Introduction

In patients with disorders of the gut-brain interaction abdominal bloating is a visceral sensation (sensation of pressure/fullness), whereas visible abdominal distension is a somatic manifestation with abnormal postural tone (abdominophrenic dyssynergia, i.e., diaphragmatic push and abdominal wall relaxation). Abdominophrenic dyssynergia can be corrected by a simple non-instrumental technique, and our aim was to determine the relation of distension and bloating responses over time.

Aims & Methods

In a randomized, placebo-controlled, parallel trial (ClincalTrials.gov number NCT06150638) 40 consecutive patients (34 women, 6 men; age range 18–58 years) with disorders of gut-brain interaction complaining of visible abdominal distension were randomized to receive biofeedback or placebo. Patients in the biofeedback group were explained the mechanism of distension, and were taught to relax the diaphragm and contract the abdominal wall, using an original audiovisual support and hands-on guidance by a trained operator. In the placebo group, sham measurements of abdominal and thoracic motion were performed, and a pill of placebo was administered. Three 30-min sessions were performed over a 4-week intervention period, with instructions to perform daily exercises (biofeedback group) or to take placebo three times a day (control group) at home. After the intervention, patients allocated to the placebo group were offered biofeedback treatment. After receiving biofeedback treatment, patients in both groups were instructed to continue practicing these same exercises over time, and were followed up: visible abdominal distension and sensation of abdominal pressure/fullness (bloating) were measured at 1 and 3 months using 10-cm scales for 7 consecutive days, and the mean values (±SE) were calculated.

Results

After undergoing the three treatment sessions, abdominal distension improved in the biofeedback group (n=19; by 24±7 %), but not in the placebo group (n=20; 8±3 % change; p=0.025 vs feedback group). In the 20 patients randomized to placebo, subsequent biofeedback treatment improved abdominal distension (by 35±7 %). Follow-up in all patients after biofeedback (n=36) showed a sustained improvement in abdominal distension and bloating sensation at 1 month (by 39±5 % and 36±7 %, respectively; p<0.001 vs before treatment for both), and at 3 months (by 37±5 % and 34±8 %, respectively; p<0.003 vs before treatment for both).

Conclusion

In patients with disorders of gut-brain interaction, correction of abdominophrenic dyssynergia by a simple, non-instrumental technique, produces a sustained improvement of visible abdominal distension, associated with a concomitant improvement of bloating sensation.

Disclosure

I have the following Conflict of Interest to declare: Coloplast, Schwabe

Introduction

Post endoscopy upper gastrointestinal cancers (PEUGIC) are often missed opportunities to diagnose earlier or even prevent cancer. PEUGIC in patients undergoing surveillance for pre-malignant conditions are a potentially important surveillance quality indicator. A national process for identifying all PEUGIC in the English National Health Service and performing root cause analysis was developed.

Aims & Methods

Potential PEUGIC between 2017 and 2023 occurring 3-36 months after an index endoscopy which did not result in a cancer diagnosis were identified from National Cancer Registration Dataset and Hospital Episode Statistics held by the National Cancer Registration and Analysis Service. Data from local root cause analysis were uploaded onto a secure portal for national analysis. Only PEUGIC following surveillance endoscopy were included in this analysis. Logistic regression analysis was used to identify associations.

Results

3151 potential PEUGIC were examined by local reviewers in 144 English hospitals. 635 (20%) were excluded and data were available for 2516 PEUGIC. 618 PEUGIC (24.6%) were undergoing surveillance for: Barrett’s oesophagus (83%); chronic atrophic gastritis (7%) or other conditions (10%). PEUGIC sites were oesophagus 85%, stomach 13% and duodenum 1%. 5% of PEUGIC were not related to the pre-malignant condition under surveillance.
Table 1 summarises the PEUGIC root cause analysis results based on the World Endoscopy Organisation categorisation. Inadequate endoscopy or decision making occurred in 30% of PEUGIC (categories B/D) and was associated with patient harm OR 2.61 (95% CI 1.74 -3.92).
Seattle biopsy protocol compliance was only 58% in Barrett’s surveillance PEUGIC. Additional focal or cancer associated lesions were present at index endoscopy in the PEUGIC segment in 23%.
Oesophageal and gastric PEUGIC often presented with stage 2 cancers or greater (48% and 43% respectively). 45.2% of oesophageal and 47.0% of gastric PEUGIC were considered at least possibly avoidable. Treatment was adversely affected with palliative treatment in 22% of oesophageal and 30% of gastric PEUGIC. 6% led to premature death.
Endoscopy practices associated with stage ≥2 cancer were: sedation without opioids OR 1.75 (95% CI 1.03-2.97); lack of image enhancement OR 1.78 (95% CI 1.18-2.70) and lack of dedicated surveillance sessions OR 2.08 (95% CI 1.46-2.98).

Table 1 Root causes of all surveillance PEUGIC

Conclusion

Inadequate assessment or decision making was noted in 30% of surveillance PEUGIC, which adversely affected treatment in 20% of oesophageal and 30% of gastric PEUGIC. 48% of oesophageal and 43% of gastric PEUGIC patients presented with stage 2 cancer or greater suggesting potential failures of surveillance. Optimal sedation practice, image enhancement and dedicated surveillance sessions were associated with stage 1 PEUGIC and better outcomes.