BACKGROUND:A conclusive diagnosis of esophagogastric junction outflow obstruction (EGJOO) requires confirmation of the manometric diagnosis either by timed barium esophagram (TBE) or functional lumen imaging probe (FLIP). However, the comparative performance of these tests for confirming EGJOO is not well defined. We aimed to assess the rate of agreement between FLIP and TBE in confirming a Chicago Classification version 4.0 (CCv4.0) manometric EGJOO diagnosis. METHODS:We included symptomatic patients with a CCv4.0 EGJOO manometric diagnosis who had confirmatory testing with both FLIP and TBE. FLIP metrics, TBE findings, tablet retention on esophagram, and Rapid Drink Challenge (RDC) results were recorded. KEY RESULTS:Among 101 total patients with manometric EGJOO, 30 had EGJOO confirmed by FLIP alone, 4 by TBE alone, and 11 by both FLIP and TBE; 56 had both negative FLIP and TBE. The FLIP and TBE positive concordance rate was 73.3%, and negative concordance rate was 65.1%. FLIP and TBE were both positive or both negative in 67/101 patients (overall concordance rate 66.3%) with a κ value of 0.22 (95% CI 0.01-0.44). Addition of barium tablet to TBE improved the κ value to 0.43 (95% CI 0.25-0.61). RDC agreed with FLIP in 45.7% and with TBE in 44.7% of patients, with RDC results frequently being indeterminant (39.4%). CONCLUSIONS:Discrepancies between FLIP and TBE for confirming EGJOO occur in one third of cases, and RDC results are often inconclusive. Additional testing may be needed to confirm manometric EGJOO despite a negative confirmatory test if clinical suspicion remains high.
BACKGROUND:Irritable bowel syndrome with constipation (IBS-C) is a common disorder of gut-brain interaction that significantly impairs quality of life. Although multiple US Food and Drug Administration (FDA)-approved medications have demonstrated efficacy in randomized controlled trials, less is known about patients' real-world experiences and factors influencing treatment decisions. Here, we conducted social media netnography-a qualitative approach for examining patient perspectives posted online on social media platforms and e-health forums, exploring the perspectives and experiences of IBS-C patients who report using FDA-approved therapies. METHODS:We examined publicly available posts from X and online health e-forums (Reddit, WebMD, ibspatient.org) made between 9/19/2007 and 9/12/2024. Overall, 7328 relevant posts referencing FDA-approved IBS-C medications (linaclotide, lubiprostone, plecanatide, tegaserod, tenapanor) were included. We employed qualitative (open coding) and quantitative approaches (natural language processing and artificial intelligence) to analyze the posts. RESULTS:Four major themes emerged: (i) perceived medication efficacy; (ii) treatment-related burden; (iii) intentional non-adherence; and (iv) barriers to adherence. Patients described heterogeneous efficacy, ranging from meaningful symptom relief to limited or no benefit. Patients discussed the biopsychosocial burden of IBS-C medications (e.g., nausea, frustration, social anxiety from potential diarrheal side effects), highlighting various barriers to adherence. Barriers such as cost, insurance coverage, and personal beliefs also influenced decisions, often prompting discontinuation, dose adjustments, or pursuit of alternative therapies. CONCLUSIONS:Social media provides unique insights into IBS-C patients' real-world experiences with FDA-approved therapies. Findings highlight variability in efficacy, biopsychosocial impacts, and adherence challenges, underscoring the need for shared decision making and proactive management of barriers to optimize outcomes.
BACKGROUND:Patients with functional dyspepsia (FD) and irritable bowel syndrome (IBS) often experience abdominal pain and reduced quality of life and need effective treatments. This exploratory study aimed to evaluate whether transcutaneous auricular vagus nerve stimulation (taVNS) could improve abdominal pain and quality of life in patients with FD and IBS, and whether the effects were mediated via the autonomic mechanisms. METHODS:A total of 64 patients with abdominal pain (43 FD and 21 IBS) with a pain score of 3 out of 10 or higher were randomized to receive 2 weeks of taVNS or sham-taVNS treatment. The primary outcome was numeric rating scale (NRS) for abdominal pain. The dyspeptic symptom scales (DSS), IBS symptom severity scale score (IBS-SSS), anxiety and depression scores, and the SF36 quality of life scale were assessed before and after the treatment. The electrocardiogram was also recorded for the assessment of autonomic function at baseline and after the treatment. KEY RESULTS:(1) taVNS reduced the abdominal pain score (p < 0.001 for both FD and IBS), the frequency of abdominal pain (p < 0.001 for both FD and IBS), and overall symptom scores in both FD patients and IBS patients (p < 0.001 for FD and IBS). There was no significant difference in the effect of taVNS on abdominal pain between FD and IBS patients. (2) taVNS improved quality of life compared with baseline in both FD and IBS patients. (3) taVNS decreased anxiety (p < 0.001) and depression (p < 0.001). (4) taVNS increased vagal activity. At the end of the taVNS treatment, the vagal activity was negatively correlated with the pain score (r = -0.491, p = 0.004). CONCLUSIONS:Non-invasive taVNS improves abdominal pain, quality of life, and anxiety and depression in patients with FD and patients with IBS, possibly attributed to the enhancement of vagal activity. TRIAL REGISTRATION:Chinese Clinical Trial Registry: ChiCTR2400085697.
BACKGROUND:Magnetic resonance imaging (MRI) enables non-invasive, radiation-free assessment of gastric emptying, intragastric liquid distribution, and motility. However, characterization of the stomach function in patients with functional dyspepsia (FD) remains limited. We aimed to apply the Virtual Gaster (VIGA) MRI platform to characterize gastric geometry, emptying dynamics, and motility patterns in patients with FD compared with healthy controls (HCs). METHODS:Twenty-six adults with Rome IV-defined FD and twenty HCs underwent static and dynamic gastric MRI during fasting, gastric filling with a liquid meal, and emptying. VIGA was used to quantify compartmental gastric volumes (fundus, corpus, antrum), estimate gastric half-emptying time (T50), and assess motility parameters. Symptoms were evaluated using PAGI-SYM and postprandial visual analog scales. RESULTS:Gastric half-emptying time was shorter in FD than in HCs (47.7 ± 27.8 vs. 68.0 ± 15.7 min; p = 0.008). FD patients showed reduced fundic content volumes with a relative shift of content toward the corpus and antrum (p < 0.05). Gastric dysrhythmias were more frequent in FD (50% vs. 10%; p = 0.006), and distal contraction propagation with rhythmic activity was slower during both accommodation (3.19 ± 0.83 vs. 4.10 ± 1.21 mm/s; p = 0.001) and emptying (3.31 ± 0.61 vs. 3.93 ± 1.02 mm/s; p = 0.01). Exploratory analyses showed moderate inverse correlations between symptom severity, particularly bloating and heartburn, and antral volume or contraction velocity during accommodation. CONCLUSIONS:VIGA-enabled gastric MRI identified differences in intragastric liquid distribution, gastric liquid emptying, and distal motility between FD patients and healthy controls. The moderate correlation with symptoms supports its value for characterizing regional gastric physiology in health and disease.
BACKGROUND/AIMS:The Sick, Control, One, Fat, Food (SCOFF) is a questionnaire that screens for risk of eating disorders. Some symptoms and psychological factors associated with disorders of gut-brain interaction (DGBI) may resemble the features of eating disorders, potentially overestimating the risk of eating disorders in populations with high DGBI prevalence such as those with Hypermobile Ehlers-Danlos syndrome/hypermobility spectrum disorder (hEDS/HSD). This study aimed to identify factors associated with screening positive on SCOFF among adult with hEDS/HSD to explore the questionnaire's suitability for this population. METHODS:A secondary analysis of data from 670 adults with hEDS/HSD recruited from Ehlers-Danlos Support UK and tertiary Neurogastroenterology. χ2 tests and logistic regression were used to examine factors associated with positive SCOFF screening result and positive responses to individual SCOFF questions. RESULTS:DGBI presence did not predict a positive SCOFF screen. However, high gastrointestinal symptom-specific anxiety (GSA) (AOR: 3.19, p < 0.001), fear of aversive consequences from eating (AOR: 1.97, p = 0.013), and anxiety (AOR = 2.53, p < 0.001) were significant predictors. Notably, high GSA strongly predicted a positive response to questions two (Do you worry you have lost Control over how much you eat?) and five (Would you say that Food dominates your life?) (Q2 AOR = 2.58, p = 0.006, Q5 AOR = 5.98, p < 0.001). CONCLUSIONS:In hEDS/HSD, high GSA strongly predicted a positive SCOFF screening outcome, suggesting that SCOFF's questions might detect behaviors associated with worries around GI symptoms rather than an eating disorder. Positive screens in this population should be interpreted with caution and accompanied by GSA-focused assessments to enhance biopsychosocial management.
BACKGROUND:Gastric emptying scintigraphy (GES) is considered the standard for differentiating gastroparesis from functional dyspepsia and other foregut disorders characterized by nausea and vomiting but provides only a brief physiologic snapshot that may not accurately reflect daily function. We utilized a non-invasive wireless patch system (WPS) to characterize multiday gastric myoelectrical activity, evaluate its relationship with GES, and assess changes following a therapeutic intervention. METHODS:Adults referred for GES for symptoms thought to represent gastroparesis were enrolled in a prospective study. Patients wore a WPS for up to 6 days, starting on the day of scintigraphy. Gastric myoelectrical activity was analyzed and categorized into relatively weak, relatively moderate, and relatively strong activity phenotypes. A subset of patients underwent repeat monitoring following individualized therapeutic interventions (e.g., anti-emetics, proton pump inhibitors, lifestyle changes). RESULTS:Forty-eight patients (mean age 44; 79% female) completed the study. GES identified delayed gastric emptying in 18%, rapid in 22%, and normal in 60% of subjects. During the 4-h concurrent GES window, gastric activity in patients with delayed emptying was lower, but this difference did not reach statistical significance (p = 0.08). When compared to the full multiday recording period, GES results showed no correlation with the myoelectric readings. Significant day-to-day variability was observed, both random and systemic. In the latter category, a "Test-Day" dip was observed with gastric activity lowest on Day 1 (GES test day) and increasing significantly on subsequent days, stabilizing by Day 4 (p < 0.001). Healthy control subjects recorded during normal daily routines showed no such day-to-day variation. In the retesting cohort, anti-emetics produced robust increases in gastric amplitude, whereas PPIs showed minimal impact. CONCLUSIONS:The WPS effectively captures distinct gastric phenotypes and quantifies physiologic responses to therapy in both gastric and intestinal regions, demonstrating its clinical utility as a robust tool for evaluating and managing foregut symptoms in real-world settings. Importantly, the multiday WPS highlights significant day-to-day physiologic variability in gastric activity that extends beyond the single-day GES 'snapshot'.
BACKGROUND:International guidelines recommend anorectal biofeedback therapy or pelvic floor physical therapy for the treatment of constipation and fecal incontinence (FI). However, the similarities and differences between these therapies are unclear. OBJECTIVE:This practitioner survey aimed to evaluate the practice patterns of biofeedback therapists (BTs) and pelvic floor physical therapists (PTs). SETTINGS:This survey was targeted at BTs and PTs in community and hospital settings. METHODS:We conducted an international online survey about training, equipment, techniques, and practice patterns of BTs and PTs in treating patients with constipation and FI, distributed through specialist societies and known contacts. Language style was adjusted to the participants' preferences. RESULTS:We received 289 responses from 226 (78.2%) PTs and 63 (21.8%) BTs from Australia/New Zealand (119; 41.2%), the USA (90; 31.1%), and the rest of the world (80; 27.7%). The use of biofeedback in treating anorectal disorders often or always differed; BTs 80.4% versus PTs 51.8% (OR 4.50 (2.48-8.17)). Equipment for delivering biofeedback differed: electromyography (BTs 32.1% versus PTs 77.1%; OR 0.14 (0.07-0.27)), manometry (BTs 71.4% versus PTs 4.8%; OR 45.94 (18.35-115.02)), and ultrasound (BTs 0% versus PTs 50.3%). Ancillary device use differed (e.g., footstool (BTs 68.8% versus PTs 88.7%; OR 0.32 (0.18-0.55)), release device (BTs 6.5% versus PTs 27.9%; OR 0.06 (0.03-0.13)), trigger point (BTs 4.9% versus PTs 28.9%; OR 0.04 (0.02-0.11))). Techniques used differed: abdominal massage (BTs 31.1% versus PTs 59.6%; OR 0.27 (0.15-0.46)), balloon expulsion BTs 65.6% versus PTs 9.4% (OR 14.82 (7.95-27.65)). LIMITATIONS:The uneven distribution of respondents between countries and groups and reliance on self-reporting limits the generalizability of this exploratory study. CONCLUSIONS:BTs and PTs reported vast differences in the delivery of care for anorectal disorders. PTs use biofeedback less often and, when delivering biofeedback, use less manometry and more electromyography and ultrasound. Recognition of these differences may better inform referring providers and facilitate a more collaborative, standardized approach in the future.
