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The role of long‐term parenteral support in patients with underlying benign conditions who do not have intestinal failure (IF) is contentious, not least since there are clear benefits in utilising the oral or enteral route for nutritional support. Furthermore, the risks of long‐term home parenteral nutrition (HPN) are significant, with significant impacts on morbidity and mortality. There has, however, been a recent upsurge of the use of HPN in patients with conditions such as gastro‐intestinal neuromuscular disorders, opioid bowel dysfunction, disorders of gut–brain interaction and possibly eating disorders, who do not have IF. As a result, the European Society of Clinical Nutrition and Metabolism (ESPEN), the European Society of Neuro‐gastroenterology and Motility (ESNM) and the Rome Foundation for Disorders of Gut Brain Interaction felt that a position statement is required to clarify – and hopefully reduce the potential for harm associated with – the use of long‐term parenteral support in patients without IF. Consensus opinion is that HPN should not be prescribed for patients without IF, where the oral and/or enteral route can be utilised. On the rare occasions that PN commencement is required to treat life‐threatening malnutrition in conditions such as those listed above, it should only be prescribed for a time‐limited period to achieve nutritional safety, while the wider multi‐disciplinary team focus on more appropriate biopsychosocial holistic and rehabilitative approaches to manage the patient's primary underlying condition. [ABSTRACT FROM AUTHOR]

Summary: Background: Functional dyspepsia (FD) is one of the most frequent conditions in gastroenterological outpatient health care. Most recent research in FD has shifted its focus to duodenal pathophysiological mechanisms, although current treatments still focus mainly the stomach. Aim: The aim of the study was to provide a comprehensive overview of the pathophysiology of FD focusing on a paradigm shift from gastric towards duodenal mechanisms. Methods: We conducted a literature search in PubMed for studies describing mechanisms that could possibly cause FD. Results: The pathophysiology of FD remains incompletely understood. Recent studies show that duodenal factors such as acid, bile salt exposure and eosinophil and mast cell activation correlate with symptom pattern and burden and can be associated with gastric sensorimotor dysfunction. The evolving data identify the duodenum an interesting target for new therapeutic approaches. Furthermore, the current first‐line treatment, that is proton pump inhibitors, reduces duodenal low‐grade inflammation and FD symptoms. Conclusion: Future research for the treatment of FD should focus on the inhibition of duodenal mast cell activation, eosinophilia and loss of mucosal integrity. [ABSTRACT FROM AUTHOR]

Abstract: Background: Small bowel manometry is a diagnostic test available only in a few specialized referral centers. Its exact place in the management of refractory symptoms is controversial. Methods: The records of all patients who underwent 24‐hour ambulatory duodenojejunal manometry over a 6‐year period were retrospectively reviewed. We studied the clinical indications for small bowel manometry, and reviewed the impact of manometric findings on the clinical outcome. One hundred and forty‐six studies were performed in 137 patients (46M, 91F) with a mean age of 44.9 ± 15.7 years. Mean follow‐up duration was 15.1 ± 22.6 months. Appropriate endoscopic, radiological and gastric scintigraphy studies were performed in all patients prior to small bowel manometry. Criteria for abnormal motor activity were based on Bharucha's classification. Key Results: The indications for small bowel manometry were chronic abdominal pain (n = 43), slow‐transit constipation (n = 17), refractory gastroparesis (n = 16), chronic diarrhea (n = 7), recurrent episodes of subocclusion (n = 16), postsurgical evaluation (n = 36), suspicion of gut involvement in systemic disease (n = 9), and unexplained nausea (n = 2). The most common finding was a normal 24‐hour ambulatory small bowel manometry (n = 113). Thirty‐three studies yielded abnormal findings which included extrinsic neuropathy (n = 6), intrinsic neuropathy (n = 18), intestinal myopathy (n = 2), and subocclusion (n = 7). Ambulatory small bowel manometry excluded a generalized motility disorder in 77% and had a significant impact on the subsequent clinical course in 23%. Conclusions & Inferences: Ambulatory small bowel manometry is a useful and safe diagnostic tool to complement traditional investigative modalities in patients with severe unexplained abdominal symptoms. [ABSTRACT FROM AUTHOR]

Background Disturbances of gastric motor function of functional dyspepsia ( FD) have been implicated in the pathogenesis of the symptoms, and hence, motility modifying agents are considered for its treatment. Mirtazapine was recently shown to improve symptoms and increase nutrient tolerance in FD patients with weight loss. We aim to evaluate the effect of mirtazapine on gastric sensorimotor function in healthy volunteers ( HV). Methods Thirty-one HV underwent an intragastric pressure ( IGP) and barostat measurements on separate days before and after 3 weeks of placebo or mirtazapine (15 mg). Gastric compliance, sensitivity and accommodation ( GA) measured by the barostat. GA was quantitated as the difference (delta) in intra-balloon volume before and after ingestion of 200 mL of a nutrient drink ( ND). GA measured by IGP was quantitated as the drop of IGP from baseline during the intragastric infusion of ND until maximal satiation. Key Results Mirtazapine significantly increased the bodyweight of subjects (67.8±3.7 to 69.1±3.7 kg; P=.01). Barostat results showed no effect on gastric compliance, sensitivity, and GA. Nutrient tolerance was not affected after treatment (1170±129.4 vs 1104±133.6 kcal; P=.4), and mirtazapine was associated with lower symptom ratings. The IGP drop during meal ingestion was significantly suppressed (area under the curve: −43.3±4.5 mm Hg vs −28.9±3.1 mm Hg; P=.005). Conclusions & Inferences In HVs, the occurrence of weight gain and decreased meal-induced symptoms in spite of a suppressed meal-induced IGP drop, point towards a central mode of action. Mirtazapine does not display changes in gastric sensorimotor function that could explain its beneficial effects on symptoms and nutrient tolerance in FD. [ABSTRACT FROM AUTHOR]

Background Altered duodenal sensorimotor responses to acid have been reported in a subset of patients with functional dyspepsia. To investigate whether NO is involved in these abnormalities, the effect of sildenafil (activates the NO pathway) on duodenal motor and sensory responses to acid in healthy humans was evaluated. Methods A barostat-manometry catheter including an infusion tube was positioned in the duodenum of 12 healthy volunteers. Duodenal motility and dyspeptic symptoms were evaluated during the whole study. A first series of stepwise isobaric distensions was performed while participants scored their perception of upper abdominal sensations at the end of every distension step. Next, the duodenum was infused with sildenafil 50 mg or saline, followed by duodenal acid infusion. During duodenal acidification, a second sequence of stepwise isobaric distensions with the assessment of sensations was repeated. Key results Acid infusion did not induce dyspeptic symptoms with both placebo and sildenafil pretreatment. Duodenal motility decreased after sildenafil infusion, whereas it was not affected by placebo. Acid-induced increase in motility was, however, observed in both conditions, and no difference between the conditions was found. Duodenal acidification decreased thresholds for discomfort and increased perception scores during duodenal distensions in both groups, but again no difference was observed between placebo and sildenafil pretreatment. Conclusions and Inferences Sildenafil does not affect duodenal motor, mechanosensory, and chemosensory responses to acid in healthy controls. Therefore, it is less likely that the NO pathway plays a role in the altered response to acid in functional dyspepsia patients. [ABSTRACT FROM AUTHOR]

Background The Rome III criteria subdivide functional dyspepsia ( FD) in the epigastric pain syndrome ( EPS) and the postprandial distress syndrome ( PDS) based on the frequency of the symptoms to optimize the diagnostic and therapeutic approach. However, it is unclear to which extent the frequency of the symptoms is related to their severity. Our aim was to explore the frequency and severity of dyspeptic symptoms and their relationship in FD patients. Methods Functional dyspepsia patients fulfilling the Rome III diagnostic completed a questionnaire that evaluated the frequency and severity of FD symptoms. The concordance between the severity and frequency categories was analyzed by means of spearman correlation and the concordance correlation coefficient (ρc). Key Results In the entire patient cohort ( n=421), the classification of symptoms severity and frequency showed good concordance for all symptoms. In the EPS subgroup ( n=....), the symptom severity and frequency score of epigastric pain showed a poor correlation ( r=.28; ρc=0.07). The PDS subgroup ( n=...) showed a good correlation for most of the symptoms. Due to its limited occurrence in this group, the correlation of the severity and frequency scores for epigastric pain is of little relevance ( r=.79; ρc=0.58). The overlap EPS- PDS group showed good correlation for most of the symptoms, except for epigastric pain (pain r=.24; ρc=0.09). Conclusions & Inferences We conclude that the information given by the assessment of frequency and severity of PDS symptoms is comparable and hence one of the scores sufficiently identifies symptom pattern in PDS patients. In EPS patients, both the symptom frequency and severity should be taken into account as two separate entities. [ABSTRACT FROM AUTHOR]

Background A validated patient-reported outcome instrument is lacking for the functional dyspepsia/postprandial distress syndrome. Aim To validate the Leuven Postprandial Distress Scale ( LPDS). Methods The LPDS diary, comprising eight symptoms with verbal descriptors rated for severity (0-4), was derived from focus groups and cognitive debriefing. It was used in a 2-week run-in, 8-week double-blind placebo-controlled trial of itopride 100 mg t.d.s. Results in 60 patients, with concealed treatment allocation, were used to analyse LPDS content validity, consistency, reliability and responsiveness. Patients also filled out Patient Assessment of Gastrointestinal Symptoms ( PAGI- SYM), Nepean Dyspepsia Index, overall treatment evaluation and overall symptom severity questionnaires. Construct validity was evaluated by known-group analyses and by correlating LPDS with these additional questionnaires. Minimum Clinically Important Difference was determined from threshold changes in anchor questionnaires. Results Symptom patterns and factor analysis identified three cardinal symptoms of postprandial distress syndrome (early satiation, postprandial fullness, upper abdominal bloating), whose mean intensities generate weekly LPDS scores. Known-groups analysis showed large-effect-size differences in LPDS scores (Cohen's d = 2.16). Strong correlations ( r > 0.57) between LPDS scores and relevant anchors at baseline indicate good convergent validity. Internal consistency of LPDS was good (α > 0.85) with high inter-item correlations (0.67-0.76), and test-retest reliability ( r = 0.85). Changes in LPDS scores were highly convergent with changes in overall treatment evaluation, overall symptom severity and PAGI- SYM ( r > 0.52). minimum clinically important difference analysis generated thresholds of 0.4-0.6. Conclusions The Leuven Postprandial Distress Scale, which is supported by the European Medicines Agency, is a sensitive and reliable patient-reported outcome instrument to assess symptoms in the functional dyspepsia/postprandial distress syndrome. [ABSTRACT FROM AUTHOR]

Background No validated patient-reported outcome ( PRO) measure exists for functional dyspepsia ( FD) assessment. Verbal descriptions of different upper abdominal symptoms may be poorly distinguishable to patients. Aim To investigate whether understanding of FD symptoms is enhanced by pictograms symbolising the nature of the symptoms, besides verbal descriptors. Methods Consecutive FD patients were randomised to fill out a questionnaire assessing nineupper gastrointestinal symptoms (post-prandial fullness, early satiation, epigastric pain, epigastric burning, bloating centred in the upper abdomen, nausea, vomiting, heartburn, regurgitation) with or without accompanying pictograms. Symptoms were rated for frequency and severity (0-5), and patients also identified the most bothersome symptom. Subsequently, in-depth history was taken by an expert clinician, who filled out the same symptom ratings. Concordance between patient and clinician ratings was quantified using chi-square and kappa statistics. Results Content validity of pictograms was first confirmed by 15 FD patients. Next, 76 patients (52 women, age 42.2 ± 1.9) were randomised to questionnaires with or without pictograms. The concordance with clinician's assessment as gold standard rose from 36 without to 48% for questions with pictograms ( P < 0.0001). Considering the Rome III subdivision, benefit in concordance with pictograms was present for post-prandial distress, epigastric pain syndrome and reflux symptoms. Kappa statistics confirmed these gains (weighted kappa values for concordance of symptom frequency ratings rose from 0.214 to 0.446 with pictograms), and also showed better concordance of the most bothersome symptom with pictograms. Conclusion Pictograms accompanying verbal descriptors significantly improve concordance of functional dyspepsia symptom ratings by patients with evaluation by their physicians. [ABSTRACT FROM AUTHOR]

Background Dumping syndrome is characterized by distinct pathophysiological features such as postprandial increase in hematocrit ( HT) and pulse rate ( PR) and delayed hypoglycemia ( HG). Treatment is based on dietary measures and somatostatin analogs ( SA), but current SAs have incomplete efficacy, possibly through limited affinity for various somatostatin receptor subtypes. We evaluated the effect of pasireotide, a novel SA with high affinity for 4/5 human somatostatin receptors, on pathophysiological events and symptoms in dumping. Methods Randomized double-blind placebo-controlled cross-over study of nine patients (six women, 47 ± 4 years) with postoperative dumping. Baseline measurements included oral glucose tolerance testing ( OGTT), abdominal ultrasound, and dumping symptom severity score ( DSSS). Patients were treated for 2 weeks with placebo or pasireotide 300 μg s.c. t.i.d. with a 1-week wash-out in a randomized fashion. On day 13 and 14 of each treatment OGTT, DSSS, and solid and liquid gastric emptying ( GE) were obtained. Key Results Baseline OGTT was pathological in all patients based on PR ( n = 5), HT ( n = 1) or HG ( n = 7). Compared to placebo, pasireotide suppressed the increase in PR (17.1 ± 2.8 vs 8.2 ± 3.5 bpm; p < 0.05) and late HG (nadir glycemia 55.6 ± 4.3 vs 83.3 ± 9.5 mg/dL; p = 0.007), increased peak glycemia (294.1 ± 33.3 vs 221.0 ± 23.1 mg/dL; p = 0.001) and delayed GE of solids (t1/2 83 ± 23 vs 43 ± 9 min; p = 0.05) and liquids (t1/2 70 ± 10 vs 40 ± 4 min, p = 0.05). The differences in DSSS did not reach statistical significance. Two patients dropped out because of adverse gastrointestinal events under pasireotide. Conclusions & Inferences Pasireotide affects pathophysiological features of both early and late dumping syndrome. [ABSTRACT FROM AUTHOR]

Background Pneumatic dilation of the lower esophageal sphincter ( LES) in achalasia has an unappreciated effect on upper esophageal sphincter ( UES) function. We studied UES pressure patterns at baseline and alterations in UES parameters resulting from therapy. Methods High-resolution manometry ( HRM) tracings from 50 achalasia patients, seen at a tertiary center between January 2009 and July 2011, were reviewed. Manometric parameters studied were (i) LES: resting pressure (restP), 4-second integrated relaxation pressure ( IRP4); (ii) UES: resting pressure (restP), minimal relaxation pressure ( MRP), peak pressure ( PP), relaxation interval ( RI), intrabolus pressure ( IBP), and deglutitive sphincter resistance ( DSR). Mixed models analyses with LES and UES parameters as dependent variables and treatment stage as within-subject independent variable of interest were used. Correlations between treatment-induced changes in LES, UES, and esophageal body ( EB) parameters were performed. Key Results Pre- and posttreatment HRM tracings were available from 50 patients (mean age 52.7 ± 18.6 years, 29 men). Upper esophageal sphincter parameters MRP (17.9 ± 1.2 vs 15.2 ± 0.9 mmHg; p = 0.02) and IBP (31.5 ± 1.5 vs 27.4 ± 1.2 mmHg; p = 0.009) were significantly reduced after initial balloon dilation and this effect was significant in type II achalasia (p = 0.002 and p = 0.0006). Peak pressure, RI, and DSR were not. The therapeutic effect on LES IRP4 correlated significantly with the change in UES MRP, statistically mediated by the change in EB deglutitive pressure (p = 0.004 and p = 0.0002). Conclusions & Inferences We present the first HRM study demonstrating that pneumatic dilation of the LES affects intraesophageal and UES pressures in patients with achalasia. [ABSTRACT FROM AUTHOR]

Background Functional dyspepsia ( FD) is characterized by chronic epigastric symptoms. The stomach has been held responsible for the generation of symptoms, but the latest reports have pointed out that also the duodenum can be implicated in the pathophysiology. The aim of this study was to elucidate which dyspeptic symptoms originate from the stomach and/or from the small intestine after a meal. Methods Two hundred eighty-four FD patients underwent a gastric emptying breath test. Breath samples were taken and the intensity of six dyspeptic symptoms (fullness, bloating, belching, nausea, epigastric burning, and epigastric pain) was scored before a meal and at 15 min intervals for a period of 240 min postprandially. Time curves of each symptom were analyzed and severity scores during the gastric and the intestinal phase were compared. Key Results Time curves of fullness, bloating, belching, and nausea displayed a significant negative slope, while symptom severity of epigastric burning and epigastric pain did not decrease over time. Numerical analysis revealed that scores for fullness, bloating, and belching were higher during the gastric phase compared with the intestinal phase. On the other hand, intensities of nausea, epigastric burning, and epigastric pain were similar during both phases. Conclusions & Inferences Intensities of fullness, bloating, and belching decrease with food moving from the stomach to the small intestine indicating that the stomach plays a crucial role in the generation of these symptoms. In contrast, the symptom severity of epigastric burning and epigastric pain persists with progression of food to the small intestine. [ABSTRACT FROM AUTHOR]

Background Duodenal acid exposure induces a duodenogastric reflex resulting in gastric relaxation, inhibition of antral motility, and sensitization of the proximal stomach to distension. Duodenal hypersensitivity to acid has been identified as a potential pathogenic mechanism in functional dyspepsia. The nature and localization of the duodenal acid-sensitive receptors are still elusive. We hypothesize that acid directly activates superficial afferent nerve endings in the duodenal mucosa, triggering the duodenogastric reflex. Methods In a double-blind, randomized, crossover study in 13 healthy volunteers, benzocaine, a local anesthetic, vs saline was perfused in the duodenum 15 min before duodenal acid perfusion. Gastric responses were monitored by a barostat. Stepwise isobaric gastric distensions were performed before and during acid perfusion. Symptoms were evaluated by visual analogue scales for six dyspeptic symptoms and an overall perception score. Key Results Benzocaine perfusion caused a relaxation of the stomach prior to duodenal acidification, indicating the existence of an excitatory duodenogastric tone. Pretreatment of the duodenum with benzocaine reduced the acid-induced gastric relaxation by 50% and abolished the inhibition of phasic motility of the proximal stomach. Finally, sensitization to distension was more pronounced in the benzocaine condition because of higher proximal gastric volumes. Conclusions & Inferences These findings support a model in which different neuronal subpopulations are responsible for the motor and sensory limb of the acid-sensitive duodenogastric reflex, making benzocaine an unsuitable drug to treat duodenal hypersensitivity to acid. These data provide more insight in the contribution of duodenal neuronal input to gastric physiology in the fasting state. [ABSTRACT FROM AUTHOR]

Duodenal acid infusion induces gastric relaxation and sensitization to distension in healthy volunteers. The acid-sensitive mechanism is still unknown. We hypothesized that 5HT-blockade can inhibit the acid-induced duodenogastric sensorimotor reflex in healthy volunteers. Fourteen healthy volunteers were included in a randomized, double-blind placebo-controlled cross-over trial. An infusion tube with attached pH-electrode was positioned in the duodenum and a barostat balloon was located in the gastric fundus. Proximal gastric volume and sensitivity to distension were assessed before and during duodenal acid infusion and after pretreatment with intravenous (i.v.) ondansetron (a 5HT-receptor antagonist, 8 mg) or saline. An overall perception score (0-6) and an assessment of nine dyspeptic symptoms by visual analogue scales (VAS) were obtained. Results are given as mean ± SEM. Ondansetron had no effect on duodenal pH and on the acid-induced increase of proximal gastric volume (increase of 80 ± 20 vs 83 ± 15 mL after ondansetron and placebo; effect of acid <0.001, between treatments ns). After ondansetron, the overall perception score during duodenal acidification and gastric distension was significantly decreased compared with placebo ( P = 0.01). There was no effect of ondansetron on the individual dyspeptic symptoms. Ondansetron decreased gastric sensitivity during duodenal acid infusion and gastric distension. 5HT-receptors are involved in acid-induced duodenogastric sensitization, but not in the duodenogastric inhibitory motor reflex. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Review article: an analysis of the efficacy, perforation rates and methods used in pneumatic dilation for achalasia," by D. A. Katzka and D. O. Castell that was published in a 2011 issue.

A response from the author of the article related to the use of pictograms for improving the communication between doctors and patients with gastrointestinal cancer.

The pathophysiology of functional dyspepsia (FD) is unknown and several mechanisms associated with specific symptom patterns have been recently proposed. Increased duodenal acid exposure has been supposed to be associated with nausea, but recently an increase of severity of several dyspeptic symptoms was noted in a subset of dyspeptic patients. As its pathogenetic role is still unclear, we evaluated an involvement of duodenal acid exposure in symptom generation by inducing a hyperacidity status of the duodenum. Twelve young adult healthy volunteers in a randomized, double-blind protocol, underwent duodenal acid (0.2 N, 5 mL min−1) or saline perfusion, antropyloroduodenal manometry and duodenal pH monitoring both during fasting and postprandially. Every 15 min, severity of discomfort, fullness, bloating, belching, nausea, heartburn, epigastric burning, satiety and pain were evaluated by visual analogue scale. During acid perfusion, symptom scores for discomfort, bloating, nausea, epigastric burning were significantly higher ( P < 0.01) compared to saline. Postprandial antral motility index was lower (2.96 ± 1.8 vs 3.62 ± 1.8, P = 0.01) and jejunal motility index higher (4.87 ± 1.0 vs 4.37 ± 1.4, P = 0.01) during acid perfusion. Occurrence and duration of phases III of the migrating motor complex showed no difference. Duodenal acid perfusion causes a sensitization to dyspeptic symptoms and induces antral hypomotility and jejunal hypercontractility. Through these mechanisms, increased duodenal acid exposure may play a role in the pathophysiology of FD symptoms. [ABSTRACT FROM AUTHOR]

Aim: Nutritional measures often suffice for managing high-output ileostomy (HOI) in paediatric patients, but pharmacological treatment may be required to control ostomy output. This paper reviews the literature on the pharmacological management of paediatric HOI and provides recommendations., Methods: PubMed and Embase were searched for relevant articles up to 22 May 2024. Relevant articles were reviewed and recommendations were formulated., Results: No pharmacological studies involving paediatric ileostomy patients were identified, apart from two case reports on octreotide. The formulated recommendations are therefore based on data from adults or other intestinal failure conditions. The primary treatment suggestions are proton pump inhibitors and loperamide. Subcutaneous octreotide can be administered when complications persist. Codeine may be used in rare cases in children over 12 years old, but addiction risk and side effects limit its use. There is no or insufficient evidence for smectite, racecadotril, probiotics or prophylactic cycled antibiotics or clonidine. Bile acid sequestrants are not indicated in patients without a colon in continuity., Conclusion: Pharmacological options for the treatment of HOI in children are limited and evidence for their use is lacking. Research in paediatric HOI patients is needed to validate the use of pharmacotherapy in this patient group., (© 2025 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Aim: Paediatric patients with high-output ileostomies (HOI) face an elevated risk of complications. This study aimed to comprehensively review the existing literature and offer nutritional management recommendations for paediatric patients with an HOI., Methods: PubMed and Embase were searched for relevant English or French language papers up to 31 June 2022. The emphasis was placed on studies involving paediatric ileostomy patients, but insights were obtained from adult literature and other intestinal failure pathologies when these were lacking., Results: We identified 16 papers that addressed nutritional issues in paediatric ileostomy patients. Currently, no evidence supports a safe paediatric HOI threshold exceeding 20 mL/kg/day on two consecutive days. Paediatric HOI patients were at risk of dehydration, electrolyte disturbances, micronutrient deficiencies and growth failure. The primary dietary choice for neonates is bolus feeding with breastmilk. In older children, an enteral fluid restriction should be installed favouring isotonic or slightly hypotonic glucose-electrolyte solutions. A diet that is high in calories, complex carbohydrates and proteins, low in insoluble fibre and simple carbohydrates, and moderate in fat is recommended., Conclusion: Adequate nutritional management is crucial to prevent complications in children with an HOI. Further research is needed to establish more evidence-based guidelines., (© 2024 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Background: The European consensus defined gastroparesis as a condition characterised by delayed gastric emptying (GE) in the absence of mechanical obstruction, with a symptom pattern of predominant nausea and/or vomiting and overlapping postprandial distress syndrome (PDS). The distinction between patients with gastroparesis and those with functional dyspepsia (FD), another gastrointestinal condition characterised by predominant PDS or epigastric pain syndrome symptoms, is ongoing., Aim: To investigate the extent that symptom patterns may differentiate gastroparesis from FD., Methods: This retrospective study included 637 patients from Leuven University Hospital in 2006-2021 who had upper gastrointestinal symptoms, underwent a GE test, and completed the Dyspepsia Symptom Severity (DSS) questionnaire. Patients were identified as with gastroparesis-like symptoms (GPLS; i.e., moderate to severe nausea with moderate to severe PDS) or FD symptoms (not fitting GPLS). We excluded patients aged <18 years, and those with diabetes, organic gastrointestinal disease or a history of abdominal surgeries. Demographic and clinical variables were compared., Results: Among 545 patients, 238 reported GPLS and 307 reported FD symptoms. Those with GPLS had a significantly higher prevalence of delayed GE (half emptying time (T1/2) ≥109 min) and lower body mass index than those with FD (33.2% vs 17.6%, p < 0.01; 19.9 vs 21.2, p < 0.01, respectively). Among GPLS patients, those with delayed GE had higher DSS than those without (13.0 vs 12.0, p < 0.01)., Conclusions: In tertiary care patients who reported gastroparesis or FD symptoms, the presence of delayed GE was associated with GPLS. In patients with GPLS, delayed GE was associated with higher symptom severity., (© 2023 The Authors. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.)

Background: Proton pump inhibitors (PPI) have no effect on non-acid reflux events which can continue to provoke gastro-oesophageal reflux disease (GERD) symptoms. Baclofen, a γ-aminobutyric acid agonist, can decrease non-acid reflux but its symptomatic benefit in refractory GERD symptoms is understudied., Aims: To assess the efficacy of baclofen 10 mg t.i.d. vs placebo as add-on therapy in PPI-refractory GERD symptoms, in a randomised, double-blind, placebo-controlled study., Methods: Patients with persisting typical GERD symptoms on b.i.d. PPI therapy were randomised to 4 weeks of baclofen 10 mg or placebo t.i.d. Before and after treatment, patients underwent 24 h impedance-pH monitoring on-PPI. Throughout the study, patients filled out ReQuest diaries. Data were analysed using mixed models., Results: About 60 patients were included (age 47.5 years [range 19-73], 41f/19 m), 31 patients were randomised to baclofen. One patient withdrew consent and five in the baclofen group stopped treatment due to side effects. There was a trend towards a better response for general wellbeing in the baclofen-treated group compared to placebo (p = 0.06). When subdividing patients according to symptom association probability (SAP), only the SAP+ (n = 25) group improved significantly with baclofen (p corr  = 0.02), and worsened with placebo (p corr  = 0.008). The total number of reflux events decreased over time (p = 0.01), mainly due to the baclofen condition (p corr  = 0.1). The number of reflux events with a high proximal extent dropped significantly after baclofen (p corr  = 0.009), but not placebo., Conclusion: Baclofen decreases several reflux parameters in PPI refractory GERD symptoms, but pH-impedance monitoring is necessary before treatment as only SAP+ patients experience clinical benefit after 4 weeks., (© 2022 John Wiley & Sons Ltd.)

Background: The prevalence of duodenogastroesophageal reflux (DGER) and its effect on symptoms and oesophageal lesions in gastroesophageal reflux disease (GERD) is unclear., Aims: To conduct a systematic review to determine the prevalence of DGER among patients with GERD, the effect of DGER on symptoms and oesophageal lesions, and the treatment of DGER., Methods: We searched Pubmed and MEDLINE for full text, English language articles until October 2020 that evaluated DGER prevalence among patients with GERD, the effect of DGER on symptoms and oesophageal lesions, and the treatment of DGER., Results: We identified 3891 reports and included 35 which analysed DGER prevalence in GERD, 15 which evaluated its effect in non-erosive reflux disease (NERD), 17 on erosive oesophagitis, 23 in Barrett's, and 13 which evaluated the treatment of DGER. The prevalence of DGER, when evaluated by Bilitec, among all GERD patients ranged from 10% to 97%, in NERD 10%-63%, in erosive oesophagitis 22%-80% and in Barrett's 50%-100%. There were no differences in the presence or degree of DGER among patients who were asymptomatic or symptomatic on proton pump inhibitors (PPI). The most commonly evaluated treatments for DGER were PPIs and DGER reduced post-PPI therapy in all studies., Conclusions: The prevalence of DGER increased with more advanced oesophageal lesions and did not explain persisting symptoms among patients taking PPI therapy. PPIs appear to be effective in the treatment of DGER. DGER remains an important consideration in patients with GERD and future therapies deserve more study., (© 2021 John Wiley & Sons Ltd.)