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: Morphological and functional changes occur after loop ileostomy surgery such as villous atrophy and decreased contractility. This study aims to examine the changes in motility of the proximal and distal limbs of the ileostomy. Morphological, molecular and functional approaches of smooth muscle are attempted to elucidate the cause of the changes in motility. : Full thickness strips of circular muscle were prepared from 25 patients (median age 64 years). Western blot was performed to quantify the expression of contractile proteins. Expression of genes was quantified using quantitative real-time polymerase chain reaction. : The distal limb showed morphological atrophy and a significant reduction in the contractile response to acetylcholine and potassium chloride, as well as a reduced relaxation response to sodium nitroprusside. However, no changes in the number of platelet derived growth factor receptor-α-positive (PDGFRα+) cells and interstitial cell of Cajal (ICC) were observed between the proximal and distal limbs. Western blot analysis confirmed that the expression levels of proteins associated with contraction such as myosin phosphatase targeting subunit 1, protein kinase C-potentiated phosphatase inhibitor protein-17 kDa, and Rho-associated, coiled-coil containing protein kinase 1, were significantly down-regulated in the distal limb. Despite the decrease in the expression of these proteins, neuronal cells and smooth muscle cells were preserved in the distal limb that has been diverted after ileostomy. : Although morphological, molecular and motility changes including down-regulation of contractile protein expression were observed in the distal loop, number of PDGFRα+ cells, ICCs, and neuronal cells were preserved. These results may explain restoration of the bowel motility after ileostomy take-down with low incidence of ileus.
: Ineffective esophageal motility (IEM) is the most frequently encountered esophageal manometric abnormality. Nonobstructive dysphagia is frequently associated with severe esophageal peristaltic dysfunction. This study aims to evaluate the presenting symptoms and association between dysphagia and specific manometric findings in patients with IEM. : We retrospectively reviewed 228 IEM patients diagnosed on high-resolution manometry at an academic institution (2010-2013). We collected data regarding the main presenting symptoms and manometric findings: bolus transit, distal esophageal pressure amplitude, and lower esophageal sphincter (LES) resting and relaxation pressure. : Dysphagia was the main presenting symptom (25%) in IEM patients. Bolus transit was incomplete in either liquid or viscous swallows (30%) and incomplete in both liquid and viscous swallows (59%) in IEM patients. The LES resting pressure and LES relaxation pressure were elevated (9% and 36%, respectively) in IEM patients. There was no significant difference between dysphagia and either poorly relaxing LES (P = 0.725) or defective bolus transit (DBT) to liquid and viscous swallows (P = 0.372) compared to the rest of the IEM patients. However, there was a significant association between dysphagia and the combination of poorly relaxing LES and DBT in liquid and viscous swallows (P = 0.006). Subgroup analysis comparing dysphagia with heartburn/regurgitation demonstrated a similar significant association between dysphagia and the combination of poorly relaxing LES and DBT during viscous and liquid swallows (P = 0.016). : Dysphagia is a variable symptom associated with complex esophageal motility abnormalities. IEM patients with a combination of poorly relaxing LES and DBT are more likely to have dysphagia.
: To evaluate the quality of life (QOL) of patients with chronic intestinal pseudo-obstruction (CIPO) before and after treatment. : This study enrolled 50 adult patients diagnosed with CIPO at 4 institutions, of whom 42 underwent therapy. Patient background, body mass index, treatment, palliative care intervention, numerical rating scale for abdominal pain or bloating, the medical outcomes study 36-item short-form health survey (SF-36) and summary scores (physical component summary, mental component summary, and role/social component summary), Japanese version of the Patient Assessment of Constipation Quality of Life (JPAC-QOL) and subscales (physical discomfort, psychosocial discomfort, worries and concerns, and satisfaction), and Patient Assessment of Constipation Symptoms (PAC-SYM) and subscales (stool, rectal, and abdominal symptoms) were prospectively sampled and collected. : The patients (n = 50; 35 females and 15 males) had an average age of onset of 44.7 years and, body mass index of 17.3 kg/m², and 38 (76%) required palliative care intervention. Effective therapeutic interventions included intestinal sterilization (19/42), decompression therapy with percutaneous endoscopic gastrojejunostomy (PEG-J) (6/42), and dietary restriction (6/42). The numerical rating scale for abdominal distension and pain decreased significantly after treatment. All SF-36 summary scores showed improvements. The JPAC-QOL and PAC-SYM both showed improvement overall and in all subscales. : Patients with CIPO have a lower physical, psychological and social QOL, which is equivalent to or lower than that of adult patients with inflammatory bowel disease or psychiatric disorders. Sterilization of the intestinal tract and PEG-J decompression effectively improve the QOL of patients.
: The International Anorectal Physiology Working Group (IAPWG) has proposed a standardized protocol and the London classification to enhance the consistency and diagnostic accuracy of anorectal manometry (ARM). However, real-world adoption in Asian countries has not been systematically assessed. This study aims to evaluate current ARM practices and adherence to the IAPWG protocol across Asian centers. : A cross-sectional, 50-item web-based survey was distributed to gastroenterologists and motility specialists practicing in Asian countries. : Thirty-one centers from 8 countries responded (20 in Korea, 3 in Japan, 2 in Taiwan, 1 in China, and 7 in other countries). High-resolution ARM was used in 80.6% of centers, primarily with solid-state catheters. While all centers performed rest and short squeeze maneuvers, only 58.1% conducted all maneuvers recommended by the IAPWG protocol. Considerable variation was observed in test methodology and interpretation, including definitions of resting pressure, squeeze duration, push maneuver repetition, and rectal balloon volume for rectoanal inhibitory reflex. For balloon expulsion and rectal sensory testing, centers differed in patient positioning, balloon type, inflation methods, and threshold definitions. Only 38.7% of centers reported having institutional normative values for test interpretation, and 64.5% applied the London classification. : Across Asian centers, ARM practice shows marked regional variation and incomplete implementation of the IAPWG standardized protocol and London classification, highlighting persistent gaps in standardization. Strengthening procedural guidance, regionally appropriate normative data, and interpretation criteria through coordinated education and international collaboration is needed to support more consistent and clinically meaningful use of ARM in routine practice.
: This study aims to identify the mechanisms underlying the effects of fecal microbiota transplantation (FMT). : This study investigated 93 patients included in our previous clinical trial: 24 received 30 g of their own feces (placebo group), while 47 and 22 received 30 g and 60 g of donor feces, respectively. The patients underwent sigmoidoscopy with biopsies, provided fecal samples, and completed questionnaires to assess irritable bowel syndrome (IBS) symptoms, fatigue, and quality of life at the baseline and at 1 month following FMT. The biopsy samples were immunostained for Musashi-1, neurogenin-3, and enteroendocrine and immune cells. The cell densities were quantified by computerized image analysis. Fecal short-chain fatty acids (SCFAs) were measured by gas chromatography, and fecal bacteria were measured by 16S ribosomal RNA polymerase chain reaction DNA amplification. : The densities of stem cells, enteroendocrine cell progenitors, serotonin, glucagon-like peptide 1, and peptide YY (PYY) cells increased following FMT in the 30-g and 60-g treated groups but not in the placebo group, and they were inversely correlated with both IBS symptoms and fatigue. The densities of submucosal immune cells and mast cells decreased following FMT in the 30-g and 60-g treated groups but not in the placebo group, and they were correlated with IBS symptoms and fatigue. The fecal level of butyric acid increased in patients treated with donor feces, and this was inversely correlated with IBS symptoms and fatigue. : Stem cells, enteroendocrine progenitors, serotonin, and glucagon-like peptide 1 as well as low-grade inflammation may play roles in IBS symptom manifestations. The effects of FMT are probably due to the amelioration of these abnormalities.
: Disorders of gut-brain interaction (DGBI) affect ~40% of the global population, yet data from Asia, including urbanized Singapore, remain limited. We aim to estimate prevalence, characterize psychological comorbidities, and assess burden using Rome IV criteria. : As part of the Rome Foundation Global Epidemiology Study, we conducted a cross-sectional, internet-based survey of 2047 nationally representative Singaporean adults (January-March 2018). The Rome IV Diagnostic Questionnaire identified 22 DGBI; participants with physician-diagnosed organic disease were excluded. Psychological comorbidities were assessed with Patient Health Questionnaire-4 (PHQ-4 [anxiety/depression]) and Patient Health Questionnaire-12 (PHQ-12 [somatization]), and quality of life with Patient-Reported Outcomes Measurement Information System Global-10. Multivariable logistic regression identified factors associated with DGBI and psychological comorbidity. : DGBI prevalence was 31.1% (95% CI, 29.1-33.2), lower than the pooled global prevalence (~40%). Functional bowel disorders predominated (25.3%), with constipation-related conditions (irritable bowel syndrome with constipation and functional constipation) affecting 9.9%. DGBI were more common in younger adults and women, but not education-related. Participants with multi-region DGBI reported higher somatization and anxiety/depression scores, poorer physical and mental health, and greater healthcare use. Regression showed younger age (per-year OR, 0.978; 95% CI, 0.970-0.986), female sex (OR, 0.667; 95% CI, 0.546-0.813), and higher somatization and anxiety scores independently associated with DGBI. Among those with DGBI, psychological comorbidity was independently associated with female sex, polypharmacy, and multi-region involvement. : In Singapore, DGBI are common but less prevalent than global estimates. Constipation-related disorders and psychological comorbidities contribute substantially to symptom burden and healthcare use, particularly in women and younger adults. Findings support integrated, culturally tailored care pathways to guide regional practice and public health policy.
Contractile activity of gastrointestinal smooth muscles is triggered by increased intracellular Ca2+, which activates myosin light chain kinase (MLCK) and leads to phosphorylation of myosin regulatory light chain (RLC), enabling contraction. Myosin light chain phosphatase (MLCP) dephosphorylates RLC for relaxation. The balance between MLCK and MLCP determines the relationship between calcium levels and contractile force. Shifting the balance between MLCK and MLCP in favor of MLCK by inhibiting MLCP allows MLCK to phosphorylate more RLC and generate increased force at any given Ca2+ concentration. Thus, when MLCP is inhibited, the myofilaments are more sensitive to calcium, allowing greater force at any given Ca2+ concentration. Major mechanisms for calcium sensitization in GI smooth muscle include protein kinase C-mediated phosphorylation of protein phosphatase 1 regulatory subunit 14A (CPI-17) and Rho-associated coiled-coil kinase 2 (ROCK2)-mediated phosphorylation of myosin phosphatase targeting subunit 1. Calcium sensitization is crucial for sphincter tone, sustained contraction, peristalsis, energy conservation, and coordinated motility. Smooth muscle cells, interstitial cells of Cajal, and platelet-derived growth factor alpha positive (PDGFRα+) cells form the SIP syncytium, which regulates excitability and calcium sensitization. This review updates our current understanding of the regulatory mechanisms of calcium sensitization with the recent findings from genetically engineered mice with deficiencies in protein kinase C and ROCK2 calcium sensitization pathways, and the involvement of interstitial cells in regulating GI smooth muscle cell excitability. Dysregulated calcium sensitization pathways in motility disorders are summarized, to potentially aid in the development of new pharmacological strategies to prevent and treat GI motility disorders.
: Although gastroesophageal reflux disease (GERD) and ineffective esophageal motility (IEM) often coexist, the directionality of their relationship remains uncertain. Clarifying physiological predictors of IEM in GERD patients with objectively verified pathological acid exposure may facilitate more personalized treatment strategies. : This retrospective analysis included 289 patients with typical reflux symptoms and abnormal acid exposure (acid exposure time > 6%) confirmed by 24-hour pH-impedance monitoring. Esophageal motility was assessed using high-resolution manometry, while mucosal integrity was evaluated through distal mean nocturnal baseline impedance (MNBI). Patients were categorized into normal motility and IEM groups. Clinical, endoscopic, manometric, and impedance parameters were compared between the groups. : IEM was identified in 41.5% of patients. Compared with those showing normal motility, the IEM group was older (median 51.5 vs 44 years, P < 0.001), had reduced lower esophageal sphincter (LES) pressure (15 vs 19 mmHg, P = 0.006), and exhibited decreased distal MNBI (1300 vs 1780 Ω, P = 0.005). Multivariate regression revealed prolonged upright bolus exposure, reduced LES pressure, delayed supine distal latency, and MNBI < 1500 Ω as independent predictors of IEM. No significant associations were observed with diabetes or Helicobacter pylori infection. : In GERD patients with confirmed pathological acid exposure, IEM is common and associated with weakened LES pressure, delayed peristalsis, and reduced mucosal integrity. The link between low MNBI and IEM suggests an interaction between epithelial barrier dysfunction and esophageal motility, emphasizing the need for comprehensive functional evaluation in GERD management.
Despite of the widespread use of hydrogen and methane breath test, the variability in testing protocols, gas measurement techniques, and interpretation criteria continues to challenge the reproducibility and comparability across centers, especially in the Asia-Pacific region. The Asian Neurogastroenterology and Motility Association hence presents the first Asian monograph guiding application and interpretation of breath test. The monograph was formulated according to the framework of indications, preparatory process, performance, and interpretation of results, as well as future direction for research.
Focal hypoganglionosis with adult-onset megacolon (FHAM) is marked by colon dilation proximal to a narrowed segment, with unaffected small bowel motility. Despite similar initial symptoms, FHAM may be more amenable to surgical intervention without recurrence, unlike chronic intestinal pseudo-obstruction (CIPO). The long-term outcomes of FHAM remain underexplored, prompting a comparison of its clinical features and prognosis with CIPO. We conducted a retrospective analysis of patients presenting with chronic constipation and megacolon, prospectively recruited between January 2017 and December 2023. Within this cohort, 87 patients were diagnosed with FHAM and 13 with CIPO, all of whom were included in the study. The median follow-up period was 3.0 years for patients with FHAM and 2.8 years for those with CIPO. The proportion of females was greater in both groups (FHAM, 67.8%; CIPO, 53.8%). The median age at diagnosis was similar between the groups (FHAM, 54.5 years; CIPO, 45.3 years). Surgery was performed in 46.0% of patients with FHAM and 69.2% of those with CIPO. Unplanned postoperative hospitalizations and the need for reoperation due to disease recurrence were notably lower in patients with FHAM. None of the patients with FHAM required long-term total parenteral nutrition, in contrast to 46.2% of patients with CIPO. Significant inter-group differences were observed in body mass index at the last follow-up. Patients with FHAM exhibit a more favorable long-term prognosis and lower postoperative recurrence rates than patients with CIPO. This study underscores the importance of differentiating between these conditions and precisely selecting surgical candidates.
: Gastric emptying scintigraphy (GES) is the reference standard test for diagnosing gastroparesis. Body surface gastric mapping (BSGM) via Gastric Alimetry is a new test of gastric function that combines non-invasive assessment of gastric electrophysiology and validated symptom profiling. This randomized, prospective pilot study evaluated the impact of GES vs BSGM test results on clinical decision-making. : Patients with chronic gastroduodenal symptoms from a tertiary center referred for GES were recruited. Subjects separately underwent baseline assessment with GES and BSGM testing. Two motility-specialists were first asked to devise a management plan after reviewing a test result (GES or BSGM, in random order). They were then asked to repeat the management plan after reviewing the other test result (BSGM or GES). Clinician-perceived certainty measures were assessed. : Sixteen patients, 13 (81.0%) female, median age 30 years, median body mass index 22.5 kg/m2, were recruited. At baseline, a diagnosis was established in 2/16 (12.5%) and increased to 8/16 (50.0%) with both tests. Abnormal test results were found in 11 patients. In patients with normal results, BSGM symptom profiling phenotyped 5 additional patients. All patients received an intervention following the first unblinding, with subsequent management changes made in 75.0% (BSGM) and 62.5% (GES) of patients. The combined GES and BSGM results significantly increased diagnostic and management certainty (P < 0.05), with both tests having similar influence on management (P > 0.05). : The combined GES and BSGM test results significantly enhanced diagnostic and management confidence in patients with suspected gastroparesis within a tertiary center.
: Spinal cord injury (SCI) frequently impairs defecation, severely affecting the quality of life. This study examines compensatory neural remodeling after SCI, focusing on basal colonic contractility, neural responses to electrical field stimulation, and alterations in excitatory cholinergic and inhibitory nitrergic pathways. : Female Sprague-Dawley rats underwent either sham surgery or T10 spinal cord transection and were categorized into 3 groups: sham, 1-week post-SCI (acute), and 4-week post-SCI (chronic). Colonic contractility was assessed in an organ bath using electrical field stimulation in the presence of a nitric oxide synthase inhibitor. Neural protein expression was analyzed by immunofluorescence and Western blotting. : SCI produced region- and time-dependent impairments in colonic contractility, with distinct alterations in the proximal circular and longitudinal muscles across acute and chronic phases. Neural excitability shifted dynamically, showing enhanced excitatory activity in the proximal longitudinal muscle at 1-week and the distal circular muscle at 4-week post-SCI. Protein analysis revealed increased neuronal nitric oxide synthase in the proximal colon, decreased soluble guanylyl cyclase in the distal colon, upregulated muscarinic M3 receptor in the proximal colon, and reduced vasoactive intestinal peptide receptor 1 in both proximal and distal regions. : SCI induces spatiotemporal remodeling of excitatory and inhibitory neural pathways, contributing to colonic dysmotility and revealing potential targets for therapeutic intervention.
: Potassium-competitive acid blockers (P-CABs) have emerged as promising alternatives to proton pump inhibitors (PPIs) to treat erosive esophagitis (EE). This study aims to compare the efficacy and safety of P-CABs and PPIs in patients with mild to severe EE stratified by treatment phase. : A systematic literature search was conducted using PubMed, MEDLINE, and the Cochrane Central Register of Controlled Trials. Randomized controlled trials comparing the efficacy of P-CABs and PPIs for EE were included. The pooled risk ratios (RRs) and risk differences with 95% confidence intervals (CIs) were calculated. A frequentist network meta-analysis was performed, and treatment ranking was assessed using P-scores. : Nineteen studies evaluating 5 P-CABs (vonoprazan, tegoprazan, keverprazan, fexuprazan, and zastaprazan) and 2 PPIs (lansoprazole and esomeprazole) were included. P-CABs demonstrated superior efficacy in healing EE during the initial phase, particularly in patients with severe EE (RR = 1.10; 95% CI, 1.00-1.20) and were also associated with a lower EE recurrence risk during maintenance treatment (RR = 0.59; 95% CI, 0.41-0.85). The efficacy was notably greater in patients with higher EE severity and among cytochrome P450 2C19 extensive metabolizers. The safety profiles of the P-CABs and PPIs were comparable. Vonoprazan consistently ranked the highest for both initial treatment (P-score = 0.68) and maintenance (P-score = 0.94). : P-CABs, especially vonoprazan, showed superior efficacy compared to PPIs in both the initial and maintenance treatment of EE. These findings support the use of P-CABs as a potent and reliable first-line option for EE management, particularly in high-risk populations, with acceptable safety outcomes.
Potassium-competitive acid blockers (P-CABs) have emerged as a potent alternative to proton pump inhibitors (PPIs) for the treatment of gastroesophageal reflux disease and functional dyspepsia (FD). This narrative review incorporating original meta-analyses summarizes the latest evidence from randomized controlled trials and meta-analyses, emphasizing the efficacy, safety, and clinical applications of P-CABs such as vonoprazan, tegoprazan, fexuprazan, keverprazan, and zastaprazan. P-CABs demonstrate rapid onset, sustained acid suppression, and superior healing rates in erosive esophagitis (EE), particularly in severe EE (grade C/D). Maintenance therapy in healed EE with P-CABs also yields higher endoscopic remission rates compared to PPIs. In non-erosive reflux disease, P-CABs offer rapid and sustained symptom control compared with placebo. Their pharmacologic profiles, including flexible dosing and rapid action, support on-demand therapy, potentially enhancing patient satisfaction. In addition, P-CABs may help overcome unmet needs from suboptimal efficacy of PPIs in nocturnal heartburn and extraesophageal symptoms. Emerging economic evaluation suggests P-CABs may be cost-effective in Asian healthcare systems. In FD, tegoprazan offers effective symptom relief without delaying gastric emptying, distinguishing it from PPIs. Limited clinical and real-world data indicate that second-generation P-CABs do not exhibit significant hepatotoxicity, however, long-term hypergastrinemia and mucosal changes warrant further surveillance. This review highlights the evolving role of P-CABs in gastroesophageal reflux disease and FD and emphasizes the need for further research to refine their clinical positioning, optimize therapeutic strategies, and evaluate long-term safety outcomes.
: The relationship between physical activity (PA) and functional dyspepsia (FD) remains unclear due to a lack of robust evidence. We conducted a Mendelian randomization (MR) analysis to assess potential genetic associations, followed by a randomized controlled trial (RCT) assessing the therapeutic effects of moderate-intensity exercise in FD patients. : In the MR analysis, genetic variants associated with PA traits from genome-wide association studies were analyzed. For the RCT, 260 FD patients were randomized to moderate-intensity exercise intervention or a control group. The primary endpoint was the adequate relief rate of dyspeptic symptoms. : Using MR, a potential inverse association of strenuous sports activity against the development of FD was estimated (inverse variance weighte OR = 0.92, 95% CI = 0.88-0.98, P = 0.0047). Additionally, a suggestive inverse association was observed between other exercises (eg, swimming, cycling, keep fit, and fishing) (inverse variance weighte OR = 0.964; 95% CI, 0.937-0.993; P = 0.013) and FD risk. In the previous high-quality study, other exercises (eg, swimming, cycling, keep fit, and fishing) were considered moderate intensity exercise. Therefore, the MR study suggest that moderate intensity exercise may reduce the occurrence of FD. In the subsequent RCT, 114 participants in the exercise intervention group and 113 in the control group completed the study. The exercise group demonstrated a significantly higher adequate relief rate (46.9% vs 30.8%, P = 0.008) and greater reductions in symptom scores (all P < 0.05) versus controls. : PA, particularly moderate-intensity exercise, may reduce the risk of FD.
: Food is thought to play a central role in the pathophysiology of disorders of gut-brain interaction (DGBI). Data on these associations come largely from Western countries. We evaluated associations between diet and common bowel DGBI using the database of the Rome Foundation Global Epidemiology Study (RFGES). : The RFGES database contains data collected via the Internet, personal interviews, or both from 33 countries, providing prevalence rates for common DGBI. Logistic regressions were used to analyze associations between DGBI and vegan, vegetarian, lactose-free and bread-, pasta-, and rice-predominant diets. : 54 127 internet and 20 973 household survey subjects were included. Rates of adherence to a vegan or vegetarian diet were low in both surveys (0.4% to 9.8%) and differences in dietary preference were also noted between surveys with lactose-free and rice-predominant diets being more common among household survey respondents. While discrepancies between results from the 2 surveys limited the interpretation of the data, some trends were evident with a lactose-free diet linked to an increased prevalence and bread- and rice-predominant diets to lower prevalence rates of several bowel DGBI. : Though complicated by variations in results between the 2 survey populations, this global survey has revealed dietary factors that may impact, in the general population, on reported prevalence rates for DGBI.
Gastroesophageal reflux disease (GERD) is common worldwide, but troublesome symptoms alone are not sufficient for a conclusive diagnosis. The Montreal Consensus introduced a symptom-based definition of GERD and defined mucosal injury phenotypes of the disease. The Lyon Consensus adapted mucosal injury findings as well as defined abnormal reflux burden criteria for the diagnosis of conclusive GERD. The diagnosis of esophageal disorders of gut-brain interaction (E-DGBI) using Rome V criteria requires exclusion of GERD, which is also described in the Lyon Consensus 2.0 criteria. Collectively utilizing these various criteria, distinct phenotypes can be identified in patients with troublesome reflux-like symptoms. The mucosal injury phenotype, initially defined by the Montreal Consensus, requires reflux management for healing of esophagitis to improve symptoms, and surveillance to identify and prevent GERD complications including Barrett's esophagus and esophageal adenocarcinoma. The abnormal reflux burden phenotype requires reflux management for symptom improvement. The E-DGBI phenotype requires specific management of each of the functional disorders for symptom relief. Hypervigilance and symptom-specific anxiety can overlap with all the phenotypes, and E-DGBI can coexist with conclusive GERD. Therefore, there are intricate interrelationships between Montreal, Lyon and Rome criteria that aid evaluation of troublesome symptoms, and concepts from each of these contribute to accurate phenotyping and optimal management of patients.
: The pylorus muscles are known to play a vital role in the process of gastric emptying and are directly implicated in symptom associated with delayed gastric drainage. Endoluminal functional luminal imaging probe (EndoFLIP) can predict clinical response to pylorus directed therapy in symptomatic children and adults. Normal pylorus EndoFLIP values are available for adult but not in children. We aim to assess the impact of age on pediatric pyloric EndoFLIP values. : Retrospective review of all children who underwent pylorus EndoFLIP in Evelina London Children's Hospital from July 2022 to March 2025. : One hundred and sixty-nine EndoFLIP values were collected from 29 children, 35% females. Mean age was 8.5 ± SD (± 4.1), children reported at least 1 symptom of impaired gastric emptying. EndoFLIP values appeared to cluster in age ranges 0-4, 4-8 and > 8 years with diameter significantly different. There was no correlation with weight range. At balloon volume of 40 mL, abdominal distension after feeding positively correlated with distensibility (r = 0.45, P = 0.018 and negatively with pressure (r = -0.41, P = 0.036). Intolerance to gastric feeding with pressure (r = 0.45, P = 0.019) and pain after feeding with pressure (r = 0.5, P = 0.009). High balloon pressure can lead to unwarranted dilatation. : Pediatric pylorus EndoFLIP values are determined by age but not weight and they correlate with symptoms of impaired gastric emptying. Adults normal values are not applicable to children. There is a need to set up a separate pediatric protocol for pylorus EndoFLIP.
Randomized controlled trials (RCTs) of fecal microbiota transplantation (FMT) in patients with irritable bowel syndrome (IBS) have produced outcomes varying from no effect at all to high efficacy and durable effects over time. This review analyzed differences in the protocols used in FMT RCTs for IBS in the recently published literature with the aim of identifying the factors responsible for the success or failure of these RCTs. The results of this analysis might be useful in formulating an effective standard protocol for FMT in IBS. A systematic search was conducted in the PubMed database of the literature published in English from January 2015 to December 2023 using several search phrases comprising MeSH expressions. Those RCTs that carefully selected donors based on environmental factors that are known to affect the gut microbiota positively and ensured bacterial diversity before and during FMT produced successful outcomes. Furthermore, direct freezing of the donor's fecal transplant, storing it at -80°C until the FMT is performed, and then thawing it at 4°C and mixing it manually appear to be factors associated with the success of FMT in IBS. Administering the donor's fecal transplant into the small intestine results in durable effects of FMT and long-term colonization of beneficial bacteria. A standard protocol for FMT with large and durable effects should include (1) careful donor selection, (2) handling the donor's fecal transplant in a way that preserves its microbiota contents, and (3) administering the transplant into the small intestine.
: Chronic constipation is prevalent yet under-diagnosed across Asia, compromising quality of life and burdening healthcare systems. Cultural stigma, varied diets, and limited access to standardized diagnostic tools delay timely care. : The Bali Chronic Constipation Roundtable in November 2024, brought together experts from 11 Asian countries. The group reviewed epidemiological data, analyzed multinational questionnaire on clinical practice pattern, and conducted structured discussions to identify key barriers and propose region-specific recommendations. : Chronic constipation prevalence varies across Asia, ranging from 1.8% in India to 16.6% in Japan, with women and the elderly disproportionately affected. Under-reporting persists owing to cultural taboos and widespread self treatment with laxatives and traditional medications. Although the Rome IV criteria remains the global standard, they may not fully reflect Asian symptom profiles, and diagnosis is limited by scarce motility laboratories. First line therapies such as dietary-fiber optimization and osmotic laxatives are widely available, but newer pharmacotherapies (prucalopride, linaclotide, lubiprostone, and elobixibat) remain costly and unevenly accessible. Biofeedback for dyssynergic defecation is underutilized due to limited availability. Experts recommend expanded regional research on to refine diagnostic criteria, coupled with enhanced physician education and public awareness. They advocate accessibility to second-line and novel therapies that incorporate culturally attuned regional guidelines, and improved access to gastrointestinal motility testing. : The Bali Chronic Constipation Roundtable highlighted Asia's need for region specific diagnostics and management. Addressing diagnostic and treatment gaps will improve outcomes, while ongoing researcher clinician policy collaboration must standardize guidelines, advance research, and ensure equitable care across Asia.