Disorders Of Gastrointestinal Tract Research Articles

Plasma Interleukin-13 Levels Correlate With the Severity of Symptoms Induced by Functional Dyspepsia.

Functional dyspepsia (FD) is a gastrointestinal functional disorder of the upper gastrointestinal tract that affects the quality of life of patients and poses a significant economic burden. It has been proposed that the local inflammatory immune response at the duodenum is associated with an increase in intestinal permeability, favoring the recruitment of Th2 cells and granulocyte degranulation. Moreover, systemic immune response could also be related to the symptoms of FD. The objective of this study was to evaluate the systemic immune response in Uruguayan patients with FD by analyzing the cytokine levels in plasma and the frequency of circulating T cells associated with duodenal recruitment. An analytic and cross-sectional study in 30 patients with FD and 15 healthy controls (HCs) was carried out. Patients were diagnosed with FD according to the Roma IV Committee definition. Cytokine levels were measured in plasma by a specific assay. Expression of α4β7 and CC chemokine receptor9 in circulating T cells was evaluated by flow cytometry. Higher levels of interleukin (IL)-5, IL-13, and IL-8 and lower levels of IL-10 and IL-12p70 were detected in patients with FD than in HC. Furthermore, a positive linear correlation between IL-13 and the severity of FD symptoms was found. CD4 + T cells from patients with FD expressed higher levels of α4β7 and CC chemokine receptor9 than those from HC. An increase of Th2-like cytokines and a positive correlation between the levels of plasma IL-13 and the severity of symptoms in patients with FD from Uruguay were detected.

Exploring intradermal sterile water injection as an alternative to natrium diclofenac for kidney-stone related pain relief: A systematic review and meta-analysis of randomized controlled trials.

Kidney stone-related pain often presents significant challenges in clinical practice, mainly due to the adverse effects by NSAIDs, which are the current first-line treatment for urolithiasis. Patients presenting with gastrointestinal tract disorders and contraindications toward NSAIDs are particularly susceptible. Intradermal sterile water injection (SWI) has evidently become apparent as one of the promising alternatives, offering rapid pain relief with minimal adverse effects. This purpose of this study to assess the safety and efficacy of SWI in comparison to NSAIDs particularly Natrium Diclofenac in the management of kidney-stone related pain. A systematic review and meta-analysis was performed on papers published up to January 2024 obtained from scientific databases, guided by the PRISMA flowchart. The Cochrane risk of bias 2.0 tool was used to assess quality of the included studies. Statistical analyses were then performed using Review Manager 5.4.1 on studies that provide the baseline and complete follow-up numerical outcomes (e.g. mean and standard deviation) required. After screening was done, 3 retrievable studies met the inclusion and exclusion criteria with a total of 770 participants with kidney stone related pain. The result revealed no significant difference in pain reduction between SWI and Natrium diclofenac at 30 min (MD -0.12, 95% CI -0.68 to 0.44) and 60 min (MD -0.23, 95% CI -0.65 to 0.18). Furthermore, patients treated with SWI display a reduced need for rescue analgesia compared to Natrium Diclofenac (OR 0.73, 95% CI 0.36 to 1.49). Adverse events result was more superior in SWI, having lower occurrence when compared to Natrium Diclofenac, although not significant (OR 0.14, 95% CI 0.05 to 0.39). Intradermal sterile water injection (SWI) appears to be a promising alternative to NSAIDs for kidney stone related pain management, offering comparable efficacy in pain reduction, reduced need for rescue analgesia while maintaining a favorable safety profile. However, further research with larger sample sizes and standardized treatment protocols are required to further validate its safety and efficacy.

Selective Serotonin Reuptake Inhibitors and Solitary Rectal Ulcer Syndrome: A Bloody Relationship.

Solitary rectal ulcer syndrome (SURS) is a poorly understood and uncommon benign disorder of the lower gastrointestinal tract. It presents with various symptoms, often misinterpreted as inflammatory bowel disease. To date, there is no association between the use of selective serotonin reuptake inhibitors (SSRIs) and SURS. A 29-year-old male on paroxetine for six months and with a non-contributory surgical history presented to the clinic due to three months of haematochezia, abdominal pain and mucoid discharge. Physical examination and a review of systems were unremarkable; a colonoscopy demonstrated a suspicious ulcerated lesion in the rectum, which was identified as SURS on biopsy. The patient was advised lifestyle and dietary modifications. In addition, paroxetine was discontinued, and patient was switched to venlafaxine, a serotonin-norepinephrine reuptake inhibitor. Subsequently, the patient's symptoms resolved gradually, and he did not report any signs of recurrence on follow-up. Literature confirms that SSRIs can increase the occurrence of GI ulceration yet focuses specifically on upper gastrointestinal bleeding rather than rectal bleeding. This finding raises the need for further research. SURS is often underdiagnosed or misdiagnosed as inflammatory bowel disease.The pathophysiology and aetiology behind SURS remain obscure.This case points to a potential correlation between SSRIs use and SURS development.

The prevalence of mutations underlying development of Helicobacter pylori resistance to antibiotics in Kazan

One of the reasons for the decrease of Helicobacter pylori eradication effectiveness is its resistance to antibiotics. To examine the prevalence of H. pylori point mutations responsible for clarithromycin and levofloxacin resistance among the patients with upper gastrointestinal (GI) tract disorders in Kazan. The study included 203 patients with symptoms of dyspepsia who underwent upper GI endoscopy at the University Hospital of Kazan Federal University (Kazan, Russia) in 2019-2021. DNA isolation from gastric antrum mucosal biopsies was performed using PureLink Genomic DNA Mini Kits (Thermo Fisher Scientific, USA). Polymerase chain reaction was performed using primers specific for the V-region of the 23S gene and the A subunit DNA gyrase encoding gyrA gene region. The sequencing of obtained DNA fragments was performed on 3730 DNA Analyzer. The sequences were searched for point mutations responsible for H. pylori resistance to clarithromycin (A2143G, A2142G and A2142C193 mutations) and levofloxacin (mutations of the gyrA gene). H. pylori was detected in 47.78% of biopsy specimens using polymerase chain reaction. The proportion of H. pylori strains with mutations leading to clarithromycin resistance was 17.53%. Amino acid substitutions in the gyrA gene were found in 12.37% of samples. In case of two H. pylori strains (2.06%), dual resistance to clarithromycin and levofloxacin was found. So high incidence of mutations underlying the development of H. pylori resistance to clarithromycin and levofloxacin was observed among examined patients in Kazan.

Gastrointestinal disorders in systemic sclerosis: cluster analysis and prognosis from a French prospective cohort.

The gastrointestinal tract (GIT) is frequently involved in systemic sclerosis (SSc) and is responsible for alteration of quality of life. Many complications can occur, including chronic intestinal pseudo-obstruction, digestive haemorrhage and small-intestinal bacterial overgrowth. Since early development of organ failure is associated with poor prognosis, we need to identify risk factors associated with severe GIT involvement to prevent severe forms of the disease. We conducted an observational prospective study, which included 90 SSc patients from December 2019 to September 2021. We collected questionnaires about digestive manifestations and quality of life, blood and stool samples, and performed imaging. At inclusion and throughout the study we assessed the occurrence of malnutrition and severe GIT disorders. We performed statistical analysis to highlight eventual risk factors associated with digestive manifestations, including hierarchical cluster analysis. A majority of our patients had gastro-oesophageal manifestations (93.3%), followed by intestinal manifestations (67.8%) and anorectal manifestations (18.9%). We found a correlation between anorectal disorders and cardiac disease, and between gastro-oesophageal involvement and impaired pulmonary function tests. Smoking was significantly associated with occurrence of severe GIT disorders. Malnutrition was frequent and associated with more cardiac and pulmonary disease. Cluster analysis identified three groups of patients, including one cluster with cardiac and digestive involvement. GIT manifestations are frequent and severe in SSc. Smoking appears to be associated with severe disease. Anorectal manifestations may be associated with cardiac disease, but we need more studies to validate these results.

Treatment of functional disorders of gastrointestinal tract of calves with complex phytomineral preparation

Significant economic losses due to diarrhoea morbidity in newborn young animals lead to a decrease in the profitability of the sector in the structure of agricultural production. Therefore, the purpose of this study was to create and investigate the therapeutic effect of application of complex phytomineral preparation using local components: opoka of Taskala deposit and decoction of camelthorn (Alhagi maurorum) for treatment of diarrhoea in calves. The therapeutic effect of the preparation was studied in the conditions of dairy farm in Kyzylorda region on 5-7-day-old calves. The effect of the preparation was studied in a comparative aspect with an analogous preparation of imported production and the results obtained from healthy animals. Clinical, haematological, and biochemical methods of investigation were employed. The findings obtained suggest a high therapeutic effect of the created preparation. Its application allowed reducing the duration of the treatment period by 5-7 days compared to the imported preparation and restoring the positive dynamics of average daily gain as early as on the 5th day after the start of treatment. Haematological studies indicate stimulation of the immune system in animals that was manifested by a 14% increase in the count of lymphocytes and a 37% increase in the proteins of the γ-globulin fraction compared to healthy animals. These indices suggest an increase in the activity of the humoral part of the immune system in animals after treatment with the preparation. Another positive therapeutic effect of the preparation was observed in the protective effect on the liver of diseased animals. Despite the present effect of both preparations, the decrease in the activity of markers characterising hepatocyte destruction was higher with the Kazakh preparation. Thus, the created preparation is characterised by a higher therapeutic effect in comparison with the imported preparation and allow recommending it for treatment and prevention of diarrhoea in young animals

Correlation between Alzheimer's Disease and Gastrointestinal Tract Disorders.

Alzheimer's disease is the most common cause of dementia globally. The pathogenesis is multifactorial and includes deposition of amyloid-β in the central nervous system, presence of intraneuronal neurofibrillary tangles and a decreased amount of synapses. It remains uncertain what causes the progression of the disease. Nowadays, it is suggested that the brain is connected to the gastrointestinal tract, especially the enteric nervous system and gut microbiome. Studies have found a positive association between AD and gastrointestinal diseases such as periodontitis, Helicobacter pylori infection, inflammatory bowel disease and microbiome disorders. H. pylori and its metabolites can enter the CNS via the oropharyngeal olfactory pathway and may predispose to the onset and progression of AD. Periodontitis may cause systemic inflammation of low severity with high levels of pro-inflammatory cytokines and neutrophils. Moreover, lipopolysaccharide from oral bacteria accompanies beta-amyloid in plaques that form in the brain. Increased intestinal permeability in IBS leads to neuronal inflammation from transference. Chronic inflammation may lead to beta-amyloid plaque formation in the intestinal tract that spreads to the brain via the vagus nerve. The microbiome plays an important role in many bodily functions, such as nutrient absorption and vitamin production, but it is also an important factor in the development of many diseases, including Alzheimer's disease. Both the quantity and diversity of the microbiome change significantly in patients with AD and even in people in the preclinical stage of the disease, when symptoms are not yet present. The microbiome influences the functioning of the central nervous system through, among other things, the microbiota-gut-brain axis. Given the involvement of the microbiome in the pathogenesis of AD, antibiotic therapy, probiotics and prebiotics, and faecal transplantation are being considered as possible therapeutic options.

Crosstalk between gastrointestinal tract disorders and obstructive sleep apnea.

Clinical studies suggested associations between obstructive sleep apnea (OSA) and gastrointestinal tract disorders. This study aims to investigate the genetic causal relationship between OSA and gastrointestinal tract disorders, specifically gastroesophageal reflux disease (GERD) and inflammatory bowel disease (IBD). In this study, we employed two-sample Mendelian Randomization (MR) analysis to investigate the potential relationships between OSA and GERD, and between OSA and IBD. More specifically, the primary analysis utilized inverse variance weighting (IVW). Weighted median, MR Egger, and MR PRESSO were applied to complicate potential violations of MR assumptions. Also, sensitivity analysis was evaluated and similar analysis was performed again after outliers were removed. Additionally, multivariable MR (MVMR) was conducted for associated pairs to adjust for obesity. Genetically predicted risk of GERD increased OSA risk by approximately 60% (ORIVW = 1.62, 95%CI = [1.43,1.84]) which was also stable by other complicated approaches, and even with BMI adjusted by MVMR (ORadjBMI[95%CI] = 1.26 [1.15,1.37]). Besides, OSA showed a mild causal effect on increased GERD risk after adjusting for obesity (ORadjBMI[95%CI] = 1.05 [1.02,1.08]). Additionally, OSA increased the risks for IBD (ORIVW[95%CI] = 1.36 [1.12,1.65]), including a higher risk of CD (ORIVW[95%CI] = 1.41 [1.08,1.83]), and a trend for increasing UC risk (ORIVW[95%CI] = 1.29 [0.99,1.67]). GERD exerts a substantial causality on increasing the risk of OSA. Conversely, the potential for a causal relationship that OSA contributes to the development of GERD or IBD remains probable. These findings support the crosstalk between gastrointestinal tract disorders and OSA.

Establishing the Interrelations of the Laboratory Parameters in the Gut-Kidney Axis in Cats with Signs of Triple Phosphate Urolithiasis

Introduction. Efficient treatment of the feline urolithiasis much depends on the early diagnosis of the disease, however, the diagnostic algorithm of this type of pathology is extremely poor due to the various reasons, in particular, it does not take into account the interrelations in the gut-kidney axis. Analysis of the state of gastrointestinal tract functioning and the composition of the gut microbiota can improve the potential of diagnosing the urolithiasis, predict the risk, improve the prognosis and choose the correct treatment strategy. The aim of this publication is to establish the interrelations of the laboratory parameters in the gut-kidney axis in cats with struvite urolithiasis with the signs of cystolithiasis.Materials and Methods. The objects of the research were the outbred cats with the triple phosphate urolithiasis with the signs of cystolithiasis: 1st experimental group — females; 2nd experimental group — neutered males; the control group — clinically healthy animals of both sexes. The laboratory and clinical examinations of sick animals included: ultrasonography of abdominal organs; macroscopic and biochemical urine tests; microscopy of urine sediment and urine culture test without determination of antibiotic sensitivity; macroscopic, microscopic and simple chemical examinations of freshly excreted feces; bacteriological culture test of rectal flushes without determination of antibiotic sensitivity.Results. In the urine of cats of the experimental groups, under the activity of gram-negative microorganisms Escherichia coli (0.03±0.01×106 CFU (colony forming units) and 1.00±0.03×106 CFU) and gram-positive microorganisms Staphilococcus intermedius (1.05±0.07×106 CFU and 1.00±0.08×107 CFU) there were recorded within the microscope field of view: alkalization, development of hypersthenuria, proteinuria, hypercalciuria, hematuria, including microhematuria and leukocyturia, crystalluria. The results of coprological examinations in sick cats indicated the presence of stercobilin, well-digested muscle fibres, undigested and digested cellulose, extracellular and intracellular starch, as well as impurities of non-food origin (wool). The data of microbiological examinations of feces indicated the growth of Escherichia coli (1.00±0.05×105 CFU and 1.04±0.08×107 CFU). Along with the cystolytiasis, the acoustic shadowing of the gastrointestinal tract organs in the experimental animals revealed the hyperechogenicity of liver capsule and parenchyma and heterogeneity of the pattern.Discussion and Conclusion. The revealed character of the laboratory parameter changes in the experimental animals, such as the increase of protein and creatinine levels in urine and growth of Escherichia coli in feces, proved the existence of the pathogenetic relationship between the urogenital tract lesion caused by the gram-negative microorganisms and the gut microbiota in the gut-kidney axis. The results of our study of the sick animals’ urine indicated on the infection of the urogenital tract with the urease-producing microorganisms, which led to the alkalization of urine and formation of the infection struvite stones. Urolithiasis, in turn, had an impact on the gut microbiome due to the topographic proximity of the urogenital and gastrointestinal tracts: examination of feces in cats of the experimental group had confirmed the disorder of gastrointestinal tract functioning due to dysbiotic processes in the large intestine.

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.

Detection of various gastrointestinal tract diseases through a deep learning method with ensemble ELM and explainable AI

The rising prevalence of gastrointestinal (GI) tract disorders worldwide highlights the urgent need for precise diagnosis, as these diseases greatly affect human life and contribute to high mortality rates. Fast identification, accurate classification, and efficient treatment approaches are essential for addressing this critical health issue. Common side effects include abdominal pain, bloating, and discomfort, which can be chronic and debilitating. Nausea and vomiting are also frequent, leading to difficulties in maintaining adequate nutrition and hydration. The current study intends to develop a deep learning (DL)-based approach that automatically classifies GI tract diseases. For the first time, a GastroVision dataset with 8000 images of 27 different GI diseases was utilized in this work to design a computer-aided diagnosis (CAD) system. This study presents a novel lightweight feature extractor with a compact size and minimum number of layers named Parallel Depthwise Separable Convolutional Neural Network (PD-CNN) and a Pearson Correlation Coefficient (PCC) as the feature selector. Furthermore, a robust classifier named the Ensemble Extreme Learning Machine (EELM), combined with pseudo inverse ELM (ELM) and L1 Regularized ELM (RELM), has been proposed to identify diseases more precisely. A hybrid preprocessing technique, including scaling, normalization, and image enhancement techniques such as erosion, CLAHE, sharpening, and Gaussian filtering, are employed to enhance image representation and improve classification performance. The proposed approach consists of twenty-four layers and only 0.815 million parameters with a 9.79 MB model size. The proposed PD-CNN-PCC-EELM extracts essential features, reduces computational overhead, and achieves excellent classification performance on multiclass GI images. The PD-CNN-PCC-EELM achieved the highest precision, recall, f1, accuracy, ROC-AUC, and AUC-PR values of 88.12 ± 0.332 %, 87.75 ± 0.348 %, 87.12 ± 0.324 %, 87.75 %, 98.89 %, and 92 %, respectively, while maintaining a minimum testing time of 0.000001 s. A comparative study utilizes 10-fold cross-validation, ablation study and various state-of-the-art (SOTA) transfer learning (TL) models as feature extractors. Then, the PCC and EELM are integrated with TL to generate predictions, notably in terms of performance and real-time processing capability; the proposed model significantly outperforms the other models. Moreover, various explainable AI (XAI) methods, such as SHAP (Shapley Additive Explanations), heatmap, guided heatmap, Grad-Cam (Gradient-weighted Class Activation Mapping), guided Grad-CAM, and guided Saliency mapping, have been employed to explore the interpretability and decision-making capability of the proposed model. Therefore, the model provides practical intelligence for increasing confidence in diagnosing GI diseases in real-world scenarios.

Histopathological Spectrum of the Upper Gastrointestinal Tract Endoscopic Biopsies at a Tertiary Hospital: A Descriptive Cross-sectional Study.

Upper gastrointestinal tract disorders are prevalent worldwide, encompassing neoplastic and non-neoplastic lesions like infections and inflammation. Endoscopic biopsies play a crucial role in diagnosis, treatment monitoring, and complication detection. Despite their routine use, comprehensive data on their histopathological spectrum is sparse. This study aimed to delineate this spectrum and assess the prevalence of non-neoplastic and neoplastic lesions in upper gastrointestinal tract endoscopic biopsies. This descriptive cross-sectional study at a tertiary care center analyzed upper gastrointestinal endoscopic biopsies from August 1, 2019, to July 31, 2021. After obtaining ethical clearance (reference number: 039-078/079), we collected all upper gastrointestinal endoscopic biopsies received during the two-year study period, excluding inadequate biopsies, resection specimens, therapeutic cases, and specific lesions.Histopathological examination was conducted using H&E, Giemsa, and Periodic acid-Schiff stains. Diagnoses were categorized into non-neoplastic and neoplastic lesions following WHO guidelines. Data were analyzed using SPSS 16.0 to determine the frequency of neoplastic and non-neoplastic cases. Among 155 upper gastrointestinal biopsies, 124 (80%) were non-neoplastic (95% CI: 73.71-86.29%) and 31 (20%) were neoplastic (95% CI: 13.71-26.29%). Non-neoplastic lesions were predominantly chronic gastritis, with chronic active gastritis being the most frequent 34 (27.41%). Neoplastic lesions were mainly adenocarcinomas in the stomach 20 (64.51%) and squamous cell carcinomas in the esophagus 7 (22.58%). The prevalence of neoplastic lesions were found to lower compared to the published literature and showed predominance of adenocarcinoma in upper gastrointestinal neoplastic lesions.

Preparation, Characterization, and Skin Permeation Evaluation of Naproxen Microemulsions for Transdermal Delivery

: Microemulsions (MEs) are considered for preparing drug delivery carriers, especially transdermal vehicles. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to manage chronic and acute pain and inflammatory diseases. However, NSAIDs have drawbacks such as gastrointestinal tract disorders and poor pharmacokinetic properties for oral administration. To address these issues, we evaluated the potential of ME as a transdermal system for locally delivering naproxen (NPX) as an NSAIDs model (NPX-MEs). Phase diagrams were constructed for MEs composed of tween 80, span 80, and propylene glycol (PG) as surfactant (S)/cosurfactant (CS), transcutol® P (TRC-P), and LabrafacTM PG as oil. The final concentration of NPX in MEs was 1% (w/v). The MEs were analyzed for particle size, refractive index, and viscosity. In vitro permeability studies of NPX-MEs were conducted using Franz diffusion cells on rat skin samples. Additionally, the effects of Eucalyptus oil (EU oil), oleic acid (OLA), and TRC-P as enhancers on the skin permeation of NPX were investigated. The particle size and viscosity values of the NPX-MEs ranged from 7.05 ± 0.03 to 79.56 ± 0.58 nm and 222.4 ± 0.87 to 681.13 ± 1.97, respectively. The optimal formulation, ME-3, consisted of 20% oil, 10% water, and 70% S/C phases. The skin permeation rates of NPX from ME-3 were higher than those of other formulations (Dapp = 1.36 ± 0.616, ERD=527.989 ± 313.627) with a lower lag time. Additionally, OLA-treated skin showed the highest transdermal permeation rate (ERD = 75.55 ± 23.532). Based on these results, the formulated NPX-ME may be a desirable carrier for transdermal delivery compared to traditional formulations, potentially reducing side effects and improving the therapeutic efficacy of NPX.

Investigations on pathomorphological alterations in ruminants affected with gastrointestinal tract disorders

Investigations on pathomorphological alterations in ruminants affected with gastrointestinal tract disorders

Evaluation of the impact of oesophageal reflux disease on muscle fatigue.

Gastroesophageal reflux disease (GERD) is a gastrointestinal tract disorder associated with regurgitation of gastric acid into the oesophagus. It can present itself as non-erosive reflux condition or erosive esophagitis. Our main objective was to evaluate the impact of oesophageal reflux disease on muscle fatigue among patients. The prospective study design was adopted using surveys performed at the South West China Medical University. All patients who were subjected to screening endoscopy at the South West China Medical University were prospectively enrolled in the study. Our study was conducted according to ethical guidelines involving animal and human subjects. Our study used Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale (HADS), and the Multidimensional Fatigue Inventory (MFI) questionnaires to perform data collection on the levels of fatigue, depression, daytime hypersomnolence and anxiety. In the (HADS, Anxiety (β = 0.657, p < .001) and Depression (β = 2.927, p < .001) exhibited significant positive associations with the predicted fatigue. The Epworth Sleepiness Scale (ESS) showed no significant difference between individuals with and without reflux esophagitis (p = 0.787, power = 0.071). However, a significant difference was observed based on the presence of GERD symptoms (p = 0.003, power = 0.789), with higher mean scores for those with GERD symptoms (6.1±3.5) compared to those without (4.9±2.9). In MFI, significant differences were observed between the two groups for General and Physical Fatigue (p = 0.040, power = 0.823), Mental Fatigue (p = 0.002, power = 0.767), and MFI Total Score (p = 0.002, power = 0.981). In conclusion, GERD symptoms exhibited stronger associations with fatigue and daytime sleepiness than endoscopic findings, emphasizing the impact of symptomatic experiences on well-being.

A REVIEW ON CURRENT TRENDS IN Helicobacter pylori MANAGEMENT WITH MEDICINAL PLANTS AND ITS CONSTITUENTS

Helicobacter pylori is a bacterium associated with gastric diseases and disorders of the upper gastrointestinal tract. The gram-negative bacterium Helicobacter pylori is known as a persistent colonizer of the human stomach, and this bacteria is also involved in extra-intestinal diseases. In 1994, the International Agency for Research on Cancer, World Health Organization classified H. pylori as a class 1 carcinogen, the only bacterium given this classification. Besides, the emergence of H. pylori resistance to antibiotics has been a major clinical challenge in the field of gastroenterology, and this concern has been shown an increasing tendency in many regions of the world. To overcome the current circulating difficulties, new potential therapeutic targets were uncovered to find active substances for the treatment of H. pylori infection. Several medicinal plants and their isolated compounds have been reported for their antimicrobial activity against H. pylori. It is demonstrated that they are efficacious against H. pylori strains that are resistant to drugs. The mechanism of action of many of these plant extracts and plant-derived compounds is different from that of conventional antibiotics. Therefore, natural compounds are emerging as a potential source of raw materials with diverse mechanisms of action. Some commonly known mechanisms can be listed as anti-urease activity, anti-adhesive activity, anti-inflammatory and gastroprotective activity, and effects on the oxidative stress process. Recently, new classes of drugs with reasonable antibacterial mechanisms against H. pylori have also been mentioned, including (1) anti-biofilm agents, (2) anti-virulence molecules (anti-VacA, anti-CagA agents, toxin BabA and LPS inhibitors, anti-motility agents, Helicobacter pylori quorum sensing inhibitors), (3) mucolytic agents, and (4) compounds that impact on essential proteins in the physiology of H. pylori such as inosin-5‘monophosphate dehydrogenase and HsrA inhibitors. This review article aims to summarize current prospects, identify possible novel targets, and be considered as a complementary therapy in the eradication treatment against Helicobacter pylori.

The Emerging Role of Human Gut Bacteria Extracellular Vesicles in Mental Disorders and Developing New Pharmaceuticals.

In recent years, further evidence has emerged regarding the involvement of extracellular vesicles in various human physiopathological conditions such as Alzheimer's disease, Parkinson's disease, irritable bowel syndrome, and mental disorders. The biogenesis and cargo of such vesicles may reveal their impact on human health nd disease and set the underpinnings for the development of novel chemical compounds and pharmaceuticals. In this review, we examine the link between bacteria-derived exosomes in the gastrointestinal tract and mental disorders, such as depression and anxiety disorders. Crucially, we focus on whether changes in the gut environment affect the human mental state or the other way around. Furthermore, the possibility of handling bacteria-derived exosomes as vectors of chemicals to treat such conditions is examined.

Tips and Thought Processes to Overcome Difficult Situations in Third Space Endoscopy.

Third space endoscopy (TSE) offers diverse treatment options for a variety of conditions of the gastrointestinal tract and motility disorders. Accuracy and precise dissection have helped treat complex conventional surgeries with TSE. Despite over a decade of its presence, difficult situations are routinely encountered. The first challenging situation is decision-making (before the procedure), the second is tackling procedure-induced pulmonary / insufflation-related adverse events and intra-operative complications (during the procedure), and the third is post-operative complications and morbidity (post-procedure). The performance of TSE procedures is not without risk. Patients should receive enough time to weigh their options, considering that attitudes toward risk impact decision-making. Continuous basic patient monitoring and the micro-movements of endoscopic and electrosurgical equipment is crucial to avoid accidental injury. Anaesthetists should be mindful of anticipated complications and closely monitor, diagnose, and treat them. Demanding situations need careful consideration, problem-solving, or persistence to overcome challenges. This brief review provides inputs on preventing and tackling difficult situations in TSE.

Should We Operate Nonagenarians with Symptomatic Giant Paraesophageal Hernias?

Introduction: Hiatal hernia (HH) is a common disorder of the upper gastrointestinal (UGI) tract that general surgeons encounter. Giant paraesophageal is a subtype of HH in which more than 30% of the stomach is located in the chest. It can cause symptoms such as dysphagia, UGI bleeding, gastroesophageal reflux disease, and vomiting. As the life expectancy of the general population increases, the incidence of giant HH increases and can cause morbidity, including recurrent admissions and prolonged length of hospitalization. In this article, we describe a cohort of nonagenarian patients with HH who were admitted to our institution and were treated either surgically or medically. Methods: We retrospectively reviewed our prospectively maintained database of all nonagenarians who were admitted to our center between 2018 and 2022 with the diagnosis of HH. We compared the demographic data, clinical data, and outcomes between patients undergoing operative and nonoperative management. Results: Twenty patients of age over 90 years were hospitalized with HH-related symptoms. Six underwent surgery, whereas 14 received medical management. Surgical patients had fewer overall hospitalization days, shorter length of stay, and less blood product requirements. Notably two cases of in-hospital mortality occurred in the nonoperative group, whereas none occurred in the operative group. All surgical procedures were performed laparoscopically, with two minor perioperative complications. Conclusion: In selected nonagenarian patients, laparoscopic HH repair is safe and should be considered favorably. It can reduce hospitalization time and can mitigate morbidity.

RELATIONSHIP BETWEEN PERIODONTAL PATHOLOGY AND GASTROINTESTINAL TRACT DISEASES: A NARRATIVE OVERVIEW

RELATIONSHIP BETWEEN PERIODONTAL PATHOLOGY AND GASTROINTESTINAL TRACT DISEASES: A NARRATIVE OVERVIEW