Gastroenterological Disorders Research Articles

P1167 Inflammatory Bowel Disease: a phenome-wide pre- and post-diagnostic association study

Abstract Background Inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), is known to be associated with various extra-intestinal manifestations, impacting organ systems beyond the gastrointestinal tract. Identifying comorbidities in IBD and the timing of their development can provide valuable insight into the mechanisms underlying IBD development. Methods We conducted the first population- and disease-wide phenomic association study in IBD, using >6 million ICD-10 coded healthcare contacts from 10 years before and up to 17 years after IBD diagnosis to investigate associations with 1583 diseases. To explore co-morbidities with potential aetiological significance with IBD, we additionally assessed the strength of association with all diseases in the pre-diagnostic compared with the post-diagnostic period. To correct for multiple testing, we adjust our significance threshold (p<0.05) with the Bonferroni correction, resulting in an adjusted p-value of 7.90×10, which we refer to as disease-wide statistical significance. Results We identified 312 disease-wide statistically significant associations with 125 of these diseases appearing up to 10 years before diagnosis. The risk of immune-mediated diseases and extra-intestinal manifestations are among those diseases increased up to 10 years prior to IBD diagnosis (psoriasis: CD-RR: 2.57, 95% CI: 2.00-3.29; UC-RR: 1.54, 95% CI: 1.25-1.87; enteropathic arthropathies: CD-RR: 3.57, 95% CI: 2.65-4.78; UC-RR: 1.8, 95% CI: 1.38-2.32). This was also the case for gastroenterological and liver disorders (gall stones: CD-RR: 1.82, 95% CI: 1.62-2.04; UC-RR: 1.26, 95% CI: 1.15-1.37; acute pancreatitis: CD-RR: 1.83, 95% CI: 1.30- 2.53; UC-RR: 2.27, 95% CI: 1.84-2.79). The risk of cardiometabolic diseases and neuropsychological disorders had increased disease-wide statistical significance both pre- and post-diagnostically, whereas potential sequelae of treatment, such as osteoporosis (CD-HR: 2.56, 95% CI: 2.30-2.86; UC-HR: 1.92, 95% CI: 1.79-2.07) or herpes simplex infections (CD-HR: 4.04, 95% CI: 2.76-5.91; UC-HR: 1.69, 95% CI: 1.2-2.38) were primarily seen post-diagnostically. Of potential aetiological importance to CD, diagnosis with infectious mononucleosis (RR: 1.87, 95% CI: 1.37-2.52) was significantly associated with the pre- compared to the post-diagnostic period. Conclusion Our results demonstrate IBD as an essentially multisystemic disease, particularly manifesting as gastrointestinal, metabolic, immune, and neuropsychological disorders, present up to 10 years prior to IBD diagnosis. Infectious diseases of aetiological interest identified warrant further investigation.

Enterosorbents in complex therapy of food allergies: a focus on digestive disorders and systemic toxicity in children.

The review analyzes mechanisms and concomitant factors in developing IgE-associated allergic diseases provoked by food allergens and discusses clinical symptoms and current approaches for the treatment of food allergies. The expediency of using enterosorbents in complex therapy of food allergies and skin and respiratory manifestations associated with gastroenterological disorders is substantiated. The review summarizes the experience of using enterosorbents in post-Soviet countries to detoxify the human body. In this regard, special attention is paid to the enterosorbent White Coal (Carbowhite) based on silicon dioxide produced by the Ukrainian company OmniFarma.

Gut Microbiome and Lipidome Signatures in Irritable Bowel Syndrome Patients from a Low-Income, Food-Desert Area: A Pilot Study.

Irritable bowel syndrome (IBS) is a common gastroenterological disorder with triggers such as fructose. We showed that our IBS patients suffering from socioeconomic challenges have a significantly high consumption of high-fructose corn syrup (HFCS). Here, we characterize gut microbial dysbiosis and fatty acid changes, with respect to IBS, HFCS consumption, and socioeconomic factors. Fecal samples from IBS patients and healthy controls were subjected to microbiome and lipidome analyses. We assessed phylogenetic diversity and community composition of the microbiomes, and used linear discriminant analysis effect size (LEfSe), analysis of compositions of microbiomes (ANCOM) on highly co-occurring subcommunities (modules), least absolute shrinkage and selection operator (LASSO) on phylogenetic isometric log-ratio transformed (PhILR) taxon abundances to identify differentially abundant taxa. Based on a Procrustes randomization test, the microbiome and lipidome datasets correlated significantly (p = 0.002). Alpha diversity correlated with economic factors (p < 0.001). Multiple subsets of the phylogenetic tree were associated with HFCS consumption (p < 0.001). In IBS patients, relative abundances of potentially beneficial bacteria such as Monoglobaceae, Lachnospiraceae, and Ruminococcaceae were lower (p = 0.007), and Eisenbergiella, associated with inflammatory disorders, was higher. In IBS patients, certain saturated fatty acids were higher and unsaturated fatty acids were lower (p < 0.05). Our study aims first to underscore the influence of HFCS consumption and socioeconomic factors on IBS pathophysiology, and provides new insights that inform patient care.

Evaluation of Gastrointestinal System Complaints and Comorbidities in Pediatric Familial Mediterranean Fever Patients.

Familial Mediterranean fever (FMF) is the most prevalent hereditary autoinflammatory disease among children. Abdominal pain and various gastrointestinal system (GIS) manifestations may arise directly from FMF or concomitantly with FMF. This study aimed to evaluate GIS complaints and findings other than classic peritonitis attacks in patients with FMF and to interpret concomitant GIS and hepatic disorders in these patients. The medical and genetic findings of patients with FMF who attended our clinic between December 2011 and December 2021 were reviewed. Gastrointestinal system symptoms, liver function tests, abdominal images, and endoscopic and histopathological data were extracted from medical records. A total of 576 pediatric patients (female, 52.3%) diagnosed with FMF were included. Among them, almost one-fifth displayed GIS complaints, such as abdominal pain, defecation problems, and dyspepsia, distinct from typical FMF attacks. High serum aminotransferase levels were detected in 18.4% of the patients, with viral infections being the most common cause of moderate/severe hypertransaminasemia. In addition, during follow-up, 26.9% of them were referred to the pediatric gastroenterology department. At least 1 gastroenterological and hepatobiliary disorder was detected in 17.5% of the patients because of organic and functional GIS disorders or hepatobiliary disorders, such as gastroesophageal reflux disease, esophagitis, functional dyspepsia, and inflammatory bowel diseases. Various GIS and hepatic disorders can be encountered in children with FMF. The spectrum of these complaints and pathologies can range from frequently observed health problems to more severe diseases.

A randomized controlled open labelled study to evaluate clinical efficacy of Bacillus clausii (TIL 19T, TIL 21C, TIL 28S, TIL 30R) in the management of acute diarrhoea in children

Acute Diarrhoea in children is the most frequent gastroenterological disorder and is a common cause of dehydration in children. The management of acute diarrhoea consists of the replacement of lost fluid with glucose-electrolyte oral rehydration solution. Probiotics have been used as adjunctive therapy in the treatment of acute diarrhoea. In this study we evaluated the efficacy of Bacillus clausii (TIL 19T, TIL 21C, TIL 28S, TIL 30R) in management of Acute diarrhoea in children. 48 children aged between 6 months and 15 years with acute bacterial gastroenteritis or acute viral gastroenteritis were included in the study. The study group received poly antibiotic resistant B. clausii strains (TIL 19T, TIL 21C, TIL 28S, TIL 30R)as a probiotic along with standard treatment for diarrhoea and the control group received standard treatment for diarrhoea without B. clausii. The results at the end of 48 hours showed a significant improvement in very severe and high grade diarrhoea category in the children belonging to the study group. That is, all patients had recovered to low grade or normal grade (P &amp;#60; 0.01). Analysis of diarrhoeal stool group showed 64% of children in the control group continued to have loose stools as compared to just 24% in the study group (P &amp;#60; 0.01). No serious adverse events were recorded in both the groups. The use of B. clausii strains(TIL 19T, TIL 21C, TIL 28S, TIL 30R)in Acute Diarrhoea in children has shown to improve the recovery time from the illness and improvement in stool consistency due to its probiotic effect.

Prevalence, Pattern, and Outcome of Gastroenterological Diseases in Primary Care Clinic of a Tertiary Hospital in Southwestern Nigeria

Purpose: Gastroenterological diseases have been documented to be common in primary care practice especially with data from western world. This study seeks to investigate its true burden and outcomes in primary care setting in this environment.&#x0D; Methodology: It was a 10-year retrospective cross-sectional study carried out at the general outpatient clinic of the family medicine department of Ekiti state university teaching hospital which is part of a larger survey and made use of secondary data.&#x0D; Findings: The study observed the prevalence of gastroenterological diseases in primary care to be 3.9% with majority of disorders being peptic ulcer disease and dyspepsia, 54.8% and 25.0% respectively. Gastroenterological diseases were poorly investigated in this study 12.2% with Abdominal Ultrasound been the most requested 63.6% and endoscopy request was 6.5%. The majority of those that presented with gastroenterological diseases were treated and discharged home, peptic ulcer diseases 100% and dyspepsia above 90%.&#x0D; Recommendations: This study showed that the prevalence of gastroenterological disorders in the primary care practice in our environment may not be as high as it’s been documented for other regions of the world. This study recommends further study into the prevalence of gastroenterological disorders using standardized definitions. Primary care doctors are encouraged to be abreast of the frequently changing diagnostic criteria in gastroenterology&#x0D;

The effectiveness of gluten-free dietary interventions: A systematic review.

Celiac disease is a chronic autoimmune gastroenterological disorder in which the digestion of gluten leads to damage and constant inflammation in the small intestine. Moreover, there are associated physical and mental health problems related to celiac disease, i.e., a lower health-related quality of life and increased depression and anxiety symptoms. The only effective treatment for celiac disease is lifelong adherence to a gluten-free diet. However, researchers suggest that strict adherence to a gluten-free diet ranges from 42 to 80%, depending on the definition and method of assessment that was utilized. This review examines interventions designed for those who need to adhere to life-long dietary measures and their success in terms of increasing gluten-free dietary adherence and improving their health-related quality of life. In April 2022, the Scopus, Web of Science, PubMed and ProQuest databases were searched using the following terms: "coeliac disease" OR "celiac disease" AND "gluten free diet" AND "intervention" AND "health related quality of life" AND "diabetes." Eight studies were suitable for this review. The studies were used to analyze different intervention techniques and their impact on gluten-free dietary adherence, quality of life, and the reasons for dietary nonadherence. The studies revealed statistically significant improvements in the knowledge base regarding celiac disease and the gluten-free diet, dietary adherence and quality-of-life satisfaction immediately after the intervention and at a three-month follow-up. Some studies were also focused on behavioral and cognitive aspects of nonadherence to dietary measures.

Homoeopathy in Treatment of Gastro Intestinal Disorders - A Retrospective Study

Introduction: Acid peptic disorder (APD) is a condition which includes peptic ulcer and gastro esophageal reflux disease (GERD). The highest prevalence rate of gastric disorders had been found out between ages 45-50. Dyspepsia is a term used for reduced digestion or indigestion. GERD is referred to as condition where there is regurgitation of stomach contents to the esophagus. Around 58.7% of peoples are having acid regurgitation or heart burn yearly once and 19.8% weekly once. Worldwide functional gastrointestinal disorder are commonest now a days, Irritable Bowel Syndrome (IBS) is also one among them having frequent pain abdomen and altered bowel habits without any structural gut abnormalities. Homoeopathy is a system which is based on individualization, and has principles of “Like cures like” and law of nature. &#x0D; Materials and methods: A retrospective study had been conducted with those patients who had attended the gastroenterology OPD of NHRIMH, Kottayam, Kerala, for a period of 1 year (from January 2022 to December 2022). Data had been collected from the case records and it had been found that around 899 patients had visited for the symptoms like nausea, vomiting, abdominal pain, altered bowel movements (diarrhea and constipation), bleeding per rectum, dysuria and hesitancy in urination,etc for the past 1 year. Aim of the study is to find out the most frequent age group, diseases affected and to know the frequently indicated remedies in treating gastroenterology disorders. &#x0D; Results: 899 patients visited in the defined period with a highest number of patients (212) were from &#x0D; the age group of 51-60, female patients were more than male patients, 758 old patients and 141 new patients. 214 pateints had diagnosed as gastritis which is the highest frequency noted. The most frequently indicated remedies were Nuxvomica in 161 patients and Suphur in 118 patients. &#x0D; Conclusion:It is concluded from the study that gastritis is the most common condition among patients visiting the above OPD in the defined period and Nux vomica, Sulphur and Lycopodium were the most common indicated and prescribed remedies.

In Silico, In Vitro, and Ex Vivo Biological Activity of Some Novel Mebeverine Precursors

In silico analysis aimed at predicting the pharmacodynamic profile of the compounds was performed. Based on these predictions, ex vivo bioelectrical activity (BEA) and immunohistochemical effects of the compounds were established. A thorough biological evaluation of the compounds was conducted assessing their in vitro antimicrobial and cytotoxic activity. All the newly synthesized compounds exerted drug-like properties, whereby 3-methyl-1-phenylbutan-2-amine 3 showed a significant change in BEA due to Ca2+ channel regulation, Ca2+ influx modulation, and a subsequent change in smooth muscle cell response. The immunohistochemical studies showed a good correlation with the obtained data on the BEA, defining amine 3 as a leader structure. No cytotoxicity to human malignant leukemic cell lines (LAMA-84, K-562) was observed for all tested compounds. Based on the experimental results, we outlined 3-methyl-1-phenylbutan-2-amine 3 as a potential effective choice for orally active long-term therapy of IBS.

Characteristics of functional and laboratory parameters in alimentary lymphoma in cats

Gastrointestinal or alimentary lymphoma is the most common primary malignant neoplasm of the gastrointestinal tract in cats. The aim of the work is to study the pathogmonicity of functional and laboratory parameters in alimentary lymphoma in cats. The objects of the study were cats of different breeds, the age ranged from 2 to 16 years, the average live weight at the time of admission was 3.9 kg with pronounced gastroenterological disorders. Two groups of cats were created for the study: 1st – control (healthy individuals; n= 10), 2nd – experimental (sick individuals; n= 20). All cats were subjected to standard clinical examination by general methods - examination, palpation, auscultation, thermometry. Anamnesis was carefully collected and general (hematological analyzer URIT-2800Vet) and biochemical (automatic biochemical analyzer IDEXX Catalist) blood tests and additional research methods were performed. Gastrointestinal lymphomas are the leaders – 79% of all lymphomas. The vast majority of cats had progressive weight loss, hypo- and anorexia, vomiting, diarrhea. Solid neoplasms in the abdominal cavity were palpated only in 11 cats. In the general blood test, erythrocytes in the experimental group are lower than in the control group (6.23±0.28x1012/l versus 8.40±0.81x1012/l; P&lt;0.01); the level of leukocytes in the experimental group is 78% higher than in the control group (P&lt;0.001); the number of lymphocytes is higher in the experimental group by 74.3% (P &lt;0.001); monocytes were higher in the experimental group - 7.21 ±0.39% versus 4.0±1.05% (P &lt;0.01). Biochemical blood analysis showed that the studied parameters in sick cats are mainly within the reference values. The level of urea is higher in sick cats by 38.71% (P &lt;0.05), AST by 88.79%. As the most pronounced clinical signs of alimentary lymphoma, hypo- and anorexia, progressive weight loss, vomiting, diarrhea can be distinguished, from laboratory indicators - a decrease in the number of red blood cells, an increase in the number of leukocytes, including monocytes, an increase in urea levels.

Gastroenterological disorders in patients with COVID-19

Introduction - It was found that the frequency of symptoms from the gastrointestinal tract (gastrointestinal tract) in COVID-19 infection varies between 11.4-50. Cases of manifestation of the disease with gastroenterological symptoms are reported, appearing on average 1-5 days before the development of respiratory symptoms. The course of the disease with the presence of diarrhea and vomiting without fever and other classical manifestations is described. The purpose is to review the scientific literature on the analysis of the leading pathogenetic factors in the formation of intestinal syndrome in a new coronavirus infection. Material and methods. The scientific literature was searched in the Web of Science, Scopus, PubMed and RSCI databases for the following keywords: coronavirus infection, intestinal syndrome. Search depth - 3 years. Results. The study revealed clinical manifestations of the gastrointestinal tract (gastrointestinal tract) in COVID-19 infection, their main mechanisms and the frequency of occurrence of certain symptoms in practice

Ultrasonographic and pathomorphological changes in Alimentary Lymphoma in cats

The study aimed to determine the characteristic changes in alimentary lymphoma in cats during ultrasonography, pathoanatomic and cytological examination of biopsy material. The survey objects are cats with gastroenterological disorders with suspected alimentary lymphoma of different ages and genders. The diagnosis was made based on a clinical examination according to generally accepted methods, laboratory blood examination, ultrasound examination, pathomorphological examination of the intestinal walls and lymph nodes, and cytological examination of the lymph node material obtained by the TIAB method. The authors carried out the material sampling for cytological examination using percutaneous fine needle aspiration (FNA) biopsy under ultrasound control on the Mindray Z6 Vet apparatus. In addition, the authors conducted pathological and cytological studies in the Vet Union laboratory. When analyzing ultrasound examination in cats diagnosed with alimentary lymphoma, hepatomegaly, 1% ascites, 3% hydrothorax, 3 % increase in mediastinal lymph nodes, 7% splenomegaly, 16% violation of differentiation of intestinal layers, 16% violation of differentiation of intestinal layers, 29% increase in mesenteric lymph nodes, 29 % thickening of intestinal walls were observed in 12% of cases. Cytological examination revealed rounded, large, separately located cells. The population is monomorphic. During a histological study in the intestinal wall, adjacent fatty tissue of the omentum, and lymph node tissue, there is a highly cellular invasive formation constructed from diffuse layers of rounded lymphoid neoplastic cells with a scanty fibrous stroma. The most characteristic ultrasound findings are the thickening of the intestinal walls and an increase in mesenteric lymph nodes.

Нутрициологические подходы, применяемые в комплексной терапии детей с расстройством аутистического спектра

The article discusses the modern scientific data demonstrating the influence of intrauterine and early postnatal macro- and microelement deficiency on fetal neurogenesis and further cognitive development of the child. The features of the development of children with autism spectrum disorder (ASD) are given, including the formation of eating behavior, manifestations of selectivity in food within the framework of sensory disintegration, self-restriction of the diet due to «novelty avoidance». Nutritional disorders in children with ASD, observed from an early age, are often accompanied, or cause the manifestation of gastroenterological disorders that require timely treatment, including diet therapy. The feeding difficulties faced by the family of a child with ASD often push parents to self-treat with various diets, the balance and effectiveness of which are often very questionable. The article discusses the positive effects of diets prescribed and controlled by nutritionists and discusses the risks of self-treatment. The authors emphasize the necessity of correcting eating disorders in children with ASD and the importance of a gastroenterologist and nutritionist participation in the interdisciplinary complex support of children with ASD.

SOX-1 antibodies in a patient with Crohn’s disease: a case report

BackgroundThe anti-SOX-1 antibodies have been mainly associated with Lambert-Eaton Myasthenic Syndrome (LETMS) and Small-Cell Lung Cancer (SCLC). In this report, we describe the interesting case of a patient with serum anti-SOX-1 antibodies and Crohn’s Disease (CD) with ensuing neurological symptoms.Case presentationA Caucasian 67-year-old female was admitted to the Emergency Department with seizures, vertigo, emesis, nausea, postural instability and recurrent falls, over a period of 10 days. She had been affected by Crohn’s Disease since 1991. A CT scan failed to detect any ischemic or haemorrhagic lesion. A brain MRI revealed signs of leukoencephalopathy. Western blot analysis of her serum revealed a high titre of the onconeural antibody anti-SOX1, consistent with a neurological, cerebellar type, paraneoplastic syndrome. In spite of multiple efforts to unmask a possible underlying malignancy, no neoplastic lesion cropped up during hospitalization. Her clinical conditions progressively deteriorated, up to respiratory failure; a few days later she died, due to ensuing septic shock and Multiple Organ Failure.ConclusionsOur experience may usher and reveal a new role of anti-neural antibodies, so far reckoned an early indicator of associated malignancy, suggesting that neurological syndromes associated with such antibodies may complicate also chronic Gastrointestinal (GI) diseases. As of now, testing for anti-neuronal antibodies appeared unnecessary within the diagnostic assessment of gastroenterological disorders, which may lead to overlooking incident neurologic autoimmune diseases. Further exploration of such research hypothesis in clinical grounds appears intriguing.

The possible association of proton pump inhibitor use with acute cholangitis in patients with choledocholithiasis: a multi-center study

Background Gallstone disease is common worldwide and can lead to severe complications, including cholangitis; thus, it is important to identify modifiable risk factors for cholangitis. Proton pump inhibitors (PPIs) are commonly prescribed to treat gastroenterological disorders. We aimed to explore whether PPI use is associated with an increased risk of acute cholangitis in patients with gallstone disease. Methods This retrospective multicenter study included all patients arriving to the hospital over a 10-year period with various presentations of choledocholithiasis. We compared active PPI use in two groups: those with cholangitis (group A) vs. without cholangitis (group B). Results Overall, 811 patients were included, 161 in group A and 650 in group B. The average age ± standard deviation (SD) in groups A and B was 74.5 ± 20.6 vs. 61.6 ± 20.9 years, respectively. PPI use in group A was higher vs. group B (42.9% vs. 29.1%, p = 0.001). On univariate analysis, male gender (OR 1.47, 95% confidence interval (CI) 1.04–2.08), age (OR 1.04, 95% CI 1.03–1.05), ischemic heart disease (IHD) (OR 1.68, 95% CI 1.07–2.64), hyperlipidemia (OR 1.59, 95% CI 1.11–2.29), hypertension (OR 1.81, 95% CI 1.28–2.57) and PPI use (OR 1.83, 95% CI 1.28–2.61), all were associated with acute cholangitis. On multivariate analysis, only PPI use kept its association after adjustment for age (OR 1.64, 95% CI 1.2–3.7). Conclusions Active PPI use was associated with a higher rate of cholangitis among patients with choledocholithiasis. We advocate considering this risk before prescribing PPIs to patients with gallstones. Trial registration number NHR-0263-20 received on 14/01/2021 date ‘retrospectively registered’.

Gut Bless Your Pain-Roles of the Gut Microbiota, Sleep, and Melatonin in Chronic Orofacial Pain and Depression.

Background. Increased attention has been paid to the gut–brain axis recently, but little is known so far regarding how this translates into pain susceptibility. Aim. The aim of this review is to determine whether gastroenterological disorders and sleep disorders (directly or indirectly) contribute to an increased susceptibility to depression and chronic orofacial pain. Method. A search was performed in the U.S. National Library of Medicine (PubMed) database in order to find studies published before 19 December 2021. We used the following terms: gut microbiome, OR sleep quality, OR melatonin, OR GERD, OR IBS, AND: depression OR chronic pain, in different configurations. Only papers in English were selected. Given the large number of papers retrieved in the search, their findings were described and organized narratively. Results. A link exists between sleep disorders and gastroenterological disorders, which, by adversely affecting the psyche and increasing inflammation, disturb the metabolism of tryptophan and cause excessive microglial activation, leading to increased susceptibility to pain sensation and depression. Conclusions. Pain therapists should pay close attention to sleep and gastrointestinal disorders in patients with chronic pain and depression.

Organizing and Developing a GI Motility Lab in Community Practice: Challenges and Rewards.

Neurogastroenterology and motility is a rapidly evolving subspecialty that encompasses over 33% of gastroenterological disorders, and up to 50% of referrals to gastroenterology practice. It includes common problems such as dysphagia, gastroesophageal reflux disease, irritable bowel syndrome, chronic constipation, gastroparesis, functional dyspepsia, gas/bloating, small intestinal bacterial overgrowth, food intolerance and fecal incontinence Standard diagnostic tests such as endoscopy or imaging are normal in these conditions. To define the underlying mechanism(s)/etiology of these disorders, diagnostic motility tests are often required. These are best performed by well-trained personnel in a dedicated motility laboratory. Our purpose is to provide an up-to-date overview on how to organize and develop a motility laboratory based on our collective experiences in setting up such facilities in academia and community practice. A lack of knowledge, training and facilities for providing diagnostic motility tests has led to suboptimal patient care. A motility laboratory is the hub for diagnostic and therapeutic motility procedures. Common procedures include esophageal function tests such as esophageal manometry and pH monitoring, anorectal function tests suchlike anorectal manometry, neurophysiology and balloon expulsion, dysbiosis and food intolerance tests such as hydrogen/methane breath tests, and gastrointestinal transit assessment. These tests provide an accurate diagnosis and guide clinical management including use of medications, biofeedback therapy, neuromodulation, behavioral therapies, evidence-based dietary interventions and endoscopic or surgical procedures. Further, there have been recent developments in billing and coding of motility procedures and training requirements that are not well known. This review provides a stepwise approach on how to set-up a motility laboratory in the community or academic practice and includes the rationale, infrastructure, staffing needs, commonly performed motility tests and their clinical utility, billing and coding strategies, training needs and economic considerations for setting up this service.

The Efficiency of Internet Base Healthcare System in Gastroenterological diseases: An Updated Systematic Review

Digital health systems such as tablet devices, smartphones, and online websites, are swiftly transforming the practice of medical science and reshaping health care approaches. A PRISMA guidelines-based systematic review was conducted using research databases (PubMed, Google Scholar, and Web of Science) to identify the applications and fill the literature gap in Gastroenterological disorders. A total of 212 articles were searched, excluding duplicate records, sixty nine articles were founded out of which only fifteen were selected using specific inclusion and exclusion criteria. Risk of a bias assessment tool called ROBVIS 2 is used to examine the risk of predisposition and precision of all the fifteen studies included. Most of the patients in these trials were females, educated, and have inflammatory bowel diseases. These clinical studies concentrated on Ulcerative colitis (n=5), Crohn's disease (n=4), and inflammatory bowel disease (n=6) with feedback of mostly 3 months (n=5) and 6 months (n=5). The internet-based intervention varied from study to study but the outcomes in each study were clear that either this system was efficient or not. Based on the searched literature and selected studies it was concluded that online health technologies can effectively cope with Gastroenterological disorders and patients with digestive disorders have shown good acceptability and pleasure in all the selected studies. Keywords: eHealth technologies, Digestive disorders, Ulcerative colitis, Crohn’s disease, Review

Future challenges in gastroenterology and hepatology, between innovations and unmet needs: A SIGE Young Editorial Board's perspective.

Gastroenterology, Digestive Endoscopy and Hepatology have faced significant improvements in terms of diagnosis and therapy in the last decades. However, many fields still remain poorly explored, and many questions unanswered. Moreover, basic-science, as well as translational and clinical discoveries, together with technology advancement will determine further steps toward a better, refined care for many gastroenterological disorders in the future. Therefore, the Young Investigators of the Italian Society of Gastroenterology (SIGE) joined together, offering a perspective on major future innovations in some hot clinical topics in Gastroenterology, Endoscopy, and Hepatology, as well as the current pitfalls and the grey zones.

Magnesium Orotate and the Microbiome-Gut-Brain Axis Modulation: New Approaches in Psychological Comorbidities of Gastrointestinal Functional Disorders.

Magnesium orotate has been cited in the medical literature for the past three years as a possible adjuvant in some pediatric and adult gastroenterological disorders associated with dysbiosis. Studies also focus on the possibility of adding magnesium orotate in psychiatric disorders’ treatment, such as major depression and anxiety. The most relevant element in these studies is the efficiency of magnesium orotate therapy in cases with both gastroenterological and psychiatric symptoms. This article proposes a literature review, focused on the studies published in the last three years, targeting magnesium orotate treatment and probiotic supplementation in patients with both digestive and psychiatric symptoms. Moreover, this review will compare the efficiency of magnesium orotate and probiotics within both the pediatric and adult communities, focusing on the possibility of gut–brain axis modulation and its involvement in the clinical evolution of these patients.