Motility Disorders Research Articles

Gastrointestinal autonomic neuropathy in patients with type 2 diabetes mellitus: features of diagnosis and treatment

Diabetes mellitus (DM) type 2 is one of the components of metabolic syndrome. One of the most common complications of type 2 diabetes is diabetic neuropathy, which results in damage to peripheral and/or autonomic nerve fibers. Disorders of the autonomic nervous system - diabetic autonomic neuropathy (DAN)-can occur in up to 60% of patients. One form of GAN is gastrointestinal autonomic neuropathy (GAN). There is no exact information about its prevalence due to the complexity of diagnosis, but according to some data, symptoms occur in half of patients with diabetes. The main manifestations of GAN are esophageal motility disorders (heartburn, reflux), gastroparesis (nausea, vomiting, feeling of fullness), intestinal motility disorders (diarrhea, constipation), anorectal dysfunction (fecal incontinence). Impaired gastrointestinal motility, in particular gastroparesis, leads to changes in the pharmacokinetics of oral glucose-lowering drugs, which reduces their effectiveness. And in patients receiving insulin therapy, impaired movement of food through the gastrointestinal tract can lead to hypoglycemia. In this regard, identifying and treating manifestations of GAN is an important aspect of managing a patient with type 2 diabetes. Diagnosis of GAN should be aimed at excluding other causes of gastrointestinal disorders and includes, depending on the clinical manifestations, fibrogastroduodenoscopy, barium radiography, colonoscopy, etc. The “gold standard” for diagnosing gastroparesis is considered to be measuring gastric emptying using scintigraphy of digested solids, but due to the high cost and complexity of the procedure, this method is not used in routine practice. The main therapeutic measures in the management of patients with diabetes and GAN are glycemic compensation, compliance with nutritional recommendations, treatment of neuropathy and symptomatic therapy.

The Effect of Natural Mineral Water on Regulators of Gastroduodenal Motility in Young Adults: a Comparative Controlled Study

INTRODUCTION. Drinking balneotherapy has long been successfully used for pathologies of the digestive system. However, the sanogenetic mechanisms of normalization of gastrointestinal motility when using drinking mineral waters have not been sufficiently studied. AIM. To assess the dynamics of the level of hormones that regulate gastric motility with a single dose of moderately mineralized sulfate-sodium-calcium mineral water in a young adults to reveal their sanogenetic role in functional dyspepsia. MATERIALS AND METHODS. 3 groups were formed: the first — 57 people with postprandial distress syndrome (PDS), the second — 57 with epigastric pain syndrome (EPS), the third — 56 healthy people. All subjects were assessed for gastroenterological symptoms using a specific validated Gastrointestinal Symptom Rating Scale (GSRS) questionnaire, and the levels of motilin and cholecystokinin in the blood were determined before and after taking 200 ml of mineral water. RESULTS. The level of motilinemia in patients with PDS initially (9811.67 ± 48.34 pg/ml) did not have significant differences from the level of healthy people (9665.64 ± 106.94 pg/ml) (p = 0.379), with EPS it was lower (8780.67 ± 102.94 pg/ml) (p = 0.000). In healthy people, the concentration of motilin in the blood after taking mineral water did not undergo statistically significant changes (p = 0.59), in patients with PDS it led to a decrease in its level by 13.8 % (p = 0.000), in patients with EPS it increased by 9.3 % (p = 0.000). The value of cholecystokininemia in EPS (180.6 ± 5.83 pg/ml) turned out to be statistically significantly higher (p = 0.008), and in PDS (116.67 ± 3.32 pg/ml) lower (p = 0.000) than in healthy group (146.64 ± 6.24 pg/ml). After drinking mineral water, healthy people experienced an increase in cholecystokininemia by 21.5 % (p = 0.003), in the group of patients with PDS — by 43.6 % (p = 0.000), with EPS — without significant dynamics (p = 0.491). CONCLUSION. Features of the dynamics of the level of motilin and cholecystokinin in the blood of healthy people and with functional dyspepsia in response to a single dose of mineral water were revealed, which play an important role in the sanogenetic effect of drinking balneotherapy for gastric motility disorders.

Neostigmine - The underutilized drug worth remembering.

Ogilvie syndrome, a rare intestinal motility disorder associated with parasympathetic plexus dysfunction, can lead to severe complications like ischemia and perforation in hospitalized patients with significant comorbidities. This retrospective observational study assessed the efficacy and safety of neostigmine in treating Ogilvie syndrome at our center from January 2021 to December 2023. Thirteen patients received neostigmine after failing initial measures such as electrolyte correction, decompression, and intravenous prokinetics. Patients had a mean age of 66 years, predominantly male (77%), with 54% on polypharmacy. Neostigmine was administered in critical care settings under continuous monitoring. Symptom resolution occurred in 70% of cases, with a single dose achieving an 86% success rate in 54% of patients. Two doses were required for the remaining 46%, with a 50% success rate. No severe adverse reactions were observed. Neostigmine demonstrated high efficacy and safety in managing Ogilvie syndrome, highlighting its potential as a first-line therapeutic alternative to more invasive interventions.

Triangle-Tip Jet Knife used as "probe mode" during C-POEM for the treatment of cricopharyngeal achalasia.

Cricopharyngeal achalasia is a rare esophageal motility disorder characterized by the inability to relax of the cricopharyngeal muscle during swallowing. Peroral endoscopic myotomy (POEM) is a minimally invasive endoscopic technique for treating achalasia that has gained increasing popularity in recent years. In this context, cricopharyngeal peroral endoscopic myotomy (C-POEM) has emerged as a novel technique for the management of cricopharyngeal achalasia.

Diagnostic approach to patients with suspected motility disorders: one size does not fit all.

Dysphagia and retrosternal chest pain are considered typical manifestations of major esophageal motility disorders (mEMD). High-resolution manometry (HRM) is the gold standard for mEMD diagnosis, while endoscopy and barium swallow are ancillary tools. We aimed to investigate the frequency of mEMD among patients referred for HRM with typical compared to non-typical symptoms. We also evaluated endoscopic and barium swallow data from patients with mEMD who underwent HRM. We retrospectively collected epidemiological, endoscopic, barium swallow, and HRM data from 302 patients. Atypical symptoms were considered to be heartburn, regurgitation, globus, oropharyngeal dysphagia, and epigastric pain. The main referral symptoms were: esophageal dysphagia, 58.3%; chest pain, 13.7%; heartburn, 8.9%; regurgitation, 8.3%; and globus/oropharyngeal dysphagia/epigastric pain, 10.8%. A diagnosis of mEMD was more common when typical symptoms existed (69.9% vs. 15.4%, P<0.001). The majority of patients with mEMD in HRM, independently of their symptoms, had an abnormal barium study (typical: 94.8% vs. non-typical: 100%, P=0.633), while compatible endoscopic data tended to be observed more frequently among patients with typical symptoms (69.1% vs. 40%, P=0.057). An HRM diagnosis of mEMD among patients with compatible findings from either barium swallow or endoscopic examination was statistically more frequent among patients with typical symptoms (92.4% vs. 52.6%, P<0.001). More than half of patients referred for HRM will be diagnosed with mEMD, at a higher rate when typical symptoms are reported. A lack of compatible endoscopic and barium swallow findings, in the absence of typical symptoms, makes the diagnosis of mEMD almost impossible.

The bitter flavor of Banxia Xiexin decoction activates TAS2R38 to ameliorate low-grade inflammation in the duodenum of mice with functional dyspepsia.

Banxia Xiexin Decoction (BXD) is a traditional herbal formulation with a bitter flavor that has a long-standing history of use in Asia for treating functional dyspepsia (FD). In traditional Chinese medicine, the bitter flavor is believed to play a critical role in the therapeutic activity of BXD. The ethnopharmacological properties of bitter plant extracts are closely associated with their anti-inflammatory effects, which may contribute to their efficacy in FD. However, the specific mechanisms remain unknown. The objective of this study is to uncover the bitter active compounds of BXD and their effects in the treatment of FD. The chemical compounds of BXD were identified using HPLC-Q-Exactive-MS. Active compounds in BXD were obtained from the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) database, and bitter active compounds were further identified using BitterDB and PlantMolecularTasteDB. Molecular docking was employed to identify potential targets of these bitter active compounds, and their activation was validated through flow cytometry analysis of Ca2+. Subsequently, a mouse model of FD was established, and our hypothesis was further validated using enzyme linked immunosorbent assay, immunohistochemistry, immunofluorescence, and western blotting. Through HPLC-Q-Exactive-MS analysis, TCMSP, BitterDB, and PlantMolecularTasteDB database, a total of 11 bitter active compounds in BXD were identified: Baicalein, Baicalin, Berberine, Coptisine, Formononetin, Isorhamnetin, Kaempferol, Naringenin, Palmatine, Quercetin, and Wogonin. Molecular docking results indicated that these active compounds exhibited strong affinity for TAS2R38, with Berberine showing the highest scoring. Flow cytometry analysis of Ca2+ revealed that both Berberine and BXD elevated intracellular calcium concentrations, although this effect was partially antagonized by the TAS2R38 inhibitor probenecid. In vivo experiments demonstrated that BXD effectively improved eosinophil infiltration in the duodenum of FD mice, downregulated the expression of inflammatory factors IL-1β, IL-5, and TNF-α, inhibition of NF-κB signaling pathway activation, alleviated damage to the duodenal mucosal barrier, and reversed gastrointestinal motility disorders, with the therapeutic effect enhancing with increasing doses of BXD. However, this therapeutic effect was partially inhibited following probenecid intervention. BXD contains numerous bitter active compounds that play a significant role in regulating inflammatory activity in the duodenum of FD through the activation of TAS2R38. This finding unveils, for the first time, the ethnopharmacological activity of bitter plant taste agents in anti-inflammatory effects, providing new insights for the treatment and drug development of FD.

Esophageal Motility Disorders: A Concise Review on Classification, Diagnosis, and Management

Esophageal Motility Disorders: A Concise Review on Classification, Diagnosis, and Management

The assessment of gastrointestinal transit by the Atmo Capsule: A comparison with the SmartPill Capsule.

Wireless motility capsules (WMCs) can be used to assess gastrointestinal transit time to facilitate diagnosis and treatment of motility disorders. The Atmo Capsule is a novel WMC that measures gases (H2, CO2, O2) and temperature. We aimed to compare and evaluate the performance characteristics of the Atmo Capsule and the SmartPill Capsule (discontinued reference standard WMC) for measurement of gastric emptying time (GET) and colonic transit time (CTT) , in patients with confirmed or suspected disordered gastrointestinal transit. Patients with symptoms indicative of an upper and/or lower gastrointestinal motility disorder ingested the two WMCs in a random order. Gastrointestinal transit times were assessed using Spearman correlation and Bland-Altman analysis. Device agreement was assessed for delayed GET (≥ 5 hours) and CTT (≥ 59 hours). There were 213 participants from 12 sites, yielding 177 paired GET and 147 paired CTT measurements. The measurements for GET and CTT with the Atmo Capsule and SmartPill Capsule were strongly correlated (GET, R=0.73, P<0.01; CTT, R=0.69, P<0.01) and their observed biases were within 10% of the delayed transit margin. Both delayed GET (68/177) and CTT (56/147) were identified in 38% of participants with 84% agreement for identification of both delayed GET (sensitivity 78%, specificity 86%) and CTT (sensitivity 67%, specificity 93%). No serious adverse device effects were reported. The performance characteristics of the Atmo capsule for measurements of GET and CTT, were equivalent to the reference standard WMC with a strong correlation and good device agreement. These results demonstrate that the Atmo Capsule is a valid method for evaluating gastrointestinal transit.

Duodenogastric Reflux in Health and Disease: Insights from a Computational Fluid Dynamics Model of the Stomach.

The stomach is responsible for physically and chemically processing the ingested meal before controlled emptying into the duodenum through the pyloric sphincter. An incompetent pylorus allows reflux from the duodenum back into the stomach, and if the amount of reflux is large enough, it could alter the low pH environment of the stomach and erode the mucosal lining of the lumen. In some cases, the regurgitated contents can also reach the esophagus leading to additional complications. In this work, "StomachSim", an in-silico model of the fluid dynamics of the stomach, is used to study the mechanism of duodenogastric reflux. The effects of variations in food properties and motility disorders on reflux are investigated. The simulations show that the primary driver of reflux is the relaxation of the antrum after a stomach contraction terminates near the pylorus. The region of the stomach walls exposed to the regurgitated contents depends significantly on the density of the stomach contents. For stomach contents of higher viscosity, the increased pressure required to maintain gastric emptying reduces the amount of duodenogastric reflux. Concomitant stomach motility disorders that weaken the relaxation of the walls also affect the amount of reflux. The study illustrates the utility of in-silico models in analyzing the factors at play in gastrointestinal diseases.

Peroral Endoscopic myotomy (POEM) in pediatric achalasia: a retrospective cohort on institutional experience and quality of life

BackgroundAchalasia is a rare esophageal motility disorder with an estimated annual incidence of 1–5/100.000 and a mean age at diagnosis > 50 years of age. Only a fraction of the patients has an onset during childhood (estimated incidence of 0.1–0.18/ 100.000 children per year). No curative treatment is currently available. Peroral Endoscopic Myotomy (POEM) is a widely accepted treatment option to improve symptoms in adults. Studies evaluating safety and efficacy of POEM in children are scarce and no data exist regarding the quality of life in patients after POEM.MethodsWe evaluated the effectiveness and safety of POEM in a cohort of children that was treated for achalasia and we prospectively evaluated their quality of life. We compared the results to a previous cohort evaluating Pneumatic Dilation (PD) and Laparoscopic Heller’s Myotomy (LHM) in children with achalasia.ResultsThirty-three achalasia patients (age at time of POEM 14.1(± 2.5) years, 54.5% female) were included. Twenty-nine (87.8%) percent had received previous treatment (PD (n = 20); LHM (n = 1); PD + LHM (n = 7); PD + Botox (n = 1). POEM was technically successful in all patients and no major complications occurred. Mean follow-up duration was 33 (± 25) months. Twenty three (70%) patients did not need retreatment after POEM during the follow up period. Quality of life after POEM did not differ from the population norms. Patients with an Eckardt score > 3 had a significantly worse general (Kidscreen-52: physical score 44.7 vs. 52.4; p = 0.011; mental score: 42.5 vs. 51.3; p = 0.038) and disease specific (35 vs. 16; p = 0.017) quality of life compared to those with an Eckardt ≤ 3. The SF-36 mental health component score was significantly lower (44.2 vs. 53.1; p = 0.036) in patients treated with POEM compared to those treated with PD and LHM. These lower scores could be related to a selection bias, as more severe patients received POEM, and other influences such as the Corona pandemic. However, the overall, quality of life after POEM was not significantly different to PD and LHM.ConclusionPOEM is an effective and safe treatment for achalasia in children. Quality of life after POEM is comparable to the results obtained after PD and Heller.

P0229 Evaluation of anorectal function and structure in patients with perianal Crohn's disease with a novel 3-D high-definition anorectal manometry technology

Abstract Background Crohn’s disease (CD) is a type of inflammatory bowel disease (IBD) that can have perianal involvement with a fistulizing phenotype (PFCD) and could affect anal sphincter integrity, leading to morbidity and reduced quality of life (QoL) due to fecal incontinence (FI) and rectal pain. High-definition 3D anorectal manometry (HD-ARM) is a novel technique that allows volumetric imaging of the anal canal through 2D and 3D images, enabling visualization of morphology and identification of pressure defects caused by lesions in the sphincter complex. There are no studies in patients with IBD with this modality of manometry. Our aim is to determine the functional and structural abnormalities of the sphincter complex using HD-ARM in patients with CD with and without PFCD and to correlate these findings with magnetic resonance imaging (MRI) results. Methods This is a prospective, longitudinal cohort study of anorectal function using HD-ARM and rectal sensitivity using rectal barostat in patients with CD from our IBD unit. Patients were recruited during follow-up visits regardless of whether or not they reported anorectal symptoms. Findings were correlated with clinical activity of CD (Harvey Bradshaw index), PFCD activity index (PDAI), FI severity index (Jorge-Wexner and St. Marks scores), QoL scores (IBDQ-9 for IBD and FIQLS for FI), and perineal MRI to confirm anatomical abnormalities. Results A total of 19 patients were recruited from December 2023 to September 2024, 68.4% of whom were female. Among patients with PFCD (68.4% of the total), 84.6% had undergone some form of anorectal surgery. Only two patients from the total cohort (10.5%) had normal HD-ARM results. The main manometric diagnoses were: rectal hypersensitivity (36.8%), rectal hyposensitivity (31.6%), internal anal sphincter insufficiency (weakness) (21.1%), incomplete evacuation maneuvers (21.1%), and dyssynergic defecation (15.8%), with no significant differences between the groups with and without PFCD. In 90% of patients with PFCD, MRI findings correlated with the presence or absence of pressure defects on the HD-ARM. Patients with pressure defects on the HD-ARM had higher FI scores on the Jorge-Wexner (7.5 vs. 3.3) and St. Marks (9 vs. 5) scores, although this difference did not reach statistical significance (p=0.07). No differences in quality of life or luminal/perianal disease activity index were found in association with manometric alterations. Conclusion Anorectal sphincter function abnormalities are common in patients with CD, with or without concomitant perianal disease. HD-ARM is a useful tool to correlate functional anorectal abnormalities with anatomic abnormalities on perineal MRI. References Eglinton TW, Barclay ML, Gearry RB, et al. The spectrum of perianal Crohn’s disease in apopulation-based cohort. Dis Colon Rectum 2012;55:773–7. Felt-Bersma, R.J.F., Vlietstra, M.S., Vollebregt, P.F. et al. 3D high-resolution anorectal manometry in patients with perianal fistulas: comparison with 3D-anal ultrasound. BMC Gastroenterol 18, 44 (2018) R Costache, A Dimitriu, A Les, C Gheorghe, P027 Anorectal Motility Disorders in Inflammatory Bowel Disease patients, Journal of Crohn's and Colitis, Volume 17, Issue Supplement_1, February 2023, Page i197 De Codes LMG, de Jesus ACC, de Codes JJG, Ferreira RF, da Silva Beda Sacramento C, da Cruz IDM, de Castro Ribeiro Fidelis F, de Carvalho AL, Motta MP, de Oliveira Alves C, Netto EM, Santana GO. Anorectal function and clinical characteristics associated with fecal incontinence in patients with Crohn's disease. J Crohns Colitis. 2023 Mar 23:jjad048

P0386 Prevalence and Impact of Anorectal Disorders in IBD: Insights from a Romanian Tertiary Gastroenterology Center

Abstract Background Anorectal motility disorders profoundly affect the quality of life in patients with quiescent inflammatory bowel disease (IBD). Although faecal incontinence (FI) has a reported prevalence of up to 74%, its true extent is likely underestimated due to the stigma surrounding the condition. Fear of FI and challenges in accessing toilets remain significant concerns. This study evaluates the prevalence of these issues in Romanian tertiary care patients using the validated questionnaire International Consultation on Incontinence Questionnaire for Bowel Incontinence – IBD (ICIQ-IBD). Methods We surveyed 65 IBD patients aged over 18, admitted to our center, who were in remission but had previously experienced moderate to severe disease. Using the ICIQ-IBD questionnaire, we collected data on faecal incontinence, soiling, anal dyskinesia, their impact on quality of life, and demographic information. The analysis was conducted using Excel and Minitab. Results Of the 65 patients included in the study, 69% were male, with a median age of 40.82 ± 12.10 years. The majority were diagnosed with Crohn’s disease (65% CD, 35% UC). During remission, 22% of patients reported the need to rush to the toilet “always” or “most of the time,” compared to 40% during relapse, with a significant difference between disease phases (p = 0.02) but no differences based on gender or diagnosis. In relapse, 68% of patients had less than one minute to reach a toilet, compared to 32% in remission (p = 0.00). Soiling was reported by 49% of patients during active disease and 25% in remission (p = 0.004). Difficulty controlling liquid stools affected 62% of patients in relapse and 55% in remission, with no significant difference between disease states (p = 0.417). Emotional impact was reported by 72% of patients in relapse and 15% in remission, highlighting the psychosocial burden of bowel dysfunction in IBD. Conclusion Anorectal disorders significantly affect IBD patients’ quality of life, even during remission. Key symptoms, such as soiling and urgency, were more prevalent during relapse and strongly linked to emotional distress. These findings underscore the need for targeted management of anorectal symptoms in IBD care. References Norton, Christine et al. “Faecal incontinence in inflammatory bowel disease: associations and effect on quality of life.” Journal of Crohn’s &amp; colitis vol. 7,8 (2013): e302-11. doi:10.1016/j.crohns.2012.11.004 Dibley, Lesley et al. “Development and initial validation of a disease-specific bowel continence questionnaire for inflammatory bowel disease patients: the ICIQ-IBD.” European journal of gastroenterology &amp; hepatology vol. 28,2 (2016): 233-9. doi:10.1097/MEG.0000000000000513

Predictive model for estimating total acid exposure time in patients with esophageal hypomotility disorders.

The latest Chicago Classification of esophageal motility disorders categorizes esophageal hypomotility disorders (EHD) into absent contractility (AC) and ineffective esophageal motility (IEM). While these disorders are commonly associated with gastroesophageal reflux disease (GERD), they are not pathognomonic. To improve diagnostic accuracy, provocative maneuvers during high-resolution esophageal manometry (HRM) -such as multiple rapid swallows (MRS) and single solid swallows (SSS) -have been introduced.

Gastrointestinal motility modulation efficacy-related chemical marker findings and QAMS-based quality control of Agastache rugosa.

Agastache rugosa (AR), a traditional edible and medicinal herb, is often used for treating gastrointestinal (GI) motility disorder. But little effort has been done on its gastrointestinal motility modulation (GMM) efficacy-related components and quality control of AR. In this study, a novel strategy was proposed to find GMM efficacy-related chemical markers for the quality control of AR. Firstly, network pharmacology and serum pharmacochemistry were applied to predict potential GMM efficacy-related marker components. Secondly, the GMM efficacy-related marker components were verified through literature matching, target isolation/identification and activity evaluation. Lastly, a quantitative analysis of multiple components by a single marker (QAMS)-based method for simultaneous quantification of marker components was established and validated by HPLC-DAD. The results showed that nine components in AR were screened as potential GMM related components, five of which (rosmarinic acid, tilianin, apigenin, acacetin, and cirsimaritin) were matched by literatures, and four (acacetin-7-O-(6''-O-malonyl)-β-D-glucopyranoside, agastachoside, acacetin-7-O-(2''-O-acetyl-6''-O-malonyl)-β-D-glucopyranoside, and isoagastachoside) were chemically identified and newly evaluated on zebrafish model. The nine components were used as marker compounds to develop an effective QAMS-based method for the quantitative evaluation of 26 batches of commercial AR samples.

Single Versus Dual Therapy for Diabetic Gastroparesis

Gastroparesis is a disorder of gastric motility hallmarked by nausea, vomiting and early satiety. While dietary and medical therapy are the mainstay of treatment, surgery has been useful to palliate symptoms. Two long-used first line surgical therapies for gastroparesis are gastric electrical stimulation and pyloric procedures (including pyloroplasty and pyloromyotomy). This manuscript will focus on the use of these surgical modalities, both separately and in combination, to treat refractory gastroparesis symptoms in patients with diabetes.

Artificial intelligence as a transforming factor in motility disorders–automatic detection of motility patterns in high-resolution anorectal manometry

High-resolution anorectal manometry (HR-ARM) is the gold standard for anorectal functional disorders’ evaluation, despite being limited by its accessibility and complex data analysis. The London Protocol and Classification were developed to standardize anorectal motility patterns classification. This proof-of-concept study aims to develop and validate an artificial intelligence model for identification and differentiation of disorders of anal tone and contractility in HR-ARM. A dataset of 701 HR-ARM exams from a tertiary center, classified according to London Classification, was used to develop and test multiple machine learning (ML) algorithms. The exams were divided in a training and testing dataset with a 80/20% ratio. The testing dataset was used for models’ evaluation through its accuracy, sensitivity, specificity, positive and negative predictive values and area under the receiving-operating characteristic curve. LGBM Classifier had the best performance, with an accuracy of 87.0% for identifying disorders of anal tone and contractility. Different ML models excelled in distinguishing specific disorders of anal tone and contractility, with accuracy over 90.0%. This is the first worldwide study proving the accuracy of a ML model for differentiation of motility patterns in HR-ARM, demonstrating the value of artificial intelligence models in optimizing HR-ARM availability while reducing interobserver variability and increasing accuracy.

Pulmonary Aspiration Syndromes: An Imaging-based Review.

The term "aspiration" describes lung injury that results from unintentional passage of contents other than air into the lungs and bronchial tree, commonly from the gastrointestinal and upper respiratory tracts. Only a small proportion of aspiration-related events are symptomatic, especially in predisposed individuals such as patients with diminished consciousness, impaired swallowing, oesophageal motility disorders, and reflux disease. Aspiration-related syndromes can be classified based on the onset of presentation, composition of the aspirated substance, and anatomic site of injury. When considering the injury site, the aspirated material can either obstruct the airways, thereby presenting with obstructive features (eg, atelectasis on radiographs); it can alternatively affect the lung parenchyma. Lung injury due to aspiration of noxious agents such as acid or lipids is termed chemical aspiration pneumonitis. The aspirated contents can alternatively lead to lung parenchymal infection when the contents are infected, which is termed aspiration pneumonia. We have reviewed the imaging manifestations of various entities related to aspiration and have classified the abnormalities based on the site of injury and the nature of the culprit agent. Differences between "aspiration pneumonitis" and "aspiration pneumonia" are also explored. This is followed by an illustration of a few specific situations related to aspiration in pediatric and adult patients.

Effectiveness and safety of full-thickness versus circular muscle myotomy in peroral endoscopic myotomy: a retrospective single-center analysis of 152 patients.

Achalasia is a primary esophageal motility disorder, which shows impaired relaxation of the lower esophageal sphincter (LES) and the absence of peristalsis, leading to dysphagia, weight loss, and chest pain. In recent years, peroral endoscopic myotomy (POEM) has become a popular method for treating achalasia. However, the effectiveness and safety of full-thickness myotomy (FTM) versus circular muscle myotomy (CMM) in POEM require further investigation. This retrospective single-center analysis studied 152 patients who underwent POEM surgery at the General Hospital of the Western Theater Command from May 2014 to May 2023. Patients were divided into two groups based on the depth of myotomy: the FTM group and the CMM group. Parameters such as surgical success rate, procedure time, and myotomy length were evaluated, and treatment efficacy was assessed based on the Eckardt score. Postoperative complications and efficacy were also monitored. Technical success was achieved in both groups, with shorter procedure times in the FTM group (P < 0.05). There were no significant differences in postoperative Eckardt scores and symptom improvement between the FTM and CMM groups. The incidence of adverse events was similar in both groups. The incidence of gastroesophageal reflux disease (GERD) seemed to be higher in the FTM group, although this difference was not statistically significant (P = 0.051). For patients with achalasia, there were no significant differences in short-to-medium-term treatment efficacy and safety between FTM and CMM in POEM. Although FTM significantly reduced procedure time, it may lead to a higher incidence of GERD. More cases are needed in the future to explore the more appropriate myotomy for different achalasia subtypes.

Modern Experience in Pharmacotherapy of Irritable Bowel Syndrome in Children

This review examines modern approaches to the diagnosis and treatment of irritable bowel syndrome (IBS) in children, one of the most common functional disorders of the gastrointestinal tract. IBS is characterized by chronic abdominal pain, intestinal motility disorders and stool changes, which significantly reduces the quality of life of patients. The article analyzes in detail the pathogenetic mechanisms of IBS, including the role of the gut–brain axis, gut microbiota and neuroendocrine factors. Special attention is paid to the pharmacotherapy of IBS in children, including the use of antidepressants, probiotics and herbal components, as well as the role of correctors of the motor activity of the digestive tract in relieving symptoms. Modern recommendations on the use of various classes of antidepressants are considered, taking into account their pharmacokinetic and pharmacodynamic characteristics. The prospects of using probiotics and herbal preparations in the complex therapy of IBS are also analyzed. The data obtained confirm the need for a personalized approach to the treatment of IBS, taking into account the genetic and physiological characteristics of patients.

Gut Neuropathies and Intestinal Motility Disorders.

The enteric nervous system plays a key role in the coordination of gastrointestinal motility together with sympathetic, parasympathetic, and extrinsic sensory pathways. In some cases, abnormalities in neural activity in these pathways contribute to disorders of gut motility. Where this is associated with damage or death of enteric neurons, usually detected by microscopy, this is considered a gut neuropathy. This review summarizes recent advances in the identification of neuropathies in a range of gastrointestinal motility disorders.