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Key Points: Patients with chronic megacolon typically have increased colonic diameter and compliance. We have identified a subset of patients with treatment-refractory constipation who have intraluminal motility findings of chronic hypercompliance without increased colonic diameters on cross-sectional imaging. We refer to this as refractory constipation with colonic hypercompliance (RCCH). The increased compliance differs from compliance reported in chronic constipation alone. Further examination of myenteric and smooth muscle structure and function is required to advance management.
Key Points In participants with irritable bowel syndrome (IBS) who show decreased symptom severity after mindfulness-based stress reduction, brain regions communicate differently with each other when at rest. These changes in brain communication are consistent with a shift from inward and overthinking to paying more attention and noticing things happening in the body and environment. The study suggests MBSR improves IBS symptoms by changing communication between brain regions at rest.
Key Points In this sample of 120 children with pain-predominant Disorders of Gut-Brain Interaction (DGBI) and their caregivers, 102 of the 120 caregivers (85%) indicated that their child had experienced at least one adverse childhood experience (ACE). ACEs due to maltreatment were significantly correlated with greater 7 day average abdominal pain intensity, poorer health-related quality of life (HRQoL), greater anxiety, and greater depression, while ACEs due to household challenges and social context were not significantly correlated. The experience of maltreatment accounted for significant portions of variance in 7-day average abdominal pain intensity and HRQoL, respectively, even after controlling for anxiety and depression.
Key Points The distal colon has a natural “brake” (the rectosigmoid brake) that controls how quickly stool enters the rectum, helping prevent urgency and maintain continence. When this brake misfires, different problems can result: after colorectal surgery it may become overactive and delay recovery; when weakened or removed it can lead to urgency or incontinence. This brake is a promising, measurable sign to guide care: it can be boosted by sacral nerve stimulation, and new non-invasive tests may help doctors track it to predict recovery and tailor treatment.
Key Points Children with chronic abdominal pain often have trouble sleeping and we found that indicators of parasympathetic activity may be linked to nighttime sleep. Girls and boys showed different patterns of associations between heart rate variability and sleep. Sleep-disordered breathing, including snoring or gasping, was associated with lower heart rate variability in both sexes.
Highlights 1. α-Syn Oligomers Are the Most Neurotoxic Species β-sheet-rich α-synuclein (α-Syn) oligomers are key drivers of neurodegeneration in Parkinson's disease (PD), exhibiting greater neurotoxicity than monomers or fibrils. 2. Gut as the Origin of Pathology The intestine serves as a critical initiation site for α-Syn oligomer formation, modulated by intestinal inflammation, microbiota dysbiosis, environmental toxins, and genetic mutations. 3. Gut-to-Brain Transmission Pathways Gut-derived α-Syn oligomers propagate to the brain via multiple routes: the vagus nerve, spinal cord, systemic circulation (including exosomes), and immune cells such as CD11c⁺ phagocytes. 4. Mechanisms of Neurotoxicity α-Syn oligomers induce neuronal injury through oxidative stress, neuroinflammation, mitochondrial dysfunction, cytoskeletal disruption, and synaptic impairment. 5. Therapeutic Strategies Targeting α-Syn Oligomers Promising interventions include: inhibiting oligomer formation (e.g., Anle138b, baicalein, doxycycline); promoting α-Syn degradation via autophagy (e.g., icariin, nilotinib); blocking pathological propagation (e.g., antibodies BIIB054, MEDI1341). 6. Clinical and Translational Potential Targeting gut-derived α-Syn oligomers provides a novel early-stage strategy for PD, capable of modifying disease progression rather than merely alleviating symptoms.
Key Points In patients with gastroparesis, the most common predominant symptoms were nausea, vomiting, and abdominal pain. Impaired QOL varied with the patient's predominant symptom, with abdominal pain associated with poorer QOL. Over 48 weeks, GSCI improved ≥ 1 in a minority of patients, more often in patients with predominant symptoms of nausea and bloating, less often for fullness and abdominal pain. The predominant symptom can change over time.
Key Points • First-line therapies for functional dyspepsia, including proton pump inhibitors and Helicobacter pylori eradication, provide limited symptom relief in a substantial proportion of patients. • Functional dyspepsia and gastroparesis share overlapping symptoms but differ in predominant pathophysiological mechanisms, requiring tailored therapeutic strategies. • Predominantly central neuromodulators are most appropriate for epigastric pain syndrome, whereas predominantly peripheral neuromodulators are better suited for postprandial distress syndrome and gastroparesis-related nausea and vomiting. • A pragmatic, symptom-oriented, and mechanism-based approach may facilitate individualized treatment selection and optimize clinical outcomes.
Key Points Wireless motility capsule (WMC) contractile data can help guide patient selection for gastric per-oral endoscopic myotomy (G-POEM) by distinguishing physiologic phenotypes of gastroparesis—those driven by severe motor dysfunction versus sensory neuroenteric dysfunction. Idiopathic gastroparesis patients with diminished antral contractions on WMC were more likely to respond to G-POEM, whereas those with preserved antral contractility were less likely to benefit. Patients who demonstrate severe gastric emptying delay measured by both WMC and gastric emptying scintigraphy were more likely to respond to G-POEM.
Key points 1. POI is a common complication after abdominal sur-gery, prolonging the postoperative recovery time ofpatients. 2. POI will prolong the time for the intestines to empty,disrupt the intestinal flora balance, trigger related inflammatory responses, and cause disorder in the body's microenvironment. 3. Lactobacillus reuteri can alleviate intestinal metabolic disorders by promoting the expression of anti-inflammatory factors and inhibiting the expression of pro-inflammatory factors, thereby regulating the intestinal microbiota and facilitating the body's recovery.
Summary • Guidelines recommend doubling the proton pump inhibitor (PPI) dosage for persistent nocturnal reflux symptoms, while wedge pillows are suggested as anon-pharmacological option. However, their efficacy compared with twice-daily PPI remains unstudied. • A wedge pillow combined with a morning PPI was non-inferior to twice-daily PPI in alleviating nocturnal reflux symptoms and was associated with greater improvements in sleep quality, despite no significant changes in reflux parameters, suggesting that the observed benefit may be mediated by sleep-related factors. • A wedge pillow can complement PPI therapy for man-aging nocturnal reflux symptoms, offering relief from night time symptoms and improving sleep quality inpatients not responding to morning PPI therapy.
Key Points: Twenty percent of patients with systemic sclerosis met diagnostic criteria for irritable bowel syndrome or functional dyspepsia, the two most common disorders of gut–brain interaction. The presence of symptoms consistent with disorders of gut–brain interaction is associated with more severe systemic sclerosis gastrointestinal disease and poorer quality of life. Effective management strategies have been used to treat disorders of gut brain interaction that could be tested in those patients with systemic sclerosis and co-morbid disorders of gut brain interaction to reduce symptom burden and improve quality of life.
Keypoints: Muscularis macrophages express high levels of ApoE after intestinal manipulation, but macrophage-specific deletion of ApoE does not impair gut motility or tissue morphology. While global ApoE deficiency mildly affects intestinal transit and promotes inflammation, macrophage-derived ApoE is dispensable for maintaining normal and postoperative gut motility.
Key Points: Calculating the CARS endoscopic score and performing FLIP panometry during endoscopy can assess the likelihood of an esophageal motility disorder and potentially expedite its diagnosis. A CARS score > 4 combined with FLIP-REO is highly predictive (100% specificity/100% positive predictive value) of an EGJ obstruction diagnosis (achalasia or confirmed EGJOO) on HRM.
Key Points: Validated options for assessing gastric emptying in patients with dietary restrictions that preclude eating the standard egg meal. We developed and tested a vegan and allergy friendly meal using a vegan egg product for gastric emptying scintigraphy in 10 healthy volunteers after confirming in vitro stability/performance. The tested vegan egg meal appears to be a suitable alternative to the standard egg meal for patients who are not able to eat eggs, though additional studies with larger sample sizes are needed for further validation.
Key Points: This study reports the first documented case of myofilament loss in gastrointestinal smooth muscle cells in MELAS-associated chronic intestinal pseudo-obstruction (CIPO). Electron microscopic analysis demonstrated marked reduction of myofilaments accompanied by abundant abnormal mitochondria throughout the digestive tract, revealing that mitochondrial dysfunction may directly impair the smooth muscle contractile apparatus independent of previously described enteric nervous system abnormalities. These findings suggest that apparent superior mesenteric artery syndrome in MELAS patients may represent underlying CIPO with inherent intestinal structural vulnerability, supporting early implementation of enteral nutrition strategies that bypass affected gastrointestinal segments. Future research should focus on quantitative assessment of contractile protein abnormalities and development of therapeutic interventions targeting smooth muscle function in mitochondrial disorders.
Key Points Patients with rectal prolapse only at defecation present a distinct, younger phenotype with more severe obstructive defecation symptoms, higher intrarectal push pressures, and better-preserved anal sphincter function. In contrast patients with spontaneous rectal prolapse are older and have higher fecal incontinence severity associated with lower resting anal tone and less sustained squeeze pressures. MRI defecography shows greater pelvic floor laxity in spontaneous prolapse (larger levator hiatus length/width, bowl volume, and wider resting anorectal angle), whereas defecation-only prolapse demonstrates more preserved hiatus anatomy and less patulous anal canal. Defecation-only prolapse may represent an early stage of disease. Identifying the phenotype of rectal prolapse can inform timing and type of intervention though surgical recurrence rates were similar between groups.
Key Points • We employed Atmo Capsules to measure the frequency and amplitude of stomach contractions using a method called accelerometry which detects changes in capsule orientation and acceleration. • Stomach contractions occurring at a frequency of 3 cycles per minute were found which were lower in amplitude in patients with delayed gastric emptying compared to healthy controls and individuals with normal gastric emptying. • This technical assessment provides support for the Atmo Capsule accelerometer to characterize normal and abnormal stomach contractile profiles in patients with suspected motility disorders.
KEY POINTS • Enterochromaffin (EC) cells release signaling molecules which can activate nearby sensory nerves.Whether this occurs via a conventional synapse for-mation is unknown. • EC cells rarely make contact with sensory nerves inthe upper gut but this frequency increases in the distal colon. • Neurite-like protrusiton on EC cells, named by some as “neuropods” are not a preferential site of contact with nerve fibres.