Neurogastroenterology and Motility最新文献

Background: Diaphragmatic breathing training (DBT) improves symptoms in patients with gastroesophageal reflux disease; however, the effect of DBT on the anti-reflux barrier and esophageal motility is unclear. This study aimed to evaluate the changes in specific parameters of EGJ function and esophageal motility before and after DBT using high-resolution manometry (HRM) in patients with reflux symptoms.

Methods: Prospectively collected data from adult patients with persistent reflux symptoms who underwent initial and follow-up HRM after at least 3 months of DBT were analyzed. Esophagogastric junction (EGJ) function was assessed using basal lower esophageal sphincter (LES) pressure (LESP), the EGJ contractile integral (EGJ-CI), and integrated relaxation pressure (IRP). Esophageal motility was assessed using the distal contractile integral (DCI) and percentage of ineffective esophageal motility (IEM).

Key results: Data from 53 patients with a median age of 45 years (range 25-77) were analyzed. LES pressure increased after DBT (mean LES pressure 25.6 [SE 1.3] vs. 29.1 [SE 1.4] mmHg after DBT; p = 0.02). This effect was also observed in patients with an initially hypotensive LES, but no effect was found on the size of hiatus hernia. There was a trend to increased EGJ-CI (mean EGJ-CI 52.8 [SE 3.7] vs. 59.9 [SE 4.3] mmHg·cm after DBT, p = 0.07). Esophageal contractility improved (mean DCI 1046.6 [SE 112] vs. 1264.1 [SE 137] mmHg·s·cm after DBT; p < 0.01) with the prevalence of IEM reduced from 38.0% [SE 5] to 29.2% [SE 4] after DBT; p = 0.03.

Conclusion and inferences: Diaphragmatic breathing training increased LES pressure and esophageal peristaltic vigor in patients with reflux symptoms.

Background: Apart from disorders of gut-brain interaction (DGBI), little data exist on the magnitude of the brain-to-gut pathway in other chronic gastrointestinal conditions such as gastroesophageal reflux disease (GERD) or inflammatory bowel disease (IBD) and what factors modify order of diagnosis. We aimed to determine the proportion of patients who received a diagnosis of a DGBI, GERD, or IBD prior to a new psychological diagnosis (gut-to-brain), and vice versa (brain-to-gut), and whether specific factors moderate the order of diagnosis.

Method: Data was collected from a retrospective study of 1,129,104 patients attending general practices in the United Kingdom. Patients diagnosed with DGBI, GERD, or IBD and a psychological disorder (anxiety and/or depression) were included (excluding those with other organic GI disease). Information on which diagnosis appeared first was recorded. Multiple logistic regression was performed to compare a diagnosis of a DGBI, GERD, or IBD first versus a psychological diagnosis first on sociodemographic factors, medical conditions, and medication usage.

Key results: Just over half of patients were diagnosed with a psychological condition first versus after for IBS (53.9%) and ulcerative colitis (55.6%). This proportion was higher for FD (61.5%) and GERD (64.2%) but lower for Crohn's disease (45.7%). In a multivariate model, being female (OR = 1.37, 95% CI 1.25, 1.49), prior PPI (OR = 9.17, 95% CI 8.4, 10.0), antibiotic (OR = 2.54, 95% CI 2.29, 2.81) and NSAID use (OR = 1.29, 95% CI 1.18, 1.42), and prior gastroenteritis (OR = 2.19, 95% CI, 1.79, 2.67) were significant predictors for being diagnosed with GERD first. Similar results were found for DGBI.

Conclusions & inferences: Prior medication usage and gastroenteritis may play a role in generating gut-to-brain pathway disturbances.

Background: Small intestinal bacterial overgrowth (SIBO) and intestinal methanogen overgrowth (IMO) are commonly diagnosed using glucose (GBT) and lactulose (LBT) breath tests. Despite their widespread use, concerns remain regarding their reproducibility and reliability, especially in asymptomatic individuals. This study aimed to evaluate the diagnostic variability and test-retest reliability of GBT and LBT in healthy volunteers.

Methods: We conducted a prospective observational diagnostic concordance study in 40 healthy adults. Participants underwent both GBT (75 g glucose) and LBT (10 g lactulose) with hydrogen (H₂) and methane (CH₄) measured at 15-min intervals. Testing was repeated 2 weeks later. A positive result was defined as an increase of ≥ 20 ppm in H₂ or CH₄ level of ≥ 10 ppm at any point during the breath testing. Symptoms were recorded during the tests. Agreement and reliability were assessed using kappa statistics and intraclass correlation coefficients (ICC), respectively.

Results: At baseline, 15.0% of participants had a positive GBT and 60.0% had a positive LBT, predominantly for H₂. In the retest, 10.0% remained GBT-positive, whereas LBT results were consistent (60.0%). ICC for GBT was 0.56 for H₂ and 0.87 for CH₄; for LBT, ICCs were 0.88 and 0.85, respectively. Symptoms occurred more frequently with LBT, and the median time to symptom onset (75 min) coincided with physiological orocecal transit.

Conclusions: GBT and LBT showed good test-retest reliability in healthy individuals. However, the high rate of positive LBT results and symptom occurrence suggests limited specificity, reinforcing the need for cautious interpretation and further standardization in breath test protocols.

Background: We previously found that the fecal levels of short-chain fatty acids (SCFAs) changed in irritable bowel syndrome (IBS) patients at 1 month and 1 year after fecal microbiota transplantation (FMT). This study analyzed SCFAs at 2 and 3 years after FMT in the same IBS patients included in those previous studies.

Methods: This study randomized 113 IBS patients into placebo, 30-g, and 60-g groups, who received FMT with 30 g of their own feces and with 30 g and 60 g of the donor's feces, respectively. The patients completed four questionnaires to assess IBS symptoms, fatigue, and quality of life, and supplied fecal samples at the baseline and at 2 and 3 years after FMT. The fecal SCFA levels were measured using gas chromatography.

Results: The butyric acid level was significantly increased at 2 and 3 years after FMT in the 30-g and 60-g groups, and was significantly higher than that in the placebo group. The total SCFA and acetic acid levels decreased significantly in the 30-g and 60-g groups at 2 and 3 years after FMT, while the propionic acid level decreased in the 60-g group at both time points. The butyric acid level was inversely correlated with IBS symptoms and fatigue.

Conclusion and inferences: The increased butyric acid levels in IBS patients at 2 and 3 years after FMT and their inverse correlation with both IBS symptoms and fatigue suggest that butyric acid contributes to the long-term improvement seen after FMT (www.

Clinicaltrials: gov: NCT03822299).

Objectives: The aim was to assess the neuroglial compartment in the myenteric plexus of two subjects with genetically verified Waardenburg syndrome (WS) type 4 (WS4) and to compare the outcome with four "age-matched" controls.

Design: Gut samples from four control cases and from two newborn subjects with WS4, one with peripheral demyelinating neuropathy, dysmyelinating leukodystrophy, WS and Hirschprung disease (PCWH) (SOX10, c.769A>T, p.Lys257*) and one with Waardenburg-Shah syndrome (WSS) (EDN3, c.472C>T,p.Arg158Cys)-were assessed histologically and immunohistochemically. Antibodies directed to glial cells (SOX10), ganglion cells (HuC/D), and interstitial cells of Cajal (CD117) were applied.

Results: For the child with PCWH syndrome, both the small and large intestine showed a reduction in the number of glial cells (SOX10), in parallel with hypoganglionosis (HuC/D), when compared with "age-matched" controls. In the child with WSS, a severe reduction in the number of glial cells (SOX10) was observed in both the small and large intestine accompanied by aganglionosis (HuC/D) with a skipped segment. The number of interstitial cells of Cajal (CD117) appeared unaffected in both PCWH and WSS cases.

Conclusion: A severe reduction of glial cells and a severe reduction or loss of ganglion cells (the number of cells assessed per unit length), were seen in our study subjects when compared with "age-matched" controls. Contrary to the above the presence of Cajal cells was unaffected.

Background: Limited data exist on long-term outcomes in patients with irritable bowel syndrome (IBS) following dietetic education on a FODMAP (fermentable, oligo-, di-, monosaccharides and polyols) diet. We aimed to investigate long-term outcomes with regards to the educative process, symptom control, quality of life, and dietary intake and patterns.

Methods: Medical histories of individuals with IBS educated on a FODMAP diet by a gastrointestinal specialist dietitian 2008-2018 were interrogated. At face-to-face interview, demographic data, symptoms, dietary intake, and overall and food-related quality of life (QOL) were assessed.

Key results: Seventy-four participants, 62% female, median age 59 (IQR 47-67) years, were educated to restrict intake of all FODMAPs; 23% had dietitian-directed progression through reintroduction and personalization phases. After mean 7.1 (range 2.5-13.4) years, 26% reported returning to habitual diet, 62% following a personalized diet and 12% continuing strict FODMAP restriction. Overall FODMAP intake was similar to that of historical healthy controls, but reduced in those continuing strict restriction. At least one type of FODMAP was restricted in 84%. Symptom severity and IBS-related QOL were similar across reported dietary patterns and FODMAP intakes, but food-related QOL was low in those with continuing strict restriction. Satisfactory relief of symptoms was reported by 64%. Symptom exacerbation was ameliorated by altering FODMAP (66%) or fiber intake (26%) with a minority (27%) utilizing medication.

Conclusions and inferences: Despite suboptimal implementation, dietitian-delivered education on a FODMAP diet in patients with IBS generally achieved satisfactory relief of symptoms, self-empowerment and minimal restriction of FODMAPs in the long term.

Background: The microbiome significantly influences the development of the gastrointestinal and immune systems. The delivery method, whether Caesarean section (CS) or vaginal birth (VB), plays a crucial role in shaping microbiota composition, with CS babies exhibiting differences. Early-life nutritional interventions using probiotics or prebiotics may help restore this imbalance in CS infants. Our study aimed to assess gut permeability in CS mice compared to VB mice and explore whether prebiotics or probiotics could mitigate any deficiencies.

Methods: Using a mouse model (NIH Swiss) for CS delivery, we measured plasma levels of a 4 kDa macromolecule (FITC) at PND7, 14, 23, and 35. We evaluated ileal gene expression of tight junction proteins, profiled intestinal microbiome composition, and examined the expression of genes involved in neurotransmitter physiology in the amygdala. Additionally, we studied the impact of administering Bifidobacterium breve in drinking water and dietary administration of GOS/FOS on these outcomes.

Key results: At PND7, CS-born mice exhibited increased ileal permeability, along with reduced expression of Tjp1, Occludin, Claudin 3, and Epcam compared to VB mice. Administration of B. breve or GOS/FOS alleviated changes in Epcam expression. During the pre-weaning period, beta diversity differed between VB and CS. Post-weaning, β-diversity increased following probiotic and prebiotic intervention. Additionally, CS mice showed changes in neurotransmitter gene expression in the amygdala, which were also mitigated by B. breve or GOS/FOS.

Discussion: Our findings indicate that targeted microbiota-associated interventions can reverse deficits in intestinal permeability induced in CS mice.

There is the lack of representation of disorders of gut-brain interaction in postgraduate curricula in both Europe and the United States, resulting in a knowledge gap and discomfort of general gastroenterologists in managing these highly prevalent conditions. We report findings from a pilot competency-based curriculum focused on principles of managing DGBI across six U.S. adult fellowship programs with no pre-existing curricula and found that a didactic based curriculum can significantly improve medical knowledge; however, there was no significant change in attitudes towards patients with DGBI. This mini review contextualizes these findings and highlights practical challenges surrounding DGBI content integration during gastroenterology training. We propose future initiatives such as scalable curricula on a national level that consciously focus on the intentional cultivation of the attitudes and skills to improve patient outcomes as well as separate initiatives to ensure continuous faculty development.

Background and aims: Achalasia subtypes are classified by high-resolution manometry (HRM) based on esophageal pressurization and contractility patterns, while esophagram-based classifications emphasize esophageal anatomy. We aimed to evaluate the relationship between esophageal pressurization on HRM and esophageal anatomy on esophagram among patients with untreated achalasia.

Methods: Adult patients with treatment-naïve achalasia that completed HRM and esophagram were included. HRM achalasia subtypes were determined by the Chicago Classification with pan-esophageal pressurization (PEP) measured among type I and type II achalasia. Anatomy on esophagram was assessed using the Brazilian (esophageal width) and Japanese Esophageal Society (JES; angulation/tortuosity) classifications.

Results: 222 patients, mean (SD) age 56 (16), 49% female were included. On HRM, 32% were type I, 53% were type II, and 15% were type III achalasia. Esophageal width and JES classification differed by HRM subtype (p-values < 0.001) with type I (HRM) having greatest esophageal width (median (IQR) 5.1(4.0-6.0) cm) and most JES-C 93% (14/15), while type III achalasia had the least (width 2.6 (2.0-3.0) cm) and 0 were JES-C. Among type I and II achalasia, higher esophageal width was significantly correlated with lower median PEP and fewer swallows exceeding PEP thresholds of 10, 15, 20, or 30 mmHg.

Conclusions: HRM subtypes and PEP on HRM correlated with esophageal morphology defined on esophagram. However, imperfect concordance between HRM and esophagram classifications suggests complementary value to assess achalasia disease stages related to disease chronicity and esophageal wall mechanics. Future investigations to facilitate combined assessment with HRM and esophagram may enhance achalasia phenotyping and treatment planning.

Background: Eosinophilic gastrointestinal diseases (EGIDs) are chronic, immune-mediated diseases characterized by pathological infiltration of eosinophils in the gut. EGIDs include eosinophilic esophagitis (EoE), gastritis (EoG), enteritis (EoN), and colitis (EoC). There are no approved drugs for non-EoE EGIDs due to a lack of evidence.

Aims and methods: In this case series, we report the efficacy of dupilumab-prescribed for concomitant EoE-for the induction and maintenance of remission of non-EoE EGIDs. Adult patients (> 18 years) diagnosed with non-EoE EGIDs and concomitant EoE who had been prescribed dupilumab 300 mg weekly were prospectively enrolled. Outcome assessment was performed according to EGID-specific instruments when available (i.e., peak eosinophil count, modified dysphagia questionnaire, Pisa EoE adaptation questionnaire, EoE and EoG endoscopic reference scores).

Results: Four patients were included. All were female and their age spanned 21-77 years at diagnosis. Two patients had EoE + EoG (case 1 and 2), one EoE + EoG + EoN (case 3), and one EoE + EoN + EoC (case 4). EoG presented with epigastric pain, while EoN and EoC presented with abdominal pain and diarrhea. Cases 1 and 2 achieved clinical, endoscopic, and histological remission with induction corticosteroid treatment, while case 3 did not, and case 4 developed steroid-related adverse events. When switched to dupilumab 300 mg weekly, cases 1, 2, and 3 achieved histological remission and sustained clinical remission up to 12-18 months from induction. In case 4, dupilumab achieved histologic remission and partial clinical response up to 16 months from induction.

Conclusion: Dupilumab, prescribed for EoE, may be effective for the management of concomitant non-EoE EGIDs.