Background
Gastric electrical simulation has been shown to relieve nausea and vomiting in medically refractory patients. Efficacy of gastric electrical stimulation has been reported mostly in ...short‐term studies, but none has evaluated its efficacy beyond 10 years after implantation.
Methods
Patients implanted at our center for medically refractory severe and chronic nausea and/or vomiting were evaluated before and over 10 years after implantation using symptomatic scale and quality of life (GIQLI) score. Improvement was defined as a reduction of more than 50% in vomiting frequency.
Key Results
A total of 50 patients were implanted from January 1998 to December 2009. Among them, 7 were explanted due to a lack of efficacy and/or side effects, 2 died, and 4 were lost to follow‐up. Mean follow‐up was 10.5 ± 3.7 years. In intention‐to‐treat analysis, 27/50 (54%) patients reported an improvement. Beyond 10 years, an improvement in early satiety (3.05 vs 1.76, <0.001), bloating (2.51 vs 1.70, P = .012), nausea (2.46 vs 1.35, P = .001), and vomiting (3.35 vs 1.49 P < .001) scores were observed. Quality of life improved over 10 years (GIQLI score: 69.7 vs. 86.4, P = .005) and body mass index (BMI: 23.4 vs. 26.2 kg/m2; P = .048).
Conclusions and Inferences
Gastric electrical simulation is effective in the long‐term in patients with medically refractory nausea and vomiting, with an efficacy of 54% at 10 years on an intention‐to‐treat analysis. Other long‐term observational studies are warranted to confirm these results.
Background
Recent studies have shown that pyloric distensibility is altered in 30–50% of gastroparetic patients but the number of diabetic patients included in prior reports has been small. The aim ...of the present study was to assess pyloric sphincter measurements in diabetic patients with gastroparesis and to determine whether diabetes characteristics were correlated to pyloric disfunction.
Methods
Pyloric distensibility and pressure were measured using EndoFLIP® system in 46 patients with diabetic gastroparesis (DGP) and compared with 21 healthy volunteers (HV), and 33 patients with idiopathic gastroparesis (IGP). Altered pyloric distensibility was defined as the measurement below 10 mm2/mmHg at 40 ml of inflation. In diabetic patients, blood glucose, glycated hemoglobin, duration, complications, and treatments were collected.
Key Results
Mean pyloric distensibility at 40 ml of inflation was lower in DGP and IGP groups with, respectively, 10.8 ± 0.9 mm2/mmHg and 14.8 ± 2.2 mm2/mmHg in comparison with the HV group (25.2 ± 2.3 mm2/mmHg; p < 0.005). 56.5% of patients had a decreased pyloric distensibility in the DGP group, 51.5% of patients in the IGP group, and 10% of patients in the HV group. No correlation was found between pyloric sphincter measurements and diabetes characteristics, including blood glucose, glycated hemoglobin, diabetes mellitus type, neuropathy, or GLP1 agonists intake.
Conclusion and Interferences
Pyloric sphincter distensibility and pressure were altered both in diabetic and idiopathic gastroparesis. Pyloric sphincter distensibility was not correlated to diabetes parameters.
Pyloric sphincter distensibility and pressure were altered both in diabetic and idiopathic gastroparesis. Pyloric sphincter distensibility was not correlated with diabetes parameters.
The majority of patients with irritable bowel syndrome (IBS) experiences food‐related symptoms, which are associated with high symptom burden, reduced quality of life, increased healthcare ...consumption and reduced intake of certain nutrients. In this review we aimed to describe a clinically useful approach for physicians, by presenting the latest progress in knowledge and its translation to management in IBS patients with food‐related symptoms, as well as the underlying mechanisms involved. The research tools currently available that can be used in the future for a better characterization of this subgroup of patients are also discussed. Working towards this approach could lead to a more individualised work‐up and management of IBS patients with food‐related symptoms.
Background and study aims
History of gastric surgery is found in 10% of patients with gastroparesis, and vagal lesion is often suspected to be the cause of pylorospasm. Recently, pyloric ...distensibility measurement using the EndoFLIP® system showed that pylorospasm was present in 30%‐50% of gastroparetic patients. Our objective was to assess whether pylorospasm, diagnosed using EndoFLIP® system was observed in three different types of gastric surgeries: antireflux surgery, sleeve gastrectomy, and esophagectomy.
Patients and Methods
Pyloric distensibility and pressure were measured using the EndoFLIP® system in 43 patients from two centers (18 antireflux surgery, 16 sleeve gastrectomy, and nine esophagectomy) with dyspeptic symptoms after gastric surgery, and in 21 healthy volunteers. Altered pyloric distensibility was defined as distensibility below 10 mm2/mm Hg as previously reported.
Results
Compared to healthy volunteers (distensibility: 25.2 ± 2.4 mm2/mm Hg; pressure: 9.7 ± 4.4 mm Hg), pyloric distensibility was decreased in 61.1% of patients in the antireflux surgery group (14.5 ± 3.4 mm2/mm Hg; P < .01) and 75.0% of patients in the esophagectomy group (10.8 ± 2.1 mm2/mm Hg; P < .05), while pyloric pressure was only increased in the antireflux surgery group (18.9 ± 2.2 mm Hg; P < .01). Pyloric distensibility and pressure were similar in healthy volunteers and in sleeve gastrectomy (distensibility: 20.3 ± 3.8 mm2/mm Hg; pressure: 15.8 ± 1.6 mm Hg) groups, with decreased pyloric distensibility affecting 18.7% of sleeve gastrectomy patients.
Conclusion
Antireflux surgery and esophagectomy were associated with pylorospasm although pylorospasm was not found in all patients. Sleeve gastrectomy was not associated with altered pyloric distensibility nor altered pyloric pressure.
In this study, patients with dyspeptic symptoms after gastric surgery and healthy volunteers underwent a pyloric distensibility measurement using the EndoFLIP system. Antireflux surgery and esophagectomy were associated with pylorospasm although pylorospasm was not found in all patients. Sleeve gastrectomy was not associated with altered pyloric distensibility nor altered pyloric pressure.
Background
The Nine Item Avoidant/Restrictive Food Intake Disorder (ARFID) Screen (NIAS) questionnaire is originally available in English. Given the significant overlap of ARFID‐like symptoms in ...gastrointestinal (GI) diseases, ARFID screening becomes crucial in these patient populations. Consequently, the translation of the NIAS questionnaire into French is necessary for its utilization in French‐speaking countries.
Methods
Clinical experts in neuro‐gastroenterology and dietetics from four medical centres in two French‐speaking countries (France and Belgium) took part in a well‐structured questionnaire translation procedure. This process involved six steps before final approval: translation from English to French, backward translation, comparison between the original and retranslated versions, testing the translated version on patients, making corrections based on patient feedback, and testing the corrected version on an additional sample of patients.
Key Results
The NIAS questionnaire in French (NIAS‐Fr) was tested on 18 outpatients across the involved centres. For the majority of native French‐speaking patients, the translated questionnaire was well understood and clear. After incorporating two relevant modifications suggested by the patients, the translated questionnaire was approved through testing on an additional sample of patients.
Conclusions and Inferences
The involvement of two French‐speaking countries was crucial for the harmonization and cultural adaptation of the questionnaire. As a result, the NIAS‐Fr is now available for use in 54 French‐speaking countries, serving approximately 321 million French speakers across five continents for screening ARFID, for both clinical and research purposes.
The NIAS questionnaire, an ARFID screening tool, was structurally translated into French, expanding its usability to 54 French‐speaking countries and 321 million French‐speakers for clinical and research purposes.
Clinical studies revealed that early-life adverse events contribute to the development of IBS in adulthood. The aim of our study was to investigate the relationship between prenatal stress (PS), gut ...microbiota and visceral hypersensitivity with a focus on bacterial lipopeptides containing γ-aminobutyric acid (GABA).
We developed a model of PS in mice and evaluated, in adult offspring, visceral hypersensitivity to colorectal distension (CRD), colon inflammation, barrier function and gut microbiota taxonomy. We quantified the production of lipopeptides containing GABA by mass spectrometry in a specific strain of bacteria decreased in PS, in PS mouse colons, and in faeces of patients with IBS and healthy volunteers (HVs). Finally, we assessed their effect on PS-induced visceral hypersensitivity.
Prenatally stressed mice of both sexes presented visceral hypersensitivity, no overt colon inflammation or barrier dysfunction but a gut microbiota dysbiosis. The dysbiosis was distinguished by a decreased abundance of
, in both sexes, inversely correlated with visceral hypersensitivity to CRD in mice. An isolate from this bacterial species produced several lipopeptides containing GABA including C14AsnGABA. Interestingly, intracolonic treatment with C14AsnGABA decreased the visceral sensitivity of PS mice to CRD. The concentration of C16LeuGABA, a lipopeptide which inhibited sensory neurons activation, was decreased in faeces of patients with IBS compared with HVs.
PS impacts the gut microbiota composition and metabolic function in adulthood. The reduced capacity of the gut microbiota to produce GABA lipopeptides could be one of the mechanisms linking PS and visceral hypersensitivity in adulthood.
Summary
Background
Oesophageal radiofrequency reduces use of proton pump inhibitors (PPIs) in patients with gastro‐oesophageal reflux disease responding to PPIs.
Aim
To determine the efficacy of ...oesophageal radiofrequency in patients with PPI‐refractory heartburn.
Methods
A randomised, double‐blind, sham‐controlled multicentre study was designed to assess the efficacy of oesophageal radiofrequency in PPI non‐responding patients with heartburn. Patients had moderate‐to‐severe heartburn defined by at least 3 occurrences a week, and not improved by continuous PPI treatment. The primary endpoint was clinical success at week 24, defined by intake of less than 7 PPI doses over the 2 preceding weeks and adequate symptom control determined by the patient.
Results
Sixty two patients were randomised, 29 to the oesophageal radiofrequency group and 33 to the sham group. Intention‐to‐treat analysis showed that 1/29 (3.4%) and 5/33 (15.1%) achieved the primary endpoint in the oesophageal radiofrequency and sham groups, respectively (NS). There was no significant difference between oesophageal radiofrequency and sham regarding the number of days without heartburn, days with PPI consumption in the last 2 weeks, and patients not taking PPIs. No pH‐impedance parameter was associated with clinical response. The occurrence of adverse events was similar in both groups.
Conclusion
This sham‐controlled, randomised study did not demonstrate any efficacy of oesophageal radiofrequency for the treatment of PPI‐refractory heartburn regarding symptom relief or consumption of PPIs. ClinicalTrials.gov NCT01682265.
Background
The low FODMAPs (fermentable oligo‐, di‐, monosaccharides, and polyols) diet improves lower gastrointestinal symptoms. Patients suffering from proton pump inhibitor (PPI) refractory ...gastroesophageal reflux disease (GERD) have limited treatment options. We investigated the efficacy of a low FODMAPs diet in patients with PPI refractory GERD.
Methods
This multicenter, randomized, open‐label study compared the efficacy of a 4‐week low FODMAPs diet and usual dietary advice (ie, low‐fat diet and head of bed elevation) in patients with symptomatic PPI refractory GERD, defined by a Reflux Disease Questionnaire (RDQ) score >3 and abnormal pH‐impedance monitoring on PPIs. The primary endpoint was the percentage of responders (RDQ ≤3) at the end of the diet.
Results
Thirty‐one patients (55% women, median age 45 years) were included, 16 randomized in the low FODMAPs diet group and 15 in the usual dietary advice group. Adherence to the assigned diet was good, with a significant difference in the FODMAPs intake per day between the low FODMAPs diet (2.5 g) and the usual dietary advice group (13 g) (p < 0.001). There was no difference in response rates (RDQ score ≤3) between the low FODMAPs diet (6/16, 37.5%) and usual dietary advice (3/15, 20%) groups (p = 0.43). Total RDQ score and dyspepsia subscore decreased significantly over time in both groups (p = 0.002), with no difference according to the assigned diet group (p = 0.85).
Conclusion
Low FODMAPs diet and usual dietary advice have similar but limited beneficial effects on symptoms in patients with PPI refractory GERD.
We compared the efficacy of a low FODMAP diet to usual dietary advice in patients with proton pump inhibitor‐refractory gastroesophageal reflux disease in a randomized trial. After 4 weeks of diet, low FODMAP diet and usual dietary advice showed similar but limited beneficial effects on symptoms.
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