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A systematic cognitive behavioral therapy approach for pediatric disorders of gut-brain interaction. 针对小儿肠脑互动障碍的系统认知行为疗法。
IF 3.5 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-04 DOI: 10.1111/nmo.14883
Leigh P Chancey, Joel B Winnick, Jessica Buzenski, Gabriel Winberry, Anquonette Stiles, Nicole E Zahka, Sara E Williams

Objective: Cognitive Behavioral Therapy (CBT) for youth with Disorders of Gut-Brain Interaction (DGBIs) is effective; however, there are calls in the field to strengthen the evidence base and identify specific mechanisms of treatment that yield the most benefit for this patient population. A unique, systematic treatment approach of CBT with initial evidence for success for pediatric patients with DGBIs was evaluated to further demonstrate its clinical utility in this population.

Methods: This was a retrospective study of 42 pediatric patients aged 11-17 years with DGBIs, who were diagnosed and referred for CBT by pediatric gastroenterology providers. Providers also completed a survey rating acceptability and effectiveness of CBT. The systematic CBT approach included 10 sessions delivered by a psychologist at an integrated Pediatric GI Clinic.

Results: Review of 42 pediatric charts showed significant decreases in self-reported functional disability, abdominal pain, as well as depression and anxiety symptoms pre- to post-CBT completion. A moderation effect was observed where patients reporting higher levels of depressive symptoms and primary symptom of abdominal pain reported smaller reductions in functional impairment compared to those with lower levels of depression and primary symptom of nausea or vomiting. Pediatric Gastroenterology providers were satisfied with this psychological treatment approach.

Conclusions: This study provides evidence for acceptability and effectiveness of implementation of a systematic CBT approach for pediatric DGBIs in an integrated GI clinic, as well as areas worthy of future research, including identifying the most important mechanisms of treatment and factors that influence treatment response.

目的:认知行为疗法(CBT)对患有肠脑互动障碍(DGBIs)的青少年是有效的;然而,该领域呼吁加强证据基础,并确定对这一患者群体产生最大益处的具体治疗机制。为了进一步证明 CBT 在这一人群中的临床实用性,我们对一种独特、系统的 CBT 治疗方法进行了评估,该方法已被初步证明对患有 DGBIs 的儿童患者有效:这是一项回顾性研究,研究对象是 42 名患有 DGBIs 的 11-17 岁儿童患者,他们均由儿科胃肠病医生诊断并转诊接受 CBT 治疗。医护人员还填写了一份调查问卷,对 CBT 的可接受性和有效性进行评分。系统的 CBT 方法包括由一名心理学家在综合儿科胃肠病诊所进行的 10 次治疗:结果:对 42 份儿科病历的审查显示,自我报告的功能障碍、腹痛以及抑郁和焦虑症状在完成 CBT 治疗前和治疗后均显著减少。与抑郁程度较低和主要症状为恶心或呕吐的患者相比,报告抑郁症状和主要症状为腹痛程度较高的患者的功能障碍减少程度较小。小儿消化科医生对这种心理治疗方法表示满意:本研究为在综合消化内科门诊中实施系统的 CBT 方法治疗小儿 DGBIs 的可接受性和有效性提供了证据,同时也为未来值得研究的领域提供了证据,包括确定最重要的治疗机制和影响治疗反应的因素。
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引用次数: 0
Electroacupuncture at different frequencies improves visceral pain in IBS rats through different pathways. 不同频率的电针通过不同途径改善肠易激综合征大鼠的内脏疼痛。
IF 3.5 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-07-19 DOI: 10.1111/nmo.14874
Xiaoli Chang, Lijun Wang, Hongwei Sun, Zhen Wang, Zongbao Yang, Shaozong Chen

Background: The aim of this study was to investigate the frequency dependence of electroacupuncture (EA) in alleviating chronic visceral pain in patients with irritable bowel syndrome (IBS) and the differences in the gut microbiota and metabolites as potential mechanisms to explain frequency dependence.

Methods: A visceral hyperalgesia model was established by colorectal instillation of 2,4,6-trinitrobenzene sulfonic acid in rats, and EA treatment at 2/10 Hz, 2/50 Hz and 2/100 Hz was applied at ST25. Visceral sensation was quantified by the abdominal withdrawal reflex score and the area under the curve of the rectus abdominis electromyogram in response to colorectal distension. Ultrastructural morphological damage of colonic tissue of the rats was examined by transmission electron microscopy. 16S rRNA gene sequencing and 1H-nuclear magnetic resonance spectroscopy were applied to study the differences in the gut microbiota and to perform metabonomic profiling of the colonic tissue.

Key results: EA at ST25 at different frequencies attenuated chronic visceral pain, ultrastructural morphological damage to colonic tissue and disruption of the gut microbiota in IBS rats. The frequency of 2/100 Hz has more regulatory pathways than 2/10 Hz and 2/50 Hz. In addition, IBS rats exhibited colonic metabolic disorders, and pantothenate was significantly upregulated after EA treatment at different frequencies. Very low-density lipoprotein and 2-hydroxybutyrate were significantly increased in the 2/10 Hz group, while low density lipoprotein, very low-density lipoprotein, 2-hydroxybutyrate, methylmalonate and alpha-hydroxyisobutyric acid were significantly increased in the 2/100 Hz group.

Conclusions and inferences: EA at ST25 at different frequencies attenuated chronic visceral pain through different gut microbiota and metabolic pathways.

研究背景本研究旨在探讨电针(EA)在缓解肠易激综合征(IBS)患者慢性内脏疼痛方面的频率依赖性,以及肠道微生物群和代谢物的差异作为频率依赖性的潜在解释机制:方法:通过向大鼠结肠灌注 2,4,6-三硝基苯磺酸建立了内脏痛觉减退模型,并在 ST25 处应用 2/10 Hz、2/50 Hz 和 2/100 Hz 的 EA 治疗。内脏感觉通过腹部退缩反射评分和腹直肌肌电图对结肠直肠胀气反应的曲线下面积进行量化。透射电子显微镜检查了大鼠结肠组织的超微结构形态损伤。应用 16S rRNA 基因测序和 1H 核磁共振波谱研究肠道微生物群的差异,并对结肠组织进行代谢组学分析:不同频率的 ST25 EA 可减轻 IBS 大鼠的慢性内脏疼痛、结肠组织的超微结构形态损伤和肠道微生物群的破坏。与 2/10 Hz 和 2/50 Hz 相比,2/100 Hz 频率的调节途径更多。此外,IBS 大鼠表现出结肠代谢紊乱,不同频率的 EA 处理后,泛酸显著上调。2/10赫兹组的极低密度脂蛋白和2-羟基丁酸显著增加,而2/100赫兹组的低密度脂蛋白、极低密度脂蛋白、2-羟基丁酸、甲基丙二酸和α-羟基异丁酸显著增加:不同频率的 ST25 EA 可通过不同的肠道微生物群和代谢途径减轻慢性内脏疼痛。
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引用次数: 0
Treatment for chronic idiopathic constipation: Use and satisfaction from a nationwide survey of US participants. 慢性特发性便秘的治疗:一项针对美国参与者的全国性调查显示的使用情况和满意度。
IF 3.5 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-18 DOI: 10.1111/nmo.14885
Brian E Lacy, Yanqing Xu, Douglas C A Taylor, Katherine J Kosch, Rachel Dobrescu, Amy Morlock, Robert Morlock, Ceciel Rooker

Background: Chronic idiopathic constipation (CIC) is a disorder of gut-brain interaction characterized by a variety of bowel movement-related and abdominal symptoms. A greater understanding of medication use and satisfaction with symptom control may provide insights to optimize patient care. Therefore, we explored these aspects of the disorder in adults with CIC.

Methods: This study assessed data collected from a large nationwide survey of adult participants in the United States, querying demographics, clinical characteristics, and comorbid conditions, as well as medication use, care-seeking behaviors, and satisfaction with symptom control. Participants were grouped into the CIC cohort if they met Rome IV criteria, with controls matched 1:1 according to age, sex, race, region, and Charlson Comorbidity Index score. All data were self-reported.

Key results: Two thousand five hundred and thirty-three participants with CIC were matched 1:1 to controls. In the CIC cohort, abdominal pain was the most reported symptom leading to medication use: 15.9% of respondents were receiving a prescription medication in addition to an over-the-counter medication, while 26.3% were taking neither. In addition, only one-third were satisfied with the control of their symptoms; however, satisfaction was significantly higher in respondents taking a prescription medication (p < 0.001). The proportion of reported comorbidities was significantly higher in the CIC cohort versus the control cohort, with chronic pain, anxiety, and depression among the highest (p < 0.001 for all).

Conclusions and inferences: This study emphasizes the need for better communication regarding prescription medications and their benefits, with the goal of further improving CIC patients' overall symptoms.

背景:慢性特发性便秘(CIC)是一种肠道与大脑相互作用的疾病,其特征是各种与肠道运动相关的症状和腹部症状。深入了解药物使用情况和症状控制满意度可为优化患者护理提供启示。因此,我们对 CIC 成人患者的这些方面进行了研究:本研究评估了从一项针对美国成年参与者的全国性大型调查中收集的数据,调查内容包括人口统计学、临床特征、合并症以及药物使用、寻求护理行为和对症状控制的满意度。根据年龄、性别、种族、地区和 Charlson 合并症指数评分,符合 Rome IV 标准的参与者被归入 CIC 队列,与对照组进行 1:1 匹配。所有数据均为自我报告:2,533 名 CIC 患者与对照组进行了 1:1 匹配。在 CIC 群体中,腹痛是导致用药的最主要症状:15.9%的受访者在服用非处方药的同时还在服用处方药,26.3%的受访者两种药都没有服用。此外,只有三分之一的受访者对症状控制情况表示满意;然而,服用处方药的受访者的满意度明显更高(p 结论和推论:本研究强调,有必要就处方药及其益处进行更好的沟通,以进一步改善 CIC 患者的整体症状。
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引用次数: 0
The goals for successful development of treatment in gastroparesis. 成功开发胃痉挛治疗方法的目标。
IF 3.5 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-06-17 DOI: 10.1111/nmo.14849
David Yi Yang, Michael Camilleri

Background: Gastroparesis is a motility disorder of the stomach characterized by cardinal symptoms and delayed gastric emptying of solid food in the absence of mechanical obstruction. There is significant unmet need in its management, and essentially there are no medications approved for its treatment over four decades.

Purpose: The objectives of this review are to develop an understanding of the goals of treatment, the evidence-based criteria for treatment success based on the current scientific understanding of gastroparesis as well as patient response outcomes, and to propose evidence-based principles for the successful development of treatments for gastroparesis. Specifically, we discuss the pathophysiologic targets in gastroparesis, eligibility criteria for clinical trial participation based on validated gastric emptying studies, and the patient response outcome measures that have been validated to appraise effects of treatment on clinically relevant outcomes. These considerations lead to recommendations regarding eligibility, design, and duration of proof-of-efficacy studies, and to endorsing the American Neurogastroenterology and Motility Society Gastroparesis Cardinal Symptom Index Daily Diary as a validated patient response outcome and to justification of the shortening of proof-of-efficacy, placebo-controlled clinical trials to 4 weeks treatment duration after a baseline period. We believe that such approaches will increase the likelihood of successful assessment of efficacy of novel approaches to treating patients with gastroparesis.

背景:胃瘫是一种胃动力障碍性疾病,主要症状是在无机械性梗阻的情况下,固体食物的胃排空延迟。目的:本综述旨在了解胃瘫的治疗目标、基于目前对胃瘫的科学认识的治疗成功循证标准以及患者的反应结果,并提出成功开发胃瘫治疗方法的循证原则。具体而言,我们讨论了胃瘫的病理生理靶点、基于有效胃排空研究的临床试验参与资格标准,以及经验证可评估治疗对临床相关结果影响的患者反应结果指标。基于这些考虑,我们提出了有关疗效验证研究的资格、设计和持续时间的建议,并认可美国神经胃肠病学与胃动力学会胃轻瘫卡迪纳尔症状指数每日日记作为有效的患者反应结果,还提出了在基线期后将疗效验证、安慰剂对照临床试验的持续时间缩短至 4 周的理由。我们相信,这些方法将增加成功评估治疗胃瘫患者的新方法疗效的可能性。
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引用次数: 0
Comparative evaluation of single versus double leg raise maneuver in high-resolution esophageal manometry. 高分辨率食管测压中单腿抬高与双腿抬高操作的比较评估。
IF 3.5 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-07-25 DOI: 10.1111/nmo.14868
Daniel S Rim, Henry P Parkman

Background: The straight leg raise (SLR) maneuver, often performed during esophageal manometry, requires patients to lift their leg(s) to augment intraabdominal pressure (IAP). Diverse techniques have been applied for SLR. This study aimed to evaluate and compare the effects of SLR between single and double leg raises.

Methods: During esophageal manometry, patients were asked to raise one leg, followed by elevating both legs. The efficacy of SLR for (1) detecting hiatal hernia, (2) increasing IAP, and (3) predicting gastroesophageal reflux disease (GERD) with intraesophageal pressure (IEP) was assessed. The value of change in impedance to indicate reflux during SLR in predicting esophageal acid exposure was investigated.

Key results: The leg raise procedures were performed in 86 patients undergoing high-resolution esophageal manometry. Both the single and double leg raises exhibited a higher hiatal hernia detection rate compared to the landmark (p = 0.008 and 0.005, respectively). Double leg raise was more effective in raising IAP by >50% compared to single leg raise (100% vs. 65.1%, p < 0.001), increasing yield by 53.6%. The change in IAP showed a positive correlation with the change in IEP during double leg raise (r = 0.31; p = 0.004), higher than that for single leg raise (r = 0.23; p = 0.03). Lower intraesophageal impedance during SLR was associated with AET > 6% with double leg raise (1.5 kΩ vs. 2.5 kΩ, p = 0.04).

Conclusions & inferences: Our study demonstrates the efficacy of both single and double leg raise maneuvers during HREMI in increasing hiatal hernia detection and possible value in predicting GERD. The double leg raise resulted in a higher rate of effective increase in IAP, potentially enabling more patients to undergo effective SLR during HREMI.

背景:直腿抬高(SLR)操作通常在食管测压过程中进行,要求患者抬起腿以增加腹内压(IAP)。直腿抬高法应用了多种技术。本研究旨在评估和比较单腿抬高和双腿抬高的 SLR 效果:方法:在食管测压过程中,要求患者先抬起一条腿,然后再抬起两条腿。方法:在食管测压过程中,要求患者先抬起一条腿,然后再抬起两条腿,评估单腿抬高法在以下方面的效果:(1) 检测食管裂孔疝;(2) 增加 IAP;(3) 通过食管内压 (IEP) 预测胃食管反流病 (GERD)。研究还探讨了在 SLR 过程中通过阻抗变化显示反流情况对预测食管酸暴露的价值:对 86 名接受高分辨率食管测压的患者进行了抬腿手术。与地标法相比,单腿抬高法和双腿抬高法的食管裂孔疝检出率都更高(p = 0.008 和 0.005)。与单腿抬高(100% vs. 65.1%,p 6%,双腿抬高(1.5 kΩ vs. 2.5 kΩ,p = 0.04)相比,双腿抬高能更有效地将 IAP 提高 >50%:我们的研究表明,在进行 HREMI 时,单腿抬高和双腿抬高两种方法都能有效提高食管裂孔疝的检出率,并具有预测胃食管反流病的可能价值。双腿抬高导致 IAP 的有效增加率更高,可能使更多患者在 HREMI 期间接受有效的 SLR。
{"title":"Comparative evaluation of single versus double leg raise maneuver in high-resolution esophageal manometry.","authors":"Daniel S Rim, Henry P Parkman","doi":"10.1111/nmo.14868","DOIUrl":"10.1111/nmo.14868","url":null,"abstract":"<p><strong>Background: </strong>The straight leg raise (SLR) maneuver, often performed during esophageal manometry, requires patients to lift their leg(s) to augment intraabdominal pressure (IAP). Diverse techniques have been applied for SLR. This study aimed to evaluate and compare the effects of SLR between single and double leg raises.</p><p><strong>Methods: </strong>During esophageal manometry, patients were asked to raise one leg, followed by elevating both legs. The efficacy of SLR for (1) detecting hiatal hernia, (2) increasing IAP, and (3) predicting gastroesophageal reflux disease (GERD) with intraesophageal pressure (IEP) was assessed. The value of change in impedance to indicate reflux during SLR in predicting esophageal acid exposure was investigated.</p><p><strong>Key results: </strong>The leg raise procedures were performed in 86 patients undergoing high-resolution esophageal manometry. Both the single and double leg raises exhibited a higher hiatal hernia detection rate compared to the landmark (p = 0.008 and 0.005, respectively). Double leg raise was more effective in raising IAP by >50% compared to single leg raise (100% vs. 65.1%, p < 0.001), increasing yield by 53.6%. The change in IAP showed a positive correlation with the change in IEP during double leg raise (r = 0.31; p = 0.004), higher than that for single leg raise (r = 0.23; p = 0.03). Lower intraesophageal impedance during SLR was associated with AET > 6% with double leg raise (1.5 kΩ vs. 2.5 kΩ, p = 0.04).</p><p><strong>Conclusions & inferences: </strong>Our study demonstrates the efficacy of both single and double leg raise maneuvers during HREMI in increasing hiatal hernia detection and possible value in predicting GERD. The double leg raise resulted in a higher rate of effective increase in IAP, potentially enabling more patients to undergo effective SLR during HREMI.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":" ","pages":"e14868"},"PeriodicalIF":3.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141760044","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 herbal preparation, STW5-II, reduces proximal gastric tone and stimulates antral pressures in healthy humans. 草药制剂 STW5-II 可降低健康人的近端胃张力并刺激前胃压力。
IF 3.5 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-02-01 DOI: 10.1111/nmo.14755
Penelope C E Fitzgerald, Vida Bitarafan, Taher Omari, Charles Cock, Karen L Jones, Michael Horowitz, Christine Feinle-Bisset

Background: The herbal preparation, STW5-II, improves upper gastrointestinal symptoms, including abdominal fullness, early satiation, and epigastric pain, in patients with functional dyspepsia, and in preclinical models decreases fundic tone and increases antral contractility. The effects of STW5-II on esophago-gastric junction pressure, proximal gastric tone and antropyloroduodenal pressures, disturbances of which may contribute to symptoms associated with disorders of gut-brain interaction, including functional dyspepsia, in humans, have, hitherto, not been evaluated.

Methods: STW5-II or placebo (matched for color, aroma, and alcohol content) were each administered orally, at the recommended dose (20 drops), to healthy male and female volunteers (age: 27 ± 1 years) in a double-blind, randomized fashion, on two separate occasions, separated by 3-7 days, to evaluate effects on (i) esophago-gastric junction pressures following a standardized meal using solid-state high-resolution manometry (part 1, n = 16), (ii) proximal gastric volume using a barostat (part 2, n = 16), and (iii) antropyloroduodenal pressures assessed by high-resolution manometry (part 3, n = 18), for 120 min (part 1) or 180 min (parts 2, 3).

Key results: STW5-II increased maximum intrabag volume (ml; STW5-II: 340 ± 38, placebo: 251 ± 30; p = 0.007) and intrabag volume between t = 120 and 180 min (p = 0.011), and the motility index of antral pressure waves between t = 60 and 120 min (p = 0.032), but had no effect on esophago-gastric junction, pyloric, or duodenal pressures.

Conclusions & inferences: STW5-II has marked region-specific effects on gastric motility in humans, which may contribute to its therapeutic efficacy in functional dyspepsia.

背景:草药制剂 STW5-II 可改善功能性消化不良患者的上消化道症状,包括腹部饱胀、早饱和及上腹痛,并在临床前模型中降低胃底张力和增加前胃收缩力。STW5-II 对食管-胃交界处压力、近端胃张力和胃十二指肠前压力的影响迄今尚未得到评估:方法:对健康的男性和女性志愿者(年龄:27 ± 1 岁)进行双人口服试验,按照推荐剂量(20 滴)分别口服 STW5-II 或安慰剂(色泽、香味和酒精含量相匹配):第 1 部分,n = 16),(ii) 使用胃压计评估近端胃容量(第 2 部分,n = 16),(iii) 使用高分辨率测压计评估胃十二指肠前压力(第 3 部分,n = 18),时间为 120 分钟(第 1 部分)或 180 分钟(第 2、3 部分)。主要结果STW5-II 增加了 t = 120 分钟和 180 分钟之间的最大袋内容积(ml;STW5-II:340 ± 38,安慰剂:251 ± 30;p = 0.007)和袋内容积(p = 0.011),以及 t = 60 分钟和 120 分钟之间的前胃压力波运动指数(p = 0.032),但对食管-胃交界处、幽门或十二指肠压力没有影响:STW5-II对人体胃运动具有明显的区域特异性影响,这可能有助于其对功能性消化不良的疗效。
{"title":"The herbal preparation, STW5-II, reduces proximal gastric tone and stimulates antral pressures in healthy humans.","authors":"Penelope C E Fitzgerald, Vida Bitarafan, Taher Omari, Charles Cock, Karen L Jones, Michael Horowitz, Christine Feinle-Bisset","doi":"10.1111/nmo.14755","DOIUrl":"10.1111/nmo.14755","url":null,"abstract":"<p><strong>Background: </strong>The herbal preparation, STW5-II, improves upper gastrointestinal symptoms, including abdominal fullness, early satiation, and epigastric pain, in patients with functional dyspepsia, and in preclinical models decreases fundic tone and increases antral contractility. The effects of STW5-II on esophago-gastric junction pressure, proximal gastric tone and antropyloroduodenal pressures, disturbances of which may contribute to symptoms associated with disorders of gut-brain interaction, including functional dyspepsia, in humans, have, hitherto, not been evaluated.</p><p><strong>Methods: </strong>STW5-II or placebo (matched for color, aroma, and alcohol content) were each administered orally, at the recommended dose (20 drops), to healthy male and female volunteers (age: 27 ± 1 years) in a double-blind, randomized fashion, on two separate occasions, separated by 3-7 days, to evaluate effects on (i) esophago-gastric junction pressures following a standardized meal using solid-state high-resolution manometry (part 1, n = 16), (ii) proximal gastric volume using a barostat (part 2, n = 16), and (iii) antropyloroduodenal pressures assessed by high-resolution manometry (part 3, n = 18), for 120 min (part 1) or 180 min (parts 2, 3).</p><p><strong>Key results: </strong>STW5-II increased maximum intrabag volume (ml; STW5-II: 340 ± 38, placebo: 251 ± 30; p = 0.007) and intrabag volume between t = 120 and 180 min (p = 0.011), and the motility index of antral pressure waves between t = 60 and 120 min (p = 0.032), but had no effect on esophago-gastric junction, pyloric, or duodenal pressures.</p><p><strong>Conclusions & inferences: </strong>STW5-II has marked region-specific effects on gastric motility in humans, which may contribute to its therapeutic efficacy in functional dyspepsia.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":" ","pages":"e14755"},"PeriodicalIF":3.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139672309","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
Randomized double-blind placebo-controlled study to evaluate the effect of long-acting mesalamine on postinfectious irritable bowel syndrome with diarrhea. 评估长效美沙拉明对感染后肠易激综合征伴腹泻的影响的随机双盲安慰剂对照研究。
IF 3.5 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-08-05 DOI: 10.1111/nmo.14889
Ashok K Tuteja, Daniel T Leung, John C Fang, Nicholas J Talley, Gregory J Stoddard

Background: A subset of patients with irritable bowel syndrome (IBS) develop their symptoms after gastroenteritis, referred to as postinfectious IBS (PI-IBS). PI-IBS is associated with low-grade intestinal inflammation. Previous studies have evaluated mesalamine, an anti-inflammatory drug, in patients with IBS. We evaluated the efficacy of long-acting mesalamine in patients with PI-IBS.

Methods: Sixty-one patients who developed diarrhea-predominant IBS (IBS-D) after gastroenteritis were randomized to receive either 2.4 g of long-acting mesalamine or placebo daily for 8-weeks. The symptoms assessed were abdominal pain, bloating, stool frequency, stool consistency, severity of diarrhea and constipation, satisfaction with bowel habits, and IBS affecting or interfering with life. Quality-of-life (QOL) was assessed using the IBS-QOL questionnaire. The prespecified primary outcome variable was the overall bowel symptom score (BSS) after 8-weeks of treatment. Effect sizes were expressed as standardized mean differences (Cohen's d).

Results: Fifty-four patients completed the 8-week treatment (n = 28 mesalamine, n = 26 placebo), 49 (91%) were male, and age range 23-71 years (mean ± SD 43 ± 13). Mesalamine demonstrated superior efficacy compared to placebo on the primary outcome variable, overall BSS (Cohen's d = 0.57, p = 0.042). Mesalamine was also superior for the secondary outcome of how much IBS affects your life in general (d = 0.72, p = 0.01). For the secondary outcomes of IBS symptoms, 7 of the 7 symptoms had trends of mesalamine superiority. For the secondary outcomes of IBS-QOL subscales, 8 of 9 had trends of mesalamine superiority.

Conclusion: In patients with PI-IBS, long-acting mesalamine demonstrated to be effective in reducing IBS symptoms and improving QOL.

背景:一部分肠易激综合征(IBS)患者是在肠胃炎后出现症状的,被称为感染后 IBS(PI-IBS)。PI-IBS 与低度肠道炎症有关。以往的研究评估了美沙拉明(一种抗炎药物)在肠易激综合征患者中的疗效。我们评估了长效美沙拉明对 PI-IBS 患者的疗效:61名肠胃炎后出现腹泻为主的肠易激综合征(IBS-D)的患者被随机分配到每天服用2.4克长效美沙拉明或安慰剂,为期8周。评估的症状包括腹痛、腹胀、大便次数、大便稠度、腹泻和便秘的严重程度、对排便习惯的满意度以及 IBS 对生活的影响或干扰。生活质量(QOL)采用肠易激综合征 QOL 问卷进行评估。预设的主要结果变量是治疗 8 周后的总体肠道症状评分 (BSS)。疗效大小以标准化平均差(Cohen's d)表示:54名患者完成了为期8周的治疗(n = 28名美沙拉明患者,n = 26名安慰剂患者),其中49人(91%)为男性,年龄在23-71岁之间(平均±标准差为43±13)。与安慰剂相比,美沙拉明在主要结果变量--总体 BSS 方面的疗效更优(Cohen's d = 0.57,p = 0.042)。在 "肠易激综合征对生活的总体影响 "这一次要结果上,美沙拉明也更胜一筹(d = 0.72,p = 0.01)。在肠易激综合征症状的次要结果中,有7种症状显示出美沙拉明的优势趋势。在IBS-QOL分量表的次要结果中,9个分量表中有8个具有美沙拉明的优势趋势:结论:在PI-IBS患者中,长效美沙拉明能有效减轻IBS症状并改善QOL。
{"title":"Randomized double-blind placebo-controlled study to evaluate the effect of long-acting mesalamine on postinfectious irritable bowel syndrome with diarrhea.","authors":"Ashok K Tuteja, Daniel T Leung, John C Fang, Nicholas J Talley, Gregory J Stoddard","doi":"10.1111/nmo.14889","DOIUrl":"10.1111/nmo.14889","url":null,"abstract":"<p><strong>Background: </strong>A subset of patients with irritable bowel syndrome (IBS) develop their symptoms after gastroenteritis, referred to as postinfectious IBS (PI-IBS). PI-IBS is associated with low-grade intestinal inflammation. Previous studies have evaluated mesalamine, an anti-inflammatory drug, in patients with IBS. We evaluated the efficacy of long-acting mesalamine in patients with PI-IBS.</p><p><strong>Methods: </strong>Sixty-one patients who developed diarrhea-predominant IBS (IBS-D) after gastroenteritis were randomized to receive either 2.4 g of long-acting mesalamine or placebo daily for 8-weeks. The symptoms assessed were abdominal pain, bloating, stool frequency, stool consistency, severity of diarrhea and constipation, satisfaction with bowel habits, and IBS affecting or interfering with life. Quality-of-life (QOL) was assessed using the IBS-QOL questionnaire. The prespecified primary outcome variable was the overall bowel symptom score (BSS) after 8-weeks of treatment. Effect sizes were expressed as standardized mean differences (Cohen's d).</p><p><strong>Results: </strong>Fifty-four patients completed the 8-week treatment (n = 28 mesalamine, n = 26 placebo), 49 (91%) were male, and age range 23-71 years (mean ± SD 43 ± 13). Mesalamine demonstrated superior efficacy compared to placebo on the primary outcome variable, overall BSS (Cohen's d = 0.57, p = 0.042). Mesalamine was also superior for the secondary outcome of how much IBS affects your life in general (d = 0.72, p = 0.01). For the secondary outcomes of IBS symptoms, 7 of the 7 symptoms had trends of mesalamine superiority. For the secondary outcomes of IBS-QOL subscales, 8 of 9 had trends of mesalamine superiority.</p><p><strong>Conclusion: </strong>In patients with PI-IBS, long-acting mesalamine demonstrated to be effective in reducing IBS symptoms and improving QOL.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":" ","pages":"e14889"},"PeriodicalIF":3.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893947","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 COVID-19 pandemic as a modifier of DGBI symptom severity: A systematic review and meta-analysis. COVID-19 作为 DGBI 症状严重程度的调节因子:系统回顾和荟萃分析。
IF 3.5 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-07-26 DOI: 10.1111/nmo.14878
Dmitrii Kulin, Ayesha Shah, Thomas Fairlie, Reuben K Wong, Xiucai Fang, Uday C Ghoshal, Purna C Kashyap, Agata Mulak, Yeong Yeh Lee, Nicholas J Talley, Natasha Koloski, Michael P Jones, Gerald J Holtmann

Background: This SRMA reviewed and assessed the changes in the severity of disorders of gut-brain interaction (DGBI) symptoms during the COVID-19 pandemic, and evaluated factors associated with symptom severity changes.

Methods: Electronic databases were searched until February 2024, for articles reporting on changes in symptom severity in DGBI patients during the COVID-19 pandemic. The proportion of DGBI patients who reported a change in their symptom severity were pooled using a random-effects model, and subgroup analyses were conducted to assess the effect of socio-cultural modifiers on symptom severity in DGBI.

Key results: Twelve studies including 3610 DGBI patients found that 31.4% (95% CI, 15.9-52.5) of DGBI patients experienced symptom deterioration, while 24.3% (95% CI, 10.2-47.5) experienced improvement. Countries with high gross domestic product (GDP) had a 43.5% (95% CI, 16.3-75.2) likelihood of symptom deterioration, compared to 9.2% (95% CI, 1.4-42.2) in lower GDP countries. Similarly, countries with low COVID fatality rates had a 60.1% (95% CI, 19.7-90.3) likelihood of symptom deterioration, compared to 18.3% (95% CI, 7.8-36.9) in higher fatality rate countries. Countries with lenient COVID policies had a 58.4% (95% CI, 14.1-92.3) likelihood of symptom deterioration, compared to 19% (95% CI, 8.2-38.1) in countries with stricter policies. Patients in high vaccine hesitancy countries had a 51.4% (95% CI, 19.5-82.2) likelihood of symptom deterioration, compared to 10.6% (95% CI, 2.7-33.4) in low vaccine hesitancy countries.

Conclusions & inferences: This meta-analysis reveals that a significantly higher proportion of DGBI patients experienced deterioration of symptoms during the COVID-19 pandemic. Various sociocultural, economic and environmental factors potentially modify the effects of the COVID-19 pandemic on DGBI.

背景:本SRMA回顾并评估了COVID-19大流行期间肠脑相互作用紊乱(DGBI)症状严重程度的变化,并评估了与症状严重程度变化相关的因素:方法:在 2024 年 2 月之前,我们在电子数据库中搜索了有关 COVID-19 大流行期间 DGBI 患者症状严重程度变化的报道文章。采用随机效应模型对报告症状严重程度发生变化的 DGBI 患者的比例进行汇总,并进行亚组分析以评估社会文化因素对 DGBI 症状严重程度的影响:包括3610名DGBI患者在内的12项研究发现,31.4%(95% CI,15.9-52.5)的DGBI患者症状恶化,而24.3%(95% CI,10.2-47.5)的患者症状改善。国内生产总值(GDP)高的国家出现症状恶化的可能性为 43.5%(95% CI,16.3-75.2),而 GDP 较低的国家为 9.2%(95% CI,1.4-42.2)。同样,在 COVID 死亡率较低的国家,症状恶化的可能性为 60.1%(95% CI,19.7-90.3),而在死亡率较高的国家,症状恶化的可能性为 18.3%(95% CI,7.8-36.9)。在 COVID 政策宽松的国家,症状恶化的可能性为 58.4%(95% CI,14.1-92.3),而在政策较严格的国家,症状恶化的可能性为 19%(95% CI,8.2-38.1)。疫苗接种犹豫程度高的国家的患者症状恶化的可能性为51.4%(95% CI,19.5-82.2),而疫苗接种犹豫程度低的国家的患者症状恶化的可能性为10.6%(95% CI,2.7-33.4):这项荟萃分析显示,在 COVID-19 大流行期间,出现症状恶化的 DGBI 患者比例明显更高。各种社会文化、经济和环境因素可能会改变 COVID-19 大流行对 DGBI 的影响。
{"title":"The COVID-19 pandemic as a modifier of DGBI symptom severity: A systematic review and meta-analysis.","authors":"Dmitrii Kulin, Ayesha Shah, Thomas Fairlie, Reuben K Wong, Xiucai Fang, Uday C Ghoshal, Purna C Kashyap, Agata Mulak, Yeong Yeh Lee, Nicholas J Talley, Natasha Koloski, Michael P Jones, Gerald J Holtmann","doi":"10.1111/nmo.14878","DOIUrl":"10.1111/nmo.14878","url":null,"abstract":"<p><strong>Background: </strong>This SRMA reviewed and assessed the changes in the severity of disorders of gut-brain interaction (DGBI) symptoms during the COVID-19 pandemic, and evaluated factors associated with symptom severity changes.</p><p><strong>Methods: </strong>Electronic databases were searched until February 2024, for articles reporting on changes in symptom severity in DGBI patients during the COVID-19 pandemic. The proportion of DGBI patients who reported a change in their symptom severity were pooled using a random-effects model, and subgroup analyses were conducted to assess the effect of socio-cultural modifiers on symptom severity in DGBI.</p><p><strong>Key results: </strong>Twelve studies including 3610 DGBI patients found that 31.4% (95% CI, 15.9-52.5) of DGBI patients experienced symptom deterioration, while 24.3% (95% CI, 10.2-47.5) experienced improvement. Countries with high gross domestic product (GDP) had a 43.5% (95% CI, 16.3-75.2) likelihood of symptom deterioration, compared to 9.2% (95% CI, 1.4-42.2) in lower GDP countries. Similarly, countries with low COVID fatality rates had a 60.1% (95% CI, 19.7-90.3) likelihood of symptom deterioration, compared to 18.3% (95% CI, 7.8-36.9) in higher fatality rate countries. Countries with lenient COVID policies had a 58.4% (95% CI, 14.1-92.3) likelihood of symptom deterioration, compared to 19% (95% CI, 8.2-38.1) in countries with stricter policies. Patients in high vaccine hesitancy countries had a 51.4% (95% CI, 19.5-82.2) likelihood of symptom deterioration, compared to 10.6% (95% CI, 2.7-33.4) in low vaccine hesitancy countries.</p><p><strong>Conclusions & inferences: </strong>This meta-analysis reveals that a significantly higher proportion of DGBI patients experienced deterioration of symptoms during the COVID-19 pandemic. Various sociocultural, economic and environmental factors potentially modify the effects of the COVID-19 pandemic on DGBI.</p>","PeriodicalId":19123,"journal":{"name":"Neurogastroenterology and Motility","volume":" ","pages":"e14878"},"PeriodicalIF":3.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141760017","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
Do antro-duodenal manometry parameters predict clinical response after gastric peroral endoscopic pyloromyotomy in refractory gastroparesis? 胃十二指肠测压参数能否预测难治性胃瘫患者经胃内镜幽门切开术后的临床反应?
IF 3.5 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-07-26 DOI: 10.1111/nmo.14879
K W E Sweerts, Z Mujagic, J W A Straathof, M J M Hereijgers, D Keszthelyi, J M Conchillo

Background: Gastric peroral endoscopic pyloromyotomy (G-POEM) is a promising therapeutic modality for refractory gastroparesis (GP). However, as characteristics of suitable patients for G-POEM remain unclear, antro-duodenal manometry (ADM) has been suggested to provide objective parameters for patient selection. The aim of the present study was to identify ADM parameters as predictors for treatment response after G-POEM in refractory GP.

Methods: Refractory GP patients who underwent a G-POEM between 2017 and 2022 were included. The following ADM parameters were mainly scored: antral hypomotility, pylorospasm, and the presence of neuropathic enteric patterns. Treatment response was defined as a GCSI-score decrease of ≥1 point 12 months after G-POEM. Explorative analyses were performed on potential predictors of response using logistic regression analysis.

Key results: Sixty patients (52 women, mean age 52 ± 14 years.) with refractory GP (33 idiopathic, 16 diabetic, 11 postsurgical) were included. Clinical response data were available for 52 patients. In 8 out of 60 patients, it was not feasible to advance the catheter beyond the pylorus. Abnormal ADM was found in 46/60 patients (77%). Antral hypomotility and pylorospasm were found in respectively 33% and 12% of patients. At least one neuropathic enteric dysmotility pattern was found in 58% of patients. No differences were found when comparing baseline ADM parameters between clinical response groups at 12 months follow-up. Following explorative analyses, no ADM parameters were identified to predict clinical response 12 months after G-POEM.

Conclusions and inferences: No ADM parameters were identified as predictors of clinical response after G-POEM in refractory GP patients. Additionally, a high percentage of abnormal ADM tracings was found, in particular with relation to enteric dysmotility, while only a low percentage of patients showed antral hypomotility or pylorospasm.

背景:胃经口内镜幽门切开术(G-POEM)是治疗难治性胃瘫(GP)的一种很有前景的方法。然而,由于适合 G-POEM 的患者特征仍不明确,因此有人建议使用反十二指肠测压法(ADM)为患者选择提供客观参数。本研究旨在确定 ADM 参数,作为难治性 GP 患者接受 G-POEM 治疗后治疗反应的预测指标:纳入2017年至2022年间接受G-POEM的难治性GP患者。主要对以下 ADM 参数进行评分:前胃蠕动减弱、幽门痉挛和是否存在神经性肠道模式。治疗反应定义为 G-POEM 治疗 12 个月后 GCSI 评分下降≥1 分。利用逻辑回归分析对反应的潜在预测因素进行了探索性分析:共纳入 60 名难治性 GP 患者(52 名女性,平均年龄为 52 ± 14 岁)(33 名特发性患者,16 名糖尿病患者,11 名手术后患者)。52 名患者有临床反应数据。60 例患者中有 8 例无法将导管推进到幽门以外。在 46/60 例患者(77%)中发现 ADM 异常。分别有 33% 和 12% 的患者发现前胃运动减弱和幽门痉挛。58% 的患者至少发现一种神经性肠道运动障碍模式。在随访 12 个月时,比较临床反应组之间的 ADM 基线参数未发现差异。经过探索性分析,没有发现 ADM 参数可预测 G-POEM 12 个月后的临床反应:结论和推论:在难治性GP患者接受G-POEM治疗后,未发现任何ADM参数可预测临床反应。结论和推论:在难治性 GP 患者中,未发现 ADM 参数可预测 G-POEM 后的临床反应。此外,发现 ADM 曲线异常的比例较高,尤其是与肠道运动障碍有关的异常,而只有较低比例的患者表现为前胃运动功能减退或幽门痉挛。
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引用次数: 0
Polysaccharide extracted from Atractylodes macrocephala improves the spleen deficiency constipation in mice by regulating the gut microbiota to affect the 5-HT synthesis. 从白术中提取的多糖通过调节肠道微生物群来影响5-羟色胺的合成,从而改善小鼠脾虚性便秘。
IF 3.5 3区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-07-30 DOI: 10.1111/nmo.14875
Lei Chen, Xiangbing Chang, Chuntao Wu, Guofu Luo, Peifeng Zhang, Wei Tian

Background: The traditional herbal medicine Atractylodes macrocephala Koidz. (A. macrocephala) is commonly utilized for alleviating symptoms associated with spleen deficiency, abdominal distension, diarrhea, and constipation. These pharmacological effects are attributed to a variety of active constituents. However, the specific bioactive compounds responsible for promoting defecation and gastrointestinal transit in A. macrocephala remain unidentified.

Methods: The primary polysaccharide characteristics of PAMK was elucidated by HPLC, FT-IR, and HGPGC. Efficacy of PAMK (0.07, 0.14, and 0.28 mg/g) on mice was evaluated in a spleen deficiency constipation mouse model by analyzing stool parameters, constipation-related physiological indexes, and SCFAs. The expression levels of 5-HT3R, 5-HT4R, and related receptor genes were examined by RT-qPCR, and neurotransmitters were examined using ELISA. Finally, the diversity of gut microbiota was analyzed with 16S rDNA sequencing.

Key results: The results showed that PAMK significantly reduced the gastrointestinal transport time and increased the number of fecal pellets and fecal water content in spleen deficiency constipation model mice. PAMK kept the balance of 5-HT, SCFAs, TPH-1, SERT, CgA, and neurotransmitter levels (VIP, SP, MTL) in mice colon. In addition, PAMK could regulate the abundance of gut microbiota such as Alistopes, Bacteroides, and Odoribacter in spleen deficiency constipation model mice gut.

Conclusions and inferences: It can be concluded that PAMK effectively ameliorated the symptoms of spleen deficiency constipation in mice by modulating the expression of 5-HT and its associated receptors. The underlying mechanism was elucidated, providing a solid theoretical foundation for the therapeutic application of A. macrocephala in treating spleen deficiency constipation and offering potential for developing novel approaches to address this condition.

背景介绍传统草药白术(Atractylodes macrocephala Koidz.(Atractylodes macrocephala Koidz)常用于缓解与脾虚、腹胀、腹泻和便秘有关的症状。这些药理作用归功于多种活性成分。然而,大黄花中促进排便和胃肠道转运的特定生物活性化合物仍未确定:方法:通过高效液相色谱法(HPLC)、傅立叶变换红外光谱法(FT-IR)和 HGPGC 法阐明了 PAMK 的主要多糖特征。在脾虚便秘小鼠模型中,通过分析粪便参数、便秘相关生理指标和 SCFAs,评估了 PAMK(0.07、0.14 和 0.28 mg/g)对小鼠的疗效。通过 RT-qPCR 检测了 5-HT3R、5-HT4R 和相关受体基因的表达水平,并使用 ELISA 检测了神经递质。最后,通过 16S rDNA 测序分析了肠道微生物群的多样性:结果表明,PAMK能显著缩短脾虚便秘模型小鼠的胃肠运输时间,增加粪便颗粒数和粪便含水量。PAMK能维持小鼠结肠中5-羟色胺、SCFAs、TPH-1、SERT、CgA和神经递质(VIP、SP、MTL)水平的平衡。此外,PAMK还能调节脾虚便秘模型小鼠肠道微生物群的丰度,如Alistopes、Bacteroides和Odoribacter等:可以得出结论:PAMK通过调节5-羟色胺及其相关受体的表达,有效地改善了小鼠脾虚便秘的症状。阐明了其潜在机制,为大戟科植物治疗脾虚便秘提供了坚实的理论基础,并为开发治疗脾虚便秘的新方法提供了可能。
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引用次数: 0
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Neurogastroenterology and Motility
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