Peptoniphilus duodeni sp. nov., a new bacterial species identified in human duodenum

We present here the main characteristics of Peptoniphilus duodeni strain Marseille-P2932 (= CSUR P2932, = DSM 103346) that was isolated from the duodenum of a 60-year-old male. Keywords: Culturomics, Taxonogenomics, Gut microbiota, Human gut, Peptoniphilus duoden

CON-COUR study: Interferential therapy in the treatment of chronic constipation in adults: study protocol for a randomized controlled trial

International audienceBackground: The prevalence of chronic constipation is about 15 % in Western countries with a significant impact on quality of life and health care costs. The first-line therapy, based on medical treatment combined with laxatives and dietary rules, is often disappointing. Interferential therapy is a new treatment that has demonstrated its efficiency in the treatment of chronic constipation in children and encouraging results in adults. The primary objective of this study is to assess the efficacy of interferential therapy during 8 weeks in adult patients. The secondary objectives are to assess this new and noninvasive therapy in terms of persistence of the clinical efficacy, colonic transit time, ano-rectal manometry, patient satisfaction and quality of life (QoL), and tolerance. Methods/ Design: Design: multicenter, prospective, randomized, placebo-controlled, double blind, two-parallel groups study. Setting: nine French adult gastroenterology centers. Inclusion criteria: adult patients with a history of chronic constipation refractory to medical treatment for at least 3 months. Treatment groups: (1) interferential-experimental group (effective stimulation); (2) placebo-control group (sham stimulation). Randomization: 1:1 allocation ratio. Evaluation times: inclusion (T0, randomization), baseline assessment (T1), start of stimulation (T2), intermediary assessment (T3, 4 weeks), end of stimulation (T4, 8 weeks), follow-up (T5 and T6, 1- and 6-month). Endpoints: (1) primary: short-term efficacy at T4 (treatment response defined as three or more spontaneous, complete bowel movements per week); (2) secondary: efficacy at T5 and T6, symptoms (Patient Assessment of Constipation Symptoms questionnaire), colonic transit time, anorectal manometry, patient satisfaction (analogical visual scale), patient QoL (Patient Assessment of Constipation Quality of Life Questionnaire), side/unexpected effects. Sample size: 200 individuals to obtain 80 % power to detect a 20 % difference in treatment response at T4 between the two groups (15 % of lost to follow-up patients expected). Discussion: The randomized, double-blind, placebo-controlled design is the most appropriate to demonstrate the efficacy of a new experimental therapeutic (Evidence-Based Medicine Working Group classification). National and international recommendations could be updated based on the findings of this study

Evaluation du traitement par dilatation pneumatique du mégaoesophage idiopathique

AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Réflexes somato-sympathiques et motricité colo-sphincterienne (étude chez le chat et chez l'homme)

AIX-MARSEILLE3-BU Sc.St Jérô (130552102) / SudocSudocFranceF

G-POEM may be an optional treatment for refractory gastroparesis in systemic sclerosis

International audienceBackground Systemic sclerosis (SSc) is a chronic autoimmune disease characterized by fibrosis involving skin and multiple internal organs. Gastrointestinal manifestations occur with a prevalence of 75-90%, and severely impact the quality of life. Among them, gastric involvement may concern 50-80% of patients with gastroparesis. GPOEM has been recently proposed as effective treatment in refractory gastroparesis, reaching 80% of short-term efficacy with very low complication rate. This procedure has never been assessed in SSc patients; thus, we describe two cases of patient who benefited from GPOEM. Patients:There were 40 and 35 years old women suffering from SSc for 10 years, whom developed gastroparesis symptoms over the last year, with GCSI score of 3.4. The diagnosis was confirmed by gastric emptying scintigraphy showing increased half emptying time and residual percentages. After failure of medical therapy associating prokinetic agents and dietary measures, they were referred after multidisciplinary discussion for GPOEM procedure. The follow-up included GCSI score calculation, adverse events, and GES at 2 months. Results The procedures were uneventful, and the patients were discharged after 4 days and gradual refeeding. The post-operative GCSI 1 and 2.1, respectively, with both patients feeling significant clinical improvement, after a follow-up of 6 months. GES were also normalized in one patient. Despite improvement, one patient did not gain weight and had an additional jejunostomy. Conclusions GPOEM may be an interesting therapeutic option in patient with SSc and severe gastroparesis after failure of classical treatment. This procedure could be proposed to patients after multidisciplinary discussion

Letter to the Editor: Initial Experience with Endoscopic Pyloromyotomy, with Description and Video of Technique.

We read with interest the article by Hedberg et al. whom reported their initial experience of endoscopic pyloromyotomy (G-POEM) combined with measures of pyloric distensibility with Endoflip before and after procedure.1 The physiopathology of gastroparesis is complex and involves gastric and/or pyloric motor dysfunction. Gastric emptying scintigraphy allows for confirming the diagnosis of gastroparesis, defined as the percentage of remaining radioisotope at 2 h (%2) > 60% and at 4H (%H4) > 10%. [...

Dysphagia in Children, Do Not Blame Eosinophils Too Quickly

Dysphagia in children is a relatively frequent symptom in childhood, and the main causes are congenital and linked to ear–nose–throat etiologies. However, non-congenital esophageal dysphagia is less common, and the main cause in such cases is eosinophilic esophagitis (EoE). When there is no response to a well-conducted treatment, with normalization of histology, the diagnosis of EoE must then be reconsidered. Here, we present the case of a 10-year-old patient whose initial diagnosis of eosinophilic esophagitis delayed the diagnosis of type III achalasia

Role of pyloric botulinum injection and endoscopic functional luminal imaging probe in predicting the outcome of gastric peroral endoscopic pyloromyotomy: Why not?

To the Editor: We read with interest the article by Vosoughi et al1 reporting the use of an endoluminal functional luminal imaging probe (EndoFLIP; Crospon, Galway, Ireland) for predicting the clinical outcome of endoscopic pyloromyotomy (G-POEM) in gastroparesis. The physiopathology of gastroparesis is complex, being associated with gastric motility disorders, neurologic disorders, and pyloric dysfunction (pylorospasm and hypercontractility). In recent years, endoscopic treatments have emerged, such as pyloric botulinum injection (PBTi) and G-POEM. PBTi, after a short promising development, was abandoned after 2 randomized trials that did not demonstrate the superiority of botulinum over placebo. [...

Redo gastric peroral endoscopic myotomy in case of recurrence of gastroparesis after the first GPOEM: It seemed to be a good option!

To the Editor: We read with interest the article by Abdelfatah et al1 reporting the short-term outcomes of endoscopic double versus single pyloromyotomy in the treatment of gastroparesis. With a clinical success rate of about 80%,2, 3, 4 gastric peroral endoscopic myotomy (GPOEM) seems to be an interesting treatment for patients with refractory gastroparesis. Nevertheless, long-term follow-up is lacking in the current literature. [...

DUAL-POEM for associated esophageal and gastric motility disorders: case series of endoscopic cardiomyotomy and endoscopic pyloromyotomy.

BACKGROUND: Per-oral esophageal myotomy endoscopic (E-POEM) has clearly proved safety and efficiency in the treatment of esophageal spastic disorders. Recent studies on endoscopic pyloromyotomy (G-POEM) suggest good efficiency and safety in the treatment of gastroparesis. In recent literature, some reports showed both esophageal motility disorders and gastroparesis. METHODS: We report the case of four patients with esophageal and gastric motility disorders who were successfully treated with DUAL POEM (E-POEM and G-POEM) in two separate procedures. RESULTS: Clinical improvement was reported in all patients with a decrease of the Eckardt score for esophageal motility disorders and a decrease of the GCSI score for gastroparesis. No adverse events occurred after any procedure. These reported cases suggest that is possible to perform an E-POEM and a G-POEM in the same patient in two distinct procedures. CONCLUSIONS: DUAL POEM seems to be faisable in patient with esophageal motility disorders associated with gastroparesis. The possibility of the concomitant occurrence of esophageal and gastric motility disorders could lead to change in practices with an overall assessment including gastric empting scintigraphy, high resolution manometry and pH-impedancemetry for patients with digestive motility disorders