Extraintestinal Symptoms Research Articles

Clinical features and adherence to a gluten-free diet in patients with celiac sprue in the north-west of Algeria

This study aims to identify the predominant form of celiac sprue and the adherence to a gluten-free diet in northwest Algeria. A retrospective analysis was performed on 128 celiac patients at the Department of Gastroenterology and the association of celiac patients. The results show a female predominance with a sex ratio of 0.4. The most affected age group is the young adults (15-29 years). Lean patients represent 42.2%, normal-weight patients represent 51.6% of the study sample, and 6.3% are overweight. 47.7% of cases have a familial form of the disease. 93% underwent a biopsy for diagnosis. 60.9% of patients were not diagnosed in childhood. The main classic gastrointestinal symptoms such as Diarrhea (89.1%) and bloating (56.3%) were detected. Extraintestinal symptoms included weight loss (64.1%), weakness and fatigue (58.6%). Other biological disorders like anemia (71.1%), thyroiditis (15.6%), and type 1 diabetes (14.8%) were observed. Most celiac patients (84.4%) follow the gluten-free diet but find its application difficult. The adherence of GFD does not depend on any parameter of the study (p>0.05). The classic form predominates through a variety of gastrointestinal symptoms and extra-digestive disorders. The unavailability and high cost of imported gluten-free products are the major barriers to gluten-free diet adherence.

Genetic variants in the HLA-DQ2 and HLA-DQ8 genes and their involvement in the predisposition to celiac disease

Celiac disease is a multisystem disorder that is triggered by the consumption of gluten in genetically predisposed people, particularly those who carry the HLA-DQ2 and HLA-DQ8 alleles. Environmental factors and certain epigenetic mechanisms play a fundamental role in the manifestation of the disease. It has been shown that the gut microbiome can influence disease progression to some extent. Celiac disease presents with gastrointestinal and extraintestinal symptoms that complicate the diagnosis. Classic symptoms include digestive disorders, while non-classic symptoms include anemia, osteoporosis, and unexplained fatigue. Serological antibody tests and duodenal biopsy are key to a diagnosis, especially in atypical cases. At present, the only treatment is a strict gluten-free diet, although this presents certain problems due to the high cost and nutritional deficiencies. New research is looking for alternatives such as gluten-breaking enzymes as well as immunomodulatory treatments in hopes of more comprehensive options in the future.

Volumetric Analysis of Motor Cortex and Basal Ganglia in Pediatric Celiac Disease Patients Using volBrain: Implications for Neurological Dysfunction-Preliminary Results.

Celiac disease (CD) is a common immune-mediated, chronic systemic disorder that is treated with a strict, life-long gluten-free diet (GFD). In addition to gastrointestinal manifestations, CD also presents with a variety of extraintestinal symptoms, including significant neurological and neuropsychiatric symptoms. Among these neurological manifestations, motor dysfunctions are particularly notable. The aim of this study is to investigate the potential volumetric differences in brain structures, particularly the motor cortex and basal ganglia, between pediatric CD patients and healthy controls using the volBrain software AssemblyNet version 1.0. This prospective study included pediatric patients with CD who complained of neurological symptoms and were scheduled for brain magnetic resonance imaging (MRI). All children had been previously diagnosed with CD and their adherence to GFD was evaluated using the Biagi score. Brain MRIs were performed on all included patients to obtain volumetry at the onset of the disease. For volumetric and segmentation data, the volBrain software was used. In total, 12 pediatric patients with CD were included, with a median duration of a GFD of 5.3 years at the time of the MRI examination. There were no statistically significant differences between patients compliant with the GFD and those non-compliant in terms of age or duration of GFD. Volumetric analysis revealed deviations in all patients analyzed, which involved either a decrease or increase in the volume of the structures studied. Despite the limited number of patients in this study, the initial findings support previously described neurological manifestations in patients with CD. Newly developed MRI tools have the potential to enable a more detailed analysis of disease progression and its impact on the motor cortex.

Gluten Unraveled: Latest Insights on Terminology, Diagnosis, Pathophysiology, Dietary Strategies, and Intestinal Microbiota Modulations-A Decade in Review.

A decade of research on gluten-related disorders (GRDs) is reviewed in this study, with a particular emphasis on celiac disease (CD) and non-celiac gluten sensitivity (NCGS). GRDs are triggered by the ingestion of gluten and gluten-like proteins found in wheat, barley, and rye. These proteins lead to intestinal damage in celiac disease, an autoimmune condition characterized by villous atrophy and a variety of gastrointestinal and extraintestinal symptoms. More enigmatic and less understood, NCGS involves symptoms similar to CD but without the immunological reaction or intestinal damage. Recent years have seen advances in the understanding of GRDs, particularly in connection to how intestinal microbiota influences disease progression and patient outcomes. The gluten-free diet (GFD) is still the standard therapy recommended for GRDs despite significant challenges, as discussed in this article. Precise diagnostic methods, patient education and dietary counseling are critical for improving patients' quality of life. The purpose of this review is to provide a more clear and up-to-date understanding of GRDs, and to help further research on this important topic.

Very Early-Onset Inflammatory Bowel Disease: Insights into Etiology, Diagnosis, and Treatment Strategies

Very early-onset inflammatory bowel disease: is a subtype of inflammatory bowel disease (IBD) and is defined by its onset in children younger than 6 years of age. The etiology includes the interplay of various factors such as genetic predisposition, environmental factors, gut microbiota and strong family history. The clinical presentation can present with both gastrointestinal symptoms such as bloody and/or mucus-containing diarrhea, recurrent vomiting, peri annal symptoms like fistulas, abscesses and perinatal skin tags and also present as extra-intestinal symptoms like intermittent fevers, arthritis, folliculitis, uveitis etc. In this article we discuss about various treatment methods used in Very early-onset inflammatory bowel disease (VEO IBD) including medical therapy, surgical therapy, hematopoietic stem cell transplantation and nutritional approach. In this systematic review, we have tried to summarized the current knowledge about Very early-onset inflammatory bowel disease

Update understanding on diagnosis and histopathological examination of atrophic gastritis: A review.

Chronic atrophic gastritis (CAG) is a complex syndrome in which long-term chronic inflammatory stimulation causes gland atrophy in the gastric mucosa, reducing the stomach's ability to secrete gastric juice and pepsin, and interfering with its normal physiological function. Multiple pathogenic factors contribute to CAG incidence, the most common being Helicobacter pylori infection and the immune reactions resulting from gastric autoimmunity. Furthermore, CAG has a broad spectrum of clinical manifestations, including gastroenterology and extra-intestinal symptoms and signs, such as hematology, neurology, and oncology. Therefore, the initial CAG evaluation should involve the examination of clinical and serological indicators, as well as diagnosis confirmation via gastroscopy and histopathology if necessary. Depending on the severity and scope of atrophy affecting the gastric mucosa, a histologic staging system (Operative Link for Gastritis Assessment or Operative Link on Gastritis intestinal metaplasia) could also be employed. Moreover, chronic gastritis has a higher risk of progressing to gastric cancer (GC). In this regard, early diagnosis, treatment, and regular testing could reduce the risk of GC in CAG patients. However, the optimal interval for endoscopic monitoring in CAG patients remains uncertain, and it should ideally be tailored based on individual risk evaluations and shared decision-making processes. Although there have been many reports on CAG, the precise etiology and histopathological features of the disease, as well as the diagnosis of CAG patients, are yet to be fully elucidated. Consequently, this review offers a detailed account of CAG, including its key clinical aspects, aiming to enhance the overall understanding of the disease.

Postoperative Intravenous Iron Infusion in Anemic Colorectal Cancer Patients: An Observational Study.

Anemia is the most common extraintestinal symptom of colorectal cancer, with a prevalence of 30-75%. While the preoperative anemia in this patient population has been well studied and its correction 4-6 weeks prior to surgery is recommended when feasible, there is a paucity of data regarding the management of postoperative anemia, which has a prevalence of up to 87% in these patients. To address this issue, we conducted an observational cohort study of surgically treated postoperative anemic patients with colorectal cancer. The objective of this study was to evaluate the effect of intravenous ferric carboxymaltose on the correction of postoperative anemia by postoperative day 30 (POD30). The primary outcome was the change in hemoglobin on POD30, while the secondary outcomes were the change in iron and other laboratory parameters, postoperative complications and transfusions. The results demonstrated that patients treated with intravenous iron exhibited a significant increase in hemoglobin levels by POD30, along with a concomitant increase in hematocrit, ferritin, and transferrin saturation levels, compared to the control group. The findings imply that patients undergoing colorectal cancer surgery with anemia that was not corrected in the preoperative setting may benefit from early postoperative intravenous iron infusion.

Assessing the Impact of a Gluten-Free Diet on Celiac Disease Symptoms in Children: A Comprehensive Review.

Celiac disease, a serious autoimmune disease, is triggered by the ingestion of gluten. It is associated with many gastrointestinal and extraintestinal symptoms. The cornerstone of treatment is a strict gluten-free diet (GFD). This paper collected studies that were screened between the 15th and 25th of June 2024 and were searched for from many databases and registers, including PubMed, Medline, ClinicalTrials.gov, Cochrane Library, Europe PMC, and EBSCO Open Dissertations. We have included the 12 most relevant studies that examined the effects of GFD adherence among pediatric patients with celiac disease. Evidence suggests that a GFD caused notable improvements in liver function, growth metrics, and quality of life indices. Extraintestinal symptoms such as cardiac dysfunctions and obstructive sleep apnea also showed compelling improvement. We conclude that there are substantial advantages of a GFD in children with celiac disease and call for the need for personal nutritional support to address nutritional deficiencies and long-term studies and comprehensive strategies to optimize treatment outcomes and improve the quality of life for affected children.

A Starch- and Sucrose-Reduced Diet Has Similar Efficiency as Low FODMAP in IBS-A Randomized Non-Inferiority Study.

A diet with low content of fermentable oligo-, di-, and monosaccharides and polyols (FODMAP) is established treatment for irritable bowel syndrome (IBS), with well-documented efficiency. A starch- and sucrose-reduced diet (SSRD) has shown similar promising effects. The primary aim of this randomized, non-inferiority study was to test SSRD against low FODMAP and compare the responder rates (RR = ∆Total IBS-SSS ≥ -50) to a 4-week dietary intervention of either diet. Secondary aims were to estimate responders of ≥100 score and 50% reduction; effects on extraintestinal symptoms; saturation; sugar craving; anthropometric parameters; and blood pressure. 155 IBS patients were randomized to SSRD (n = 77) or low FODMAP (n = 78) for 4 weeks, with a follow-up 5 months later without food restrictions. The questionnaires Rome IV, IBS-severity scoring system (IBS-SSS), and visual analog scale for IBS (VAS-IBS) were completed at baseline and after 2 and 4 weeks and 6 months. Weight, height, waist circumference, and blood pressures were measured. Comparisons were made within the groups and between changes in the two groups. There were no differences between groups at baseline. The responder rate of SSRD was non-inferior compared with low FODMAPs at week 2 (79.2% vs. 73.1%; p = 0.661;95% confidence interval (CI) = -20-7.2) and week 4 (79.2% vs. 78.2%; p = 1.000;95%CI = -14-12). Responder rate was still high when defined stricter. All gastrointestinal and extraintestinal symptoms were equally improved (p < 0.001 in most variables). SSRD rendered greater reductions in weight (p = 0.006), body mass index (BMI) (p = 0.005), and sugar craving (p = 0.05), whereas waist circumference and blood pressure were equally decreased. Weight and BMI were regained at follow-up. In the SSRD group, responders at 6 months still had lowered weight (-0.7 (-2.5-0.1) vs. 0.2 (-0.7-2.2) kg; p = 0.005) and BMI (-0.25 (-0.85-0.03) vs. 0.07 (-0.35-0.77) kg/m2; p = 0.009) compared with baseline in contrast to non-responders. Those who had tested both diets preferred SSRD (p = 0.032). In conclusion, a 4-week SSRD intervention was non-inferior to low FODMAP regarding responder rates of gastrointestinal IBS symptoms. Furthermore, strong reductions of extraintestinal symptoms were found in both groups, whereas reductions in weight, BMI, and sugar craving were most pronounced following SSRD.

Overweight and vitamin D deficiency are common in patients with irritable bowel syndrome - a cross-sectional study

BackgroundIrritable bowel syndrome (IBS) is a common disease with unknown etiology. Poor dietary intake with nutritional deficiency and overweight have been described to increase the risk of IBS. The aim of the present study was to compare weight and circulating levels of micronutrients in IBS compared with healthy controls.DesignCross-sectional study.MethodsPatients diagnosed with IBS and healthy volunteers were recruited. Participants had to complete a dietary diary book and the questionnaires Rome IV, IBS-severity scoring system (IBS-SSS), and visual analog scale for IBS (VAS-IBS). Weight and height were measured, and blood samples were drawn. C-reactive protein (CRP), cobalamin, folate, iron, total iron-binding capacity (TIBC), and 25-hydroxy (25-OH) vitamin D were analyzed. Differences were calculated between groups and generalized linear model for regressions was adjusted for false discovery rate (FDR).ResultsIBS patients (n = 260) were elder than controls (n = 50) (44.00 (33.25-56.00) vs. 37.85 (30.18–45.48) years; p = 0.012). After adjustment for age, both weight (β: 5.880; 95% CI: 1.433–10.327; p = 0.010, FDR = 0.020) and body mass index (BMI) (β: 2.02; 95% CI: 0.68–3.36; p = 0.003, FDR = 0.012) were higher in patients. Among IBS participants, 48.1% were overweight/obese compared with 26.0% in controls (p = 0.007). Diarrhea-predominated IBS had highest weight (p < 0.001) and BMI (p = 0.077). CRP and cobalamin were higher in patients than controls (p = 0.010 vs. p = 0.007), whereas folate was highest in controls (p = 0.001). IBS patients had lower intake of vegetables (p = 0.026), dairy products (p = 0.004), and cereals (p = 0.010) compared with controls. Despite 21.5% of IBS patients were taking vitamin D supplements, 23.65% of them had vitamin D levels below 50 nmol/L, compared with 26.0% observed in the control group (p = 0.720). Vitamin D levels were lower in overweight than in normal weight IBS patients (60 (48–73) nmol/L vs. 65 (53–78) nmol/L, p = 0.022). Vitamin D correlated with cobalamin and folate but correlated inversely with TIBC and BMI. IBS patients had a high degree of gastrointestinal and extraintestinal symptoms, which were inversely associated with iron levels. Extraintestinal symptoms were associated with increased BMI.ConclusionIBS patients were often overweight or obese, with low vitamin D levels. High burden of extraintestinal symptoms were associated with overweight and lower iron levels.RegistrationClinicalTrials.gov, NCT05192603 (Date of registration 11/29/2021) and NCT03306381 (Date of registration 09/18/2017), respectively.

IBS stress reactivity phenotype is associated with blood transcriptome profiles and microstructural and functional brain changes.

Clinical evidence suggests significant interindividual differences in stress reactivity (SR), but biological mechanisms and therapeutic implications of these differences are poorly understood. We aimed to identify the biological basis of increased SR by investigating associations between a psychometric-based phenotype with blood transcriptomics profiles of increased sympathetic nervous system (SNS) activation and brain imaging phenotypes in irritable bowel syndrome (IBS) participants and healthy controls (HCs). A cross-sectional observational study design, transcriptomics profiling, multimodal brain imaging, and psychosocial assessments were obtained in 291 female and male IBS participants and HCs. Prior to analyses, unsupervised clustering was applied to derive high and low SR subgroups across participants based on two measures of SR. General linear models tested for SR group differences in clinical and biological parameters. Exploratory analyses examined associations between SR group-specific brain alterations and gene expression. The high, compared to low SR group showed greater cyclic AMP response element-binding protein (CREB) gene expression consistent with tonic SNS activity and proinflammatory changes in whole blood. Brain imaging showed neuroplastic changes in the high SR group consistent with an upregulation of ascending arousal systems and sensory processing and integration regions, and functional connectivity changes in the central autonomic network. SR moderated the sex difference in extraintestinal symptoms. The findings support a model of tonically increased SNS activity as a plausible risk factor for increased autonomic reactivity to psychosocial stressors and low grade immune activation in both IBS and HCs, with a greater prevalence in IBS. These findings may have important implications for personalized treatment interventions in IBS.

Risk Factors for Decreased Bone Density in Adults with Celiac Disease

Background: Celiac disease (CD) is an autoimmune disease characterized by inflammation in the intestine, causing atrophy of the mucosal villi of the small intestine. Celiac disease can manifest with various signs and symptoms, including extra-intestinal symptoms such as osteopenia and osteoporosis. Objectives: Our study aimed to determine the frequency of osteopenia/osteoporosis in newly diagnosed CD cases and to evaluate the effect of different independent variables on the development of osteopenia/osteoporosis in these patients. Methods: Adult patients with CD who were referred to a celiac clinic were evaluated for osteopenia/osteoporosis using dual-energy X-ray absorptiometry. This cross-sectional analytical study took place from October 2017 to July 2022. Logistic regression analysis was used to assess the odds ratio (OR) of different independent variables for osteopenia/osteoporosis. Results: A total of 302 patients enrolled in this study, with 64.2% being female and 35.8% male. The mean ± SD age was 29.73 ± 12.39. Overall, 71.2% of patients had osteopenia or osteoporosis. The odds of developing osteopenia/osteoporosis were significantly higher in participants older than 30 years (OR: 2.19; 95% CI: 1.22 - 3.92; P = 0.008), underweight patients (OR: 2.38; 95% CI: 1.30 - 4.34; P = 0.005), and those with histologically severe atrophy (OR: 2.22; 95% CI: 1.14 - 4.32; P = 0.019). The mean ± SD serum levels of 25-hydroxy vitamin D in CD patients without and with osteopenia/osteoporosis were 34.0 ± 17.1 ng/mL and 25.8 ± 14.2 ng/mL, respectively. Participants with normal levels of 25-hydroxy vitamin D had a significantly lower OR of developing osteopenia/osteoporosis than patients with vitamin D deficiency (OR: 0.37; 95% CI: 0.21 - 0.62; P &lt; 0.001). Other variables, including gender, anti-tTG levels, and GI manifestations, did not significantly increase the OR of developing osteopenia/osteoporosis. Conclusions: The present study showed that increasing age, weight loss, severe villous atrophy, and low levels of vitamin D can significantly increase the OR of developing osteopenia/osteoporosis in CD patients. Until further studies are conducted, bone mineral density (BMD) evaluation is especially recommended in these high-risk subgroups of CD patients.

The prevalence of self-reported gluten sensitivity (SRGS) in irritable bowel syndrome (IBS)in a Brazilian community. A pilot study

Background – A significant number of irritable bowel syndrome (IBS) patients report onset of symptoms after ingestion of a specific food, including those containing gluten. NCGS includes both intestinal and extra-intestinal symptoms which are related to the ingestion of gluten containing food-after exclusion of celiac disease (CD) and wheat allergy. The overlap between irritable bowel syndrome (IBS) and NCGS has been described but the knowledge of the etiopathogenesis of this clinical entity is incomplete. In Brazil, data on the prevalence of IBS and its association with food intolerance are scarce. Objective – To study the prevalence of SRGS in a group of volunteers diagnosed with IBS in a Brazilian community. Methods – A total of 400 volunteers over 18 years old were selected from students and staff of the Medical School of the Fluminense Federal University, Brazil. Participants completed a questionnaire divided in basic demographic information (age, sex), evaluation of IBS diagnosis in accordance with the Rome III criteria and self-reported food intolerance, including gluten. Results – Eighty-seven (21.7%) (Group I) [mean age 30.4±12.65 (77.4%) females] fulfilling the Rome III criteria for IBS. Twenty-six (32%) reported gastrointestinal symptoms after ingestion of food in general and 28 (32.1%) after gluten ingestion. Within the 313 volunteers non-IBS (78.2%) (Group II) [mean age 30.6±21.77, 215 (68.2%) females] 66 (21%) and 50 (15.9%) reported gastrointestinal symptoms after ingestion of food in general and gluten respectively. Demographic data (mean age and sex) were not statistically different when we compared the two groups of volunteers (p&gt;0.05). Conclusion – The report of gastrointestinal symptoms after ingestion of food in general and gluten-containing foods were statistically different in the two groups (p&lt;0.05). The interaction between IBS, food intolerance and NCGS needs to be better defined, since the role of diet in IBS and its feeding management is an essential condition for the treatment of most of those patients

Predictors of response to a dietary intervention in patients with irritable bowel syndrome

BackgroundDifferent diets have emerged as potential therapeutic options for patients with irritable bowel syndrome (IBS). ObjectiveTo identify predictors of improvement after a low-FODMAP, low-starch and low-sucrose diet among patients with IBS. MethodsWe performed a descriptive cross-sectional study including patients with IBS according to Rome IV criteria undertaking a social-media based program with a two-week dietary intervention. Patients completed an online survey before and after the intervention including the presence of intestinal and extra-intestinal symptoms, the IBS-SSS (irritable bowel syndrome symptoms severity scale) and the PHQ-9 (patient health questionnaire-9). Clinical improvement was defined as a decrease of at least 50% in IBS-SSS post dietary intervention. Variables associated with symptomatic response were identified with logistic regression analysis. A clinical score to predict response was created and tested with a with a receiver operating characteristic (ROC) curve analysis. ResultsA total of 3583 patients with IBS were included. Mean IBS-SSS before and after dietary intervention was 295.5±52.32 and 240±48.66, respectively (p=0.01); 1178 (32.8%) patients showed clinical improvement. A mean basal IBS-SSS >400 (OR 3.04), chronic headache (OR 1.96), and chronic fatigue (OR 1.81) were significantly associated with symptomatic response. Patients with arthralgia (OR 0.41) and/or fibromyalgia (OR 0.33) were less likely to improve. Each variable received the following individuals scores: IBS-SSS >400: +2, chronic headache: +1.5, chronic fatigue: +1, arthralgia: −1, and fibromyalgia: −1. The ROC curve analysis of the proposed score showed an area under the curve of 0.72 (95% CI 0.69–0.76). A score ≥3 had a sensitivity of 72.64% and specificity of 60.56% for predicting symptomatic improvement. ConclusionsThere are clinical variables that could serve as reliable predictors of response to a low-FODMAP, low-sucrose, low-starch diet among patients with IBS. Further research is needed to understand the link between the presence of extra-intestinal symptoms and clinical improvement after dietary interventions for IBS.

Clinical Spectrum of Celiac Disease among Adult Population: Experience from Largest Tertiary Care Hospital in Karachi, Pakistan.

Celiac disease (CD) is a systemic autoimmune enteropathy triggered by dietary gluten in genetically susceptible individuals. Celiac disease affects 0.6-1.0% of the population worldwide. The prevalence of CD in Pakistan is yet unknown due to under diagnosis and lack of awareness. To determine a vast variety of presenting features in subtypes of CD to overcome the burden of disease. This was a prospective, comparative, cross-sectional study conducted at Gastroenterology department of Jinnah Postgraduate Medical Center, Karachi from December 2022 till June 2023. This study included all adult patients ≥18 years diagnosed with CD on the basis of clinical presentation, positive IgA and IgG anti-transglutaminase antibodies (value >12 IU/mL detected by ELISA followed by small intestinal biopsy classified as per Marsh criteria. The data obtained were analyzed on the statistical software SPSS version 23. Descriptive statistics were obtained by frequencies and percentages. About 142 patients were enrolled in the study, 103 (91.5%) had classical CD (CCD) whereas 36 (25%) had non-classical (NCCD). About 89 (62.7%) were females and 53 (37.3%) were males. The mean age was found to be 23 ± 6 years. Nutritional deficiencies including anemia, B12, folate, osteopenia and low body mass index (BMI) <18 was found more in CCD group as compared with NCCD group with significant p-values. Titers of anti-TTG between CCD and NCCD were not statistically significant. Hypothyroidism and PCOS were the most common associated conditions observed in adult CD patients. In conclusion, CD in adults and has diverse presentations. Adults with unexplained extra-intestinal symptoms like anemia and bone pain should be investigated for CD. Butt N, Shahid B, Butt S, et al. Clinical Spectrum of Celiac Disease among Adult Population: Experience from Largest Tertiary Care Hospital in Karachi, Pakistan. Euroasian J Hepato-Gastroenterol 2024;14(1):24-29.

Unresolved conundrum of the role of physical activity in inflammatory bowel disease: What next?

There is considerable controversy on the role of physical activity in irritable bowel disease (IBD) since published reports are conflicting. It is well known that there is known relapse with specific treatment in IBD. This, in addition to onset of extraintestinal symptoms creates a need to think of alternate approaches. In this context, the current article describes the need of a multi-institutional study with standard protocol of physical activity for documenting its effect on both the primary disease and the extra alimentary manifestations. This paper also points out the possibility of using adjuvant complementary medicine such as yoga, whose effects have been documented in other diseases like irritable bowel syndrome. A third approach could be to focus on the intestinal dysbiosis in IBD and concentrate on research on restoring the microbial flora to normal, to see whether the extra-intestinal symptoms are alleviated.

Exploration of the Effects of Agarwood Extract on the Inflammtory Microbiota in the Oral-Gut Axis

Agarwood, as a precious medicinal material with distinctive characteristics from Hainan, has been shown in recent studies to possess significant anti-inflammatory and antibacterial properties. With the rapid growth in public recognition of health concepts, oral health has garnered increased attention. The main focus of this study is the impact of agarwood extracts on the oral-gut axis microbiota. The relationship between the oral and gut microbiota is closely intertwined, where oral microbiota can directly colonize the intestine via saliva and other means, altering the original microbial composition of the gut and leading to dysbiosis. For instance, Porphyromonas gingivalis significantly increases in patients with gingivitis and periodontitis, as it can tolerate the acidic environment of the stomach and colonize the intestines through the gastric barrier. Therefore, oral health can affect intestinal health. Additionally, oral lesions are evident in patients with intestinal inflammation; such patients, like those with IBD, exhibit a significant accumulation of oral bacteria in the intestines. Although IBD primarily affects the intestines, its extraintestinal symptoms, often prominently displayed, include oral manifestations. Hence, intestinal health can also influence oral health. Agarwood extracts inhibit pathogenic oral microbiota, impedes their colonization in the intestine, and consequently reduces the likelihood of inflammatory bowel disease.. This article, by introducing the microbiota of periodontitis and the pathogenesis of inflammatory bowel disease, along with extraintestinal symptoms, the preventive and inhibitory mechanisms of agarwood extract on the associated microbiota are analyzed, providing new insights for the treatment of such patients. It underscores the importance of maintaining oral hygiene and preventing oral diseases as well.

Global Approach to Follow-Up of Celiac Disease.

Celiac disease, an autoimmune disorder induced by the ingestion of gluten, affects approximately 1.4% of the population. Gluten damages the villi of the small intestine, producing symptoms such as abdominal pain, bloating and a subsequent loss of nutrient absorption, causing destabilization of the nutritional status. Moreover, gluten can trigger extra intestinal symptoms, such as asthma or dermatitis, but also mental disorders such as depression or anxiety. Moreover, people suffering from celiac disease sometimes feel misunderstood by society, mainly due to the lack of knowledge about the disease and the gluten-free diet. Thus, the treatment and follow-up of patients with celiac disease should be approached from different perspectives, such as the following: (1) a clinical perspective: symptomatology and dietary adherence monitorization; (2) nutritional assessment: dietary balance achievement; (3) psychological assistance: mental disorders avoidance; and (4) social inclusion: educating society about celiac disease in order to avoid isolation of those with celiac disease. The aim of this narrative review is to gain deep insight into the different strategies that currently exist in order to work on each of these perspectives and to clarify how the complete approach of celiac disease follow-up should be undertaken so that the optimum quality of life of this collective is reached.

The role of Killer immunoglobulin-like receptors (KIRs) in the genetic susceptibility to non-celiac wheat sensitivity (NCWS).

Non-celiac wheat sensitivity (NCWS) is an emerging clinical condition characterized by gastrointestinal and extraintestinal symptoms following the ingestion of gluten-containing foods in patients without celiac disease (CD) or wheat allergy. Despite the great interest for NCWS, the genetic risk factors still need to be fully clarified. In this study, we first assessed the possible contribution of KIR genes and KIR haplotypes on the genetic predisposition to NCWS. Fifty patients with NCWS, 50 patients with CD, and 50 healthy controls (HC) were included in this study. KIR genes and KIR genotyping were investigated in all subjects by polymerase chain reaction with the sequence oligonucleotide probe (PCR-SSOP) method using Luminex technology. We found a statistically different distribution of some KIR genes among NCWS, CD, and HC. Specifically, NCWS showed a decreased frequency of KIR2DL1, -2DL3, -2DL5, -2DS2, -2DS3, -2DS4, -2DS5, and -3DS1 genes, and an increased frequency of -3DL1 gene respect to both CD and HC. No difference was detected in the KIR haplotype expression. At the multivariate analysis, KIR2DL5, -2DS4, and -2DS5 were independent predictors of NCWS. Our findings suggest a role of KIR genes in NCWS susceptibility, with KIR2DL5, -2DS4, and -2DS5 having a protective effect. Further large-scale multicentric studies are required to validate these preliminary findings.

Prevalence of extra-intestinal symptoms according to irritable bowel syndrome subtype.

Irritable bowel syndrome (IBS) is a functional disorder commonly associated with extra-intestinal symptoms. However, the prevalence of these symptoms according to IBS subtype is not well established. To compare the prevalence of extra-intestinal symptoms among patients with different subtypes of IBS. A descriptive cross-sectional study including patients with IBS according to Rome IV criteria was performed between July 2022 and April 2023. Patients were classified according their subtype of IBS: IBS-D (diarrhea-predominant), IBS-C (constipation-predominant), and IBS-M (mixed bowel habits). Patients completed the IBS severity scoring system questionnaire (IBS-SSS) to determine severity of IBS symptoms and patient health questionnaire- 9 (PHQ-9) to define presence and severity of depressive symptoms. The prevalence of reported extra-intestinal symptoms was also assessed and compared between groups. A total of 4862 patients with IBS were included; 608 IBS-D (12.5%), 1978 IBS-C (40.7%), and 2276 IBS-M (46.8%). Patients with IBS-C had significantly lower IBS-symptoms severity (mean IBS-SSS 290 vs. 310 and 320 for IBS-D and IBS-M, respectively, p = 0.03). The prevalence of obesity was also significantly lower in these patients (17.1% vs. 30.9% IBS-D and 27.9% IBS-M, p = 0.0001). Patients with IBS-D showed a significantly higher prevalence of food intolerance perception (9.5%, p = 0.03), history of cholecystectomy (17.8%, p = 0.03), and fecal incontinence (36.2%, p = 0.0001) as compared to the other groups. Patients with IBS-M had significantly higher mean PHQ-9 score (12.7 vs. 11.1 IBS-D and 10.5 IBS-C, p = 0.001) and prevalence of depressive symptoms (80.0%, p = 0.01). Patients with IBS-M also had higher prevalence of extra-intestinal symptoms such as arthralgia (62.4%, p = 0.0001), extremity numbness (64.5%, p = 0.0001), atopic dermatitis (28.2%, p = 0.02), and chronic cervicalgia (81.0%, p = 0.01). The prevalence of most extra-intestinal symptoms is higher among patients with IBS-M. Further research is needed to better characterize IBS subtypes, which could potentially help refining tailored therapeutic strategies.