Objectives: To determine the prevalence of objectively defined gastric dysmotility in SSc and to evaluate its associations with SSc clinical and immunological features and adverse outcomes (SSc-related death and/or lung transplantation). Methods: We conducted a retrospective cohort study. All participants underwent a standardized 4-h solid gastric emptying scintigraphy. Gastric dysmotility was defined as ≥20% gastric retention at 4-h. We examined associations between gastric dysmotility and demographic, clinical and immunologic characteristics of SSc, as well as relevant clinical outcomes. Results: Ninety-four patients were included (mean age 48 ± 12 years; 81% female). Gastric dysmotility was identified in 33 patients (35%). Patients with gastric dysmotility had a higher prevalence of interstitial lung disease (63.6% vs 30.3%, P = 0.033) and absent oesophageal contractility (75.8% vs 45.9%, P < 0.001) compared with those without. Gastric dysmotility was less frequent in patients with ACAs (27.3% vs 55.0%, P = 0.009) but more common in those with anti-U1RNP antibodies (15.6% vs 1.7%, P = 0.011). During follow-up (mean duration 2.8 ± 1.7 years; 260 person-years), 16 patients (17.0%) experienced the composite end point of SSc-related death and/or lung transplantation. In unadjusted Cox regression, gastric dysmotility was strongly associated with adverse outcomes (HR = 6.47, 95% CI: 2.09–20.10, P = 0.001), which remained significant after adjustment for confounders (HR = 4.23, 95% CI: 1.25–14.33, P = 0.020). Conclusions: In SSc, we have confirmed that gastric dysmotility is associated with a distinct clinical and serological phenotype and that it independently predicts serious adverse outcomes. These findings underscore the importance of objective assessment of gastric function and its potential role in risk stratification.

Hiccups result from involuntary contractions of the diaphragm, driven by a complex neuromuscular reflex. Three patients with persistent hiccups underwent esophageal high-resolution manometry during hiccup episodes, revealing a consistent finding: sustained contraction of the esophagogastric junction with intermittent pressure peaks. This pattern, termed the “Hiccup-Induced Esophagogastric Waveform,” shows significant esophageal pressure changes linked to hiccup reflex. It may reflect a compensatory mechanism to expel excess esophageal residue or gas. These findings suggest hiccups could exacerbate symptoms of esophageal disorders, such as dysphagia and chest pain, and highlight the need for targeted therapeutic strategies. Further research is needed to explore these mechanisms.

Francisco A Félix-Téllez, Alejandra X Cruz-Salgado, José M Remes-Troche, Ángel R Flores-Rendon, Héctor R Ordaz-Álvarez, José A Velarde-Ruiz Velasco, Marco A O Flores-Lizárraga, José I Soto-González, and Nadia S Abizaid-Herrera. J Neurogastroenterol Motil 2025;31:95-101. https://doi.org/10.5056/jnm24070

Background. Gastroesophageal reflux disease (GERD) is highly prevalent in systemic sclerosis (SSc) and frequently persists despite proton pump inhibitor (PPI) therapy. However, the mechanisms underlying PPI refractory GERD in SSc remain incompletely understood. Methods. We conducted a single centre, retrospective study of adults with SSc who underwent ambulatory pH multichannel intraluminal impedance (pH/MII) monitoring while receiving twice daily PPI therapy (2021 to 2025). Esophageal motility (high resolution manometry, HREM) and gastric emptying scintigraphy were integrated to examine associations between gastroesophageal dysmotility and reflux phenotypes. Results. Thirty patients were included, of whom 67% had PPI refractory reflux symptoms and 33% were undergoing prelung transplantation evaluation. Refractory GERD was present in 29/30 patients (97%) based on Lyon 2.0 classification, with conclusive evidence in 53% and borderline evidence in 43%. Esophageal dysmotility was identified in 80%, most commonly absent contractility (67%), and was associated with impaired reflux clearance, reflected by longer acid clearance times (2.20 [1.15, 3.75] vs 1.15 [0.43, 1.90] min) and prolonged reflux episode duration (16.60 [4.38, 40.63] vs 1.95 [0.53, 20.43] min). Gastric dysmotility was identified in 60.7% and was associated with an increased reflux episode burden (51.00 [30.00, 81.50] vs 25.00 [21.00, 54.00] episodes/24h). Conclusions. PPI refractory GERD is nearly universal in this SSc cohort and reflects heterogeneous, quantifiable abnormalities across the foregut, including impaired esophageal clearance and increased reflux burden related to gastric retention. These findings support integrated physiologic evaluation to define reflux mechanisms, inform risk stratification (including lung transplantation), and guide targeted, mechanism based therapies beyond acid suppression.

Goals: This study aimed to investigate the clinical phenotype of urinary symptoms in patients diagnosed with irritable bowel syndrome, the factors associated with this overlap, and the impact of urinary symptoms on their quality of life. Background: Irritable bowel syndrome is a common disorder, affecting up to 3.8% of the population. The overlap with other disorders of the gut-brain interaction, psychiatric disorders, and other somatic disorders is common. Moreover, the association between irritable bowel syndrome and urinary symptoms has been recognized, but the clinical phenotype remains unclear. Study: This cross-sectional study involved patients with irritable bowel syndrome according to Rome IV. Lower urinary tract symptoms were classified using the International Continence Society’s classification. Data on demographics, medical history, medication use, anxiety, depression, and quality of life were collected and analyzed using logistic regression analysis. Results: The study included 428 subjects, 86 diagnosed with irritable bowel syndrome. Patients exhibited a higher prevalence of lower urinary tract symptoms (60.5%, 95% CI: 50.5-71.9). Multivariate analysis revealed associations between irritable bowel syndrome and lower urinary tract symptoms (OR: 2.49, 95% CI: 1.48-4.18, P=0.001), particularly storage urinary symptoms (OR: 1.94, 95% CI: 1.10-3.40, P=0.021). Patients with urinary symptoms reported significantly lower quality of life compared with those without these symptoms (50.8±17.2 vs. 76.7±21.8, P<0.001). Conclusions: Irritable bowel syndrome is associated with lower urinary tract symptoms, contributing to a significant reduction in quality of life. Clinicians should consider referring patients with irritable bowel syndrome and lower urinary tract symptoms to experts in urodynamics to provide targeted management.