Updated document on the management of functional dyspepsia by the Asociación Española de Neurogastroenterologia y Motilidad (ASENEM) and Sociedad Española de Medicina Familiar y Comunitaria (semFYC).

Functional dyspepsia (FD) is a gut-brain axis disorder characterized by postprandial fullness, early satiety, bloating and/or epigastric pain, which are presumed to originate in the gastroduodenal tract. While the international recommendations in the Rome IV consensus require endoscopy to rule out an organic condition before establishing a diagnosis of FD, international guidelines recommend that, in the absence of risk factors, patient management be initiated at the primary care level by establishing Helicobacter pylori infection status, with eradication when positive, followed by empiric therapy with proton pump inhibitors and/or prokinetics, and that endoscopy be reserved for patients refractory to said measures. Second-line therapy includes neuromodulating agents, among which tricyclic antidepressants and atypical antipsychotics such as levosulpiride stand out.

Prospective evaluation of opioid cessation in patients with suspected Opioid-induced esophageal dysfunction (OIED).

Introduction: The causal relationship between chronic opioid use and esophageal motor dysfunction in symptomatic patients has not been established.

Methods: A prospective before-and-after multicenter study, including chronic active opioid patients referred for esophageal motility tests due to non-obstructive dysphagia.

Results: 37 patients were evaluated, 27 (73%) had criteria of opioid-induced esophageal dysfunction (OIED).

European Guideline on Chronic Nausea and Vomiting-A UEG and ESNM Consensus for Clinical Management.

Introduction: Chronic nausea and vomiting are symptoms of a wide range of gastrointestinal and non-gastrointestinal conditions. Diagnosis can be challenging and requires a systematic and well-structured approach. If the initial investigation for structural, toxic and metabolic disorders is negative, digestive motility and gut-brain interaction disorders should be assessed.

Evaluation of Perceived Competence and Satisfaction in Neurogastroenterology and Motility Training During the Gastroenterology Fellowship in Spain.

Introduction: We evaluated the level of achievement of the published recommendations of the European and American neurogastroenterology and motility (NGM) Societies, on the competence in managing NGM disorders in a European Country with regulated gastroenterology training program.

Methods: We conducted a nationwide survey to gastroenterologists in Spain. Information regarding demographics, training center characteristics, NGM training, self-reported interest, satisfaction with the Tier 1 skills recommended by the ANMS-ESNM, and perceived competence in the diagnosis and management of diseases in the spectrum of NGM was obtained.

Resolution of dysphagia due to secondary achalasia with neuropathic chronic intestinal pseudo-obstruction by peroral endoscopic myotomy.

Chronic intestinal pseudo-obstruction (CIPO) is a rare condition affecting the motility of the lower gastrointestinal tract, while achalasia is an uncommon esophageal motility disorder. The coexistence of both conditions is extremely rare. We present the case of a patient who had both pathologies, admitted for dysphagia and oral intolerance, the symptoms finally resolved by performing a POEM.

Impact of gastrointestinal symptoms and psychological distress on quality of life in systemic sclerosis: a cross-sectional study.

Background: Systemic sclerosis (SSc) is a chronic autoimmune disease characterised by microvascular damage and fibrosis. Mortality in patients with SSc has significantly decreased. Consequently, patients with SSc have longer life expectancy, and health-related quality of life (HrQoL) has become more relevant in the comprehensive management of the disease.

Evaluation of the mechanism of action of paracetamol, drotaverine, and peppermint oil and their effects in combination with hyoscine butylbromide on colonic motility: human study.

Introduction: Drotaverine, paracetamol, and peppermint oil are often prescribed for the treatment of gastrointestinal spasm and pain. This study aimed to evaluate the effect of these drugs alone and combined with the well-known antispasmodic hyoscine butylbromide on the human colon.

Methods: Colon samples were obtained from macroscopically normal regions of 68 patients undergoing surgery and studied in muscle bath.

New insights into the characterization of the mechanism of action of hyoscine butylbromide in the human colon ex vivo.

Introduction: Hyoscine butylbromide (HBB) is one of the most used antispasmodics in clinical practice. Recent translational consensus has demonstrated a similarity between human colonic motor patterns studied ex vivo and in vivo, suggesting ex vivo can predict in vivo results. It is unclear whether the mechanism of action of antispasmodics can predict different use in clinical practice.

Distinctive gastrointestinal motor dysfunction in patients with MNGIE.

Background: Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is a rare mitochondrial disease caused by mutations in TYMP, encoding thymidine phosphorylase. Clinically it is characterized by severe gastrointestinal dysmotility associated with cachexia and a demyelinating sensorimotor polyneuropathy. Even though digestive manifestations are progressive and invariably lead to death, the features of gastrointestinal motor dysfunction have not been systematically evaluated.

Benefit of extending the protocol for high resolution manometry according to the version 4.0 of the Chicago criteria. A multicenter study.

Background: The last version of the Chicago Criteria for high resolution esophageal manometry proposes an expanded protocol including complementary maneuvers to improve the diagnostic yield of the exploration. Our aim was to determine the diagnostic gain of the CCv4.0 protocol compared to the CCv3.

Evaluation of abdominal gas by plain abdominal radiographs.

Background: Our aim was to determine the reliability of plain abdominal radiographs for the evaluation of abdominal gas content in patients with functional digestive symptoms.

Methods: Abdominal CT scan scout views, mimicking a conventional plain abdominal radiograph, were obtained from 30 patients both during episodes of abdominal distension and basal conditions. Physicians (n = 50) were instructed to rate the estimated volume of gas in the 60 images presented in random sequence using a scale graded from 0 to ≥600 ml.

Clinical significance of small bowel manometry patterns suggestive of intestinal obstruction.

Introduction: Minute rhythm and prolonged simultaneous contractions are patterns of postprandial small bowel contractile activity that historically have been considered as suggestive of mechanical intestinal obstruction; however, these patterns have been also encountered in patients with motility-like symptoms in the absence of bowel obstruction. The objective of this study was to determine the current diagnostic outcome of patients with these intestinal manometry patterns.

Methods: Retrospective study of patients with chronic digestive symptoms evaluated by intestinal manometry at our center between 2010 and 2018.

Effect of colonic distension on small bowel motility measured by jejunal high-resolution manometry.

Background: Abnormal motility patterns in the jejunum can be detected in patients with prominent colonic content, and these abnormalities may be due to either a primary jejunal dysfunction or a reflex distortion. The objective of the present study was to determine the effect of colonic distension on small bowel postprandial motility using high-resolution manometry.

Methods: Single center, controlled, parallel, randomized, single blind study in healthy subjects testing the effect of colonic filling vs sham infusion on the responses to a meal in 16 healthy subjects.

Underlying etiology associated with the diagnosis of absent contractility on high resolution esophageal manometry.

Background/aims: Absent contractility is considered a disorder of peristalsis. The literature about the etiology and clinical characteristics is scarce and the evidence on systemic diseases associated with this esophageal disorder is limited. Therefore, we aimed to determine the etiology of absent contractility in our population using the clinical algorithm recently described in the literature.

Severity of gastrointestinal bleeding is similar between patients receiving direct oral anticoagulants or vitamin K antagonists.

Background: Gastrointestinal bleeding (GIB) is a common adverse event related to anticoagulation therapy. However, evidence comparing the severity, etiology and outcome of GIB in patients taking direct oral anticoagulants (DOAC) vs. vitamin K antagonists (VKA) is scarce.

Propagation patterns of jejunal motor activity measured by high-resolution water-perfused manometry.

Background: The manometric diagnosis of severe intestinal dysmotility is performed at most institutions using catheters with 2-8 sensors 5-10 cm apart. The recent application of high-resolution manometry catheters with closely spaced sensors to other gut segments has been highly successful. The objective of the present study was to determine the feasibility of a jejunal high-resolution manometry method and to carry out a descriptive analysis of normal jejunal motor function.

Rumination syndrome: Critical review.

Rumination syndrome is a functional disorder characterized by the involuntary regurgitation of recently swallowed food from the stomach into the mouth, from where it can be re-chewed or expelled. Clinically, it is characterized by repeated episodes of effortless food regurgitation. The most usual complaint is frequent vomiting.

Opioid-induced esophageal dysfunction - Prevalence and manometric findings.

Background: prescription opioid use is on the rise. There has been an increasing recognition that chronic opioid consumption can result in esophageal motility disorders, and this association has been named opioid-induced esophageal dysfunction (OIED).

Aims: to analyze the prevalence of chronic opioid consumption in patients referred for esophageal motility testing in a European center; to describe the clinical characteristics and the association of opioid consumption with esophageal motility disorders.