Altered Bowel Habits Research Articles

StepFit-18K: Improving Irritable Bowel Syndrome (IBS) Symptoms with a Simple, Structured Walking Intervention.

Background: Irritable Bowel Syndrome (IBS) is a chronic functional gastrointestinal (GI) disorder characterized by abdominal pain, altered bowel habits, and bloating, affecting approximately 10.1% of the global population. While current treatments emphasize dietary modifications and symptom management, emerging evidence suggests that physical activity (PA) may help alleviate IBS symptoms. This study evaluated the effects of a structured walking program, "StepFit-18K", on IBS symptom relief. Methods: A total of 106 participants (68 females and 38 males) completed the 12-week intervention, which consisted of 18,000 additional steps per week (6000 extra steps on three days per week) tracked via fitness devices. The program emphasized step count, ease of adoption, and social support through walking groups. Results: As assessed by validated questionnaires, significant reductions in GI symptoms were observed. The IBS Symptom Severity Score (IBS-SSS) decreased from 118.30 ± 98.73 to 74.46 ± 74.93, with a delta score of -43.84%, highlighting bloating as the most improved symptom. No clinically significant changes were observed in anthropometric or biochemical markers. Conclusions: StepFit-18K is a simple, accessible, and effective form of physical activity that has demonstrated therapeutic benefits for IBS symptoms. This offers an additional application beyond its well-established role in preventing cardiovascular diseases.

A Systematic Review of Comparative Effectiveness of Interventions for Low Anterior Resection Syndrome: Impacts on Bowel Function and Quality of Life.

Low anterior resection syndrome (LARS) is a common complication following sphincter-preserving surgical resection for rectal cancer, characterized by symptoms such as fecal incontinence, urgency, and altered bowel habits, which significantly affect patients' quality of life. This cluster of symptoms not only limits their day-to-day physical activity but also has a debilitating effect on their emotional and mental well-being, undermining their integration and overall psychological health. This systematic review aimed to evaluate the effectiveness of invasive and non-invasive interventions for LARS, including pelvic floor rehabilitation, transanal irrigation, and various surgical options such as sacral neuromodulation and stoma formation, either as part of primary surgery or as a definitive treatment option for refractory cases. We systematically searched relevant databases for studies published in the last decade, focusing on adult patients diagnosed with LARS post-low anterior resection (LAR), with outcomes assessed through bowel function and quality of life metrics. The review identified six studies that met our eligibility criteria; a pooled cohort of 794 patients was identified, with sample sizes ranging from 37 to 430 participants. Our analysis revealed that pelvic floor rehabilitation significantly improves bowel function and quality of life in patients with LARS; yet, the optimal management approach remains unclear due to variability in patient responses. These findings highlight the inherent complexity and heterogeneity of LARS management, underscoring the necessity for multifaceted and individualized treatment strategies. Although pelvic floor rehabilitation shows promise, especially among motivated patients, its long-term sustainability remains uncertain. Surgical options are typically reserved for severe cases and carry significant risks and psychological impacts. For patients identified as being at high risk for LARS, treatment options must be considered and discussed at an earlier phase of their care. Our review concludes with the need for a tailored, patient-centered approach to managing LARS, highlighting the importance of ongoing research to fill existing evidence gaps. There is a need for translational research across various treatment modalities, comparing their effects, cost-effectiveness, implementation strategies, and the consequent effects on patients' quality of life and mental health.

Unusual gastrointestinal bleeding - Small intestinal venous ectasias.

A 34-year-old man presented to our emergency department with a 6-day history of bloody stools. He had no complaints of alteration in bowel habits in the stool. He did not consume alcohol and was a non-smoker. The patient had no any previous notable medical history or family history of similar complaints. Physical examination was unremarkable. In the local hospital, laboratory studies showed a hemoglobin level of 6.0g per deciliter (normal range, 11.5 to 15.5). After blood transfusion, an upper gastrointestinal endoscopy and complete colonoscopy did not reveal any bleeding lesion. In our hospital, the patient underwent abdominal contrast-enhanced CT, small intestinal venous ectasias were detected. The selective angiography was performed, but no aneurysm or arteriovenous fistula was found. The gastrointestinal tract bleeding still occurred for an unknown reason. Subsequently, single-balloon enteroscopy was carried out. By oral approach enteroscopy, obvious jejunum venous ectasias were detected.

Colonic lipoma, a rare cause of intestinal intussusception: A narrative review and how to diagnose it.

Colonic lipomas (CLs) are benign tumors of the adipose tissue of the gastrointestinal tract that are often asymptomatic. A search of medical literature in English using PubMed and Google Scholar was conducted for articles related to CL. Occasionally, patients present with intestinal bleeding or obstructive symptoms. Although intussusception is commonly observed in children, it is rare in adults. Moreover, CL as the most common entity, is very rare, with an incidence rate of 0.035% to 4.4%. Although fatty composition can assist in diagnosis through computed tomography and magnetic resonance imaging, the latter cannot exclude local infiltration. CLs are distributed evenly between both sexes and can be located anywhere in the gastrointestinal tract; however, they are more frequently located in the colon, particularly in the right colon and cecum (39.6%), followed by the transverse colon (25%), descending colon (20.8%), and the sigmoid colon (14.6%). Symptoms included abdominal pain (79.2%), alterations in bowel habits (45.8%), rectal bleeding (22.9%), colocolic intussusception (50%), weight loss (6.2%), vomiting (14.6%), and nausea (12.5%). Surgical and endoscopic techniques are widely used to manage CLs. The challenge for physicians is differentiating this lesion from malignant colonic lesions, at the outset. The risk of misdiagnosis is possible, and the recommendation in cases of doubt is still segmental surgical resection, as it ensures correct collection of lymph nodes for appropriate staging of presumed colonic carcinoma.

Correlation between the neuroendocrine axis, microbial species, inflammatory response, and gastrointestinal symptoms in irritable bowel syndrome.

This study examines the complex relationships among the neuroendocrine axis, gut microbiome, inflammatory responses, and gastrointestinal symptoms in patients with irritable bowel syndrome (IBS). The findings provide new insights into the pathophysiology of IBS and suggest potential therapeutic targets for improving patient outcomes. To investigate the interactions between the neuroendocrine axis, gut microbiome, inflammation, and gastrointestinal symptoms in patients with IBS. Patients diagnosed with IBS between January 2022 and January 2023 were selected for the study. Healthy individuals undergoing routine check-ups during the same period served as the control group. Data were collected on neuroendocrine hormone levels, gut microbiome profiles, inflammatory biomarkers, and gastrointestinal symptomatology to analyze their interrelations and their potential roles in IBS pathogenesis. IBS patients exhibited significant dysregulation of the neuroendocrine axis, with altered levels of cortisol, serotonin, and neuropeptides compared to healthy controls. The gut microbiome of IBS patients showed reduced diversity and specific alterations in bacterial genera, including Bifidobacterium, Lactobacillus, and Faecalibacterium, which were associated with neuroendocrine disturbances. Additionally, elevated levels of inflammatory markers, such as C-reactive protein, interleukin-6, and tumor necrosis factor-α, were observed and correlated with the severity of gastrointestinal symptoms like abdominal pain, bloating, and altered bowel habits. The findings suggest that targeting the neuroendocrine axis, gut microbiome, and inflammatory pathways may offer novel therapeutic strategies to alleviate symptoms and improve the quality of life in IBS patients.

SP5.4 - Is Fecal Calprotectin a useful test?

Abstract Aim To identify whether there is a correlation between a positive Fecal Calprotectin level(FCP) and a diagnosis of Inflammatory Bowel Disease. Method Data was collected retrospectively from a database of all colonoscopies performed at a District General Hospital. Data was collected including patient demographics, FCP result, colonoscopy and histology report from the hospital electronic record system. Results A total of 450 patients underwent a colonoscopy for any reason with 250 male and 200 female. The average age was 63.5 years. Patients undergoing surveillance or interventional colonoscopies were excluded. 90 patients were referred for colonoscopy with a change in bowel habit and all these patients had a FCP. Out of these, 42 had a FCP greater than 99 ug/g. Only 4 had IBD confirmed on histology, 3 had non-specific bowel inflammation. Of the other 360 patients who underwent a colonoscopy for other indications, 33 had a FCP sent, with 6 being positive. Out of a total of 48 patients who had a positive FCP, 25 had a FCP result greater than 250 ug/g. however, only three of these patients had IBD confirmed on histology. Conclusion The results show no correlation between a positive FCP and a diagnosis of IBD even using a higher cut off at 250 ug/g. For most cases with altered bowel habits or rectal bleeding, a FCP should not be recommended as it will not change the need for a colonoscopy.

FP2.9 - Colonoscopy perforation: a single centre study

Abstract Aim Colonoscopy is increasing utilized as a diagnostic & therapeutic tool. Colonoscopy perforation is reported to occur in 1/1500 (diagnostic colonoscopy), 1/500 (polypectomy) & 1/50 (EMR) procedures. The aim of the study is to evaluate the management of colonoscopy perforation at a single centre. Methods Colonoscopy is carried out on patients with colorectal cancer trigger symptoms (altered bowel habit, rectal bleeding, weight loss, abdominal pain, anaemia, ano-rectal symptoms, etc), family history screening, colorectal cancer & polyp surveillance. This is cohort study carried out since 2012 to December 2023 on all colonoscopy perforations carried out at a single centre. Results N = 22 Age (yrs) 70.8 ± 3.4 Sex (M:F) 4 : 18 BMI (kg/m2) 25.3 ± 1.8 ASA 2 Sigmoid Perf site (n) 13 LOS (days) 6 ± 6.5 Deaths (n) 30 day 3 60 day 3 90 day 3 IBD (n) 3 DD (n) 11 WCC (x109/L) 11.3 ± 1.4 CRP (mg/L) 100.1 ± 25.7 Lactate (mmol/L) 1.3 ± 0.7 Op time (mins) 119.0 ± 15.3 Bx 6 Polypectomy 5 Colonoscopy 21 (9 incomplete) Flexi siggy 1 Sedation 16 Entonox 5 GA 1 Xray 10 CT scan 22 Conservative 9 Surgery 13 Stoma (n) 6 Lap 2 Lap open 2 Open 9 Conclusion Colonic perforation during colonoscopy is increased in: polypectomy (especially right colonic), therapeutic EMR, diseased bowel (IBD inflammatory bowel disease, diverticular disease), & in challenging colons. The management of colonoscopy perforation should individualized with early clinical & radiological diagnosis. Site and size of colonic perforation determines management. Good bowel preparations, minimizes contamination and therefore allows safe conservative management of small colonoscopy perforation.

Burden of illness and treatment attitudes among participants meeting Rome IV criteria for irritable bowel syndrome: A nationwide survey in the United States.

Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction characterized by abdominal pain and altered bowel habits, with patient-perceived dissatisfaction of treatment symptom control. We assessed disease burden, satisfaction with medication use, and impact on activities, in participants with IBS with constipation (IBS-C) and diarrhea (IBS-D). This study assessed data from a large, United States survey of adults querying demographics, comorbid conditions, quality of life, medication use, satisfaction with symptom control, and work productivity. Participants were grouped into the IBS-C or IBS-D cohort if they met Rome IV criteria, with controls matched 1:1 according to age, sex, race, region, and Charlson Comorbidity Index score. All data were self-reported. Nine hundred and ten participants with IBS-C and 669 with IBS-D were matched to controls. The most reported symptoms were abdominal discomfort for IBS-C and abdominal pain and abdominal discomfort for IBS-D. Among the IBS-C and IBS-D cohorts, 74.2% and 65.9%, respectively, took prescription and/or over-the-counter medication for their symptoms. Respondents were more dissatisfied than satisfied with control of their symptoms. Respondents taking prescription medication(s) with or without over-the-counter medication(s) reported better symptom control than respondents only taking over-the-counter medications (p < 0.001). There was significantly higher mean presenteeism, work productivity loss, and daily activity impairment (p < 0.001 for all) in respondents with IBS compared with controls. This study provides insight into respondents' experiences of IBS symptoms, including the impact on daily activity, as well as satisfaction with control of symptoms and prescription and over-the-counter medications.

Prevalence of Irritable Bowel Syndrome Among Physicians at General Governmental Hospitals in Jeddah, Saudi Arabia.

Background Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disorder characterized by symptoms such as abdominal pain and altered bowel habits. It significantly impacts the quality of life and imposes a financial burden on healthcare systems. Previous studies have shown varying prevalence rates of IBS among different populations. Objective This study aims to determine the prevalence of IBS among physicians working in general governmental hospitals in Jeddah, Saudi Arabia, and to analyze the associated demographic and lifestyle factors. Methods An analytical cross-sectional study of 391 physicians from King Fahad and East Jeddah General Hospitals used an anonymous electronic survey covering demographics, health, lifestyle, and the Birmingham IBS Symptoms Questionnaire. Data were analyzed with SPSS version 29 (IBM Corp., Armonk, NY, USA) using Kruskal-Wallis and Mann-Whitney U tests, with p < 0.05 as significant. Results The prevalence of IBS among the participants was 45% (n=176). Significant associations were found between Birmingham scores and various demographic and lifestyle factors. Younger age groups (25-29 years, 51.4%, n=201) had higher mean ranks (212.98) compared to older age groups, with a p-value of .009. Males (54.5%, n=213) had a significantly higher mean rank (213.37) compared to females (45.5%, n=178; 175.22) (p<.001). Non-smokers (38.1%, n=149) had a significantly higher mean rank (214.27) compared to smokers (61.9%, n=242; 166.33) (p<.001). Physical exercise was associated with a lower prevalence of IBS symptoms, with non-exercisers (39.9%, n=156) having a higher mean rank (207.67) compared to exercisers (60.1%, n=235; 178.42) (p=.012). Additionally, 46.3% (n=181) of participants reported missing work due to IBS symptoms. Conclusion The study found a high prevalence of IBS among physicians in Jeddah, with significant associations between IBS symptoms and various demographic and lifestyle factors. These findings highlight the need for increased awareness, regular screening, and support for physicians suffering from IBS to improve their quality of life and job performance.

Distribution Patterns of Morphologies of Colorectal Carcinoma: A Descriptive, Cross-Sectional Study

Background: Colorectal malignancies are one of the commonest cancers throughout the world which is often diagnosed at advanced stages. Several lifestyle factors contribute to the development of this cancer such as a high intake of processed meats and low intake of fruits and vegetables, sedentary lifestyle, obesity, smoking and excessive alcohol consumption. Methods: This cross-sectional study was conducted in BIRDEM General Hospital in Dhaka in the Department of Pathology with 109 resected colectomy specimens during the period of March 2020 to February 2022. Relevant findings were recorded and analyzed for determining the morphological characteristics based on histopathological types, grading and staging of the malignancy. Results: Maximum patients belonged to 51-60 years of age; were males, hailing from urban regions and found to indulge in smoking. Per rectal bleeding, alteration of bowel habits and abdominal pain were the most frequently reported clinical symptoms. The commonest areas of occurrence of the tumors were rectum, recto-sigmoid junction and caecum. Out of all the 109 cases, 48, 45 and 16 belonged to non-mucinous, mucinous and signet-ring types as per histological classification respectively. Among these, 39 of non-mucinous and 24 of mucinous types belonged to Dukes’ B staging whereas 11 of the signet-ring variants fell in Dukes’ C stage. Regarding grading, maximum patients, meaning 68 out of 109, belonged to Grade II. After performing Fisher’s exact test, associations between staging and grading, grading and types and types and grading were found statistically significant. Conclusion: Colon and rectal mucin-secreting and signet-ring cell adenocarcinomas are high grade cancers that usually show up at an advanced stage.

Role of Inflammatory and Prognostic Markers and Its Outcome Among Patients with Pre and Post-Operative Colorectal Carcinoma

Colorectal carcinoma is a significant health concern, often presenting with symptoms like bleeding per rectum, mucous discharge, tenesmus, altered bowel habits, and weight loss. This study examines the influence of inflammatory and prognostic markers on the outcomes of patients undergoing per and post-operative treatment for colorectal carcinoma. Objective: To evaluate the role of inflammatory and prognostic markers on the outcomes of patients with per and post-operative colorectal carcinoma. Methods: This cross-sectional study included 112 patients aged 20-60 years, of either gender, with symptoms such as bleeding per rectum, mucous discharge, tenesmus, altered bowel habits, and weight loss for ≥1 month, diagnosed with colorectal cancer regardless of stage and grade. Results: The mean age of the patients was 45.16 ± 10.52 years, with 51.8% males and 48.2% females. Common symptoms included abdominal pain, per rectal bleeding, and weight loss, with 89.3% presenting with anemia. Tumors were located in the colon (84.8%) and rectum (28.6%). Pre-operative markers showed elevated WBC in 59.8%, CRP in 87.5%, decreased serum albumin in 77.7%, raised ESR in 61.6%, ferritin in 65.2%, and LDH in 60.7%. Post-operative markers indicated elevated WBC in 92.9%, CRP in 94.6%, decreased serum albumin in 82.1%, raised ESR in 68.8%, ferritin in 69.6%, and LDH in 73.2%. Complications included wound infection, pneumonia, sepsis, and prolonged hospital stays, with a mortality rate of 3.6%. Conclusions: Serum inflammatory markers significantly influence prognoses and predict adverse outcomes in patients undergoing surgical treatment for colorectal carcinoma.

Impact of mechanical barrier damage and interleukin-17 on symptoms in patients with post-infectious irritable bowel syndrome.

Aims/Background The pathogenesis of irritable bowel syndrome encompasses various factors, including abnormal gastrointestinal motility, heightened visceral sensitivity, dysfunction in the brain-gut axis, psychological influences, and disturbances in the intestinal flora. These factors manifest primarily as persistent or intermittent abdominal pain, diarrhoea, alterations in bowel habits, or changes in stool characteristics. In our investigation, we delve into the repercussions of mechanical barrier damage and immune dysfunction on symptoms among patients with post-infectious irritable bowel syndrome. Methods This study recruited a total of 20 healthy controls and 49 patients diagnosed with irritable bowel syndrome. Among the irritable bowel syndrome patients, we categorised them into two groups based on the ROME IV diagnostic criteria: the post-infectious irritable bowel syndrome group (n=23) and the non-post-infectious irritable bowel syndrome group (n=26). To compare clinical features, we utilised the Gastrointestinal Symptom Rating Scale, Self-Rating Depression Scale, and Self-Rating Anxiety Scale. Furthermore, we employed various techniques including haematoxylin and eosin (HE) staining, electron microscopy, Enzyme-linked Immunosorbent Assay, and flow cytometry to assess changes in immune cells, immune factors, inflammatory biomarkers, and intestinal barrier function. Results Under haematoxylin and eosin staining, post-infectious irritable bowel syndrome patients demonstrated increased neutrophils and plasma cells compared to the control group. Additionally, electron microscopy revealed ultrastructural changes such as the widening of the epithelial cell gap in the intestinal mucosa among post-infectious irritable bowel syndrome patients. Comparatively, the Gastrointestinal Symptom Rating Scale, Self-Rating Anxiety Scale, and Self-Rating Depression Scale scores were significantly elevated in the post-infectious irritable bowel syndrome group in contrast to both the control group and the non- post-infectious irritable bowel syndrome group (p < 0.05). Moreover, post-infectious irritable bowel syndrome patients exhibited a notably higher neutrophil-to-lymphocyte ratio compared to the control group (p < 0.05). Furthermore, the levels of interleukin-17 (IL-17) were elevated in post-infectious irritable bowel syndrome patients compared to the control group (p < 0.05). Additionally, the post-infectious irritable bowel syndrome group displayed a higher percentage of T helper 17 (Th17) cells compared to both the control and non-post-infectious irritable bowel syndrome groups (p < 0.05). Conclusion Acute gastrointestinal infection can disrupt the balance of intestinal flora, leading to dysbiosis. This dysbiosis can trigger the release of pro-inflammatory factors, including interleukin-17, which contributes to the impairment of the intestinal mucosal barrier. Consequently, this sets the stage for the development of long-lasting, mild chronic intestinal inflammation, ultimately culminating in the onset of post-infectious irritable bowel syndrome. Furthermore, within the framework of the gut-brain axis interaction, anxiety and depression may exacerbate intestinal inflammation in post-infectious irritable bowel syndrome patients. This interaction can perpetuate and prolong clinical symptoms in individuals with post-infectious irritable bowel syndrome, further complicating the management of the condition.

Irritable bowel syndrome: When food is a pain in the gut.

Irritable bowel syndrome (IBS) is a chronic gastrointestinal condition associated with altered bowel habits and recurrent abdominal pain, often triggered by food intake. Current treatments focus on improving stool pattern, but effective treatments for pain in IBS are still lacking due to our limited understanding of pathophysiological mechanisms. Visceral hypersensitivity (VHS), or abnormal visceral pain perception, underlies abdominal pain development in IBS, and mast cell activation has been shown to play an important role in the development of VHS. Our work recently revealed that abdominal pain in response to food intake is induced by the sensitization of colonic pain-sensing neurons by histamine produced by activated mast cells following a local IgE response to food. In this review, we summarize the current knowledge on abdominal pain and VHS pathophysiology in IBS, we outline the work leading to the discovery of the role of histamine in abdominal pain, and we introduce antihistamines as a novel treatment option to manage chronic abdominal pain in patients with IBS.

Assessment of Interleukin 10 (IL-10) Single Nucleotide Polymorphism (SNP) in Irritable Bowel Syndrome (IBS) Patients

Abstract Background Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder characterized by the presence of abdominal pain, bloating and altered bowel habits. The pathophysiological mechanisms underlying IBS are unclear. The abnormalities of motility, visceral hypersensitivity, gut microbial alteration and psychological stress contribute to the clinical symptoms of IBS. The associations of IBS and its risk gene polymorphisms have been ascertained by many researchers. Single nucleotide polymorphisms (SNPs) represent the most widespread type of sequence variations in genomes. It is known to be valuable genetic markers, because it may reveal the evolutionary history and common genetic polymorphisms that explain the hereditary risks for common diseases. Cytokines are involved in the pathogenesis of IBS. To date, only a few studies concerned the association of interleukin-10 (IL-10) gene polymorphism (rs1800871) -819 position to IBS. Objective We assessed interleukin 10 (IL-10) single nucleotide polymorphism rs1800871 (-819 C/T) in IBS patients. Method This was comparative case - control study for 40 participants, 20 cases and 20 controls, IL-10 rs1800871 (−819 T/C) single nucleotide polymorphism (SNP) was done via real time polymerase chain reaction for both study groups to assess its relation with IBS. Results The studied participants were divided into two groups according to ROME IV _criteria. For the case group (n = 20), the mean age was 41.05 ± 17.45 years, with 50% being male and 50% being female. In the control group (n = 20), mean age was 39.80 ± 14.84 years, with 25% being male and 75% being female Compared to the controls subjects, the frequencies of the IL-10 -819 T/T genotype and T allele were observed to be overrepresented in patients with IBS (60%; odds ratio [OR] = 1.143; 95% confidence interval [CI]: (0.152 – 8.593) for the TT genotype; P = 0.897) and (72.5%; OR: 1.582; 95% CI: (0.615 – 4.066)for the T allele; P = 0.341, respectively). The results demonstrated that T/T genotype was the most common genotype in the case group (60%). T allele was the most prevalent in case group (72.5%), while the C allele was the least prevalent (27.5%). However, T/T polymorphism in cases was greater than in control with non- statistical significance (p = 0.157). Conclusion IL-10 polymorphism (rs-1800871) has no association with IBS, However, T/T genotype was shown frequently in cases, with strong association with IBS. Abbreviations: IBS (irritable bowel syndrome), IL-10 (Interleukin-10 cytokine), SNP (single nucleotide polymorphism)

Ayurveda management of irritable bowel syndrome

Irritable Bowel Syndrome (IBS) is a complex and challenging Gastrointestinal (GI) disorder that can cause chronic abdominal pain or discomfort and altered bowel habits. Despite being a global health concern, a definitive treatment for IBS is currently not available. It has a significant effect on health, cost, and quality of life. In Ayurveda, it can be compared with Grahani roga (~disorders of lower GI tract), characterized by Muhurbhaddha-muhurdrava mala pravritti (~formed stools at one moment and another moment loose stools) associated with Udara shoola (~colicky abdominal pain), Adhmana (~abdominal distention), and Dourbalya (~weakness). A 22-year-old male patient reported to the outpatient department with complaints of frequent loose stools with varied consistency, foul smell, gaseous distention of the abdomen, nausea, loss of appetite, generalized weakness, and other associated complaints of reduced sleep and occasional headache since 5 years. The patient was diagnosed with Grahani roga based on the presenting symptoms. Rome IV criteria were used to establish IBS, and the IBS-unclassified was the diagnosis in this case. A combination of Hingwastaka choorna, Jeerakadyarishta, Shilajatwadi louha, Bilwavaleha, Panchamrita parpati, Brahmi vati, and Saraswatarishta were administered for a total period of 4 months along with diet modification, after which, a significant response was observed in the symptoms inferring the impact Ayurveda medicines in managing the pathology.

Irritable bowel syndrome: Clinical practice update.

Irritable bowel syndrome (IBS) is a common and burdensome disorder characterized by chronic recurrent abdominal pain and altered bowel habits. IBS remains misunderstood, leading to delayed diagnosis, impaired quality of life, and substantial healthcare costs. Advancing clinicians' understanding of this complex biopsychosocial process, using a positive diagnostic strategy rather than a diagnosis of exclusion, and incorporating a multimodal treatment approach expedite time to diagnosis, facilitate symptom relief, and reduce financial expenditure.

The Neutrophil-to-Albumin Ratio (NAR): A Novel Index in Relation to Clinical Symptoms, Quality of Life, and Psychological Status in Diarrhea-Predominant Irritable Bowel Syndrome (IBS-D).

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder characterized by chronic abdominal pain and alterations in bowel habits. Despite the importance of biomarkers in disease management, the quest for precise and non-invasive biomarkers for IBS continues. This study focuses on investigating the clinical significance of the neutrophil-to-albumin ratio (NAR) as a potential biomarker in IBS. A cohort of 86 patients diagnosed with diarrhea-predominant IBS (IBS-D) and 106 healthy individuals were assessed for clinical symptoms, quality of life (QOL), psychological status, as well as serum and mucosal cytokine production. Our findings revealed that NAR levels were notably elevated in patients with IBS-D compared to healthy controls. Positive correlations were observed between NAR levels and IBS clinical symptoms, while negative correlations were noted with QOL. Additionally, NAR showed positive associations with anxiety and depression scores, along with significant relationships with cytokine production (serum IL-6, TNF-α, IL-1β, IL-17A, GM-CSF, IFN-γ, MCP-1; mucosal IL-6, TNF-α, IL-1β, IL-17A) in IBS-D. Interestingly, patients with lower baseline NAR levels demonstrated potentially better clinical outcomes. The study underscores the potential utility of NAR as a novel biomarker in IBS, emphasizing its role in enhancing disease monitoring, understanding disease pathophysiology, and tailoring treatment strategies for patients with IBS-D.

Efficacy and tolerability of chitin-glucan combined with simethicone (GASTRAP® DIRECT) in irritable bowel syndrome: A prospective, open-label, multicenter study

BACKGROUND Irritable bowel syndrome (IBS), defined according to the Rome IV diagnostic criteria, is a chronic functional gastrointestinal disorder characterized by recurrent abdominal pain related to altered bowel habits. First-line recommended treatments are limited to combining drugs targeting predominant symptoms, particularly pain (antispasmodics), constipation (laxatives), and diarrhea (loperamide), yielding only a limited therapeutic gain. GASTRAP® DIRECT is a class IIa medical formulation composed of a combination of chitin-glucan and simethicone indicated for the symptomatic treatment of gas-related gastrointestinal disorders by combining different mechanisms of action. AIM To evaluate the efficacy, tolerability, and safety of 4-week GASTRAP® DIRECT treatment in patients with IBS. METHODS In this prospective, multicenter, open-label trial, 120 patients with IBS received three sticks of GASTRAP® DIRECT (1.5 g/d of chitin-glucan and 0.75 mg/d of simethicone) per day for 4 weeks. The primary endpoint was the responder rate, defined as the number of patients whose abdominal pain score decreased by ≥ 30% from baseline to week (W) 4. The analysis was performed using the per-protocol set. Cardinal symptoms, impact of global symptoms on daily life, change in stool consistency, and improvement in defecatory disorders were evaluated. RESULTS Overall, 100 patients were evaluated. At W4, 67% (95%CI: 57-75) showed improvement in abdominal pain (score: 5.8 ± 2.4 vs 2.9 ± 2.0, P &lt; 0.0001). Similar improvements were observed for bloating [8.0 ± 1.7 vs 4.7 ± 2.9, P &lt; 0.0001; 60% (95%CI: 50-70) responders], abdominal distension [7.2 ± 2.1 vs 4.4 ± 3.1, P &lt; 0.0001; 53% (95%CI: 43-63) responders], and impact of global symptoms on daily life [7.1 ± 2.0 vs 4.6 ± 2.9, P &lt; 0.0001; 54% (95%CI: 44-64) responders]. Stool consistency improved in most patients (90% and 57% for patients with liquid and hard stools, respectively). Overall, 42% of patients with defecatory disorders reported very much/considerable improvements by W2. No severe adverse event occurred, and tolerability was rated “good” or “very good” by 93% of patients. CONCLUSION GASTRAP® DIRECT is safe and well tolerated, alleviating IBS symptoms rapidly in 2 weeks. This open-label study suggests that the combination of chitin-glucan and simethicone could be beneficial in patients with IBS.

Red Flag Signs and Symptoms for Patients With Early-Onset Colorectal Cancer

Early-onset colorectal cancer (EOCRC), defined as a diagnosis at younger than age 50 years, is increasing, and so-called red flag signs and symptoms among these individuals are often missed, leading to diagnostic delays. Improved recognition of presenting signs and symptoms associated with EOCRC could facilitate more timely diagnosis and impact clinical outcomes. To report the frequency of presenting red flag signs and symptoms among individuals with EOCRC, to examine their association with EOCRC risk, and to measure variation in time to diagnosis from sign or symptom presentation. PubMed/MEDLINE, Embase, CINAHL, and Web of Science were searched from database inception through May 2023. Studies that reported on sign and symptom presentation or time from sign and symptom presentation to diagnosis for patients younger than age 50 years diagnosed with nonhereditary CRC were included. Data extraction and quality assessment were performed independently in duplicate for all included studies using Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines. Joanna Briggs Institute Critical Appraisal tools were used to measure risk of bias. Data on frequency of signs and symptoms were pooled using a random-effects model. Outcomes of interest were pooled proportions of signs and symptoms in patients with EOCRC, estimates for association of signs and symptoms with EOCRC risk, and time from sign or symptom presentation to EOCRC diagnosis. Of the 12 859 unique articles initially retrieved, 81 studies with 24 908 126 patients younger than 50 years were included. The most common presenting signs and symptoms, reported by 78 included studies, were hematochezia (pooled prevalence, 45% [95% CI, 40%-50%]), abdominal pain (pooled prevalence, 40% [95% CI, 35%-45%]), and altered bowel habits (pooled prevalence, 27% [95% CI, 22%-33%]). Hematochezia (estimate range, 5.2-54.0), abdominal pain (estimate range, 1.3-6.0), and anemia (estimate range, 2.1-10.8) were associated with higher EOCRC likelihood. Time from signs and symptoms presentation to EOCRC diagnosis was a mean (range) of 6.4 (1.8-13.7) months (23 studies) and a median (range) of 4 (2.0-8.7) months (16 studies). In this systematic review and meta-analysis of patients with EOCRC, nearly half of individuals presented with hematochezia and abdominal pain and one-quarter with altered bowel habits. Hematochezia was associated with at least 5-fold increased EOCRC risk. Delays in diagnosis of 4 to 6 months were common. These findings highlight the need to identify concerning EOCRC signs and symptoms and complete timely diagnostic workup, particularly for individuals without an alternative diagnosis or sign or symptom resolution.

Gastrointestinal side effects of somatostatin analogs in neuroendocrine tumors: a focused review.

Neuroendocrine tumors (NETs) are a group of well-differentiated heterogeneous neoplasms characterized by slow progression and distinct clinical and biological behavior. In the majority of patients with NET, first-line treatment is represented by somatostatin analogs (SSAs) that, despite being drugs with high tolerability (even at high doses) and providing to carcinoid symptoms control and anti-proliferative effects, may present some side effects, with potential impact on quality of life and nutritional status. The most frequent side effects are represented by gastrointestinal events in particular alterations in bowel habits (diarrhea and constipation), abdominal pain, exocrine pancreatic insufficiency, and cholelithiasis. Considering the relative rarity of NETs, literature about frequency and standard clinical management of adverse events SSA-related is still lacking and heterogeneous. The aim of this review is to arm gastroenterologists and other physicians treating NET patients with essential knowledge on the side effects of SSAs. By identifying and managing these adverse events early, healthcare professionals can offer optimal care, avert foreseeable complications, and ensure the best outcomes for patients. Without such early recognition, there is a risk of diminishing the patient's quality of life and their ability to sustain treatment over time.