Functional Gastrointestinal Disorders Research Articles

Infant formulas for the treatment of functional gastrointestinal disorders: A position paper of the ESPGHAN Nutrition Committee.

Functional gastrointestinal disorders (FGID), such as infant regurgitation, infant colic, and functional constipation, are common and typically physiological phenomena during the early months of an infant's life and account for frequent consultations with pediatricians. Various infant formulas are marketed for their management and are frequently given by parents to infants before a medical consultation. However, the evidence supporting their effectiveness is limited and some have altered nutritional compositions when compared to standard formulas. Thus, these products should only be used under medical supervision and upon medical advice. Marketing and over-the-counter sales do not ensure proper medical guidance and supervision. The aim of this position paper is to review the current evidence regarding the safety and efficacy of formulas specifically formulated for addressing regurgitation, colic, and constipation, recognized as FGID. The objective is to provide guidance for clinical management based on the highest quality of available evidence. A wide search using Pubmed, MEDLINE, EMBASE and Cochrane Database of Systematic Reviews was performed including the MESH terms infant formula, colic, constipation, regurgitation, reflux, palmitate, lactase, lactose, magnesium, hydrolyzed protein, prebiotics or probiotics. 752 papers were identified and screened. Finally, 72 papers were included in the paper. In the absence of evidence, recommendations reflect the authors' combined expert opinion. Final consensus was obtained by multiple e-mail exchange and meetings of the Nutrition Committee. (1) For breastfed infants experiencing FGID such as regurgitation, colic, or constipation, transitioning from breastfeeding to commercial formulas is not recommended. (2) In general, whether an infant is breastfed or formula-fed, it's crucial to reassure parents that FGIDs are normal and typically do not necessitate treatment or change to a special formula. (3) Thickened formulas, often termed anti-reflux formulas, may be considered in specific cases of regurgitation. (4) The usage of specialized formulas for infants with colic is not advised due to a lack of clinical evidence. (5) In the case of constipation in infants, the use of formulas enriched with high β-palmitate and increased magnesium content may be considered to soften the stool. Generally, there is limited evidence supporting the use of specialized formulas for FGID. Breastfeeding should never be discontinued in favor of formula feeding.

Natural History and Outcomes of Individuals with Functional Bowel Disorder: a 9-year Population-based Longitudinal Study.

Long-term studies characterizing the natural history of functional bowel disorder (FBD) from community-based settings and exploring association with psychological factors are sparse. We aimed to evaluate the evolution of symptoms, health outcomes, and association of FBD with psychological disorders in Chinese population. Individuals identified from random sampling of residents of Hangzhou, China participated in a baseline survey in January of 2010. Follow-up phone survey was conducted in December of 2018. FBD was diagnosed based on Rome III criteria. Among 452 individuals (mean age 44.6±15.3 years, 174 (38%) male) who completed the study, the prevalence of FBD was 36.3% (95%CI 32.6-40.0%) at enrollment and 36.1% (95%CI 32.3-39.8%) at follow-up survey (p=0.94). However, 214 (47%) individuals had interval change in diagnosis. Although no difference in incidence of organic disease or death was observed, a higher proportion of patients with FBD (16/164, 9.8% vs. 9/288, 3.1%; p=0.003) compared to those without FBD received non-cancer-related abdominal and/or pelvic surgery during follow-up. FBD was associated with anxiety and/or depression at initial (AOR=1.7, 95%CI 1.7-2.7, p=0.02) and follow-up (AOR=8.0, 95%CI 3.2-20.0, p<0.001) surveys. Diagnosis of FBD at baseline was associated with new-onset anxiety and/or depression at follow-up (OR=3.2, 95%CI 1.2-8.3, p=0.01). Although the prevalence of FBD remained stable, transformation of symptoms was common over time. Patients with FBD may have increased risk of receiving non-cancer related abdominal and/or pelvic surgery. FBD symptoms at baseline increased the risk of new-onset anxiety and/or depression by 3.2-fold over the next 9 years.

Gastrointestinal adverse reaction to food (GARF) and endoscopic confocal laser endomicroscopy (eCLE).

Gastrointestinal adverse reaction to food (GARF) is reported frequently in the general population and even more in patients with disorders of the gut brain axis. However, there is a significant difference between self-reported and objective proven GARF. The aim of the study was to characterize a mucosal correlate of GARF by endoscopic confocal laser endomicroscopy (eCLE) with duodenal food challenge (DFC). In an observational and proof of concept study we evaluated 71 patients with disorders of the gut brain axis without (group I, n=19) and with (group II, n=52) GARF by eCLE and DFC. Spontaneous and food induced transfer of fluorescein into duodenal lumen was detected 10 minutes following intravenously application of fluorescein and 10 minutes after DFC. According to Rom IV, the patients (group I/II) could be classified as irritable bowel syndrome (IBS) 32%/31%, functional abdominal pain without changes in bowel movement 47 %/48 %, functional abdominal bloating/distension 0 %/10 %, functional diarrhea 5 %/ 2 %, and unspecified functional bowel disorder 16 %/10 %, respectively. 21 %/27 % of the patients responded with a fluorescein leakage into the duodenal lumen before and 74 %/69 % following to DFC. Frequency rank order of food components that induced a response were soy (55.5 %/60 %), wheat (60 %/45.5 %), egg (35.7 %/8.3), milk (30 %/18.2 %) and yeast (10 %/6.6 %), respectively. Histology of duodenal biopsies, number, form and distribution of intraepithelial lymphocytes and mucosal mast cells as well as mast cell function were normal. Overall, 14 %/79 % reported main symptom benefit following a food exclusion therapy according to eCLE and DFC that was significant different between the groups. The results of our study indicate that eCLE with DFC is a technique to clinically evaluate patients with disorders of the gut brain axis and GARF resulting in a high proportion of patients reporting symptom benefit upon food exclusion dietary advice focussed on the results of eCLE.

Thalamic Nucleus Reuniens Glutamatergic Neurons Mediate Colorectal Visceral Pain in Mice via 5-HT2B Receptors.

Irritable bowel syndrome (IBS) is a common functional bowel disorder characterized by abdominal pain and visceral hypersensitivity. Reducing visceral hypersensitivity is the key to effectively relieving abdominal pain in IBS. Increasing evidence has confirmed that the thalamic nucleus reuniens (Re) and 5-hydroxytryptamine (5-HT) neurotransmitter system play an important role in the development of colorectal visceral pain, whereas the exact mechanisms remain largely unclear. In this study, we found that high expression of the 5-HT2B receptors in the Re glutamatergic neurons promoted colorectal visceral pain. Specifically, we found that neonatal maternal deprivation (NMD) mice exhibited visceral hyperalgesia and enhanced spontaneous synaptic transmission in the Re brain region. Colorectal distension (CRD) stimulation induced a large amount of c-Fos expression in the Re brain region of NMD mice, predominantly in glutamatergic neurons. Furthermore, optogenetic manipulation of glutamatergic neuronal activity in the Re altered colorectal visceral pain responses in CON and NMD mice. In addition, we demonstrated that 5-HT2B receptor expression on the Re glutamatergic neurons was upregulated and ultimately promoted colorectal visceral pain in NMD mice. These findings suggest a critical role of the 5HT2B receptors on the Re glutamatergic neurons in the regulation of colorectal visceral pain.

Rapid biotransformation of STW 5 constituents by human gut microbiome from IBS- and non-IBS donors.

STW 5 is an herbal medicinal product with proven clinical efficacy in the treatment of functional gastrointestinal disorders, like functional dyspepsia and irritable bowel syndrome (IBS). The effects of STW 5 on fecal microbial communities and metabolite production effects have been studied in an experimental model with fecal samples from individuals with and without IBS. While only minor taxonomic disparities were noted between IBS- and non-IBS samples and upon treatment with STW 5, rapid metabolic turnover of STW 5 components into specific degradation products with reported anti-inflammatory, cytoprotective, or spasmolytic activities was observed, which may be relevant for the pharmacological activity of STW 5.

Identifying Novel Subtypes of Functional Gastrointestinal Disorder by Analyzing Nonlinear Structure in Integrative Biopsychosocial Questionnaire Data

Background/Objectives: Given the limited success in treating functional gastrointestinal disorders (FGIDs) through conventional methods, there is a pressing need for tailored treatments that account for the heterogeneity and biopsychosocial factors associated with FGIDs. Here, we considered the potential of novel subtypes of FGIDs based on biopsychosocial information. Methods: We collected data from 198 FGID patients utilizing an integrative approach that included the traditional Korean medicine diagnosis questionnaire for digestive symptoms (KM), as well as the 36-item Short Form Health Survey (SF-36), alongside the conventional Rome-criteria-based Korean Bowel Disease Questionnaire (K-BDQ). Multivariate analyses were conducted to assess whether KM or SF-36 provided additional information beyond the K-BDQ and its statistical relevance to symptom severity. Questions related to symptom severity were selected using an extremely randomized trees (ERT) regressor to develop an integrative questionnaire. For the identification of novel subtypes, Uniform Manifold Approximation and Projection and spectral clustering were used for nonlinear dimensionality reduction and clustering, respectively. The validity of the clusters was assessed using certain metrics, such as trustworthiness, silhouette coefficient, and accordance rate. An ERT classifier was employed to further validate the clustered result. Results: The multivariate analyses revealed that SF-36 and KM supplemented the psychosocial aspects lacking in K-BDQ. Through the application of nonlinear clustering using the integrative questionnaire data, four subtypes of FGID were identified: mild, severe, mind-symptom predominance, and body-symptom predominance. Conclusions: The identification of these subtypes offers a framework for personalized treatment strategies, thus potentially enhancing therapeutic outcomes by tailoring interventions to the unique biopsychosocial profiles of FGID patients.

ACUTE AND LONG-TERM EFFECTS OF APP-DELIVERED HEARTFULNESS MEDITATION ON PSYCHOLOGICAL OUTCOMES AND THE ENDOCANNABINOID SIGNALING SYSTEM IN CYCLIC VOMITING SYNDROME.

Cyclic vomiting syndrome (CVS) is a disorder of gut brain interaction (DGBI) often triggered by stress. Interventions like meditation may improve psychological outcomes and Health-Related Quality of Life (HRQoL), but their efficacy and the underlying mechanism are unknown. We conducted a 6-week single-arm pilot study to assess the effects of Heartfulness meditation (HFM) in CVS using a custom-designed meditation app. Primary outcomes included state and trait anxiety and mood state changes pre- vs. post-meditation, and secondary outcomes were psychological distress, coping, sleep quality and HRQoL at baseline and weeks 3 and 6. Serum concentrations of endocannabinoids N-arachidonylethanolamine (AEA) and 2-arachidonoylglycerol (2-AG) and related lipids were measured pre-and-post HFM at baseline and week 6. In 30 treatment completers, there was a significant improvement in state anxiety (p<0.001), total mood disturbance (p<0.001), and other mood states (all p values <0.05) across the three time points. Trait anxiety was also improved at week 6. There was a significant improvement in psychological distress (global severity index), sleep quality (daytime dysfunction), coping (using religion/spirituality) and HRQoL (mental and physical) across the three time points (all p <0.05). Significant increases in AEA and related lipids N-oleoylethanolamine and palmitoylethanolamide post-vs.-pre HFM were observed at week 6 (p<0.001, 0.002, 0.003, respectively). No adverse effects were noted. App-delivered HFM is feasible, safe and effective and improves psychological outcomes and augments endocannabinoids. This provides insight into the mechanism underlying HFM and has potential for widespread use as a digital therapeutic in CVS and other DGBI.Study Highlights.

Antibiotic duration and gastric dysmotility in preterm neonates.

Prolonged antibiotic use after birth is associated with neonatal feeding intolerance and functional gastrointestinal disorders (FGIDs). A gastric dysrhythmia (tachygastria) with frequencies >4-9 cycles per minute, measured by electrogastrography (EGG), is associated with FGIDs. The relationship between prolonged antibiotic use and % time spent in tachygastria is unknown in preterm infants. We aimed to compare weekly changes in % tachygastria between preterm infants receiving long (>48 h) versus short (≤48 h) courses of antibiotics for early onset sepsis evaluation (initiated at <3 days of life). This was a longitudinal, prospective cohort study of 88 preterm infants (<34 weeks' gestation) with weekly EGG recordings from the first week of life until 40 weeks' post-menstrual age, discharge, or death. We calculated % of EGG recording time in tachygastria and determined the mean across weekly sessions. A mixed effects model assessed variance in % tachygastria between the short- and long-antibiotic exposure groups across all weeks. Baseline characteristics were similar between the two groups. There was no difference in % tachygastria between short and long antibiotic exposure groups across nine postnatal weeks (p = 0.08). Early, prolonged antibiotic exposure among preterm infants may not lead to significant gastric dysrhythmia. Future studies including larger sample sizes and a "no antibiotic" exposure arm are essential in elucidating this potential relationship.

EBM BLS: Kiwifruit may Improve Constipation in Patients with Functional Gastrointestinal Disorders.

EBM BLS: Kiwifruit may Improve Constipation in Patients with Functional Gastrointestinal Disorders.

COMBINED HIGH-INTENSITY INTERVAL TRAINING FOR PEOPLE WITH DISORDERS OF GUT BRAIN INTERACTION: A CASE REPORT

AIMS The efficacy of high intensity exercise for improving symptoms of chronic idiopathic constipation, a highly prevalent disorder of gut brain interaction (DGBI), remains uncertain. The aim of this case report was to investigate the feasibility, safety, and efficacy of 8-weeks of combined high-intensity interval training (C-HIIT) for a person (female, 23 years old) with chronic constipation. METHODS The participant enrolled in the C-HIIT for DGBI controlled trial that aims to recruit 32 participants with DGBI. Following comprehensive assessments of gastrointestinal symptoms, neuromuscular fitness, cardiorespiratory fitness and mental health, the participant completed an 8-week intervention consisting of thrice weekly 26-minute C-HIIT sessions. These consisted of a 3-minute aerobic warm-up (treadmill; 50-60% peak heart rate [HRpeak]) followed by 4-minutes of high-intensity aerobic exercise at ≥85% HRpeak. After 1-minute rest, eight whole body resistance exercises were performed. These involved continuous repetitions with good technique for 1-minute at an ≥8/10 (very hard) rating of perceived exertion; 1-minute rest separated each exercise. Adverse events were recorded throughout the intervention. RESULTS The participant adhered to the intervention, attending 100% of sessions and reaching the prescribed intensity for 100% of aerobic and 80% of resistance exercises. Efficacy of the exercise training was indicated by a reduction in the severity of gastrointestinal symptoms measured via the irritable bowel syndrome-symptom severity scale (from 111 to 100) and the structured assessment of gastroIntestinal symptoms (39 to 12). There were some improvements in neuromuscular fitness (handgrip strength: 27 to 29.5 kg, 30-second sit to stands: 12 to 10 repetitions) and cardiorespiratory fitness (VO2max: 36.7 to 38.2 mL/kg/min). No changes were observed in mental health (Hospital Anxiety and Depression scale), and one non-serious adverse event (nausea post-eating), which was deemed not related to the intervention. CONCLUSION The C-HIIT intervention in a person with DGBI was feasible, efficacious and safe.

Double-blind, randomized, 8-week multicenter study of the efficacy and safety of STW 5-IIversus placebo in functional dyspepsia.

Herbal products are widely used to treat patients with disorders of gut brain interaction but clinical efficacy and safety data for treatments lasting >4 weeks are widely lacking. We evaluated the efficacy and safety of 8 weeks of treatment with the herbal combination product STW 5-II for patients with functional dyspepsia (FD) meeting Rome II criteria. We also conducted a post hoc analysis including patients meeting Rome IV criteria for FD and evaluated the effect of the G-protein beta 3 (GNB3) subunit polymorphism (C825T) on therapeutic response. This multicenter, placebo-controlled, double-blind study included 272 FD patients meeting Rome II criteria in the intention-to-treat cohort and 266 meeting Rome IV criteria. We used the validated Gastrointestinal Symptom Score (GIS) to assess GI symptoms, defining response rate as the proportion of patients with ≥50% GIS improvement in at least three of four assessments. After 8 weeks, the response rate was significantly higher in the STW 5-II group versus placebo (61.2% vs 45.1%, P = 0.008). Mean GIS non-significantly improved with STW 5-II treatment (7.9 ± 4.41 vs 6.7 ± 4.91 with placebo; P = 0.07). In the Rome IV subgroup analysis, STW 5-II yielded a better response rate (P = 0.01) versus placebo and greater postprandial distress symptom improvement (P = 0.04) versus placebo. Safety parameters did not differ between groups, and GNB3 status was not linked with therapeutic response. STW 5-II is efficacious, with no observed safety signals at up to 8 weeks of treatment in patients with FD meeting Rome II or IV criteria.

Prevalence of Anti- Saccharomyces Cerevisiae Antibodies (ASCA) in Patients With Irritable Bowel Syndrome (IBS). A Case-control Study.

Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction that affects patients' quality. Recent research has shown variations in the mycobiome of individuals with IBS, particularly involving Saccharomyces cerevisiae , and its association with dysbiosis and visceral hypersensitivity. However, the role of Anti-Saccharomyces cerevisiae antibodies (ASCA) in IBS remains unclear, despite their significance as markers of disease severity in inflammatory bowel disease. This study aimed to investigate the role of ASCA in Mexican IBS patients compared with healthy controls (HCs) and determine whether these antibodies could help differentiate between IBS patients and healthy individuals. Serum samples from 400 IBS patients and 400 HC were analyzed. ASCA IgG levels were measured using enzyme-linked immunosorbent assay (ELISA). The IBS patients were further categorized into subtypes: constipation predominant (IBS-C), diarrhea predominant (IBS-D), and mixed (IBS-M). Among the participants, 66 IBS patients (16.5%) and 63 HC (15.75%) tested positive for ASCA IgG. No significant difference was observed in ASCA IgG levels between the 2 groups ( P value: 0.8451). The prevalence of ASCA IgG positivity was 14.5% in IBS-C, 17.8% in IBS-D, and 15.9% in IBS-M. Surprisingly, a high prevalence of ASCA IgG was found in the HC group in Mexico. Furthermore, there was no significant difference in ASCA IgG levels between IBS patients and controls. These findings suggest that ASCA is not useful as a discriminatory biomarker for distinguishing IBS patients from healthy individuals and cannot serve as a surrogate marker for visceral hypersensitivity.

The Presence of Ganglionic Acetylcholine Receptor Antibodies in Sera from Patients with Functional Gastrointestinal Disorders: A Preliminary Study

Background: Functional gastrointestinal disorders (FGIDs), including functional dyspepsia (FD) and irritable bowel syndrome (IBS), are characterized by chronic and recurrent gastrointestinal symptoms. Clinically, FD and IBS often resemble gastrointestinal dysmotility caused by autoimmune autonomic neuropathy. We examined the seropositive frequency of autoantibodies against ganglionic nicotinic acetylcholine receptors (gnAChRs) in patients presenting with FGIDs. Objective: To elucidate the seropositivity of gnAChR antibodies and the clinical features of seropositive FD and IBS. Materials and Methods: We measured autoantibodies against the gnAChR α3 and β4subunits using luciferase immunoprecipitation systems. Serum samples from patients with any autonomic symptoms were obtained from hospitals in Japan between January 2012 and August 2018 (1787 serum samples of 1381 patients). We selected FD and IBS patients and compared the clinical characteristics and prevalence of autonomic symptoms between those with seropositive and seronegative IBS and FD. Results: Nine IBS and two FD cases (one comorbid case with IBS) were found. We found four patients (36.4%) in whom gnAChR antibodies were positive in these eleven patients. Sicca symptoms were observed in three of four cases (75%) of seropositive FGID compared with zero of seven cases (0%) of seronegative FGID. Conclusions: We found patients with gnAChR antibodies in FD and IBS patients. These data will be valuable for elucidating the pathophysiology of these FGIDs and developing new treatment strategies.

Reliability of pediatric Rome IV criteria for the diagnosis of disorders of gut-brain interaction.

The diagnosis of disorders of gut-brain interaction (DGBI) in children is exclusively based on clinical criteria called the Rome criteria. The inter-rater reliability (IRR) measures how well two raters agree with a diagnosis using the same diagnostic tool. Previous versions of the Rome criteria showed only fair to moderate IRR. There have been no studies assessing the IRR of the current edition of the pediatric Rome criteria (Rome IV). This study sought to investigate the IRR of the pediatric Rome IV criteria and compare its reliability with the previous versions of the Rome criteria. We hypothesized that changes made to Rome IV would result in higher IRR than previous versions. This study used the same methodology as the previous studies on Rome II and III, including identical clinical vignettes, number of raters, and levels of expertise. Participants included 10 pediatric gastroenterology fellows and 10 pediatric gastroenterology specialists. IRR was assessed using the percentage of agreement and Cohen's kappa coefficient to account for possible agreement by chance. The average IRR percentage of agreement using the Rome IV criteria was 55% for pediatric gastroenterologists and 48.5% for fellows, indicating moderate agreement (k = 0.54 for specialists, k = 0.47 for fellows). The results demonstrated higher percentages of agreement and kappa coefficients compared to the Rome II and III criteria. The findings demonstrate improved reliability in Rome IV compared to Rome II and III, suggesting that the changes incorporated into the Rome IV criteria have enhanced diagnostic consistency. Despite the advancements, the reliability is still moderate, indicating the need for further refinement of future versions of the Rome criteria.

Corrigendum: Functional bowel disorders among bariatric surgery candidates before and after surgery: A prospective cohort study

Corrigendum: Functional bowel disorders among bariatric surgery candidates before and after surgery: A prospective cohort study

Multimorbidity of Allergic Diseases Is Associated With Functional Gastrointestinal Disorders in a Young Japanese Population.

Although certain allergic diseases have been reported to be associated with the prevalence of functional dyspepsia (FD) and irritable bowel syndrome (IBS), it is unclear whether the presence of multiple allergic diseases further increases the prevalence of FD and IBS. The aim of this study is to determine this issue in young people. A cohort of 8923 Japanese university students was enrolled and diagnoses of FD and IBS were confirmed using Rome III criteria. Allergic disorders diagnosed at medical institutions were obtained by means of a self-administered questionnaire. The prevalence of FD, IBS, and their overlap was found to be 1.9%, 6.5%, and 1.1%, respectively. Pollen allergy was independently positively correlated with FD, IBS, and overlap of FD and IBS. Allergic rhinitis was positively linked to IBS. Drug allergy was positively associated with FD. The presence of multiple allergic diseases was positively correlated with FD and IBS (FD: adjusted OR for 2 allergic diseases: 1.95 [95% CI, 1.24-2.98], P for trend = 0.003; and IBS: adjusted OR for 1 allergic disease: 1.40 [95% CI, 1.15-1.69], 2 allergic diseases 1.47 [95% CI, 1.12-1.91], and 3 or more allergic diseases: 2.22 [95% CI, 1.45-3.28], P for trend = 0.001). Additionally, the concomitant existence of multiple allergic diseases was also demonstrated to have a trend that correlated with the overlap of FD and IBS (P for trend = 0.018). Allergic disease multimorbidity is positively correlated with the prevalence of FD and IBS in a young population.

Development of an emulsion composition with fennel and caraway essential oils for use in the combined therapy of ulcerative colitis

The aim of the study is to develop the composition of an emulsion containing essential oils of Fennel and Caraway seeds for use in the symptomatic complex therapy of ulcerative colitis with the aim of eliminating functional intestinal disorders. Materials and methods. The objects of the study were samples of emulsions containing active pharmaceutical ingredients (essential oils of Fennel and Caraway), purified water, oils (refined sunflower oil, refined olive oil, refined sesame oil), emulsifiers (polyethylene glycol 40 hydrogenated castor oil, polysorbate 80, polyethylene glycol 100 stearate, acacia gum, guar gum, xanthan gum, soya lecithin), viscosity regulator - apple pectin and flavouring agents (food additives with cherry and tarragon flavour). Organoleptic properties, stability, rheological parameters, pH, particle size determination by microscopy, and a taste test were carried out with model emulsion samples. Research to establish the optimal technological parameters was carried out in parallel. Results. The main parameters of the technological process have been established, which allow to obtain an emulsion with evenly distributed particles: 15 minutes at maximum speed. The concentration of emulsifiers at which the emulsions are stable was selected. It was found that the samples containing polyethylene glycol 100 stearate, gums, and soy lecithin have satisfactory organoleptic properties. The sample with soy lecithin emulsifier differs from the others in its ability to form microemulsions, but it has low viscosity. To improve the rheological properties, apple pectin was added to the emulsion. The taste test showed that among vegetable oils, refined sesame oil has a more neutral taste, and the flavouring additive "Tarkhun" balances the taste better. The release of active pharmaceutical ingredients (APIs) from the emulsion base was confirmed by thin-layer chromatography. Conclusions. A microemulsion with essential oils based on refined sesame oil, soy lecithin, with the addition of viscosity and flavour correctors was developed. The obtained emulsion has satisfactory organoleptic properties and conforms to the requirements for emulsion quality indicators

Differential Diagnosis of Inflammatory Bowel Disease and Functional Bowel Disorder in Children Based on Ultrasonography

Objective: To study the diagnostic efficiency (DE) of sonographic signs in differentiation of inflammatory bowel disease (IBD) and functional bowel disorder (FBD) in children and to develop an optimal mathematical model for differential diagnosis of IBD and FBD using comprehensive assessment of sonographic signs.Material and methods: We examined 79 children with and without clinical signs of large-bowel disease. All the children underwent bowel ultrasonography with strain elastography. We also determined the level of fecal calprotectin (FC). The FC level &gt; 120 μg/g was a cutoff value to differentiate IBD from FBD.Results: We determined the DE of sonographic signs in verification of IBD and FBD: large-bowel wall thickening (DE, 87%; P &lt; .0001), large-bowel wall stratification (DE, 93.1%; P &lt; .0001), enlarged mesenteric lymph nodes (DE, 53.4%; P=.591), interloop ascites (DE, 98.3%; P &lt; .0001), Color Doppler findings in the large-bowel wall (DE, 98.3%; P &lt; .0001), strain elastography findings in the large-bowel wall (DE, 96.5%; P &lt; .0001). We developed an optimal model for differentiation of FBD and IBD using the analysis of sonographic signs (DE, 98.7%).Conclusions: The sonographic signs (large-bowel wall thickening, large-bowel wall stratification, interloop ascites, color Doppler findings in the large-bowel wall, stiffness found on strain elastography) can be effectively used for differential diagnosis of FBD and IBD in children. The developed mathematical model enables to reliably differentiate children with FBD and IBD.

Exploring Electrical Neuromodulation as an Alternative Therapeutic Approach in Inflammatory Bowel Diseases

Background and Objectives: This review systematically evaluates the potential of electrical neuromodulation techniques—vagus nerve stimulation (VNS), sacral nerve stimulation (SNS), and tibial nerve stimulation (TNS)—as alternative treatments for inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s Disease (CD). It aims to synthesize current evidence on the efficacy and safety of these modalities, addressing the significant burden of IBD on patient quality of life and the limitations of existing pharmacological therapies. Materials and Methods: We conducted a comprehensive analysis of studies from PubMed, focusing on research published between 1978 and 2024. The review included animal models and clinical trials investigating the mechanisms, effectiveness, and safety of VNS, SNS, and TNS in IBD management. Special attention was given to the modulation of inflammatory responses and its impact on gastrointestinal motility and functional gastrointestinal disorders associated with IBD. Results: Preliminary findings suggest that VNS, SNS, and TNS can significantly reduce inflammatory markers and improve symptoms in IBD patients. These techniques also show potential in treating related gastrointestinal disorders during IBD remission phases. However, the specific mechanisms underlying these benefits remain to be fully elucidated, and there is considerable variability in treatment parameters. Conclusions: Electrical neuromodulation holds promise as a novel therapeutic avenue for IBD, offering an alternative to patients who do not respond to traditional treatments or experience adverse effects. The review highlights the need for further rigorous studies to optimize stimulation parameters, understand long-term outcomes, and integrate neuromodulation effectively into IBD treatment protocols.

Pathology of the gastrointestinal tract in overweight and obese children

Obesity and diseases of the gastrointestinal tract are widespread among the children and have common developmental mechanisms. The article provides a literature review on the relationships between certain pathological conditions of the digestive system (gastroesophageal reflux disease, gastritis, functional intestinal disorders, Crohn’s disease, diverticular disease) in children with overweight and obesity. Excess body weight and obesity can become risk factors for the development of gastrointestinal pathology. The data available in modern literature on changes in the composition of the intestinal and stomach microbiocenosis with increasing body weight are summarized (changes in enterotype, increase in the Firmicutеs/Bacteroides ratio, increase in the number of bacteria Methanobrevibacter, Escherichia coli, Lactobacillus rhamnosus, Lactobacillus delbrueckii and Lactobacillus reuteri). The strains of bacteria that contribute to the anorexigenic effect are considered: Lactobacillus gasseri, some strains of Bifidobacterium, Saccharomyces, Streptococcus and Enterococcus. The pathogenetic aspects of obesity and overweight caused by microbiota are presented: activation of lipid synthesis, breakdown of polysaccharides, absorption of mono- and disaccharides, development of metabolic endotoxemia, etc. Features of the functioning of the autonomic nervous system in obesity in children are presented, indicating the predominance of the hypersympathicotonic variant of autonomic reactivity.