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A Case of Post-fundoplication Dysphagia: Another Possible Interpretation of the Manometric Findings.

Jennifer C MYERS ; John DENT

Journal of Neurogastroenterology and Motility.2014;20(4):561-561. doi:10.5056/jnm14103

No abstract available.
Deglutition Disorders*

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Optimal Testing for Diagnosis of Fructose Intolerance: Over-dosage Leads to False Positive Intolerance Test.

Askin ERDOGAN ; Enrique Coss ADAME ; Siegfried YU ; Kulthep RATTANAKOVIT ; Satish S C RAO

Journal of Neurogastroenterology and Motility.2014;20(4):560-560. doi:10.5056/jnm14085

No abstract available.
Diagnosis* ; Fructose Intolerance*

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Circulating Inflammatory Cytokines Are Associated With the Risk of Barretths Esophagus in Western Persons.

Su Youn NAM

Journal of Neurogastroenterology and Motility.2014;20(4):558-559. doi:10.5056/jnm14098

No abstract available.
Cytokines* ; Esophagus* ; Humans

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What Is the Therapeutic Mechanism of the Probiotics in Irritable Bowel Syndrome Patients With Visceral Hypersensitivity?.

Ji Won KIM

Journal of Neurogastroenterology and Motility.2014;20(4):555-557. doi:10.5056/jnm14100

No abstract available.
Humans ; Hypersensitivity* ; Irritable Bowel Syndrome* ; Probiotics*

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Hypertensive Peristalsis: A Rare Cause of Dysphagia in a Child.

Mayank JAIN ; Jenisha JAIN

Journal of Neurogastroenterology and Motility.2014;20(4):553-554. doi:10.5056/jnm14036

No abstract available.
Child* ; Deglutition Disorders* ; Humans ; Peristalsis*

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How to Perform and Assess Colonic Manometry and Barostat Study in Chronic Constipation.

Yeong Yeh LEE ; Askin ERDOGAN ; Satish S C RAO

Journal of Neurogastroenterology and Motility.2014;20(4):547-552. doi:10.5056/jnm14056

Management of chronic constipation with refractory symptoms can be challenging. Although new drugs and behavioral treatments have improved outcome, when they fail, there is little guidance on what to do next. At this juncture, typically most doctors may refer for surgical intervention although total colectomy is associated with morbidity including complications such as recurrent bacterial overgrowth. Recently, colonic manometry with sensory/tone/compliance assessment with a barostat study has been shown to be useful. Technical challenges aside, adequate preparation, and appropriate equipment and knowledge of colonic physiology are keys for a successful procedure. The test itself appears to be safe with little complications. Currently, colonic manometry is usually performed with a 6-8 solid state or water-perfused sensor probe, although high-resolution fiber-optic colonic manometry with better spatiotemporal resolutions may become available in the near future. For a test that has evolved over 3 decades, normal physiology and abnormal findings for common phenotypes of chronic constipation, especially slow transit constipation, have been well characterized only recently largely through the advent of prolonged 24-hour ambulatory colonic manometry studies. Even though the test has been largely restricted to specialized laboratories at the moment, emerging new technologies and indications may facilitate its wider use in the near future.
Colectomy ; Colon* ; Constipation* ; Manometry* ; Phenotype ; Physiology

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Length Tension Function of Puborectalis Muscle: Implications for the Treatment of Fecal Incontinence and Pelvic Floor Disorders.

Ravinder K MITTAL ; Geoff SHEEAN ; Bikram S PADDA ; Mahadevan R RAJASEKARAN

Journal of Neurogastroenterology and Motility.2014;20(4):539-546. doi:10.5056/jnm14033

BACKGROUND/AIMS: External anal sphincter (EAS) and puborectalis muscle (PRM) play important role in anal continence function. Based on length-tension measurement, we recently reported that the human EAS muscle operates at short sarcomere length under physiological conditions. Goal of our study was to determine if PRM also operates at the short sarcomere length. METHODS: Length-tension relationship of the PRM muscle was studied in vivo in 10 healthy nullipara women. Length was altered by vaginal distension using custom-designed probes of 5, 10, 15, 20, 25 and 30 mm diameters as well as by distending a polyethylene bag with different volumes of water. Probes were equipped with a reverse perfuse sleeve sensor to measure vaginal pressure (surrogate of PRM tension). PRM electromyogram (EMG) was recorded using wire electrodes. Three-dimensional ultra-sound images were obtained to determine effect of vaginal distension on PRM length. RESULTS: Ultrasound images demonstrate distension volume dependent increase in PRM length. Rest and squeeze pressures of vaginal bag increased with the increase in bag volume. Similarly, the change in vaginal pressure, which represents the PRM contraction increased with the increase in the probe size. Increase in probe size was not associated with an increase in EMG activity (a marker of neural drive) of the PRM. CONCLUSIONS: Probe size dependent increase in PRM contraction pressure, in the presence of constant EMG (neural input) proves that the human PRM operates at short sarcomere length. Surgically adjusting the PRM length may represent a novel strategy to improve treat anal continence and possibly other pelvic floor disorders.
Anal Canal ; Electrodes ; Fecal Incontinence* ; Female ; Humans ; Muscles ; Pelvic Floor Disorders* ; Polyethylene ; Sarcomeres ; Ultrasonography ; Water

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Fecal Evacuation Disorder Among Patients With Solitary Rectal Ulcer Syndrome: A Case-control Study.

Atul SHARMA ; Asha MISRA ; Uday C GHOSHAL

Journal of Neurogastroenterology and Motility.2014;20(4):531-538. doi:10.5056/jnm14030

BACKGROUND/AIMS: Data on frequency of fecal evacuation disorder (FED) among patients with solitary rectal ulcer syndrome (SRUS), hitherto an enigmatic condition, are scanty. Moreover, most such studies had limitations due to small sample size and lack of inclusion of healthy controls (HC). METHODS: Forty patients with SRUS underwent symptom assessments, sigmoidoscopy, anorectal manometry, defecography, balloon expulsion test (BET); endoscopic ultrasound (EUS) of anal sphincter complex was performed in a subgroup. Physiological tests (anorectal manometry and BET) were also performed in 19 HC. RESULTS: Patients with SRUS (26/40 male, age 37 [18-80] years) more often had FED than HC (10/19 male, age 43 [25-72] years) as shown by weight needed to expel the balloon (300 [0-700] g vs. 100 [0-400] g; P = 0.006), a trend towards abnormal BET (need of > 200 g weight for expulsion) (21/40 [53%] vs. 5/19 [26%], P = 0.058) and impaired anal relaxation (14/40 [35%] vs 2/19 [10.5%]; P = 0.048). Using Rome III criteria, most patients with SRUS reported having chronic constipation (36/40 [90%]) in spite of having normal (Bristol stool type IV, 21/40 [53%]) and diarrheal (types V, VI, VII, 6/40 [20%]) stool forms (Asian classification). SRUS patients more often (17/40 [43%]) had functional defecation disorder (Rome III criteria). Patients with SRUS with abnormal BET had thicker internal anal sphincter than those without (3.9 [3.4-7.0] mm vs 2.8 [2.0-4.0] mm; P = 0.01). CONCLUSIONS: FED was commoner among patients with SRUS as evidenced by abnormal BET and sphincter relaxation. Those with abnormal BET had thicker internal sphincter on EUS than those without.
Anal Canal ; Case-Control Studies* ; Constipation ; Defecation ; Defecography ; Humans ; Male ; Manometry ; Relaxation ; Sample Size ; Sigmoidoscopy ; Symptom Assessment ; Ulcer* ; Ultrasonography

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Post-traumatic Stress Disorder Is Associated With Irritable Bowel Syndrome in African Americans.

Natalya IORIO ; Kian MAKIPOUR ; Amiya PALIT ; Frank K FRIEDENBERG

Journal of Neurogastroenterology and Motility.2014;20(4):523-530. doi:10.5056/jnm14040

BACKGROUND/AIMS: Psychosocial stressors likely play an important role in irritable bowel syndrome (IBS). The association between IBS and post-traumatic stress disorder (PTSD) in non-minorities has been described. Our aim was to investigate the potential association between IBS and PTSD in an urban African American population. METHODS: Our institution maintains a longitudinal population-based survey of African Americans (AA). The survey utilizes a complex, stratified sampling design. The study group consisted of adult AA meeting Rome III criteria for IBS of any subtype. The 4-item Primary Care PTSD screener was administered; score of > or = 3 (range, 0-4) was considered positive for PTSD. Depression (Public Health Questionnaire-9 depression) and anxiety (generalized anxiety disorder-7) levels were measured using standardized scales. To assess quality of life, norm-based physical and mental component summary scores from the short-form 36 health survey version 2 were obtained. Descriptive and inferential statistics were calculated using Complex Sample Module of SPSS after weighting of the study sample. RESULTS: Four hundred nineteen subjects included corresponded to a weighted 21,264 (95% CI, 19,777-22,751) individuals. The prevalence of IBS in our sample of urban AA was 8.2%. In multivariate regression analysis, female gender, age > 40, higher educational attainment and divorce were independently associated with IBS. Those with IBS were considerably more likely to suffer from PTSD (OR, 4.54; 95% CI, 4.07-5.06). PTSD was independently associated with depression, anxiety, harmful drinking and substance abuse. CONCLUSIONS: In AA, PTSD is independently associated with IBS. PTSD has a significantly negative impact on physical and mental self-assessment of quality of life. Evaluation of minorities presenting with functional gastrointestinal disorders should include screening for PTSD.
Adult ; African Americans* ; Anxiety ; Depression ; Divorce ; Drinking ; Female ; Gastrointestinal Diseases ; Health Surveys ; Humans ; Irritable Bowel Syndrome* ; Mass Screening ; Prevalence ; Primary Health Care ; Quality of Life ; Self-Assessment ; Stress Disorders, Post-Traumatic* ; Substance-Related Disorders ; Weights and Measures

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A Pilot Trial of Ambulatory Monitoring of Gastric Motility Using a Modified Magnetic Capsule Endoscope.

Hee Man KIM ; Ja Sung CHOI ; Jae Hee CHO

Journal of Neurogastroenterology and Motility.2014;20(2):261-264.

The magnetic capsule endoscope has been modified to be fixed inside the stomach and to monitor the gastric motility. This pilot trial was designed to investigate the feasibility of the magnetic capsule endoscope for monitoring gastric motility. The magnetic capsule endoscope was swallowed by the healthy volunteer and maneuvered by the external magnet on his abdomen surface inside the stomach. The magnetic capsule endoscope transmitted image of gastric peristalsis. This simple trial suggested that the real-time ambulatory monitoring of gastric motility should be feasible by using the magnetic capsule endoscope.
Abdomen ; Capsule Endoscopes* ; Capsule Endoscopy ; Healthy Volunteers ; Monitoring, Ambulatory* ; Peristalsis ; Stomach

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