Digestive Symptoms Research Articles

Factors Influencing Treatment Satisfaction and Recognition Gaps Between Physicians and Patients with Systemic Sclerosis.

It is important to understand the differences in patient-physician perceptions and factors affecting satisfaction with treatment in patients with systemic sclerosis (SSc). This web-based survey (conducted in Japan in March 2023) targeted patients aged ≥ 18years with SSc and physicians in hospitals with ≥ 20 beds and seeing ≥ 3 patients with SSc monthly. Physicians and patients answered similar questions. Responders were 301 patients (63.8% female; 47.5% limited cutaneous SSc; 44.9% diffuse cutaneous SSc) and 129 physicians (51.2% rheumatologists; 20.9% dermatologists). The most common problematic symptoms reported by patients having each symptom were Raynaud's phenomenon (RP) (59.5%), skin tightening (47.4%), and malaise (45.5%). Physicians also perceived RP as the common problematic symptoms (46.5%). Conversely, there was a large gap in the perception of malaise as problematic (5.4%). There was a ≥ 20% difference in the percentage of respondents who felt that treatments improved symptoms of reflux esophagitis (48.8% in patients vs. 76.7% in physicians), dysphagia (25.0% vs. 52.7%), constipation (35.1% vs. 62.8%), diarrhea (36.1% vs. 62.8%), and pain (47.6% vs. 69.0%). Patient characteristics associated with high satisfaction with treatment included treatment responsiveness, age ≥ 50years, being anti-topoisomerase I antibody positive, having dermatological or digestive symptoms as problematic symptoms, and not feeling they should have seen their physician earlier. Patients and physicians had different perceptions of symptoms and treatment response. Patients' perception of improvement affected their satisfaction with treatment. Reviewing treatment goals and content between patients and physicians is necessary to improve treatment satisfaction. UMIN000050368.

Lower gastrointestinal bleeding, vomiting and weight stagnation in a well-appearing neonate with neonatal transient eosinophilic gastroenterocolitis

This article presents a novel case of neonatal transient eosinophilic gastroenterocolitis, a proposed new entity causing upper and lower digestive symptoms and extensive gastrointestinal eosinophilic infiltration in newborns without a proven active food allergy. The condition’s proposed pathophysiology and relationship to similar conditions, alongside clinical and therapeutic approaches, are also discussed.

Randomized, multicenter, active-controlled open-label study of NPC-25, zinc histidine hydrate, (non-inferiority to NOBELZINTM, zinc acetate dihydrate) for patients with hypozincemia

ObjectiveThis study evaluated the efficacy and safety of NPC-25, zinc histidine hydrate, in patients with hypozincemia. This randomized multicenter active-controlled open-label trial aimed to verify the non-inferiority of NPC-25 to NOBELZINTM, zinc acetate dihydrate. MethodsParticipants whose serum zinc concentrations were <70 μg/dL at two points within 8 weeks before the start of treatment were randomized 1:1 into the NPC-25 (active drug) administration group and the NOBELZINTM (control drug) administration group, using dynamic allocation. The initial daily doses were 50mg or 100mg as the baseline serum zinc levels, and administration periods were set at maximum of 24 weeks with the goal of maintaining the target serum zinc concentration (≥80 and <200 μg/dL) for 8 weeks, with extension up to 52 weeks as needed in the NPC-25 group, but not the NOBELZIN group. The primary efficacy endpoint was the proportion of participants who maintained the target serum zinc concentration for 8 weeks at the same dosage within 24 weeks after the start of administration. The key secondary endpoints were the cumulative achievement percentage for target serum zinc concentration at each observation time point, the cumulative achievement percentage for maintenance of target concentration for 8 weeks at the same dosage at each observation time point, change in mean serum zinc concentration, and comparison of dosage amount. Safety assessments included the incidence of adverse events and adverse drug reactions, as well as changes in clinical laboratory and physical measurements. ResultsFor the primary endpoint for full analysis (FAS) set (n=103, NPC-25 group; n=107, NOBELZIN group), the proportion of participants who maintained the target serum zinc concentration for 8 weeks at the same dose was 86.4% (89/103) in the NPC-25 group and 80.4% (86/107) in the NOBELZIN group, which confirmed the non-inferiority of NPC-25 to NOBELZINTM. For the secondary endpoint for FAS, at each observation point, although there was no significant difference between the two groups in the proportion of participants who achieved the target serum zinc concentration, there was a tendency that the maintenance of the target concentration for 8 weeks was achieved earlier with NPC-25.There was also a tendency to achieve maintenance with a lower daily dose in the NPC-25 group. Furthermore, at each observation point, there was no significant difference between the two groups in terms of the mean serum zinc concentration or the average change in serum zinc concentration from baseline. In the safety assessment for safety population (SP), the incidence of nausea and vomiting was lower with NPC-25 than with NOBELZIN (2.8% and 6.4% with nausea, 0.9% and 2.8% with vomiting), but there were no significant differences in other adverse drug reactions. ConclusionIn this study, non-inferiority of NPC-25 to NOBELZINTM was confirmed in terms of efficacy and safety. Furthermore, regarding safety, NPC-25 resulted in a lower frequency of digestive symptoms, such as nausea and vomiting.

P-1303. Moving Research into Action: The Use of Hospital Admission Data as a Measure of Ukrainian Child Migrants’ and War Refugees’ Health Needs in the First 100 Days of the War

Abstract Background Since the start of the war in Ukraine on February 24th, 2022, Poland has been one of the countries with the largest arrival of migrant and war refugees from Ukraine. As the presence of Ukrainian migrant and war refugee children has increased in Poland, studies of their health condition and the use of health services have become of key importance in fulfilling their unmet health needs. Methods Data on the hospitalization of Ukrainian pediatric patients in Polish hospitals come from the Nationwide General Hospital Morbidity Study (NGHMS). The analyses were based on the diagnoses and conditions most responsible for the patient’s stay in hospital and coded in accordance with ICD-10. Results According to the NGHMS, during the first 100 days of war 2,544 Ukrainian children and adolescents under 18 years of age were admitted to Polish hospitals. The most frequently reported hospital events among the Ukrainian migrant children were infectious and parasitic diseases (A00-B99) – 24.1%, mainly viral and other specified intestinal infections (A08; 49.3%), other gastroenteritis and colitis of infectious and unspecified origin (A09; 36.2%). Symptoms, signs and abnormal clinical and lab findings (R00-R99 – 17.8%) were the second most frequently reported cause of hospitalization, the majority of which were related to digestive system symptoms - mostly nausea and vomiting and abdominal pain, as well as fever of unknown origin. Diseases of the respiratory system (J00-J99) ranked as the third leading cause of pediatric hospitalization (12.2%), with a predominance of acute bronchitis (J20) and influenza due to identified seasonal influenza virus (J10). 88 Ukrainian children were admitted to hospital due to COVID-19. One third of analyzed hospitalizations (33.1%) had a principal diagnosis of vaccine-preventable disease (VPD). Conclusion Our findings suggest a greater focus on preventive healthcare and public health interventions, especially in the area of VPD. As vaccination should be considered a health equity intervention, the tailored vaccination program SAY YES TO VACCINATION in collaboration with UNICEF (SBC Office) has been implemented to increase mothers’ vaccination literacy and address gaps in vaccination coverage among Ukrainian children in Poland. Disclosures All Authors: No reported disclosures

Self-Reported Post-COVID Symptoms at 18 Months After Infection Among Adults in Southern Brazil: A Cross-Sectional Study

Background/Objectives: Currently, there is a limited understanding of the long-term consequences following acute COVID-19, referred to as long COVID. This cross-sectional study aims to analyze the prevalence of persistent signs and symptoms of long COVID, 18 months after primary SARS-CoV-2 infection in adults in southern Brazil. Methods: Using two national databases (the digital registry of SARS-CoV-2 positive cases), 370 individuals living in the state of Paraná (Brazil) were recruited. Data were collected through telephone interviews conducted in 2021 and 2022. Results: The overall prevalence of long COVID was 66.2% among study participants. During the acute phase of infection, the most common symptom clusters included neurological symptoms (87.0%; n = 318), followed by respiratory (82.0%; n = 301), musculoskeletal (66.0%; n = 241), digestive (50.0%; n = 184), psychological (38.0%; n = 138), and endocrine symptoms (28.0%; n = 104). In the 18 month follow-up, the main persistent symptoms were memory loss (42.7%), fatigue (32.2%), anxiety (23.5%), dyspnea (19.7%), and hair loss (19.7%). The proportion of participants with long COVID was statistically higher in females (73.9%), those with a family income below two minimum wages (94.7%), those who do not practice physical activity (83.3%), those who report poor sleep quality (93.3%), those who use long-term medication (85.9%), those who needed health care in the previous six months (87.3%), those who required professional and/or family care (79.3%), those who were in the ICU (79.0%), and those who used ventilatory support (77.5%). Conclusions: Long COVID is a complex condition that requires long-term monitoring and investment in health services due to its high prevalence and the health consequences in the population.

P0294 Functional outcomes after primary ileocecal resection for Crohn’s disease

Abstract Background Ileocecal resection (ICR) is a common procedure in Crohn’s disease (CD). Increasing evidence suggests ICR may be considered a first-line treatment for localized ileal CD to maintain long-term remission, rather than starting biologics. However, removal of the ileocecal valve affects bowel transit and disabling symptoms may arise. The aim of our study was to prospectively assess the impact of primary ICR on daily digestive symptoms in CD patients. Methods We included patients who underwent primary ICR at Saint-Antoine Hospital between January 2017 and December 2022. Patients were assessed after a morphological evaluation (endoscopy or MRI) performed between 5 months and 1 year post-ICR. Digestive symptoms were prospectively and systematically collected using a dedicated database. The primary endpoint was the prevalence of a composite outcome, defined as at least 4 soft or liquid stools per day and/or a fecal urgency with inability to delay defecation for more than 15 minutes, and/or moderate to severe daily abdominal pain. Secondary endpoints included other digestive symptoms. Multiple logistic regression analysis was performed to assess predictive factors for the primary outcome. Results One hundred nine patients were included. Indications for ICR were fistulizing disease (n=61, 56%) and stenosis (n=41, 37.6%). Only 7 patients (6.4%) had surgery for uncomplicated inflammatory disease. Thirty-five patients (32.1%) had morphological recurrence, defined as i2b, i3, i4 score, deep ulcers, stenosis, or fistulas on MRI. The primary endpoint was met by 24 patients (22%), with 21.1% having at least 3 liquid stools per day. Diarrhea (soft to liquid stools daily) was observed in 56.9%, fecal urgency in 22.9%, and abdominal pain in 32.1% (Figure 1). The primary endpoint prevalence was 17.6% in patients without morphological recurrence and 31.4% in those with recurrence (p=0.17) (Table 1). Multivariate analysis showed that age &amp;gt;40 years at surgery (OR=3.58 [95%CI 1.06-12.8] p=0.04), disease duration &amp;gt;2 years (OR=5.67 [95%CI 1.69-23.0] p=0.008), sepsis (fever &amp;gt;38.3°C within 7 days before surgery) (OR=8.06 [95%CI 1.68-44.2] p=0.01), and small bowel resection length &amp;gt;40 cm (OR=9.50 [95%CI 2.35-45.8] p=0.003) were associated with poorer digestive quality of life as defined by the primary composite endpoint. Conclusion The prevalence of digestive symptoms after primary ICR for CD is notable, regardless of disease recurrence. Advanced age, long disease duration, sepsis at surgery, and resection length were associated with disabling digestive symptoms. These results suggest that ICR leads to frequent and disabling digestive symptoms for many patients, which should be considered when proposing ICR.

P0652 Norovirus Infection May Be Responsible For More Severe Flares of Ulcerative Colitis

Abstract Background Viral infections are known to cause exacerbations of inflammatory bowel disease (IBD). Norovirus is responsible for highly contagious infections presenting with variable digestive tract symptoms. We checked the hypothesis that norovirus infection contributes to IBD flare. Methods A total of 58 IBD patients (18 with Crohn’s disease; CD, 40 with ulcerative colitis; UC) hospitalized from April to August 2024 for exacerbation of IBD, after exclusion of common bacterial and viral infections, were tested for the presence of norovirus in their stool specimen by one step combo card test. Results Norovirus infection was detected in 37% of IBD patients (42,5% with UC, 22,2% with CD). Patients with UC infected with norovirus had higher CRP serum level (95,6±98,3 vs. 35,8±63,2 mg/l, p=0,004), required higher volume of i.v. fluids (45,5±36,8 vs.10,6±12,1 of 500 ml i.v. drips, p&amp;lt;0,001), were in need of greater number of abdominal x-rays (64,7% vs. 21,74%, p=0,016), CT scans (70,6% vs. 30,4%, p=0,028) and longer hospitalization time (20,7±14,4 vs. 9,5±10,7 days, p=0,003) than patients not infected. Moreover, norovirus positive patients showed higher total Mayo score (9,94±1,82 vs. 6,83±3,57, p=0,004) with higher patients’ self-reported subscores (stool frequency 3,00±0,00 vs. 2,04±1,26, p=0,021; rectal bleeding 2,41±1,00 vs. 1,65±1,22, p=0,043) and the physician-rated subscore (2,71±0,59 vs. 1,65±0,98, p&amp;lt;0,001). Respective comparison of in the endoscopic subscore was: 2,81±0,40 vs. 2,07±1,10 (p=0,052). Four (23,5%) norovirus positive UC patients required colectomy due to pharmacological treatment failure vs. single (5,88%) norovirus negative patient. Previously used biological, immunosuppressive and steroid therapies were not associated with risk factors for norovirus infection (p&amp;gt;0,05). In CD norovirus infection had no significant impact on investigated parameters. Crohn’s Disease Activity Index was 208±133,21 vs. 259,07±125,45 (p=0,4250) in infected and not infected patients, respectively. Conclusion Norovirus infection was responsible for more severe flare in UC but not in CD, characterized by higher Mayo score, increased need for intravenous hydration, imaging examinations and surgery resulting in longer hospitalization time. Norovirus infection seems to be independent on biological, immunosuppressive or steroid therapy.

Implementasi Sistem Pakar untuk Diagnosis Penyakit Lambung Menggunakan Pendekatan Fuzzy Mamdani Berbasis Website

This study aims to develop a more specific diagnostic approach for various gastric diseases in humans, such as gastritis, peptic ulcers, gastric cancer, gastric tumors or polyps, dyspepsia, gastroesophageal reflux disease (GERD), gastroparesis, and gastroenteritis. This approach seeks to enhance the accuracy of disease identification based on more detailed symptoms. An expert system utilizing the Fuzzy Mamdani method is designed to reduce reliance on internal medicine specialists, enabling patients to gain preliminary insights into the type of gastric disease they may have. This expert system is implemented on a web-based platform, leveraging information technology to integrate large-scale databases, supporting efficiency, accuracy, and relevance to the latest developments in medical science. By analyzing digestive disorder symptoms, the system can provide detailed diagnoses, offer insights into identified symptoms, and recommend appropriate treatment solutions.

Pancreatic tuberculosis revealed by a mass with neoplastic appearance: a case report

Introduction. Pancreatic tuberculosis is an extremely rare form of extrapulmonary tuberculosis. This condition can be challenging to diagnose due to its rarity, nonspecific symptoms and radiological features that may mimic a neoplastic origin. Case report. A 46-year-old immunocompetent patient with no past history of tuberculosis exposure presented with spontaneously resolving jaundice over the past month, accompanied by nonspecific fever episodes and general fatigue with no other associated digestive symptoms. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) scans revealed a poorly defined, partially necrotic mass in the pancreatic head with heterogeneous hypodensity and enhancement after contrast injection. Additionally, there were nodal and hilar macro-nodal lesions with necrotic appearances, as well as peripancreatic lymphadenopathy. The patient was scheduled for an endoscopic ultrasound (EUS) examination, which revealed the presence of a heterogeneous lesion with areas of necrosis in the posterosuperior aspect of the head and isthmus of the pancreas, accompanied by perilesional and coeliac lymphadenopathies with necrotic centres. EUS-guided tissue sampling allowed the diagnosis of pancreatic tuberculosis, with both histological examination and GeneXpert MTB/RIF testing rapidly positive for Mycobacterium tuberculosis, followed by culture on solid Loewenstein–Jensen medium. The patient responded well to antitubercular chemotherapy. Conclusion. Pancreatic tuberculosis, though rare, should be considered in cases of pancreatic masses, especially in endemic regions. Tissue samples with necrosis should be tested for M. tuberculosis using GeneXpert and Loewenstein–Jensen culture. This work highlights the GeneXpert MTB/RIF test as highly sensitive, specific and fast, making it ideal for diagnosing extrapulmonary tuberculosis, particularly when smear results are negative.

A Novel AGR2 Variant Causing Aberrant Monomer-Dimer Equilibrium Leading to Severe Respiratory and Digestive Symptoms

Anterior gradient 2 (AGR2) is a protein disulfide isomerase that is important for protein processing in the endoplasmic reticulum and is essential for mucin production in the digestive and respiratory tracts. Bi-allelic AGR2 variants were recently found to cause recurrent respiratory infections and failure to thrive with or without diarrhea (RIFTD; MIM # 620233), although the mechanisms behind this condition remain unclear. To date, at least 15 patients with homozygous AGR2 variants have been reported. Here, we report two affected siblings in a consanguineous family who had recurrent respiratory infections and digestive symptoms, one of whom needed lung transplantation. To identify the genetic cause of their symptoms, we performed exome sequencing and identified a novel homozygous missense variant in AGR2 (NM_006408.4, c.250A>C, p.(Ser84Arg)) in both affected siblings. Both parents had the identical variant in a heterozygous state. This variant is quite rare in the general population and is clinically compatible with RIFTD, substituting a highly conserved CXXS motif with CXXR. We performed structural modeling and functional studies to investigate the effect of this variant. Through transient overexpression, Ser84Arg AGR2 decreased protein stability, and promoted aberrant dimerization under non-reducing conditions. AGR2 functions in a monomer-dimer equilibrium. Size-exclusion chromatography showed that the Ser84Arg mutant had a larger molecular size than the wild-type protein under non-reducing, but not reducing conditions, indicating that Ser84Arg enhanced intermolecular disulfide bonds. In conclusion, we identified a novel pathogenic AGR2 variant and indicated its abnormal monomer-dimer equilibrium as a possible mechanism involved in the pathogenesis of RIFTD.

FODMAP Diet in Celiac Disease and Gluten-Related Disorders.

Individuals with celiac disease (CD) often report the persistence of gastrointestinal symptoms despite adherence to a gluten-free diet (GFD). A diet rich in fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) could cause symptoms in CD on a GFD, and conversely a low-FODMAP diet could positively influence the therapeutic management of CD and non-celiac gluten sensitivity (NCGS). The aim of this review was to explore the hypothetical impact of the FODMAD diet and the low-FODMAP diet (LFD) in CD and gluten-related disorders. A complete online search for FODMAP related to CD, NCGS, and the GFD was carried out using the Pubmed, Medline, and Cochrane databases. Indeed, an LFD could successfully provide symptom relief in GFD-treated CD patients. Fructans, typical components of FODMAPs, have been associated with digestive symptoms in NCGS, and an LFD could improve the clinical picture. According to some evidence, an LFD could also improve the psychological status both in celiac patients on a GFD and in NCGS. However, an LFD should not have a significant impact on gut microbiota. Recent evidence supports the role of FODMAP restriction in CD patients with persistent symptoms on a GFD and in decreasing gastrointestinal disturbances in NCGS, although the GFD still represents the first-line therapy.

In Silico design of a multi-epitope vaccine for Human Parechovirus: Integrating immunoinformatics and computational techniques.

Human parechovirus (HPeV) is widely recognized as a severe viral infection affecting infants and neonates. Belonging to the Picornaviridae family, HPeV is categorized into 19 distinct genotypes. Among them, HPeV-1 is the most prevalent genotype, primarily associated with respiratory and digestive symptoms. Considering HPeV's role as a leading cause of life-threatening viral infections in infants and the lack of effective antiviral therapies, our focus centered on developing two multi-epitope vaccines, namely HPeV-Vax-1 and HPeV-Vax-2, using advanced immunoinformatic techniques. Multi-epitope vaccines have the advantage of protecting against various virus strains and may be preferable to live attenuated vaccines. Using the NCBI database, three viral protein sequences (VP0, VP1, and VP3) from six HPeV strains were collected to construct consensus protein sequences. Then the antigenicity, toxicity, allergenicity, and stability were analyzed after discovering T-cell and linear B-cell epitopes from the protein sequences. The fundamental structures of the vaccines were produced by fusing the selected epitopes with appropriate linkers and adjuvants. Comprehensive physicochemical, antigenic, allergic assays, and disulfide engineering demonstrated the effectiveness of the vaccines. Further refinement of secondary and tertiary models for both vaccines revealed promising interactions with toll-like receptor 4 (TLR4) in molecular docking, further confirmed by molecular dynamics simulation. In silico immunological modeling was employed to assess the vaccine's capacity to stimulate an immune reaction. In silico immunological simulations were employed to evaluate the vaccines' ability to trigger an immune response. Codon optimization and in silico cloning analyses showed that Escherichia coli (E. coli) was most likely the host for the candidate vaccines. Our findings suggest that these multi-epitope vaccines could be the potential HPeV vaccines and are recommended for further wet-lab investigation.

An upcycled dietary fiber rich in bioactives from hemp hulls supports digestive comfort in healthy adults: Randomized, placebo-controlled trial

Background: Dietary fiber is a key component of a health-promoting diet, and it is acknowledged as a short-fall nutrient in most Western diets. Some sources of dietary fiber, such as hemp hull fiber, also include inherent small molecule bioactive that further promote health and well-being. While dietary fiber is a key component that supports digestive health, certain types of fiber can cause digestive discomfort. Digestive symptoms such as gas, bloating, belly pain, and the resulting decrease in digestive quality of life are common among adults. Objective: The aim of this study was to evaluate changes in digestive comfort, after consuming a proprietary dietary fiber supplement from hemp hull to a dietary fiber supplement made from inulin in individuals who currently experience digestive discomfort. Methods: This study was a completely virtual, double-blind, placebo-controlled, randomized clinical trial of healthy adults. The parallel arm study tested two fiber supplements at a practical dose yielding a “Good Source of Fiber” based on United States Dietary Reference Intakes (2.8 grams of fiber per day) and a digestible control (Maltodextrin) for six weeks. The study is registered at ClinicalTrials.gov: NCT06009614. Results: Five hundred seventy-nine randomized participants provided follow-up outcomes data. Digestion-associated quality of life questionnaire, belly pain, and gas and bloating scores were assessed and found to be superior after hemp hull fiber intake compared to inulin intake at multiple time points (p&lt;0.05). Conclusion: This study demonstrated that a practical dose of bioactive-rich fiber from hemp hull is well-tolerated, provides superior digestive comfort relative to both placebo and inulin fiber, and can aid in reaching total fiber intake goals. Keywords: dietary fiber; hemp hull fiber; inulin; digestive tolerance; gas, bloating; abdominal pain

Real-World Evidence on Adverse Events and Healthcare Resource Utilization in Patients with Chronic Lymphocytic Leukaemia in Spain Using Natural Language Processing: The SRealCLL Study.

Objectives: The SRealCLL study described the occurrence of adverse events (AEs) and healthcare resource utilization in patients with chronic lymphocytic leukaemia (CLL) using artificial intelligence in a real-world scenario in Spain. Methods: We collected real-world data on patients with CLL from seven Spanish hospitals between January 2016 and December 2018, focusing on their AE and healthcare service utilization. Data extraction from electronic health records of 385,904 patients was performed using the EHRead® technology, which is based on natural language processing and machine learning. Results: Among the 534 CLL patients finally included, 270 (50.6%) were categorized as watch and wait (W&W), 230 (43.1%) as first-line treatment (1L), and 58 (10.9%) as relapse/refractory with second-line treatment (2L). The median study follow-up periods were 14.4, 8.4, and 6 months for W&W, 1L, and 2L, respectively. The most common antineoplastic treatments were ibrutinib (64.8%) and bendamustine + rituximab (12.6%) in 1L, and ibrutinib (62.1%) and venetoclax (15.5%) in 2L. Among the most frequent AEs, anaemia and thrombocytopenia presented higher rates in the treated groups (1L and 2L) compared with W&W (2.01 and 2.32 vs. 0.93; p ≤ 0.05 and 1.29 and 1.62 vs. 0.42; p ≤ 0.05). Moreover, several AEs, such as major bleeding, digestive symptoms, general symptoms, or Richter syndrome, were more frequent in 1L than W&W (all p ≤ 0.05). No differences were shown between groups in the rates of outpatient visits. However, rates of outpatient visits due to AE were higher in 1L than in W&W (1.07 vs. 0.65, p ≤ 0.05). The rates of patients being hospitalized were higher in the treated groups compared to W&W (1.68 and 1.9 vs. 0.88; p ≤ 0.05), and those due to AE were higher in 1L than W&W (1.23 vs. 0.60; p ≤ 0.05). Conclusions: Patients with CLL in 1L or 2L treatments often require healthcare resources due to AEs, particularly cytopenias. The methodology used in this study likely enabled us to identify higher rates of AEs that may be underreported using other real-world approaches. Addressing AEs with effective agents that maximize patient safety and optimize healthcare resource use is crucial in this typically older and comorbid population.

Effect of Postbiotic Bifidobacterium longum CECT 7347 on Gastrointestinal Symptoms, Serum Biochemistry, and Intestinal Microbiota in Healthy Adults: A Randomised, Parallel, Double-Blind, Placebo-Controlled Pilot Study.

A randomised, double-blind, placebo-controlled pilot trial was conducted to assess the effect of heat-treated Bifidobacterium longum CECT 7347 (HT-ES1) in healthy adults with mild to moderate digestive symptoms. A total of 60 participants were recruited and received either HT-ES1 or an identical placebo for 8 weeks with a further follow-up at week 10. This study monitored changes in the total Gastrointestinal Symptom Rating Scale for IBS score (GSRS-IBS), Irritable Bowel Syndrome Symptom Severity Scale (IBS-SSS), IBS Quality of Life index (IBS-QoL), gut microbiome using 16S rRNA sequencing, and the Visceral Sensitivity Index, as well as a range of biochemical markers, anthropometric parameters, and adverse events. While minimal changes were observed in gastrointestinal (GI) symptoms, the HT-ES1 group showed a significant decrease in total and non-HDL cholesterol compared to the placebo. The intervention group also exhibited a significant increase in the abundance of the genera Faecalibacterium and Anaerobutyricum, both of which were positively correlated with butyrate concentrations. Faecal calprotectin significantly increased over time in the placebo group but remained stable in the HT-ES1 group. Overall, these findings suggest that HT-ES1 may promote gut health by increasing butyrate-producing bacteria in the gut, maintaining normal levels of faecal calprotectin and reducing serum cholesterol.

Adjunct Therapies to Standard Care for IBS and IBD Patients: Digestive Symptoms Improvement and Quality of Life Optimization.

Background: The prevalence of both inflammatory bowel diseases (IBD) and Irritable Bowel Syndrome (IBS) is increasing, with persistent digestive symptoms, an altered quality of life, and higher rates of anxiety, chronic fatigue, and sleep trouble than the general population. Methods: This scoping review will analyze the latest clinical practice recommendations and clinical studies on non-pharmaceutical interventions such as diet adaptations, physical activity, cognitive behavioral therapies, and medical nutrition therapies such as probiotics, soluble fibers, chitin-glucan, and micronutrients for digestive symptoms relief, quality of life improvement and nutritional deficiencies correction in IBS and IBD patients. The objective is to help healthcare practitioners and dietitians to build personalized care program for IBD and IBS patients. Results: Mediterranean diet, physical activity, cognitive behavioral therapies and medical nutrition therapies such as selected probiotics, soluble fibers, chitin glucan, peppermint oil and micronutrients are effective as adjunct therapies. Conclusions: These adjunct therapies may help to reduce persistent digestive symptoms, correct nutritional deficiencies and improve quality of life of IBS and IBD patients.

Digestive Amyloidosis Trends: Clinical, Pathological, and Imaging Characteristics.

Amyloidosis is a group of diseases characterized by the extracellular deposition of abnormally folded, insoluble proteins that lead to organ dysfunction. While it commonly affects the cardiovascular system, gastrointestinal (GI) tract involvement is undetermined. Recent research has focused on understanding the pathophysiology, diagnostic challenges, and therapeutic approaches to GI amyloidosis, particularly in systemic amyloid light-chain (AL) and amyloid A (AA) forms. GI manifestations can include motility disorders, bleeding, and, in severe cases, bowel obstruction. This review highlights the importance of the early recognition of digestive symptoms and associated imagistic findings in GI amyloidosis by analyzing the research that included clinical, pathological, and endoscopic approaches to amyloidosis. A systematic search of the PubMed and Scopus databases identified 19 relevant studies. Our findings showed that amyloid deposits commonly affect the entire GI tract, with AL amyloidosis being the most predominant form. Endoscopic evaluations and biopsy remain key diagnostic tools, with Congo Red staining and mass spectrometry being used to confirm amyloid type. Although progress has been made in diagnosis, the absence of targeted therapies and the indistinct nature of GI symptoms continue to be challenging.

Can flow cytometry be a key in the difficult diagnosis of coeliac disease?

We present the clinical case of a 39-year-old woman with a medical history of juvenile idiopathic arthritis and uveitis, evaluated for abdominal pain and distension, difficulty gaining weight, and diarrhea. Blood tests were requested, including antibodies which were negative and common genetic markers, showing positivity for HLA DQ 7.5. A gastroscopy with duodenal biopsies revealed findings consistent with stage 3b of the modified Marsh classification. Due to diagnostic uncertainty, an IEL study was performed, showing a characteristic CD pattern, leading to the initiation of a strict gluten-free diet (GFD). During follow-up, the patient showed partial improvement, with persistent digestive symptoms. A repeat endoscopic study revealed persistent atrophy, but refractory disease type 2 was ruled out. During a flare of rheumatologic disease, Tocilizumab was initiated by Rheumatology, resulting in improvement of duodenal atrophy.

Presence of COVID-19 self-reported symptoms at 12 months in patients discharged from hospital in 2020–2021: a Spanish cross-sectional study

The long-term effects of SARS-CoV-2 infection, and their determinants, are still unknown. This study aimed to assess symptoms one year after admission for COVID-19, according to the organ/system involved, and to identify factors. Cross-sectional study with retrospective data collection from March 2020 to February 2021. Inclusion criteria: aged ≥ 18 years and admitted for COVID-19. Exclusion criteria: death, not localized, refusal to participate, cognitive impairment or language barrier. A telephone survey was conducted on long COVID-related symptoms one year after hospital discharge. n = 486. The most frequent symptom groups were neurological (n = 225; 46.3%) and respiratory (n = 201; 41.4%). Multivariable analysis showed that a history of anxiety was significantly associated with psychiatric symptoms (ORa = 2.04, 95%CI = 1.02–4.06), fibromyalgia/chronic fatigue with general symptoms (ORa = 11.59, 95%CI = 1.47–9.34) and obesity with respiratory (ORa 1.90, 95%CI = 1.27–2.83) and musculoskeletal symptoms (ORa 1.96, 95%CI = 1.30–2.96). Male sex was associated with a significantly lower risk of neurological (ORa 0.64, 95%CI = 0.44–0.93), respiratory (ORa 0.45, 95%CI = 0.31–0.67), general (ORa 0.43, 95%CI = 0.29–0.63), psychiatric (ORa 0.34, 95%CI = 0.22–0.51), musculoskeletal (ORa 0.47, 95%CI = 0.32–0.70), dermatological (ORa 0.24, 95%CI = 0.14–0.42) and digestive (ORa 0.38, 95%CI = 0.20–0.73) symptoms. Advanced age (≥ 71 years) also had a protective effect against general (ORa 0.60, 95%CI = 0.39–0.95), psychiatric (ORa 0.39, 95%CI = 0.23–0.64), and dermatological (ORa 0.47, 95%CI = 0.24–0.92) symptoms. Patients admitted for SARS-CoV-2 infection frequently experience symptoms at one year, especially neurological and respiratory symptoms. Female sex, obesity, a history of anxiety and fibromyalgia/chronic fatigue were independent risk factors for presenting symptoms. Advanced age acted as a protective factor.

Severe childhood poisoning caused by Ferraga practices. Data from the Moroccan Poison Control and Pharmacovigilance Centre.

To highlight the complications associated with the products and practice of healers "Ferraga" who treat young children using traditional Moroccan pharmacopoeia. This is a retrospective analysis of cases of products and practice of "Ferraga" intoxication in young children reported to the Moroccan Poison Control and Pharmacovigilance Center (MPCPC), Rabat, Morocco, from 2010-2020. During the study period, 24 cases of products and practice of "Ferraga" poisoning were reported to MPCPC, Rabat, Morocco. The average age of the patients was 2.48 years. The oral route was noted in 21 cases. The vast majority of patients (23 cases) exhibited symptoms upon admission, predominantly of digestive (16 cases), respiratory (3 cases), and neurological (4 cases). However, 29.16% of patients presented with both digestive and respiratory symptoms, 20.83% had digestive and neurological symptoms, and 4 cases manifested all 3 types of symptoms. The outcome was positive in 18 patients and fatal in 2 infants. Products and practice of "Ferraga" poisoning in children remains a major health problem. It is crucial to implement a strategy to combat this type of practice in order to reduce the prevalence of such poisoning.