AIM： To compare efficacy of proton pump inhibitors （PPIs） with H2-receptor antagonists （H2RA$） plus pro- kinetics （Proks） for dysmotility-like symptoms in func- tional dyspepsia （FD）. METHODS： Subjects were ...AIM： To compare efficacy of proton pump inhibitors （PPIs） with H2-receptor antagonists （H2RA$） plus pro- kinetics （Proks） for dysmotility-like symptoms in func- tional dyspepsia （FD）. METHODS： Subjects were randomized to receive openlabel treatment with either rabeprazole 10 mg od （n = 57） or famotidine 10 mg bid plus mosapride 5 mg tid （n = 57） for 4 wk. The primary efficacy endpoint was change （%） from baseline in total dysmotility-like dyspepsia symptom score. The secondary efficacy endpoint was patient satisfaction with treatment. RESULTS： The improvement in dysmotility-like dyspep- sia symptom score on day 28 was significantly greater in the rabeprazole group （22.5% ± 29.2% of baseline） than the famotidine ＋ mosapride group （53.2%±58.6% of baseline, P 〈 0.0001）. The superior benefit of rabeprazole treatment after 28 d was consistent regardless of Helicobacter pylori status. Significantly more subjects in the rabeprazole group were satisfied or very satisfied with treatment on day 28 than in the famotidine ＋ mosapride group （87.7% vs 59.6%, P = 0.0012）. Rabeprazole therapy was the only significant predictor of treatment response （P 〈 0.0001）, defined as a total symptom score improvement ≥ 50%. CONCLUSION： PPI monotherapy improves dysmotil- ity-like symptoms significantly better than H2RAs plus Proks, and should be the treatment of first choice for Japanese FD.展开更多
The detailed process and mechanism of colonic motility are still unclear, and colonic motility disorders are associated with numerous clinical diseases. Colonic manometry is considered to the most direct means of eval...The detailed process and mechanism of colonic motility are still unclear, and colonic motility disorders are associated with numerous clinical diseases. Colonic manometry is considered to the most direct means of evaluating colonic peristalsis. Colonic manometry has been studied for more than 30 years;however, the long duration of the examination, high risk of catheterization, huge amount of real-time data, strict catheter sterilization, and high cost of disposable equipment restrict its wide application in clinical practice. Recently, highresolution colonic manometry (HRCM) has rapidly developed into a major technique for obtaining more effective information involved in the physiology and/or pathophysiology of colonic contractile activity in colonic dysmotility patients. This review focuses on colonic motility, manometry, operation, and motor patterns, and the clinical application of HRCM. Furthermore, the limitations, future directions, and potential usefulness of HRCM in the evaluation of clinical treatment effects are also discussed.展开更多
AIM: To investigate the effects of Japanese apricot(JA) consumption on gastroesophageal reflux disease(GERD)-related symptoms.METHODS: Participants included individuals living in Minabe-cho,a well-known JA-growing reg...AIM: To investigate the effects of Japanese apricot(JA) consumption on gastroesophageal reflux disease(GERD)-related symptoms.METHODS: Participants included individuals living in Minabe-cho,a well-known JA-growing region,who received specific medical check-ups by the local community health service in 2010.GERD-related symptoms were examined in 1303 Japanese individuals using a validated questionnaire,the Frequency Scale for Symptoms of GERD(FSSG),which consists of 7 questions associated with acid reflux symptoms and 5 questions asking about gastrointestinal dysmotility symptoms.Each question was answered using a 4-point scale,with higher scores indicating more severe GERDrelated symptoms.Subjects were divided into two groups according to their intake of dried and pickled JA: daily intake(≥ 1 JA daily)(392 subjects) and none oroccasional intake(< 1 JA daily)(911 subjects).FSSG scores were compared between subjects who consumed JA daily and those who did not.Next,subjects were stratified by age,gender and Helicobacter pylori(H.pylori) status for subanalyses.RESULTS: Those who ate JA daily were significantly older than those who did not(60.6 ± 10.5 years vs 56.0 ± 11.0 years,P < 0.001).Total FSSG scores were significantly lower in subjects with daily JA intake than in those with none or only occasional intake(2.13 ± 3.14 vs 2.70 ± 3.82,P = 0.005).In particular,subjects who consumed JA daily showed significantly improved FSSG dysmotility scores compared with subjects who did not(1.05 ± 1.58 vs 1.46 ± 2.11,P < 0.001).In contrast,the FSSG reflux score did not differ between subjects with and without daily intake of JA(1.08 ± 1.90 vs 1.24 ± 2.11,P = 0.177).Subanalysis indicated that improvement in dysmotility by JA intake was specifically observed in non-elderly(1.24 ± 1.68 vs 1.62 ± 2.22,P = 0.005) and H.pylori-negative subjects(0.99 ± 1.58 vs 1.57 ± 2.06,P < 0.001).GERD patients(total FSSG score ≥ 8) were less frequently observed among subjects with daily intake of JA as compared to those without daily intake of JA(6.1% vs 9.7%,P = 0.040).CONCLUSION: Daily JA intake may improve digestive dysmotility symptoms,resulting in relief of GERD symptoms.The effect is more obvious in non-elderly and H.pylori-negative subjects.展开更多
Objective To investigate the effect of erythromycin on the contractive activity of the isolated gastric antrum smooth muscle and somatostatin （SS）, vasoactive intestinal peptide （VIP）, motilin （MTL）, and substan...Objective To investigate the effect of erythromycin on the contractive activity of the isolated gastric antrum smooth muscle and somatostatin （SS）, vasoactive intestinal peptide （VIP）, motilin （MTL）, and substance P （SP） in plasma and isolated gastric antrum tissue of diabetes mellitus （DM） rat models. Methods Thirty male Sprague-Dawley rats were divided into three groups： control group （n = 10）, DM group （n = 10）, and erythromycin group （DM models with erythromycin treatment, n = 10）. A single dose of streptozotocin （100 mg/kg, dissolved in 0. I mol/L citric acid buffer, pH4.5） was injected intraperitoneally. After 48 to 72 hours, rats with blood glucose above 16.7 mmol/L and urine glucose level to be （＋＋＋ ） to （＋＋＋＋） over one week were considered successful DM models. The resting tension, mean contractile amplitude and fi＇equency of spontaneous change in isolated longitudinal and circular gastric antrum smooth muscle strips were measured. SS, VIP, MTL, and SP levels in plasma and gastric antrum tissue were measured using radioimmunoassay. Results （1） In the isolated gastric antrum smooth muscle strips, the gastric motility parameters were lower in DM group than those in control group except circular smooth muscle contractile amplitude and longitudinal smooth muscle contractile fi＇equency. The gastric motility parameters were significantly strengthened in erythromycin group, compared with DM group except longitudinal smooth muscle resting tension （P 〈 0.01 ）. （2） Plasma SS, VIP, and MTL concentrations in DM group were higher than those in control （P 〈 0.05）, while the SP level decreased （P 〈 0.05）. In the gastric antrum, SS of DM group was significantly higher than that of control group （P 〈 0.01 ）, while SP and MTL levels were lower than those of control group （P 〈 0.05 and P 〈 0.01, respectively）. However, the level of VIP in gastric antrum tissue did not change among three groups. The plasma level of SS in erythromycin group was higher than that of DM group （P 〈 0.05）. （3） The blood glucose was lower in erythromycin group than DM group （P 〈 0.01 ）. Conclusions Erythromycin has direct effects on contractive activity of gastric smooth muscle in diabetic rats, but there are few effects on neuroendocrine peptides. Gastric-motility disorders in diabetic rats have a correlation with the changes of neuroendocrine peptide levels in plasma and gastric antrum tissue.展开更多
BACKGROUND Peroral endoscopic myotomy is an increasingly used less invasive modality to treat esophageal dysmotility.Recently,triangular tip knife with integrated water jet function has been introduced to mitigate mul...BACKGROUND Peroral endoscopic myotomy is an increasingly used less invasive modality to treat esophageal dysmotility.Recently,triangular tip knife with integrated water jet function has been introduced to mitigate multiple instrument exchanges.AIM To compare traditional triangular tip knife and water jet knife in terms of procedural success,duration,instrument exchanges,coagulation forceps use,and adverse events.METHODS We conducted a systemic review and meta-analysis with two authors independently in electronic databases(PubMed,Embase,and Cochrane Library)from inception through May 2021.In addition,we conducted a relevant search by Reference Citation Analysis(RCA)(https://www.referencecitationanalysis.com).A fixed-effects model was used to calculate weighted mean,odds ratio(OR),and confidence intervals(CI).RESULTS We included 7 studies involving 558 patients.Triangular knife and water jet knife were similar in odds of procedural success with ratio of 4.78(95%CI=0.22-102.47)and odds of clinical success with ratio of 0.93(95%CI=0.29-2.97),respectively.Water jet knife had fewer instrument exchanges compared to triangular knife(2.21,95%CI=1.98-2.45 vs 11.9,95%CI=11.15-12.70)and usage of coagulation forceps(1.75,95%CI=1.52-1.97 vs 2.63,95%CI=2.37-2.89).Adverse events were higher in triangular knife group(OR:2.30,95%CI=1.35-3.95).CONCLUSION Peroral endoscopic myotomy using water jet knife is comparable in terms of pro cedural success to triangular tip knife.Water jet knife also required shorter procedural duration,less instrument exchanges,coagulation devices,and overall adverse events.展开更多
When kidney function declines to a point where it can no longer maintain life and requires renal replacement therapy(i.e.renal transplant or dialysis),it is called end-stage renal disease(ESRD).Patients with ESRD ofte...When kidney function declines to a point where it can no longer maintain life and requires renal replacement therapy(i.e.renal transplant or dialysis),it is called end-stage renal disease(ESRD).Patients with ESRD often experience a range of gastrointestinal(GI)symptoms,with prevalence rates reported as high as 77%-79%.These symptoms and pathologies arise from various factors,including electrolyte imbalance,fluid imbalance,toxin buildup,uremia,medications,dietary and lifestyle restrictions,and the effects of dialysis.GI diseases in patients with renal failure can be further categorized into upper GI,small bowel,and lower GI issues.Common conditions include gastroesophageal reflux disease,nausea and vomiting,dysmotility within the esophagus and stomach,upper GI bleeding,peptic ulcer bleeding,angioectasia,irritable bowel syndrome,mesen-teric ischemia,angiodysplasia,diverticular disease,constipation,pancreatitis,and diseases associated with peritoneal dialysis peritonitis and peritoneal stenosis.This review assesses the existing literature on the different GI diseases among individuals with ESRD,shedding light on their pathophysiology and prevalence.展开更多
BACKGROUND The pathophysiology behind gastroesophageal reflux disease and its association with poor outcomes after lung transplantation is incompletely understood.The physiologic impact of lung transplantation on pulm...BACKGROUND The pathophysiology behind gastroesophageal reflux disease and its association with poor outcomes after lung transplantation is incompletely understood.The physiologic impact of lung transplantation on pulmonary function,intrathoracic pressures,and vagal innervation may affect esophageal motility,bolus clearance and reflux risk.However,the effect of changes in esophageal function after lung transplantation on the risk of poor post-transplant outcomes remains unclear.AIM To evaluate the association between change in esophageal motility pre-/post-lung transplantation and rejection outcome.METHODS This was a retrospective cohort study of lung transplant recipients who underwent both pre-and post-transplant esophageal testing including high resolution manometry(HRM)at a tertiary center.Acute cellular rejection(ACR)was defined histologically per International Society for Heart and Lung Transplantation criteria.Univariate analyses were performed using student’s t-test,χ2 test,and Spearman’s correlation where appropriate.Multivariable time-to-event analysis using Cox proportional hazards model was applied.Subjects not meeting ACR outcome were censored at death or date of last clinic visit.RESULTS 55 subjects(65%men,mean age:61,median follow-up:840 days)were included,with 17 (31%) experiencing ACR. Increase in failed swallows correlated with lower baseline total lung capacity(TLC) (R = -0.32, P = 0.05) and decreased post-transplant esophageal bolus clearance (R = -0.45, P = 0.004). Onmultivariable analysis, post-transplant hypomotility independently predicted increased ACR (HR: 3.62, 95%CI:1.11-11.8;P = 0.03). Kaplan-Meier analysis demonstrated increased ACR for subjects with increased vs unchangedfailed swallows post-transplant (P = 0.048). On Cox regression, a 20% elevated risk of ACR was found for every10% increase in failed swallows, after controlling for confounders including reflux severityCONCLUSIONEsophageal hypomotility, specifically an increase in failed swallows on HRM, from pre- to post-lungtransplantation was independently associated with ACR. Additionally, lower baseline TLC correlated with increasein failed swallows, suggesting restrictive lung disease may be associated with post-transplant esophagealhypomotility. Lung transplantation may affect esophageal function and contribute to rejection outcomes. Routineesophageal function testing may help identify patients at higher risk for poor lung transplantation outcomes.展开更多
BACKGROUND We previously identified miR-10b-5p as a key regulator of gastrointestinal(GI)motility through its essential role in the development and function of interstitial cells of Cajal(ICC),the pacemaker cells of t...BACKGROUND We previously identified miR-10b-5p as a key regulator of gastrointestinal(GI)motility through its essential role in the development and function of interstitial cells of Cajal(ICC),the pacemaker cells of the gut.Loss of miR-10b-5p in ICC im-pairs intestinal motility and contributes to constipation,a common condition in the elderly.Notably,miR-10b-5p is co-expressed with its paralog,miR-10a-5p,in ICC.AIM To investigate the roles of miR-10a-5p and miR-10b-5p in age-associated intestinal dysmotility and assess the therapeutic potential of restoring their expression.METHODS We employed aged mice,mir-10a and mir-10b single and double knockout(KO)models,and human plasma and colon samples across age groups.GI and colonic transit,ICC network integrity,and expression levels of miR-10a/b-5p were eva-luated.Additionally,we tested whether treatment with their microRNA mimics could restore GI motility in aged mice.RESULTS Aged mice exhibited delayed GI and colonic transit,reduced fecal output,and diminished expression of miR-10a-5p and miR-10b-5p,which peaked during late embryonic and early postnatal stages and declined with age.This decline para-lleled ICC network deterioration in the colon.All KO models exhibited impaired motility and ICC loss,with mir-10a KO mice displaying more severe phenotypes than mir-10b KO mice.Double KO mice demonstrated growth retardation and reduced survival,with homozygous mutants living only up to 3 months.Treatment of aged mice with miR-10a-5p and miR-10b-5p mimics encapsu-lated in jetPEI significantly improved GI and colonic motility.Successful delivery to the gut,including the colon,was confirmed.In human samples,both miR-10a/b-5p and KIT expression decreased with age.CONCLUSION miR-10a-5p and miR-10b-5p are essential for ICC maintenance and colonic motility,and their age-related decline contributes to GI dysmotility in both mice and humans.Restoring their levels offers a promising therapeutic stra-tegy for treating age-related constipation and other motility disorders.展开更多
Irritable bowel syndrome(IBS) is a common gastrointestinal disorder that is generally considered to be functional because there appears to be no associated anatomical defect. Stress and psychological factors are thoug...Irritable bowel syndrome(IBS) is a common gastrointestinal disorder that is generally considered to be functional because there appears to be no associated anatomical defect. Stress and psychological factors are thought to play an important role in IBS. The gut neuroendocrine system(NES),which regulates all functions of the gastrointestinal tract,consists of endocrine cells that are scattered among the epithelial cells of the mucosa,and the enteric nervous system. Although it is capable of operating independently from the central nervous system(CNS),the gut NES is connected to and modulated by the CNS. This review presents evidence for the presence of an anatomical defect in IBS patients,namely in the gastrointestinal endocrine cells. These cells have specialized microvilli that project into the lumen and function as sensors for the luminal content and respond to luminal stimuli by releasing hormones into the lamina propria,which starts a chain reaction that progresses throughout the entire NES. The changes in the gastrointestinal endocrine cells observed in IBS patients are highly consistent with the other abnormalities reported in IBS patients,such as visceral hypersensitivity,dysmotility,and abnormal secretion.展开更多
This review provides information on the definition of constipation, normal continence and defecation and a description of the pathophysiologic mechanisms of constipation. In addition, changes in the anatomy and physio...This review provides information on the definition of constipation, normal continence and defecation and a description of the pathophysiologic mechanisms of constipation. In addition, changes in the anatomy and physiology of the lower gastrointestinal tract associated with aging that may contribute to constipation are described. MEDLINE (1966-2007) and CINAHL (1980-2007) were searched. The following MeSH terms were used: constipation/etiology OR constipation/ physiology OR constipation/physiopathology) AND (age factors OR aged OR older OR 80 and over OR middle age). Constipation is not well defined in the literature. While self-reported constipation increases with age, findings from a limited number of clinical studies that utilized objective measures do not support this association. Dysmotility and pelvic floor dysfunction are important mechanisms associated with constipation. Changes in GI function associated with aging appear to be relatively subtle based on a limited amount of conflicting data. Additional research is warranted on the effects of aging on GI function, as well as on the timing of these changes.展开更多
The global prevalence of diabetes mellitus is increasing; arguably as a consequence of changes in diet, lifestyle and the trend towards urbanization. Unsurprisingly, the incidence of both micro and macrovascular compl...The global prevalence of diabetes mellitus is increasing; arguably as a consequence of changes in diet, lifestyle and the trend towards urbanization. Unsurprisingly, the incidence of both micro and macrovascular complications of diabetes mirrors this increasing prevalence. Amongst the complications with the highest symptom burden, yet frequently under-diagnosed and sub-optimally treated, is diabetic autonomic neuropathy, itself potentially resulting in cardiovascular autonomic neuropathy and gastrointestinal(GI) tract dysmotility. The aims of this review are fourfold. Firstly to provide an overview of the pathophysiological processes that cause diabetic autonomic neuropathy. Secondly, to discuss both the established and emerging cardiometric methods for evaluating autonomic nervous system function in vivo. Thirdly, to examine the tools for assessing pan-GI and segmental motility and finally, we will provide the reader with a summary of putative non-invasive biomarkers that provide a pathophysiological link between lowgrade neuro inflammation and diabetes, which may allow earlier diagnosis and intervention, which in future may improve patient outcomes.展开更多
Gastrointestinal(GI) dysmotility is a common problemin the critically ill population. It can be a reflection and an early sign of patient deterioration or it can be an independent cause of morbidity and mortality. GI ...Gastrointestinal(GI) dysmotility is a common problemin the critically ill population. It can be a reflection and an early sign of patient deterioration or it can be an independent cause of morbidity and mortality. GI dysmotility can be divided for clinical purposes on upper GI dysmotility and lower GI dysmotility. Upper GI dysmotility manifests by nausea, feeding intolerance and vomiting; its implications include aspiration into the airway of abdominal contents and underfeeding. Several strategies to prevent and treat this condition can be tried and they include prokinetics and post-pyloric feeds. It is important to note that upper GI dysmotility should be treated only when there are clinical signs of intolerance(nausea, vomiting) and not based on measurement of gastric residual volumes. Lower GI dysmotility manifests throughout the spectrum of ileus and diarrhea. Ileus can present in the small bowel and the large bowel as well. In both scenarios the initial treatment is correction of electrolyte abnormalities, avoiding drugs that can decrease motility and patient mobilization. When this fails, in the case of small bowel ileus, lactulose and polyethylene glycol solutions can be useful. In the case of colonic pseudo obstruction, neostigmine, endoscopic decompression and cecostomy can be tried when the situation reaches the risk of rupture. Diarrhea is also a common manifestation of GI dysmotility and the most important step is to differentiate between infectious sources and non-infectious sources.展开更多
Hirschsprung’s disease(HSCR)is a congenital disorder characterized by failure of the neural crest cells to migrate and populate the distal bowel during gestation affecting different lengths of intestine leading to a ...Hirschsprung’s disease(HSCR)is a congenital disorder characterized by failure of the neural crest cells to migrate and populate the distal bowel during gestation affecting different lengths of intestine leading to a distal functional obstruction.Surgical treatment is needed to correct HSCR once the diagnosis is confirmed by demonstrating the absence of ganglion cells or aganglionosis of the affected bowel segment.Hirschsprung’s disease associated enterocolitis(HAEC)is an inflammatory complication associated with HSCR that can present either in the pre-or postoperative period and associated with increased morbidity and mortality.The pathogenesis of HAEC remains poorly understood,but intestinal dysmotility,dysbiosis and impaired mucosal defense and intestinal barrier function appear to play a significant role.There is no clear definition for HAEC,but the diagnosis is primarily clinical,and treatment is guided based on severity.Here,we aim to provide a comprehensive review of the clinical presentation,etiology,pathophysiology,and current therapeutic options for HAEC.展开更多
The esophagus is the most commonly affected part of the gastrointestinal system in patients with systemic sclerosis(SSc).Esophageal involvement may lead to a significant reduction in patient quality of life.The exact ...The esophagus is the most commonly affected part of the gastrointestinal system in patients with systemic sclerosis(SSc).Esophageal involvement may lead to a significant reduction in patient quality of life.The exact pathophysiology is complex and not yet fully elucidated.Ultimately,esophageal smooth muscle becomes atrophied and replaced by fibrous tissue leading to severe motility disturbance of the distal esophagus.Symptoms are mainly attributed to gastroesophageal reflux disease and to esophageal dysmotility.Compelling evidence has correlated esophageal involvement to the severity of pulmonary disease.No formed guidelines exist about the diagnostic modalities used to assess esophageal disease in patients with SSc,though upper gastrointestinal endoscopy is the first and most important modality used as it can reveal alterations commonly observed in patients with SSc.Further exploration can be made by high resolution manometry and pH-impedance study.Proton pump inhibitors remain the mainstay of treatment,while prokinetic agents are commonly used as add-on therapy in patients with symptoms attributed to gastroesophageal reflux disease not responding to standard therapy as well as to motility disturbances.Gastroesophageal reflux disease symptoms in patients with SSc are frequently difficult to manage,and new therapeutic modalities are emerging.The role of surgical treatment is restricted and should only be preserved for resistant cases.展开更多
Neuromuscular diseases(NMDs)affect the development and growth of the neuromuscular system in children.The pathology can occur anywhere along the neuromuscular pathway,from the brain to the nerves to the muscle fibers....Neuromuscular diseases(NMDs)affect the development and growth of the neuromuscular system in children.The pathology can occur anywhere along the neuromuscular pathway,from the brain to the nerves to the muscle fibers.These diseases have a profound impact on the quality of life not only of children but also of their families.The predominant manifestation in NMDs is hypotonia,which leads to muscle weakness and fatigue,reduced mobility,and decreased physical performance.However,multiple organ systems can be affected,with resulting orthopedic,cardiac,infectious,respiratory,and nutritional problems.Children with NMD present an increased risk for several dietary and feeding difficulties because of their neuromuscular diagnosis,presentation,and severity.These problems include chronic gastrointestinal issues(constipation,dysphagia,gastroesophageal reflux,and diarrhea),dysphagia,malnutrition,and body composition alterations.As a result,compared to the overall pediatric population,infants and children with NMD are more likely to be malnourished,ranging from failure to thrive to overweight or obesity.Disease-specific guidelines vary in level of detail and recommendations for dietary management.Overall,nutritional data available are sparse,with the exception of Duchenne muscular dystrophy,spinal muscular atrophy,and congenital muscular dystrophy.The purpose of this review is to describe the spectrum of nutritional challenges in children with NMD and to summarize the main dietary and gastrointestinal recommendations for each neuromuscular disorder to provide guidance for daily clinical practice.展开更多
Dysphagia lusoria is a term used to describe dysphagia secondary to vascular compression of the oesophagus. The various embryologic anomalies of the arterial brachial arch system often remain unrecognised and asymptom...Dysphagia lusoria is a term used to describe dysphagia secondary to vascular compression of the oesophagus. The various embryologic anomalies of the arterial brachial arch system often remain unrecognised and asymptomatic, but in 30%-40% of cases can result in tracheo-oesophageal symptoms, which in the majority of cases manifest as dysphagia. Diagnosis of dysphagia lusoria is via barium swallow and chest Computed tomography scan. Manometric abnormalities are variable, but age-related manometric changes may contribute to clinically relevant dysphagia lusoria in patients who present later in life. Our report describes a case of lateonset dysphagia secondary to a right aortic arch with an aberrant left subclavian artery, which represents a rare variant of dysphagia lusoria. The patient had proven additional oesophageal dysmotility with solid bolus only and a clinical response to dietary modification.展开更多
BACKGROUND Recently,a technique has been developed to use magnetic resonance enterography(MRE)for the evaluation of small bowel motility.The hypothesis was that assessment of the motility index(MI)should reflect diffe...BACKGROUND Recently,a technique has been developed to use magnetic resonance enterography(MRE)for the evaluation of small bowel motility.The hypothesis was that assessment of the motility index(MI)should reflect differences in motility between clinical conditions.AIM To aim of the present observational,cross-sectional study was to evaluate the use of the MI in daily clinical practice.METHODS All consecutive patients aged 18-70 years who were referred for MRE at the Department of Radiology during a 2-year period were asked to participate.Healthy volunteers were included as controls.MRE was prepared and conducted in accordance with clinical routines.On the day of examination,all the participants had to complete the visual analog scale for irritable bowel syndrome(IBS)and IBS-symptom severity scale.Maps of MI were calculated from dynamic MR images.ANOVA was used to evaluate differences in MI between groups,classified as healthy,Crohn’s disease,ulcerative colitis,IBS,other assorted disorders and dysmotility.Logistic and linear regression were applied to the MI values.All medical records were scrutinized for medical history.RESULTS In all,224 examinations were included(inclusion prevalence 76.3%),with 22 controls and 202 patients.There was a significant difference in the MI of the jejunum(P=0.021)and terminal ileum(P=0.007)between the different groups.The MI was inversely associated with the mural thickness of the terminal ileum in men(P<0.001)and women(P=0.063)after adjustments,and tended to be lower in men than in women(P=0.056).Subjectively observed reduction of motility on MRI was accomplished by reduced MI of terminal ileum in men(P<0.001)and women(P=0.030).In women,diarrhea was inversely associated with the MI of the jejunum(P=0.029),and constipation was positively associated with the MI of the terminal ileum(P=0.039).CONCLUSION Although MIs differ across diseases,a lower MI of the terminal ileum is mainly associated with male sex and an increased mural thickness.Symptoms are weakly associated with the MI.展开更多
Lymphocytic esophagitis(LyE) is a rare condition characterised histologically by high numbers of esophageal intraepithelial lymphocytes without significant granulocytes infiltration, in addition to intercellular edema...Lymphocytic esophagitis(LyE) is a rare condition characterised histologically by high numbers of esophageal intraepithelial lymphocytes without significant granulocytes infiltration, in addition to intercellular edema("spongiosis"). The clinical significance and natural history of LyE is poorly defined although dysphagia is reportedly the most common symptom. Endoscopic features range from normal appearing esophageal mucosa to features similar to those seen in eosinophilic esophagitis, including esophageal rings, linear furrows, whitish exudates, and esophageal strictures/stenosis. Symptomatic gastroesophageal reflux disease is an inconsistent association. LyE has been associated in paediatric Crohn's disease, and recently in primary esophageal dysmotility disorder in adults. There are no studies assessing effective treatment strategies for LyE; empirical therapies have included use of proton pump inhibitor and corticosteroids. Esophageal dilatation have been used to manage esophageal strictures. Ly E has been reported to run a benign course; however there has been a case of esophageal perforation associated with Ly E. Here, we describe the clinical, endoscopic and histopathological features of three patients with lymphocytic esophagitis along with a review of the current literature.展开更多
Disorders of esophageal motility have been described in patients with cirrhosis in a small number of studies.In this review,we aim to provide an overview of the available evidence on esophageal motility disorders in c...Disorders of esophageal motility have been described in patients with cirrhosis in a small number of studies.In this review,we aim to provide an overview of the available evidence on esophageal motility disorders in cirrhosis and their clinical implications.This review delves into the following concepts:(1)Gastroesophageal reflux disease is common in liver cirrhosis due to many mechanisms;however,when symptomatic it is usually nocturnal and has an atypical presentation;(2)Endoscopic band ligation is better than sclerotherapy in terms of its effect on esophageal motility and seems to correct dysmotilities resulting from the mechanical effect of esophageal varices;(3)Chronic alcoholism has no major effects on esophageal motility activity other than lower esophageal sphincter hypertension among those with alcoholic autonomic neuropathy;(4)An association between primary biliary cholangitis and scleroderma can be present and esophageal hypomotility is not uncommon in this scenario;and(5)Cyclosporin-based immunosuppression in liver transplant patients can have a neurotoxic effect on the esophageal myenteric plexus leading to reversible achalasia-like manifestations.展开更多
文摘AIM： To compare efficacy of proton pump inhibitors （PPIs） with H2-receptor antagonists （H2RA$） plus pro- kinetics （Proks） for dysmotility-like symptoms in func- tional dyspepsia （FD）. METHODS： Subjects were randomized to receive openlabel treatment with either rabeprazole 10 mg od （n = 57） or famotidine 10 mg bid plus mosapride 5 mg tid （n = 57） for 4 wk. The primary efficacy endpoint was change （%） from baseline in total dysmotility-like dyspepsia symptom score. The secondary efficacy endpoint was patient satisfaction with treatment. RESULTS： The improvement in dysmotility-like dyspep- sia symptom score on day 28 was significantly greater in the rabeprazole group （22.5% ± 29.2% of baseline） than the famotidine ＋ mosapride group （53.2%±58.6% of baseline, P 〈 0.0001）. The superior benefit of rabeprazole treatment after 28 d was consistent regardless of Helicobacter pylori status. Significantly more subjects in the rabeprazole group were satisfied or very satisfied with treatment on day 28 than in the famotidine ＋ mosapride group （87.7% vs 59.6%, P = 0.0012）. Rabeprazole therapy was the only significant predictor of treatment response （P 〈 0.0001）, defined as a total symptom score improvement ≥ 50%. CONCLUSION： PPI monotherapy improves dysmotil- ity-like symptoms significantly better than H2RAs plus Proks, and should be the treatment of first choice for Japanese FD.
文摘The detailed process and mechanism of colonic motility are still unclear, and colonic motility disorders are associated with numerous clinical diseases. Colonic manometry is considered to the most direct means of evaluating colonic peristalsis. Colonic manometry has been studied for more than 30 years;however, the long duration of the examination, high risk of catheterization, huge amount of real-time data, strict catheter sterilization, and high cost of disposable equipment restrict its wide application in clinical practice. Recently, highresolution colonic manometry (HRCM) has rapidly developed into a major technique for obtaining more effective information involved in the physiology and/or pathophysiology of colonic contractile activity in colonic dysmotility patients. This review focuses on colonic motility, manometry, operation, and motor patterns, and the clinical application of HRCM. Furthermore, the limitations, future directions, and potential usefulness of HRCM in the evaluation of clinical treatment effects are also discussed.
文摘AIM: To investigate the effects of Japanese apricot(JA) consumption on gastroesophageal reflux disease(GERD)-related symptoms.METHODS: Participants included individuals living in Minabe-cho,a well-known JA-growing region,who received specific medical check-ups by the local community health service in 2010.GERD-related symptoms were examined in 1303 Japanese individuals using a validated questionnaire,the Frequency Scale for Symptoms of GERD(FSSG),which consists of 7 questions associated with acid reflux symptoms and 5 questions asking about gastrointestinal dysmotility symptoms.Each question was answered using a 4-point scale,with higher scores indicating more severe GERDrelated symptoms.Subjects were divided into two groups according to their intake of dried and pickled JA: daily intake(≥ 1 JA daily)(392 subjects) and none oroccasional intake(< 1 JA daily)(911 subjects).FSSG scores were compared between subjects who consumed JA daily and those who did not.Next,subjects were stratified by age,gender and Helicobacter pylori(H.pylori) status for subanalyses.RESULTS: Those who ate JA daily were significantly older than those who did not(60.6 ± 10.5 years vs 56.0 ± 11.0 years,P < 0.001).Total FSSG scores were significantly lower in subjects with daily JA intake than in those with none or only occasional intake(2.13 ± 3.14 vs 2.70 ± 3.82,P = 0.005).In particular,subjects who consumed JA daily showed significantly improved FSSG dysmotility scores compared with subjects who did not(1.05 ± 1.58 vs 1.46 ± 2.11,P < 0.001).In contrast,the FSSG reflux score did not differ between subjects with and without daily intake of JA(1.08 ± 1.90 vs 1.24 ± 2.11,P = 0.177).Subanalysis indicated that improvement in dysmotility by JA intake was specifically observed in non-elderly(1.24 ± 1.68 vs 1.62 ± 2.22,P = 0.005) and H.pylori-negative subjects(0.99 ± 1.58 vs 1.57 ± 2.06,P < 0.001).GERD patients(total FSSG score ≥ 8) were less frequently observed among subjects with daily intake of JA as compared to those without daily intake of JA(6.1% vs 9.7%,P = 0.040).CONCLUSION: Daily JA intake may improve digestive dysmotility symptoms,resulting in relief of GERD symptoms.The effect is more obvious in non-elderly and H.pylori-negative subjects.
基金Supported by the Natural Science Foundation of Jiangsu Province(BS99037 ).
文摘Objective To investigate the effect of erythromycin on the contractive activity of the isolated gastric antrum smooth muscle and somatostatin （SS）, vasoactive intestinal peptide （VIP）, motilin （MTL）, and substance P （SP） in plasma and isolated gastric antrum tissue of diabetes mellitus （DM） rat models. Methods Thirty male Sprague-Dawley rats were divided into three groups： control group （n = 10）, DM group （n = 10）, and erythromycin group （DM models with erythromycin treatment, n = 10）. A single dose of streptozotocin （100 mg/kg, dissolved in 0. I mol/L citric acid buffer, pH4.5） was injected intraperitoneally. After 48 to 72 hours, rats with blood glucose above 16.7 mmol/L and urine glucose level to be （＋＋＋ ） to （＋＋＋＋） over one week were considered successful DM models. The resting tension, mean contractile amplitude and fi＇equency of spontaneous change in isolated longitudinal and circular gastric antrum smooth muscle strips were measured. SS, VIP, MTL, and SP levels in plasma and gastric antrum tissue were measured using radioimmunoassay. Results （1） In the isolated gastric antrum smooth muscle strips, the gastric motility parameters were lower in DM group than those in control group except circular smooth muscle contractile amplitude and longitudinal smooth muscle contractile fi＇equency. The gastric motility parameters were significantly strengthened in erythromycin group, compared with DM group except longitudinal smooth muscle resting tension （P 〈 0.01 ）. （2） Plasma SS, VIP, and MTL concentrations in DM group were higher than those in control （P 〈 0.05）, while the SP level decreased （P 〈 0.05）. In the gastric antrum, SS of DM group was significantly higher than that of control group （P 〈 0.01 ）, while SP and MTL levels were lower than those of control group （P 〈 0.05 and P 〈 0.01, respectively）. However, the level of VIP in gastric antrum tissue did not change among three groups. The plasma level of SS in erythromycin group was higher than that of DM group （P 〈 0.05）. （3） The blood glucose was lower in erythromycin group than DM group （P 〈 0.01 ）. Conclusions Erythromycin has direct effects on contractive activity of gastric smooth muscle in diabetic rats, but there are few effects on neuroendocrine peptides. Gastric-motility disorders in diabetic rats have a correlation with the changes of neuroendocrine peptide levels in plasma and gastric antrum tissue.
文摘BACKGROUND Peroral endoscopic myotomy is an increasingly used less invasive modality to treat esophageal dysmotility.Recently,triangular tip knife with integrated water jet function has been introduced to mitigate multiple instrument exchanges.AIM To compare traditional triangular tip knife and water jet knife in terms of procedural success,duration,instrument exchanges,coagulation forceps use,and adverse events.METHODS We conducted a systemic review and meta-analysis with two authors independently in electronic databases(PubMed,Embase,and Cochrane Library)from inception through May 2021.In addition,we conducted a relevant search by Reference Citation Analysis(RCA)(https://www.referencecitationanalysis.com).A fixed-effects model was used to calculate weighted mean,odds ratio(OR),and confidence intervals(CI).RESULTS We included 7 studies involving 558 patients.Triangular knife and water jet knife were similar in odds of procedural success with ratio of 4.78(95%CI=0.22-102.47)and odds of clinical success with ratio of 0.93(95%CI=0.29-2.97),respectively.Water jet knife had fewer instrument exchanges compared to triangular knife(2.21,95%CI=1.98-2.45 vs 11.9,95%CI=11.15-12.70)and usage of coagulation forceps(1.75,95%CI=1.52-1.97 vs 2.63,95%CI=2.37-2.89).Adverse events were higher in triangular knife group(OR:2.30,95%CI=1.35-3.95).CONCLUSION Peroral endoscopic myotomy using water jet knife is comparable in terms of pro cedural success to triangular tip knife.Water jet knife also required shorter procedural duration,less instrument exchanges,coagulation devices,and overall adverse events.
文摘When kidney function declines to a point where it can no longer maintain life and requires renal replacement therapy(i.e.renal transplant or dialysis),it is called end-stage renal disease(ESRD).Patients with ESRD often experience a range of gastrointestinal(GI)symptoms,with prevalence rates reported as high as 77%-79%.These symptoms and pathologies arise from various factors,including electrolyte imbalance,fluid imbalance,toxin buildup,uremia,medications,dietary and lifestyle restrictions,and the effects of dialysis.GI diseases in patients with renal failure can be further categorized into upper GI,small bowel,and lower GI issues.Common conditions include gastroesophageal reflux disease,nausea and vomiting,dysmotility within the esophagus and stomach,upper GI bleeding,peptic ulcer bleeding,angioectasia,irritable bowel syndrome,mesen-teric ischemia,angiodysplasia,diverticular disease,constipation,pancreatitis,and diseases associated with peritoneal dialysis peritonitis and peritoneal stenosis.This review assesses the existing literature on the different GI diseases among individuals with ESRD,shedding light on their pathophysiology and prevalence.
文摘BACKGROUND The pathophysiology behind gastroesophageal reflux disease and its association with poor outcomes after lung transplantation is incompletely understood.The physiologic impact of lung transplantation on pulmonary function,intrathoracic pressures,and vagal innervation may affect esophageal motility,bolus clearance and reflux risk.However,the effect of changes in esophageal function after lung transplantation on the risk of poor post-transplant outcomes remains unclear.AIM To evaluate the association between change in esophageal motility pre-/post-lung transplantation and rejection outcome.METHODS This was a retrospective cohort study of lung transplant recipients who underwent both pre-and post-transplant esophageal testing including high resolution manometry(HRM)at a tertiary center.Acute cellular rejection(ACR)was defined histologically per International Society for Heart and Lung Transplantation criteria.Univariate analyses were performed using student’s t-test,χ2 test,and Spearman’s correlation where appropriate.Multivariable time-to-event analysis using Cox proportional hazards model was applied.Subjects not meeting ACR outcome were censored at death or date of last clinic visit.RESULTS 55 subjects(65%men,mean age:61,median follow-up:840 days)were included,with 17 (31%) experiencing ACR. Increase in failed swallows correlated with lower baseline total lung capacity(TLC) (R = -0.32, P = 0.05) and decreased post-transplant esophageal bolus clearance (R = -0.45, P = 0.004). Onmultivariable analysis, post-transplant hypomotility independently predicted increased ACR (HR: 3.62, 95%CI:1.11-11.8;P = 0.03). Kaplan-Meier analysis demonstrated increased ACR for subjects with increased vs unchangedfailed swallows post-transplant (P = 0.048). On Cox regression, a 20% elevated risk of ACR was found for every10% increase in failed swallows, after controlling for confounders including reflux severityCONCLUSIONEsophageal hypomotility, specifically an increase in failed swallows on HRM, from pre- to post-lungtransplantation was independently associated with ACR. Additionally, lower baseline TLC correlated with increasein failed swallows, suggesting restrictive lung disease may be associated with post-transplant esophagealhypomotility. Lung transplantation may affect esophageal function and contribute to rejection outcomes. Routineesophageal function testing may help identify patients at higher risk for poor lung transplantation outcomes.
基金Supported by National Institutes of Health Grants,No.R01DK103055(to Ro S)RosVivo Therapeutics,No.AWD-01-00003158(to Ro S)the National Research Foundation of Korea Grant Funded by the Korean Government(MSIT),No.NRF-2021R1C1C2006743(to Kim MS)and No.NRF-2021R1A2C1095311(to Lee MY).
文摘BACKGROUND We previously identified miR-10b-5p as a key regulator of gastrointestinal(GI)motility through its essential role in the development and function of interstitial cells of Cajal(ICC),the pacemaker cells of the gut.Loss of miR-10b-5p in ICC im-pairs intestinal motility and contributes to constipation,a common condition in the elderly.Notably,miR-10b-5p is co-expressed with its paralog,miR-10a-5p,in ICC.AIM To investigate the roles of miR-10a-5p and miR-10b-5p in age-associated intestinal dysmotility and assess the therapeutic potential of restoring their expression.METHODS We employed aged mice,mir-10a and mir-10b single and double knockout(KO)models,and human plasma and colon samples across age groups.GI and colonic transit,ICC network integrity,and expression levels of miR-10a/b-5p were eva-luated.Additionally,we tested whether treatment with their microRNA mimics could restore GI motility in aged mice.RESULTS Aged mice exhibited delayed GI and colonic transit,reduced fecal output,and diminished expression of miR-10a-5p and miR-10b-5p,which peaked during late embryonic and early postnatal stages and declined with age.This decline para-lleled ICC network deterioration in the colon.All KO models exhibited impaired motility and ICC loss,with mir-10a KO mice displaying more severe phenotypes than mir-10b KO mice.Double KO mice demonstrated growth retardation and reduced survival,with homozygous mutants living only up to 3 months.Treatment of aged mice with miR-10a-5p and miR-10b-5p mimics encapsu-lated in jetPEI significantly improved GI and colonic motility.Successful delivery to the gut,including the colon,was confirmed.In human samples,both miR-10a/b-5p and KIT expression decreased with age.CONCLUSION miR-10a-5p and miR-10b-5p are essential for ICC maintenance and colonic motility,and their age-related decline contributes to GI dysmotility in both mice and humans.Restoring their levels offers a promising therapeutic stra-tegy for treating age-related constipation and other motility disorders.
文摘Irritable bowel syndrome(IBS) is a common gastrointestinal disorder that is generally considered to be functional because there appears to be no associated anatomical defect. Stress and psychological factors are thought to play an important role in IBS. The gut neuroendocrine system(NES),which regulates all functions of the gastrointestinal tract,consists of endocrine cells that are scattered among the epithelial cells of the mucosa,and the enteric nervous system. Although it is capable of operating independently from the central nervous system(CNS),the gut NES is connected to and modulated by the CNS. This review presents evidence for the presence of an anatomical defect in IBS patients,namely in the gastrointestinal endocrine cells. These cells have specialized microvilli that project into the lumen and function as sensors for the luminal content and respond to luminal stimuli by releasing hormones into the lamina propria,which starts a chain reaction that progresses throughout the entire NES. The changes in the gastrointestinal endocrine cells observed in IBS patients are highly consistent with the other abnormalities reported in IBS patients,such as visceral hypersensitivity,dysmotility,and abnormal secretion.
文摘This review provides information on the definition of constipation, normal continence and defecation and a description of the pathophysiologic mechanisms of constipation. In addition, changes in the anatomy and physiology of the lower gastrointestinal tract associated with aging that may contribute to constipation are described. MEDLINE (1966-2007) and CINAHL (1980-2007) were searched. The following MeSH terms were used: constipation/etiology OR constipation/ physiology OR constipation/physiopathology) AND (age factors OR aged OR older OR 80 and over OR middle age). Constipation is not well defined in the literature. While self-reported constipation increases with age, findings from a limited number of clinical studies that utilized objective measures do not support this association. Dysmotility and pelvic floor dysfunction are important mechanisms associated with constipation. Changes in GI function associated with aging appear to be relatively subtle based on a limited amount of conflicting data. Additional research is warranted on the effects of aging on GI function, as well as on the timing of these changes.
文摘The global prevalence of diabetes mellitus is increasing; arguably as a consequence of changes in diet, lifestyle and the trend towards urbanization. Unsurprisingly, the incidence of both micro and macrovascular complications of diabetes mirrors this increasing prevalence. Amongst the complications with the highest symptom burden, yet frequently under-diagnosed and sub-optimally treated, is diabetic autonomic neuropathy, itself potentially resulting in cardiovascular autonomic neuropathy and gastrointestinal(GI) tract dysmotility. The aims of this review are fourfold. Firstly to provide an overview of the pathophysiological processes that cause diabetic autonomic neuropathy. Secondly, to discuss both the established and emerging cardiometric methods for evaluating autonomic nervous system function in vivo. Thirdly, to examine the tools for assessing pan-GI and segmental motility and finally, we will provide the reader with a summary of putative non-invasive biomarkers that provide a pathophysiological link between lowgrade neuro inflammation and diabetes, which may allow earlier diagnosis and intervention, which in future may improve patient outcomes.
文摘Gastrointestinal(GI) dysmotility is a common problemin the critically ill population. It can be a reflection and an early sign of patient deterioration or it can be an independent cause of morbidity and mortality. GI dysmotility can be divided for clinical purposes on upper GI dysmotility and lower GI dysmotility. Upper GI dysmotility manifests by nausea, feeding intolerance and vomiting; its implications include aspiration into the airway of abdominal contents and underfeeding. Several strategies to prevent and treat this condition can be tried and they include prokinetics and post-pyloric feeds. It is important to note that upper GI dysmotility should be treated only when there are clinical signs of intolerance(nausea, vomiting) and not based on measurement of gastric residual volumes. Lower GI dysmotility manifests throughout the spectrum of ileus and diarrhea. Ileus can present in the small bowel and the large bowel as well. In both scenarios the initial treatment is correction of electrolyte abnormalities, avoiding drugs that can decrease motility and patient mobilization. When this fails, in the case of small bowel ileus, lactulose and polyethylene glycol solutions can be useful. In the case of colonic pseudo obstruction, neostigmine, endoscopic decompression and cecostomy can be tried when the situation reaches the risk of rupture. Diarrhea is also a common manifestation of GI dysmotility and the most important step is to differentiate between infectious sources and non-infectious sources.
文摘Hirschsprung’s disease(HSCR)is a congenital disorder characterized by failure of the neural crest cells to migrate and populate the distal bowel during gestation affecting different lengths of intestine leading to a distal functional obstruction.Surgical treatment is needed to correct HSCR once the diagnosis is confirmed by demonstrating the absence of ganglion cells or aganglionosis of the affected bowel segment.Hirschsprung’s disease associated enterocolitis(HAEC)is an inflammatory complication associated with HSCR that can present either in the pre-or postoperative period and associated with increased morbidity and mortality.The pathogenesis of HAEC remains poorly understood,but intestinal dysmotility,dysbiosis and impaired mucosal defense and intestinal barrier function appear to play a significant role.There is no clear definition for HAEC,but the diagnosis is primarily clinical,and treatment is guided based on severity.Here,we aim to provide a comprehensive review of the clinical presentation,etiology,pathophysiology,and current therapeutic options for HAEC.
文摘The esophagus is the most commonly affected part of the gastrointestinal system in patients with systemic sclerosis(SSc).Esophageal involvement may lead to a significant reduction in patient quality of life.The exact pathophysiology is complex and not yet fully elucidated.Ultimately,esophageal smooth muscle becomes atrophied and replaced by fibrous tissue leading to severe motility disturbance of the distal esophagus.Symptoms are mainly attributed to gastroesophageal reflux disease and to esophageal dysmotility.Compelling evidence has correlated esophageal involvement to the severity of pulmonary disease.No formed guidelines exist about the diagnostic modalities used to assess esophageal disease in patients with SSc,though upper gastrointestinal endoscopy is the first and most important modality used as it can reveal alterations commonly observed in patients with SSc.Further exploration can be made by high resolution manometry and pH-impedance study.Proton pump inhibitors remain the mainstay of treatment,while prokinetic agents are commonly used as add-on therapy in patients with symptoms attributed to gastroesophageal reflux disease not responding to standard therapy as well as to motility disturbances.Gastroesophageal reflux disease symptoms in patients with SSc are frequently difficult to manage,and new therapeutic modalities are emerging.The role of surgical treatment is restricted and should only be preserved for resistant cases.
文摘Neuromuscular diseases(NMDs)affect the development and growth of the neuromuscular system in children.The pathology can occur anywhere along the neuromuscular pathway,from the brain to the nerves to the muscle fibers.These diseases have a profound impact on the quality of life not only of children but also of their families.The predominant manifestation in NMDs is hypotonia,which leads to muscle weakness and fatigue,reduced mobility,and decreased physical performance.However,multiple organ systems can be affected,with resulting orthopedic,cardiac,infectious,respiratory,and nutritional problems.Children with NMD present an increased risk for several dietary and feeding difficulties because of their neuromuscular diagnosis,presentation,and severity.These problems include chronic gastrointestinal issues(constipation,dysphagia,gastroesophageal reflux,and diarrhea),dysphagia,malnutrition,and body composition alterations.As a result,compared to the overall pediatric population,infants and children with NMD are more likely to be malnourished,ranging from failure to thrive to overweight or obesity.Disease-specific guidelines vary in level of detail and recommendations for dietary management.Overall,nutritional data available are sparse,with the exception of Duchenne muscular dystrophy,spinal muscular atrophy,and congenital muscular dystrophy.The purpose of this review is to describe the spectrum of nutritional challenges in children with NMD and to summarize the main dietary and gastrointestinal recommendations for each neuromuscular disorder to provide guidance for daily clinical practice.
文摘Dysphagia lusoria is a term used to describe dysphagia secondary to vascular compression of the oesophagus. The various embryologic anomalies of the arterial brachial arch system often remain unrecognised and asymptomatic, but in 30%-40% of cases can result in tracheo-oesophageal symptoms, which in the majority of cases manifest as dysphagia. Diagnosis of dysphagia lusoria is via barium swallow and chest Computed tomography scan. Manometric abnormalities are variable, but age-related manometric changes may contribute to clinically relevant dysphagia lusoria in patients who present later in life. Our report describes a case of lateonset dysphagia secondary to a right aortic arch with an aberrant left subclavian artery, which represents a rare variant of dysphagia lusoria. The patient had proven additional oesophageal dysmotility with solid bolus only and a clinical response to dietary modification.
基金the Development Foundation of Region Skåne,No.REGSKANE-619091the Foundation of Skåne University Hospital,No.2017-008and the Dir Albert Påhlsson’s Foundation,No.2019.
文摘BACKGROUND Recently,a technique has been developed to use magnetic resonance enterography(MRE)for the evaluation of small bowel motility.The hypothesis was that assessment of the motility index(MI)should reflect differences in motility between clinical conditions.AIM To aim of the present observational,cross-sectional study was to evaluate the use of the MI in daily clinical practice.METHODS All consecutive patients aged 18-70 years who were referred for MRE at the Department of Radiology during a 2-year period were asked to participate.Healthy volunteers were included as controls.MRE was prepared and conducted in accordance with clinical routines.On the day of examination,all the participants had to complete the visual analog scale for irritable bowel syndrome(IBS)and IBS-symptom severity scale.Maps of MI were calculated from dynamic MR images.ANOVA was used to evaluate differences in MI between groups,classified as healthy,Crohn’s disease,ulcerative colitis,IBS,other assorted disorders and dysmotility.Logistic and linear regression were applied to the MI values.All medical records were scrutinized for medical history.RESULTS In all,224 examinations were included(inclusion prevalence 76.3%),with 22 controls and 202 patients.There was a significant difference in the MI of the jejunum(P=0.021)and terminal ileum(P=0.007)between the different groups.The MI was inversely associated with the mural thickness of the terminal ileum in men(P<0.001)and women(P=0.063)after adjustments,and tended to be lower in men than in women(P=0.056).Subjectively observed reduction of motility on MRI was accomplished by reduced MI of terminal ileum in men(P<0.001)and women(P=0.030).In women,diarrhea was inversely associated with the MI of the jejunum(P=0.029),and constipation was positively associated with the MI of the terminal ileum(P=0.039).CONCLUSION Although MIs differ across diseases,a lower MI of the terminal ileum is mainly associated with male sex and an increased mural thickness.Symptoms are weakly associated with the MI.
文摘Lymphocytic esophagitis(LyE) is a rare condition characterised histologically by high numbers of esophageal intraepithelial lymphocytes without significant granulocytes infiltration, in addition to intercellular edema("spongiosis"). The clinical significance and natural history of LyE is poorly defined although dysphagia is reportedly the most common symptom. Endoscopic features range from normal appearing esophageal mucosa to features similar to those seen in eosinophilic esophagitis, including esophageal rings, linear furrows, whitish exudates, and esophageal strictures/stenosis. Symptomatic gastroesophageal reflux disease is an inconsistent association. LyE has been associated in paediatric Crohn's disease, and recently in primary esophageal dysmotility disorder in adults. There are no studies assessing effective treatment strategies for LyE; empirical therapies have included use of proton pump inhibitor and corticosteroids. Esophageal dilatation have been used to manage esophageal strictures. Ly E has been reported to run a benign course; however there has been a case of esophageal perforation associated with Ly E. Here, we describe the clinical, endoscopic and histopathological features of three patients with lymphocytic esophagitis along with a review of the current literature.
文摘Disorders of esophageal motility have been described in patients with cirrhosis in a small number of studies.In this review,we aim to provide an overview of the available evidence on esophageal motility disorders in cirrhosis and their clinical implications.This review delves into the following concepts:(1)Gastroesophageal reflux disease is common in liver cirrhosis due to many mechanisms;however,when symptomatic it is usually nocturnal and has an atypical presentation;(2)Endoscopic band ligation is better than sclerotherapy in terms of its effect on esophageal motility and seems to correct dysmotilities resulting from the mechanical effect of esophageal varices;(3)Chronic alcoholism has no major effects on esophageal motility activity other than lower esophageal sphincter hypertension among those with alcoholic autonomic neuropathy;(4)An association between primary biliary cholangitis and scleroderma can be present and esophageal hypomotility is not uncommon in this scenario;and(5)Cyclosporin-based immunosuppression in liver transplant patients can have a neurotoxic effect on the esophageal myenteric plexus leading to reversible achalasia-like manifestations.
