic regression.

Key results: 2008 participants (50% female; age: 48 years [IQR: 31]; BMI: 25.25 kg/m² [IQR: 5.98]) were included. Overall DGBI prevalence was 30.63% (95% CI: 28.65-32.68), with no significant regional differences (Region 1: 30.40%, 95% CI [26.61-34.47]; Region 2: 30.19%, 95% CI [27.19-33.36]; Region 3: 31.45%, 95% CI [27.96-35.16]; p = 1.000). No regional variation was found across DGBI groups or subtypes (all p > 0.05). Younger age (OR = 0.98, 95% CI [0.98-0.99]), female sex (OR = 2.10, 95% CI [1.70-2.59]), underweight (OR = 2.53, 95% CI [1.36-4.73]), and obesity (OR = 1.59, 95% CI [1.19-2.13]) were associated with higher odds of DGBI. In models adjusted for age, sex, and BMI, limited/no healthcare access (OR = 2.47, 95% CI [1.62-3.77], p < 0.0001) was associated with higher DGBI odds, whereas employment showed lower odds (OR = 0.65, 95% CI [0.52-0.81], p < 0.001). Other SES indicators were not associated.

Conclusion and inferences: DGBI affect nearly one-third of adults in the Netherlands, with no regional variation in prevalence. Putative risk factors include limited/no healthcare access and unemployment, supporting consideration of socioeconomic determinants in DGBI care, although further research is warranted.

Background: Functional luminal imaging probe (FLIP) and barium esophagogram (BE) are complementary to high-resolution manometry in achalasia. Anatomical changes and achalasia treatment could alter their interpretation. Our objective was to compare FLIP and BE for achalasia diagnosis and follow up and to evaluate the impact of anatomical changes.

Methods: One hundred and thirty patients who underwent FLIP were included. The indication of FLIP was a suspicion of achalasia (naive group, n = 68 patients) or symptoms after achalasia treatment (treated group, n = 62 patients). Esophago-gastric junction distensibility index (EGJ-DI) was considered low when < 3 mm²/mmHg for a 50 mL distension plateau. BE were reviewed for the presence of esophageal stasis and anatomical changes. FLIP and BE results were compared.

Key results: EGJ-DI was significantly lower in the naive group than in the treated group (2.7 mm²/mmHg vs. 5.6, p < 0.01). BE revealed abnormalities more frequently in the treated group than in the naive group (esophageal stasis 61% vs. 37%, p < 0.01; esophageal dilation 63% vs. 39%, p < 0.01; blown out myotomy 26% vs. 3%, p < 0.01). EGJ-DI was lower in patients with stasis on BE compared to those without in the naive group but not in the treated group. Intrabag pressure tended to be lower in treated patients with stasis or blown out myotomy compared to those without.

Conclusions & inferences: FLIP is complementary to BE and should be interpreted with caution, notably after achalasia treatment. Further studies should determine the respective place of BE and FLIP in patients' work up.

Introduction: Many patients with obstructed defecation report concurrent fecal incontinence. However, the impact of psychological factors on coexisting symptoms remains unclear. We aimed to investigate the association between history of adverse childhood experiences (ACEs) and psychological symptoms on the severity of coexisting obstructed defecation and fecal incontinence.

Methods: Retrospective analysis of a prospective IRB registry of patients with primary complaint of obstructed evacuation symptoms who completed validated surveys for assessment of psychological symptoms using the Hospital Anxiety and Depression Scale (HADS), the Adverse Childhood Experiences (ACE) questionnaire, and clinical characteristics including symptom severity.

Results: A total of 128 patients with obstructed defecation and fecal incontinence (110 women), average (SD) age 55 (16) years, were included; mean Renzi Obstructed Defecation Syndrome (ODS) score of 9.75 (3.97) and mean Cleveland Clinic Fecal Incontinence (CCFI) score of 9.38 (5.54). ACEs were reported by 60 (47%) and HADS anxiety and depression ≥ 8 by 63 (49%) and 36 (28%) of the cohort, respectively. Patients with ACEs had more severe ODS (not CCFI) scores which correlated with higher HADS anxiety and depression scores. There were no correlations between CCFI and HADS anxiety and depression scores (p > 0.05). Younger patients were more likely to report ACEs, higher HADS, ODS and lower CCFI scores. After adjusting for age, higher depression scores correlated significantly with the severity of both CCFI and ODS scores.

Conclusions: The observed differences in the impact of ACEs and psychological symptoms on coexisting obstructed defecation and fecal incontinence symptoms suggest distinct pathophysiological mechanisms, which could guide targeted treatment strategies across different age groups.

Background: Chronic intestinal pseudo-obstruction (CIPO) is a rare, severe disorder of gastrointestinal motility. Although 5-hydroxytryptamine type 4 (5-HT₄) receptor agonists stimulate gastrointestinal motility, few trials have assessed their therapeutic effects in patients with CIPO.

Aim: To assess the efficacy and safety of velusetrag, a highly selective 5-HT₄ receptor agonist, in patients with CIPO.

Methods: This was a phase 2, placebo-controlled, crossover, multiple (n = 1), multicenter, double-blind, proof-of-concept trial. Eligible patients were aged 18-80 years, had CIPO (idiopathic or secondary to neurodegenerative disorders) and received ≥ 30% of their daily caloric intake orally. Over four periods, each of four weeks, patients were randomly assigned to once-daily, oral velusetrag 15 mg (two periods) or placebo (two periods), with a 2-week washout between each treatment period. The primary endpoint was the improvement in the weekly global gastrointestinal symptoms average index score (WGGSAIS) from the start to the end of each treatment period, assessed among patients who were responders or naive to previous 5-HT₄ receptor agonist treatment.

Results: Overall, 17 patients with idiopathic CIPO received treatment and were included in safety analyses; efficacy was assessed in 15 patients. Mean (standard deviation) changes in WGGSAIS during treatment were -0.42 (0.693) for velusetrag and -0.19 (0.688) for placebo (between-treatment difference: -0.24; 95% confidence interval: -0.553, 0.074; p = 0.1279). No deaths or serious or treatment-related treatment-emergent adverse events were reported.

Conclusion: Velusetrag treatment was associated with improved symptoms versus placebo, although differences were not statistically significant at this sample size. Velusetrag was generally well tolerated.

Trial registration: ClinicalTrials.gov identifier: NCT05724069; EudraCT number: 2021-000854-24.