For this installment of the Gastro Journal Club, we are honored to host Prof. Fernando Azpiroz from University Hospital Vall d’Hebron. He is joined by fellows from the Lewis Katz School of Medicine at Temple University for a discussion of the article “Thoracoabdominal Wall Motion–Guided Biofeedback Treatment of Abdominal Distention: A Randomized Placebo-Controlled Trial,” published in the August 2024 issue of Gastroenterology.
The Gastro Journal Club is by and for fellows and residents. During these sessions, fellows and residents have the opportunity to ask authors questions about their recently published work in Gastroenterology. If you are interested in arranging a Gastro Journal Club session at your institution, please contact [email protected].
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Outline of the meeting:
[0:07] Introduction
[1:06] Discussion of the article
[12:32] What is the pathophysiology of abdominophrenic dyssynergia?
[15:35] Are there both local (ie, within the gastrointestinal tract) and central (ie, brain stem) causes of abdominophrenic dyssynergia?
[17:27] Can the author discuss plethysmography technology? Are there other known clinical applications for it?
[18:53] How were organic diseases classified for the purposes of exclusion criteria in this study?
[20:05] There is a known overlap between psychiatric comorbidity and disorders of gut-brain interaction. What were the reasons for excluding patients with psychiatric disease or who were taking psychotropic medication? Does this limit the application to general practice?
[21:49] Why was a pill chosen as a placebo, rather than a different or unvalidated exercise?
[22:53] Nearly all participants were women of childbearing age. Was there any interaction with issues related to menstrual cycle? Are results generalizable to men?
[24:36] The instructions for how to alter dyssynergia kinetics are simple. Can this technique be reliably taught without plethysmography?
[27:41] As there are no substantial risks associated with this exercise, should it be incorporated into care while awaiting additional validation?
[30:41] Is bloating a different symptom than abdominal distention? Could a patient with bloating be considered for biofeedback?
[34:58] In addition to evaluation for celiac disease, did pretreatment clinical workup involve exclusion of small intestinal bacterial overgrowth, lactose intolerance, or Helicobacter pylori infection?
[36:15] What was the racial and ethnic makeup of the participant groups?
[37:01] What were the most reproducible offending meals? Were there any observed trends in the offending meals?
[38:44] Conclusion
