Neurogastroenterology and Motility最新文献

Background: Current clinical guidelines for chronic constipation offer limited dietary recommendations. The aim of this project was to develop the first comprehensive evidence-based dietary guidelines for the management of chronic constipation in adults.

Methods: Four systematic reviews and meta-analyses were performed to identify eligible randomized controlled trials (RCTs). The findings generated from the meta-analyses were then used to develop guideline statements using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach and a Delphi consensus survey among a multidisciplinary expert Guideline Steering Committee. Recommendation statements were produced for treatment response, stool output, gut symptoms, adverse events, and quality of life, and only based on the findings where ≥ 2 RCTs contributed to the meta-analysis. The strength of recommendation was assessed using the GRADE approach. Consensus voting among the Guideline Steering Committee was performed using a modified Delphi survey approach.

Results: The four systematic reviews included a total of 75 RCTs. Fifty-nine dietary recommendation statements were generated and accepted through the Delphi survey. For dietary supplements, 15 recommendation statements relate to fiber supplements, 20 relate to probiotics, two to synbiotics, five to magnesium oxide, two to senna, and three to kiwifruit supplements. For foods, three recommendation statements related to kiwifruits, two to prunes, and two to rye bread. For drinks, five recommendation statements related to high mineral-containing water. No recommendations were made for whole diet approaches due to lack of evidence. Twelve statements had a very low level of evidence, 39 had a low level of evidence, and eight had moderate evidence. Twenty-seven statements were strong recommendations, and 32 were qualified recommendations.

Conclusions: These are the first comprehensive evidence-based dietary guidelines for the management of constipation based upon a robust systematic review and GRADE processes. Recommendations were made for dietary supplements, foods, and drinks that have never been previously included in clinical guidelines, and can now be rapidly implemented into clinical practice, thereby improving clinical care and patient outcomes.

Background: During the COVID-19 pandemic, the prevalence of disorders of gut-brain interaction (DGBI) in the US increased. The pandemic also led to health inequities among racial and ethnic minorities. Here, we conducted monthly national surveys during the pandemic to examine the association between race/ethnicity and pandemic-onset DGBI.

Methods: From March 2021 to May 2022, we recruited a nationally representative sample of adults in the US to complete an online survey with Rome IV questionnaires (9 gastroduodenal and bowel DGBI) along with demographic and comorbidity questions. Participants with a DGBI were asked whether their cardinal symptoms started before or after the COVID-19 pandemic began in the US (March 2020). Our primary outcome was the prevalence of pandemic-onset DGBI. Multivariable logistic regression models identified factors associated with pandemic-onset DGBI. We also tested for an interaction between race/ethnicity and COVID-19 positivity to assess whether the relationship between pandemic-onset DGBI and race/ethnicity varied by COVID-19 status.

Results: Among 71,547 respondents, 26,103 (36.5%) had ≥ 1 DGBI. Across most DGBI, non-Hispanic Blacks and Hispanics had higher odds for pandemic-onset DGBI (e.g., irritable bowel syndrome, functional dyspepsia, functional bloating) versus non-Hispanic Whites. When including interaction terms between race/ethnicity and COVID-19 positivity, most were not significant (p > 0.05), showing that the relationship between pandemic-onset DGBIs and race/ethnicity did not vary by COVID-19 status.

Conclusions: In this US survey, racial/ethnic minorities had higher odds of reporting pandemic-onset DGBI. This association was independent of COVID-19 positivity, suggesting that differences in pandemic-onset DGBI among groups may be related to psychosocial challenges faced by racial/ethnic minorities rather than direct effects of SARS-CoV-2.

Background: During pre-bariatric surgery evaluation, we routinely perform objective testing for GERD (endoscopy, pH monitoring if no reflux esophagitis found) with high-resolution manometry (HRM) and functional lumen imaging probe (FLIP) to evaluate esophageal motility. In this study, we aimed to identify differences in FLIP metrics between obese patients with and without GERD.

Methods: We reviewed our clinical database of obese patients evaluated for bariatric surgery, including surgery-naïve patients and patients who had sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) that resulted in inadequate weight loss. We recorded GERD symptoms, HRM findings, and FLIP metrics (EGJ-diameter, distensibility index, and contractile response patterns). Patients with reflux esophagitis or acid exposure time (AET) > 6% were considered GERD+; those with AET ≤ 6% were deemed GERD.

Key results: We included 160 patients (mean age 50.2 ± 12.4 years; 79% women; 66 surgery-naïve) (29 GERD-, 37 GERD+), 70 SG (20 GERD-, 50 GERD+), 24 RYGB (16 GERD-, 8 GERD+). FLIP abnormalities were frequent, including reduced EGJ opening (REO) (12.1% surgery-naïve, 14.3% SG, 12.5% RYGB) and abnormal contractile response (59.1% surgery-naïve, 71.4% SG, 62.5% RYGB). FLIP differences were found between GERD+ and GERD- patients: REO (8.0% vs. 30.0%, p = 0.02) and BCR (2.0% vs. 15.0%, p = 0.02) were both less frequent in GERD+ than in GERD- SG patients. SRCR was more frequent in GERD- than in GERD+ surgery-naïve patients (31.0% vs. 5.4%, p = 0.01).

Conclusions: While FLIP differences between GERD- and GERD+ patients exist, there were no FLIP metrics that clearly predicted GERD in obese patients either before or after bariatric surgery.

Background: Neurogenic fecal incontinence (NFI) is a disorder of anal dysfunction caused by nerve damage. Electroacupuncture (EA), grounded in Traditional Chinese Medicine (TCM) theory, has demonstrated efficacy in treating various degenerative disorders and is extensively utilized in the clinical management of neurogenic FI. The proliferation and differentiation of muscle satellite cells (SCs) are crucial in the onset and progression of this condition. However, the specific mechanism of electroacupuncture in treating neurogenic fecal incontinence is not yet clear. This study sought to determine whether EA could enhance anal function in rats with neurogenic FI and to elucidate its mechanisms of action.

Methods: We observed the effect of electroacupuncture on anorectal function in rats with neurogenic fecal incontinence and its mechanism of action.

Key results: The morphology and arrangement of anal sphincter muscle fibers were altered due to pudendal nerve injury. The expression levels of two atrophy markers, Muscle-specific RING finger protein 1 (MuRF-1) and Atrogin-1, were elevated in the anal sphincter muscles, and shifts were seen from slow-twitch to fast-twitch muscle fibers. Post EA treatment, the expression levels of atrophy markers were reversed; the proportion of slow-twitch fibers in the muscles increased, and the expressions of Pax3 and Myod1, which had decreased 3 weeks post-injury, significantly increased and gradually normalized.

Conclusions & inferences: These results indicate that EA effectively ameliorates anal function in rats with neurogenic FI, primarily through mechanisms that involve the activation of muscle SCs.

Background: The circadian rhythm regulates gastrointestinal motility. In humans and preclinical models, such as rodents, whole gut transit (WGT) is slower during the rest phase compared to the active phase. Investigators typically study GI transit in rodents during the day, which is their rest phase, rather than during the night, which is their active phase. A circadian rhythm reversal in which mice are in a dark room during the working day (reverse light) allows studies on nocturnal animals during their active phase and has been previously shown to reduce WGT time. GI motility is often disrupted in individuals with disorders of gut-brain interaction (DGBI), which are female predominant. However, the effect of circadian rhythm on regional transit and sex dependence of the differences is not known, as most motility studies looking at circadian rhythm reversal are done in male mice.

Methods: We tested C57BL/6 wild-type male and female mice in rest (12 h of light during the day) and active (reverse cycle for 2 weeks: 12 h of dark during the day) phases. We noted female estrous cycle by visual inspection. We performed carmine WGT by monitoring time-lapse videos of pellet production. We performed fluorescence imaging of excised intestines 30 min after gavage to assess percent fluorescence for each GI region and then examined small intestinal transit (SIT) by measuring geometric center and leading edge. For colonic transit, we monitored bead expulsion time from distal colon to anus.

Key results: Compared to rest phase, in the active phase, like male mice, female mice had (1) faster WGT, (2) increased frequency of pellet expulsion in the first 3 h of transit, (3) and greater total pellet production. Both male and female mice in their active phase exhibited (4) more contrast emptied from the stomach and they had (5) further leading edge of fluorescence and (6) geometric center, in SIT, and (7) faster colonic bead expulsion times. There were no significant sex differences in the active phase of WGT. In SIT, male mice had further leading edge in the rest phase than female mice, but this difference was not seen in the active phase, and in colonic transit, male mice in both the active and rest phases had faster bead expulsion than female mice.

Conclusions: Mice in the active phase have faster regional transit in small and large bowel than mice in the rest phase that collectively contributes to faster WGT times in the active phase of both male and female mice. These findings highlight the importance of circadian biology in sex-dependent rodent GI transit.

Backgrounds: Diverticular disease, particularly symptomatic uncomplicated diverticular disease (SUDD), significantly impacts patient quality of life and is increasing in prevalence, especially in Western countries. While its pathophysiology is multifactorial, diet-specifically low fiber intake-has been implicated as a key modifiable factor in disease development and progression. Fibers influence colonic motility and stool composition, potentially reducing the formation of diverticula and symptom severity. Polyphenols, bioactive compounds with antioxidant and anti-inflammatory properties, may further protect intestinal integrity and modulate gut microbiota.

Purpose: This narrative review explores emerging evidence on the role of dietary fiber and polyphenols in SUDD management. Despite promising mechanistic insights, current studies are limited by heterogeneity and methodological constraints. Personalized nutritional strategies focusing on fiber and polyphenol-rich foods warrant further investigation to optimize therapeutic outcomes in SUDD.

Fennel tea has a region-specific effect on the stomach motility. It relaxes the fundus and the corpus and acts pro-motility in the antrum. The store operated Ca2+ entry blocker SKF-96365 hampers the spasmolytic effect of fennel tea in the fundus and corpus. The image was created using Biorender.

Background: Disorders of gut-brain interaction (DGBI) are associated with reduced health-related quality of life (HRQoL) and psychological disorders. Among individuals with DGBI, abdominal pain correlates with increased healthcare-seeking and analgesic use. This study aimed to evaluate the influence of pain as a cardinal symptom on HRQoL and psychological disorders.

Methods: This is a sub-analysis of data from four Latin American countries included in the Rome Foundation Global Epidemiology Study (RFGES). DGBI were classified into (1) painful DGBI, including individuals with diagnoses characterized by pain as a primary symptom, and (2) non-painful DGBI, including individuals with only non-painful diagnoses. Prevalence rates, healthcare-seeking behavior, HRQoL (Patient-Reported Outcomes Measurement Information System Global-10 [PROMIS Global-10]), anxiety and depression (Patient Health Questionnaire-4 [PHQ-4]) and somatization (Patient Health Questionnaire-12 [PHQ-12]) were compared.

Key results: A total of 8069 participants from the four countries completed the RFGES online survey, including 1132 in the painful group and 1720 in the non-painful group. Participants with painful DGBI more commonly sought healthcare at least monthly compared to those with non-painful disorders (18.6% vs. 14.9%). Painful disorders were associated with significantly lower HRQoL scores and higher PHQ-4 and PHQ-12 scores, both in unadjusted and adjusted analyses (sex, age, education, and community size).

Conclusion and inferences: In four Latin American countries, individuals with painful DGBI were more likely to seek healthcare, had worse HRQoL and exhibited greater psychological distress compared to those with non-painful DGBI. These findings highlight the need for targeted interventions for individuals with painful DGBI symptoms.

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.