간행물

Journal of Neurogastroenterology and Motility update

  • : 대한소화기기능성질환·운동학회(구 대한소화관운동학회)
  • : 의약학분야  >  내과학
  • : KCI등재
  • : SCI,SCOPUS
  • : 연속간행물
  • : 계간
  • : 2093-0879
  • : 2093-0887
  • : 대한소화관운동학회지(~2009)→Journal of Neurogastroenterology and Motility(2010~)

수록정보
수록범위 : 1권1호(1994)~25권2호(2019) |수록논문 수 : 1,195
Journal of Neurogastroenterology and Motility
25권2호(2019년 04월) 수록논문
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1Screening for Barrett's Esophagus: Balancing Clinical Value and Cost-effectiveness

저자 : Amit Patel , C Prakash Gyawali

발행기관 : 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 간행물 : Journal of Neurogastroenterology and Motility 25권 2호 발행 연도 : 2019 페이지 : pp. 181-188 (8 pages)

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In predisposed individuals with long standing gastroesophageal reflux disease (GERD), esophageal squamous mucosa can transform into columnar mucosa with intestinal metaplasia, commonly called Barrett's esophagus (BE). Barrett's mucosa can develop dysplasia, which can be a precursor for esophageal adenocarcinoma (EAC). However, most EAC cases are identified when esophageal symptoms develop, without prior BE or GERD diagnoses. While several gastrointestinal societies have published BE screening guidelines, these vary, and many recommendations are not based on high quality evidence. These guidelines are concordant in recommending targeted screening of predisposed individuals (eg, long standing GERD symptoms with age > 50 years, male sex, Caucasian race, obesity, and family history of BE or EAC), and against population based screening, or screening of GERD patients without risk factors. Targeted endoscopic screening programs provide earlier diagnosis of high grade dysplasia and EAC, and offer potential for endoscopic therapy, which can improve prognosis and outcome. On the other hand, endoscopic screening of the general population, unselected GERD patients, patients with significant comorbidities or patients with limited life expectancy is not cost-effective. New screening modalities, some of which do not require endoscopy, have the potential to reduce costs and expand access to screening for BE.
(J Neurogastroenterol Motil 2019;25:181-188)

KCI등재 SCI SCOPUS

2Control of Motility in the Internal Anal Sphincter

저자 : Kathleen D Keef , Caroline A Cobine

발행기관 : 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 간행물 : Journal of Neurogastroenterology and Motility 25권 2호 발행 연도 : 2019 페이지 : pp. 189-204 (16 pages)

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The internal anal sphincter (IAS) plays an important role in the maintenance of fecal continence since it generates tone and is responsible for > 70% of resting anal pressure. During normal defecation the IAS relaxes. Historically, tone generation in gastrointestinal muscles was attributed to mechanisms arising directly from smooth muscle cells, ie, myogenic activity. However, slow waves are now known to play a fundamental role in regulating gastrointestinal motility and these electrical events are generated by the interstitial cells of Cajal. Recently, interstitial cells of Cajal, as well as slow waves, have also been identified in the IAS making them viable candidates for tone generation. In this review we discuss four different mechanisms that likely contribute to tone generation in the IAS. Three of these involve membrane potential, L-type Ca2+ channels and electromechanical coupling (ie, summation of asynchronous phasic activity, partial tetanus, and window current), whereas the fourth involves the regulation of myofilament Ca2+ sensitivity. Contractile activity in the IAS is also modulated by sympathetic motor neurons that significantly increase tone and anal pressure, as well as inhibitory motor neurons (particularly nitrergic and vasoactive intestinal peptidergic) that abolish contraction and assist with normal defecation. Alterations in IAS motility are associated with disorders such as fecal incontinence and anal fissures that significantly decrease the quality of life. Understanding in greater detail how tone is regulated in the IAS is important for developing more effective treatment strategies for these debilitating defecation disorders.
(J Neurogastroenterol Motil 2019;25:189-204)

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3Opioid Treatment and Excessive Alcohol Consumption Are Associated With Esophagogastric Junction Disorders

저자 : Valeria Schindler , Daniel Runggaldier , Amanda Bianca , Anton S Becker , Fritz Murray , Edoardo Savarino , Daniel Pohl

발행기관 : 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 간행물 : Journal of Neurogastroenterology and Motility 25권 2호 발행 연도 : 2019 페이지 : pp. 205-211 (7 pages)

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Background/Aims
The influence of external factors such as opioids and alcohol has been extensively investigated for various segments of the gastrointestinal tract. However, the association between their use and the development of esophagogastric junction outflow obstruction disorders (EGJOODs) is unknown. Therefore, the aim of this study is to analyze prevalence and clinical relevance of opioids and alcohol intake in patients with EGJOODs.
Methods
In this single-center, retrospective study, we reviewed clinical and pharmacological data of 375 consecutive patients who had undergone high resolution impedance manometry for EGJOODs. EGJOODs were classified according to the Chicago classification version 3.0 and to recently published normal values for test meals. Demographics, manometric data, and symptoms were compared between different groups using Pearson's chi-squared test, Fisher's exact test, and multivariate analysis. A P < 0.05 was considered significant.
Results
EGJOOD was found in 30.7% (115/375) of all analyzed patients. The prevalence of opioids (14.8% vs 4.2%, P = 0.026) was significantly higher in patients with EGJOODs compared to patients without EGJOODs. Additionally, excessive alcohol consumption (12.2% vs 3.5%, P = 0.011) was associated with EGJOODs. Excessive alcohol consumption was especially frequent in the non-achalasia esophagogastric junction outflow obstruction subgroup (16.2%) and opioid use in the achalasia type III subgroup (20.0%).
Conclusions
We found a significant association between EGJOODs and opioid as well as excessive alcohol consumption. This underlines the importance of detailed history taking regarding medication and ethanol consumption in patients with dysphagia. Further prospective studies on mechanisms undelaying esophagogastric junction dysfunction due to opioids or alcohol are warranted.
(J Neurogastroenterol Motil 2019;25:205-211)

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4Degranulated Eosinophils Contain More Fine Nerve Fibers in the Duodenal Mucosa of Patients With Functional Dyspepsia

저자 : Min Jin Lee , Hye-kyung Jung , Ko Eun Lee , Yeung-chul Mun , Sanghui Park

발행기관 : 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 간행물 : Journal of Neurogastroenterology and Motility 25권 2호 발행 연도 : 2019 페이지 : pp. 212-221 (10 pages)

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Background/Aims
Functional dyspepsia (FD) is characterized as chronic recurrent upper gastrointestinal symptoms in the absence of any organic disorder. We hypothesized that duodenal low-grade inflammation activates superficial afferent nerve sprouting, thereby contributing to hypersensitivity in patients with FD.
Methods
A prospective case-control study was conducted in a tertiary referral center. FD was defined using the Rome III criteria. Standardized endoscopic biopsies were performed in the stomach and duodenum. Hematoxylin and eosin staining and immunohistochemical staining for major basic proteins were performed to detect granulated eosinophil-derived granules, and S-100 staining was performed to detect fine nerve fibers.
Results
A total of 51 patients with FD (82% female; mean age 35.8 ± 13.4 years) and 35 controls were enrolled. Activated eosinophil counts in the duodenum were significantly higher in patients with FD than in controls (41.4% vs 17.1%, P = 0.005). Microscopic duodenitis was more frequently detected in patients with FD than in controls. Fine nerve fibers were more abundant in patients with FD than in controls (45.1% vs 11.4%, P = 0.029). The abundance of fine nerve fibers highly correlated with the degree of activated eosinophils.
Conclusion
Duodenal low-grade inflammation, such as mucosal eosinophilic accumulation with degranulation, promoted mucosal enteric nerve fiber density and sprouting in patients with FD.
(J Neurogastroenterol Motil 2019;25:212-221)

KCI등재 SCI SCOPUS

5Self-reported Food Intolerance in Korean Patients With Irritable Bowel Syndrome

저자 : Hyo Jeong Lee , Hyun Jin Kim , Eun Hee Kang , Kee Wook Jung , Seung-jae Myung , Yang Won Min , Chang Hwan Choi , Han Seung Ryu , Jong Kyoung Choi , Joong Goo Kwon , Kyoung Sup Hong , Kyung Sik Park

발행기관 : 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 간행물 : Journal of Neurogastroenterology and Motility 25권 2호 발행 연도 : 2019 페이지 : pp. 222-232 (11 pages)

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Background/Aims
Various foods trigger and/or worsen the symptoms of irritable bowel syndrome (IBS). However, Korean food-related gastrointestinal (GI) symptoms in IBS patients have not yet been investigated. This study aims to evaluate the prevalence of self-reported food intolerance in Korean IBS patients and determine the Korean food items and food groups perceived by patients to worsen their GI symptoms.
Methods
We recruited 393 study subjects, comprising 101 IBS patients, 167 symptomatic non-IBS subjects, and 125 control subjects. All participants completed a questionnaire to identify the most problematic foods and assess the occurrence of GI symptoms caused by 119 Korean food items. They also completed the validated Rome III questionnaire for IBS.
Results
The prevalence of self-reported food intolerance in Korean IBS patients was 79.2%, which was significantly higher than that in control subjects (44.8%, P < 0.001). The most problematic foods reported by IBS patients who experienced food intolerance were high-fat foods (25.0%), gluten foods (23.8%), spicy foods (15.0%), and dairy products (15.0%). A total of 63.4% of IBS patients reported GI symptoms related to the consumption of foods high in fermentable oligo-, di-, mono-saccharides, and polyols (FODMAP), while 48.5% of IBS patients reported symptoms associated with high-fat foods. Gas problems and loose stools were the most frequently reported symptoms.
Conclusions
A large proportion of Korean IBS patients complained of intolerance to certain food items, with high-fat and high-FODMAP foods being the main triggers. This study provides a basis for planning food intervention studies for Korean IBS patients.
(J Neurogastroenterol Motil 2019;25:222-232)

KCI등재 SCI SCOPUS

6Psychosocial Factors Associated With Irritable Bowel Syndrome Development in Chinese College Freshmen

저자 : Chen Jiang , Yan Xu , Stuti Sharma , Lei Zhang , Huan Wang , Jun Song , Wei Qian , Tao Bai , Xiaohua Hou

발행기관 : 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 간행물 : Journal of Neurogastroenterology and Motility 25권 2호 발행 연도 : 2019 페이지 : pp. 233-240 (8 pages)

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Background/Aims
The role of psychosocial factors on irritable bowel syndrome (IBS) in adolescents is incompletely understood. The aim of this study is to investigate the association between the psychosocial factors and the risk of developing IBS in college freshmen.
Methods
A cross-sectional survey was conducted in a randomly selected freshmen population in Wuhan China (n = 2449). Questionnaire evaluated demographics and psychosocial risks. The population was divided into 3 groups: non-discomfort, chronic abdominal discomfort and IBS. The association between the development of IBS and psychosocial factors was analyzed by ordinal and multiple logistic regression analysis.
Results
A total of 2053 (83.8%) completed this survey (mean age, 18.2 ± 0.9 years; female, 35.6%). Among them, 82 (4.0%) fulfilled the Rome III criteria for IBS. Female (odds ratio [OR], 3.31; 95% confidence interval [CI], 2.47-4.45), experience of abuse (OR, 2.44; 95% CI, 1.10-5.56), and suicidal intention (OR, 2.17; 95% CI, 1.15-4.17) were more likely to have IBS. Compared with chronic abdominal discomfort, however, depression (OR, 5.55; 95% CI, 1.36-22.71) was the only dependent risk factor for IBS.
Conclusion
The prevalence of IBS in college freshmen is 4.0%, and to the freshmen, psychosocial factors such as experience of abuse, depression, and suicidal intention were associated with high risk of developing IBS.
(J Neurogastroenterol Motil 2019;25:233-240)

KCI등재 SCI SCOPUS

7Is Long-term Ambient Air Pollutant Exposure a Risk Factor for Irritable Bowel Syndrome in Children? A 12-year Longitudinal Cohort Study

저자 : Teck-king Tan , Miguel Saps , Cheng-li Lin , Chang-ching Wei

발행기관 : 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 간행물 : Journal of Neurogastroenterology and Motility 25권 2호 발행 연도 : 2019 페이지 : pp. 241-249 (9 pages)

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Background/Aims
Recent studies suggest that air pollution may play a role in gastrointestinal disorders. However, the effect of long-term exposure to air pollution on childhood irritable bowel syndrome (IBS) is unclear. Hence, we conducted a nationwide cohort study to investigate the association between long-term air pollution exposure and the incidence and risk of IBS in Taiwanese children during 2000-2012.
Methods
We collected data from the Taiwan National Health Insurance Research Database, linked to the Taiwan Air Quality-Monitoring Database according to the insurant living area and the air quality-monitoring station locations. Children < 18 years old, identified from January 1st, 2000, were followed-up until IBS diagnosis or December 31st, 2012. The daily average air pollutant concentrations were categorized into 4 quartile-based groups (Q1-Q4). We measured the incidence rate, hazard ratios (HRs), and 95% confidence intervals for IBS stratified by the quartiles of air pollutant concentration.
Results
A total of 3537 children (1.39%) were diagnosed with IBS within the cohort during the follow-up period. The incidence rate for IBS increased from 0.84 to 1.76, from 0.73 to 1.68, from 0.85 to 1.98, and from 0.52 to 3.22 per 1000 person-years, with increase in the carbon monoxide, nitrogen dioxide, non-methane hydrocarbon, and methane quartile (from Q1 to Q4) exposure concentration, respectively. The adjusted HR for IBS increased with elevated carbon monoxide, nitrogen dioxide, non-methane hydrocarbon, and methane exposure in Q4 to 1.98, 2.14, 2.19, and 5.87, respectively, compared with Q1.
Conclusion
Long-term ambient air pollutant exposure is an environmental risk factor for childhood IBS.
(J Neurogastroenterol Motil 2019;25:241-249)

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Background/Aims
High-resolution anorectal manometry (HRAM) has been considered a first-line diagnostic tool for functional defecation disorder. However, clinical studies on HRAM used in constipation patients are very limited and few studies have reported the characteristics of anorectal pressure in Chinese patients. The aim of this study is to investigate the characteristics of motility data in a cohort of Chinese patients with functional constipation.
Methods
A total of 82 consecutive patients with functional constipation who underwent a standardized HRAM were retrospectively enrolled in this study. The functional defecation disorder was classified into Rao's types.
Results
The mean age of 82 patients was 51 years (range, 16-83 years). Indications for anorectal manometry were functional constipation for all patients. The mean resting pressure was 69.2 ± 21.2 mmHg (range, 24.5-126.9 mmHg). The mean maximum squeezing pressure was 198.4 ± 75.6 mmHg (range, 54.2-476.9 mmHg). The mean length of the anal high pressure zone was 3.4 ± 1.0 cm (range, 0.6- 4.9 cm). Sixty (73.2%) patients were diagnosed as functional defecation disorder. In attempted defecation, type I was most common (n = 24), followed by type II (n = 12), type III (n = 11), and type IV (n = 13) that were present on HRAM according to Rao's classification. In all 60 patients with functional defecation disorder, 37 were women and 23 were men. Men were significantly more likely than women to have functional defecation disorder (92.0% vs 64.9%, P = 0.014).
Conclusion
HRAM could be used as a test for the diagnosis of functional defecation disorder and functional defecation disorder is common in Chinese patients with functional constipation.
(J Neurogastroenterol Motil 2019;25:250-257)

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9Influence of Age and Body Mass Index on Total and Segmental Colonic Transit Times in Constipated Subjects

저자 : Michel Bouchoucha , Marinos Fysekidis , Pierre Rompteaux , Gheorge Airinei , Jean-marc Sabate , Robert Benamouzig

발행기관 : 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 간행물 : Journal of Neurogastroenterology and Motility 25권 2호 발행 연도 : 2019 페이지 : pp. 258-266 (9 pages)

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Background/Aims
Discordant data are found in the literature for the relationships between total and segmental colonic transit time (CTT) and demographic parameters. The aim of this study is to examine the influence of age, and body mass index (BMI) on total and segmental CTT in constipated subjects.
Methods
We included 354 constipated patients on this cross-sectional study. According to the Rome III criteria, patients were classified as having irritable bowel syndrome with constipation, or functional constipation. All patients filled the Bristol stool form, and reported the severity of constipation, bloating, and abdominal pain on a 10-point Likert scale. Total and segmental CTT were measured using radiopaque markers.
Results
Females were 84% of patients, with a mean age of 46.0 ± 15.9 years. The association between total and segmental CTT with age and BMI was significant after adjustment for gender, clinical phenotype, the presence of defecation disorders, and abdominal pain or bloating intensity despite the severity of symptoms, and the frequency of defecation disorders were higher in irritable bowel syndrome with constipation than in functional constipation patients. By comparison with subjects less than 30 years, rectosigmoid transit time (RSTT) was lower in patients between 30 and 60 years. Age was negatively associated with RSTT (P = 0.004). By comparison with patients with normal BMI, RSTT and total CTT were lower in patients of the overweight group. BMI was negatively associated with RSTT (P < 0.001). The severity of constipation was correlated with total (P < 0.001), right (P = 0.002), and left CTT (P = 0.049).
Conclusion
Age and BMI are both associated with RSTT in constipated patients.
(J Neurogastroenterol Motil 2019;25:258-266)

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10High Prevalence of Slow Transit Constipation in Patients With Gastroparesis

저자 : Thomas A Zikos , Afrin N Kamal , Leila Neshatian , George Triadafilopoulos , John O Clarke , Monica Nandwani , Linda A Nguyen

발행기관 : 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 간행물 : Journal of Neurogastroenterology and Motility 25권 2호 발행 연도 : 2019 페이지 : pp. 267-275 (9 pages)

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Background/Aims
Current evidence suggests the presence of motility or functional abnormalities in one area of the gastrointestinal tract increases the likelihood of abnormalities in others. However, the relationship of gastroparesis to chronic constipation (slow transit constipation and dyssynergic defecation) has been incompletely evaluated.
Methods
We retrospectively reviewed the records of all patients with chronic dyspeptic symptoms and constipation who underwent both a solid gastric emptying scintigraphy and a high-resolution anorectal manometry at our institution since January 2012. When available, X-ray defecography and radiopaque marker colonic transit studies were also reviewed. Based on the gastric emptying results, patients were classified as gastroparesis or dyspepsia with normal gastric emptying (control group). Differences in anorectal and colonic findings were then compared between groups.
Results
Two hundred and six patients met the inclusion criteria. Patients with gastroparesis had higher prevalence of slow transit constipation by radiopaque marker study compared to those with normal emptying (64.7% vs 28.1%, P = 0.013). Additionally, patients with gastroparesis had higher rates of rectocele (88.9% vs 60.0%, P = 0.008) and intussusception (44.4% vs 12.0%, P = 0.001) compared to patients with normal emptying. There was no difference in the rate of dyssynergic defecation between those with gastroparesis vs normal emptying (41.1% vs 42.1%, P = 0.880), and no differences in anorectal manometry findings.
Conclusions
Patients with gastroparesis had a higher rate of slow transit constipation, but equal rates of dyssynergic defecation compared to patients with normal gastric emptying. These findings argue for investigation of possible delayed colonic transit in patients with gastroparesis and vice versa.
(J Neurogastroenterol Motil 2019;25:267-275)

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