Gastrointestinal Pain Research Articles

Tuberculosis miliar en paciente inmunocompetente: Reporte de caso

Milar Tuberculosis (TB) is a presentation with a fatal outcome if it is not diagnosed or treated on time; although certain conditions are required to develop this presentation. In this In this article, the case of a 48-year-old man with no pathological history is studied, who started the disease with a time of six months with an initial diffuse gastrointestinal pain and later one month before admission presented progressive respiratory symptoms; he was admitted for emergencies where bilateral diffuse miliary compromise was evident in the chest computed tomography; upon admission, he was administered oxygen and support measures, an HIV test was obtained which was negative, and positive results were obtained in the sputum smear microscopy. His clinical evolution was stationary until the administration of antituberculosis therapy, observing slight clinical improvement, likewise, low doses of corticosteroids were administered after which a favorable evolution was demonstrated and he was discharged.

Sensory reactivity in children and adolescents with autism

IntroductionThe gut-brain axis establishes the relationships between bacteria, neurotransmitters and psychophysiological responses associated with a neuronal and behavioral correlate in autism and different mental disorders.In recent years, there has been an increase in studies on the implications of the gut microbiota (MI) in children with autism spectrum disorders (ASD).Objectives1. To study if there is a dysbiosis or alteration of the MI can trigger the appearance of ASD symptoms.It is considered that there is a frequent comorbidity with gastro-intestinal symptoms (GS), pain and sensory reactivity in ASD, and that these are indicators of a possible alteration in the gut-brain axis.MethodsIn this sense, children with ASD have hypersensitivity to certain visual, olfactory, tactile, etc. stimuli. which makes them be more picky about food and have certain repetitive patterns of behavior, as a consequence they present gastrointestinal symptoms such as constipation and abdominal pain. Sensory reactivity can influence both feeding and sleep patterns in autism.Results Currently, there are measuring instruments for sensory reactivity, pain and gastro-intestinal symptoms. However, there are several limitations of these instruments and especially with sensory reactivity in autism because: (1) the items had not been developed in collaboration with interested parties (pediatricians, neuropsychologists, etc.) and (2) the lack of structural validity analysis. Thus, it appears that most validation studies do not meet the criteria of sufficient psychometric quality according to the COSMIN guidelines. Additionally, there is a lack of consensus around terminology (e.g., sensory overreactivity, hyperreactivity, SOR, etc.) and components relevant to sensory functioning.ConclusionsIn the present work, preliminary data are presented on new measures to take into account to evaluate sensory reactivity and pain in the population with autism. This is a first step to obtain an index of the gut-brain axis for the ASD population.Keywords: ASD, gut-brain, sensory reactivity, painDisclosure of InterestNone Declared

A Mini Literature Review of Probiotics: Transforming Gastrointestinal Health Through Evidence-Based Insights.

As our understanding of the intricate interaction between gut bacteria and human health continues to expand, so too has interest in the ability of probiotics to manage gut microbiota and confer multiple health benefits to the host. The mini literature review focuses on the expanding potential of the use of probiotics in GI health, with a focus on probiotics' potential therapeutic advantages in a variety of gastrointestinal (GI) illnesses. Probiotics play a significant role in managing diarrhea and symptoms of irritable bowel syndrome with diarrhea (IBS-D) by modulating gut microbial communities. Specific probiotic strains have been found to reduce the abundance of harmful bacteria, regulate inflammatory markers like interleukin 6, and improve GI symptoms such as abdominal discomfort and stool consistency. Additionally, probiotic blends have shown potential for preventing GI infections and alleviating GI pain in IBS-D patients. Studies have demonstrated that certain multi-strain probiotics, including Bifidobacterium and Lactobacillus species, can significantly increase the frequency of bowel movements and reduce the proportion of individuals experiencing constipation. It has also been found that probiotic supplementation may reduce the incidence of postoperative complications and mortality, particularly in patients undergoing colorectal adenocarcinoma surgery. Additionally, probiotics have been associated with decreased levels of pro-inflammatory cytokines and improved clinical outcomes in patients with colorectal cancer. Furthermore, probiotics have been associated with enhanced digestive tolerance, reduced GI inflammation, and prolonged clinical remission in certain UC patients. Studies have also shown that probiotics, administered either directly to infants or pregnant women during the perinatal stage, can alleviate symptoms such as inconsolable crying and irritation associated with infant colic, improve bowel movement frequency in cases of functional constipation, and enhance overall conditions in premature infants, including reducing regurgitation and improving feeding tolerance. The review addresses both encouraging results and challenges with probiotic therapy, while also arguing for more studies to elucidate underlying mechanisms and enhance therapeutic techniques. As we traverse the complex field of probiotic therapy in the treatment of GI illnesses, researchers, physicians, and other healthcare professionals can benefit from the informative information provided by this study.

Determination of vitamin c in raw fruit and vegetable homogenates: dietary exposure and health effects of excess intake in adults and children.

The aim of the study was to determine Vitamin C content in some fruits and vegetables (FAV) including apple, banana, orange, pineapple, watermelon, carrot and cucumber, sold in the local markets in Awka, Anambra State, Nigeria as well as Vitamin C content in two-component and three-component homogenates FAV. The work was also designed to investigate the dietary exposure and health effects of excess vitamin C intake in adults and children. Vitamin C as total ascorbic acid (AA) after reduction of dehydroascorbic acid was analyzed using both titrimetric and spectrophotometric methods. The titrimetric method involved iodometric back-titration while the spectrophotometric method was done at an absorbance of 530 nm. The dietary exposure was evaluated as the total FAV intake multiplied by chemical concentration in the FAV whereas the health effect of excess vitamin C intake was conducted using the hazard quotient (HQ). The results revealed that Vitamin C for single fruits ranged from 11.76 - 41.17 mg/L for spectroscopic method and 16.9 - 31.84 mg/L for titrimetric method. Fruit homogenates showed Vitamin C concentrations of 14.70 - 220.58 mg/L and 17.23 - 209.09 mg/L for two-components homogenates: 29.41-132.35 mg/L and 31.05-113.10 mg/L for tri-components homogenates for spectrophotometric and titrimetric methods respectively. The results of dietary exposure and the health effects of excess vitamin C intake showed that children are more susceptible to health issues than adults in illnesses such as nausea, gastrointestinal pains, increased kidney stones and hyperactivity. There is therefore the need for a national recommended dietary allowance for total ascorbic acid (AA) in FAV homogenates from a stakeholder point of view in Nigeria.

Pediatric Chest Pain: A Review of Diagnostic Tools in the Pediatric Emergency Department.

Pediatric chest pain is a common chief complaint in the emergency department. Not surprisingly, children with chest pain are usually brought to the emergency department by their parents out of fear of heart disease. However, chest pain in the pediatric population is generally a benign disease. In this review, we have identified musculoskeletal pain as the most prevalent etiology of chest pain in the pediatric population, accounting for 38.7-86.3% of cases, followed by pulmonary (1.8-12.8%), gastrointestinal (0.3-9.3%), psychogenic (5.1-83.6%), and cardiac chest pain (0.3-8.0%). Various diagnostic procedures are commonly used in the emergency department for cardiac chest pain, including electrocardiogram (ECG), chest radiography, cardiac troponin examination, and echocardiography. However, these examinations demonstrate limited sensitivity in identifying cardiac etiologies, with sensitivities ranging from 0 to 17.8% for ECG and 11.0 to 17.2% for chest radiography. To avoid the overuse of these diagnostic tools, a well-designed standardized algorithm for pediatric chest pain could decrease unnecessary examination without missing severe diseases.

Irritable bowel syndrome (IBS): could we decide what is behind?

Functional visceral problems are frequently present nowadays in the medical practice probably due to the significant mental and emotional load on people. Although physicians and psychophysiologists are active on the field, still we are far from a complete knowledge, despite the fact that scientists like the Hungarian Professor György Ádám already had initiated a new approach called visceral psychophysiology already a long time ago. In this article, we commemorate Professor Ádám by analyzing one of the most frequent functional disorders, irritable bowel syndrome (IBS), calling psychophysiology for help. First, we try to give a definition, then show the general descriptions and characteristics of IBS. Factors like stress, gender, and gastrointestinal pain are followed by the potential role of the immune system and the neuronal factors as well as the supposed brain mechanisms. We hope that this overview of the IBS-history would show how significant scientists can be decisive in certain fields of the science and practice.

The burden of cervical cancer survivorship: Understanding morbidity and survivorship needs through hospital admissions

ObjectiveTo describe disease- and treatment-related survivorship burden amongst survivors of cervical cancer and identify risk factors for hospital admissions after initial treatment. MethodsRetrospective chart review including patients treated for cervical cancer from 2014 to 2020 at a single urban academic institution. Clinical, demographic, and hospital admission characteristics were summarized. Associations between patient characteristics and likelihood of admission were examined using univariate and multivariate regression. ResultsOf 366 patients undergoing surveillance following completion of primary treatment, 156 (43 %) were hospitalized for cancer or treatment-related sequela in the median follow-up of 3.6 years (IQR 1.4–6.4), with a median of 2 admissions (IQR 1–4.5) per patient and 570 unique admissions. While 65 (35 %) of admitted patients had multiple reasons for admission, the most common reasons for admission were: gastrointestinal complications (43 %), infection (38 %), genitourinary complications (33 %), and pain control (23 %). A substantial proportion of admitted patients underwent interventions including surgical procedures (57 %), transfusion of blood products (40 %), and interventional radiology procedures (28 %) and utilized supportive care services including case management (53 %), physical therapy (40 %), and occupational therapy (36 %). On multivariate analysis, odds of admission were higher among Black patients (aOR 2.4, p <.01), uninsured patients (aOR 2.7, p <.05), those with lower performance status (aOR 1.4, p <.05), and those with recurrence (aOR 5.5, p <.001). ConclusionSurvivors of cervical cancer represent a high-risk population frequently hospitalized after initial treatment. Black patients, uninsured patients, those with recurrence, and those with lower performance status faced higher odds of admission. Comprehensive, team-based care is necessary to address complex survivorship needs.

Spatial immune landscapes of SARS-CoV-2 gastrointestinal infection: macrophages contribute to local tissue inflammation and gastrointestinal symptoms.

In some patients, persistent gastrointestinal symptoms like abdominal pain, nausea, and diarrhea occur as part of long COVID-19 syndrome following acute respiratory symptoms caused by SARS-CoV-2. However, the characteristics of immune cells in the gastrointestinal tract of COVID-19 patients and their association with these symptoms remain unclear. Data were collected from 95 COVID-19 patients. Among this cohort, 11 patients who exhibited gastrointestinal symptoms and underwent gastroscopy were selected. Using imaging mass cytometry, the gastrointestinal tissues of these patients were thoroughly analyzed to identify immune cell subgroups and investigate their spatial distribution. Significant acute inflammatory responses were found in the gastrointestinal tissues, particularly in the duodenum, of COVID-19 patients. These alterations included an increase in the levels of CD68+ macrophages and CD3+CD4+ T-cells, which was more pronounced in tissues with nucleocapsid protein (NP). The amount of CD68+ macrophages positively correlates with the number of CD3+CD4+ T-cells (R = 0.783, p < 0.001), additionally, spatial neighborhood analysis uncovered decreased interactions between CD68+ macrophages and multiple immune cells were noted in NP-positive tissues. Furthermore, weighted gene coexpression network analysis was employed to extract gene signatures related to clinical features and immune responses from the RNA-seq data derived from gastrointestinal tissues from COVID-19 patients, and we validated that the MEgreen module shown positive correlation with clinical parameter (i.e., Total bilirubin, ALT, AST) and macrophages (R = 0.84, p = 0.001), but negatively correlated with CD4+ T cells (R = -0.62, p = 0.004). By contrast, the MEblue module was inversely associated with macrophages and positively related with CD4+ T cells. Gene function enrichment analyses revealed that the MEgreen module is closely associated with biological processes such as immune response activation, signal transduction, and chemotaxis regulation, indicating its role in the gastrointestinal inflammatory response. The findings of this study highlight the role of specific immune cell groups in the gastrointestinal inflammatory response in COVID-19 patients. Gene coexpression network analysis further emphasized the importance of the gene modules in gastrointestinal immune responses, providing potential molecular targets for the treatment of COVID-19-related gastrointestinal symptoms.

Unusual Presentations of Epilepsy: A Series of Paediatric Cases with Abdominal Epilepsy and Epileptic Angina

Epilepsy, a common neurological disorder characterised by recurrent seizures, can manifest in unusual clinical presentations such as abdominal pain, nausea, vomiting, and bloating associated with diverse Central Nervous System (CNS) symptoms like confusion, fatigue, headache, dizziness, and syncope. The importance of recognising and documenting such unusual presentations lies in their potential to be misdiagnosed or overlooked, delaying appropriate treatment and causing undue distress to both the patients and their families. In the present case series, patients presented with gastrointestinal or chest pain for a prolonged period. As the symptoms did not subside with treatment, an Electroencephalogram (EEG) was performed to rule out epilepsy. In all three cases (10-year and 10-month-old female, 11-year-old male, seven-year-old male), EEG revealed a generalised seizure disorder. The present case series highlights unusual presentations of epilepsy in paediatric patients, including Abdominal Epilepsy (AE) and epileptic angina. These cases underscore the importance of considering epilepsy as a potential aetiology in patients with recurrent and atypical symptoms.

Strongyloides stercoralis Infestation Manifesting as Protein Losing Enteropathy and Dyselectrolytaemia in an Immunocompetent Adult: A Case Report

Strongyloides stercoralis is an intestinal nematode which persists as chronic asymptomatic infection for several years. Clinical manifestations become apparent long after initial infection which includes non specific gastrointestinal (GI) symptoms like pain abdomen, nausea, vomiting, altered bowel habits or weight loss. Larval reproduction can lead to disseminated infection in the immunocompromised. Very rarely, hyperinfection or disseminated strongyloides can lead to ulceration, bleeding, small bowel obstruction, colitis or ascites. In severe cases, electrolyte disturbances and protein losing enteropathy may occur. We present a unique case of intestinal infestation of Strongyloides stercoralis in a 42-year-old immunocompetent male with a rare manifestation of protein losing enteropathy and dyselectrolytaemia without any GI symptoms at the outset, whose presentation was anasarca and initial investigations including work-up for cardiovascular, hepatic and renal causes of anasarca were unremarkable except for hypoalbuminaemia and electrolyte abnormalities and notable absence of peripheral eosinophilia. The diagnosis was arrived at by simple and conventional investigations like stool microscopy which demonstrated the Strongyloides larvae and upper GI endoscopy aided the biopsy which was confirmatory. He responded to appropriate medical treatment. Helminthic infestation should be kept in mind as a rare cause of malabsorption syndrome manifesting as protein losing enteropathy in a tropical and endemic country like India. These are treatable causes and respond to specific cost-effective antihelminthic treatments.

Timing of High-Dose-Rate Brachytherapy With External Beam Radiation Therapy in Patients With Intermediate- and High-Risk Localized Prostate Cancer and Its Effects on Toxicity and Quality of Life: A Randomized Controlled Trial (THEPCA)

BackgroundHDR brachytherapy(HDR-BT) and external beam radiotherapy(EBRT) are effective treatments for prostate cancer(PC) but cause genitourinary(GU) and gastrointestinal(GI) toxicities. There is no consensus on the timing of HDR-BT in relation to EBRT and the effect of sequencing on patients. ObjectiveThe primary objective was to assess differences, if any, in the incidence of Grade 3 or higher GU toxicities from treatment. We also aimed to explore the incidence of G1-4 GI toxicities, quality of life and patient satisfaction. Suppression of PSA and signals for survival differences were also analysed. MethodologyA single-centre randomised trial in intermediate and high-risk localised PC patients to receive HDR-BT before (Arm A) or after (Arm B) EBRT. Toxicities were graded using CTCAE. IIEF and FACT-P were used to assess erectile dysfunction and QOL at 0, 3, 9 and 12 months. Results50 patients were recruited to each arm, with 48 and 46 patients completing treatment and follow up in each arm. 81.5% had high-risk disease. There were no G3 or G4 GU or GI toxicities. G1 urinary frequency was the most common adverse event experienced in both arms, peaking in incidence 3 months after commencing treatment (45.7 and 42.2% in Arm A and B, respectively). Up to 11 % of patients reported G1 urinary frequency at 12 months. Other G1 GU toxicities experienced by >10% of patients were urinary tract obstruction, tract pain and urgency. These symptoms also peaked in incidence at 3 months. G2 GU toxicities were uncommon and experienced in a maximum of 2 patients within each arm at any time point.Over 30% of patients had G1 flatulence at baseline and this remained the most frequently occurring G1 GI toxicity throughout the study, peaking at 12months (21.4% and 25.6% in Arm A and Arm B, respectively). Other GI toxicities experienced by more than 10% of patients were GI pain, proctitis and rectal mucositis, most of which demonstrated a peak incidence at 3 or 9 months. G2 GI toxicities were uncommon, except G2 flatulence.No significant difference was found in CTCAE, IPSS, IIEF, FACT-P and QOL scores between the arms.Median PSA follow-up was 5 years. 7 patients had treatment failure in each arm. DFRS was 93.3% and 90.7% at 5 years in Arm A and B respectively, with median failure time of 60 and 48 months in Arm A and B respectively. There were no statistically significant difference between arms. ConclusionsThe sequencing of HDR-BT and EBRT did not impact the incidence of G3 or G4 toxicities and no significant differences were seen in other patient reported outcomes. Treatment was well tolerated with maintained QOL scores. Treatment failure was low in both arms in a high-risk cohort, however a larger study with longer follow up is underway to establish whether the difference in median time to failure between the two arms is a signal of superiority.

Variety of Serotonin Levels in Pediatric Gastrointestinal Disorders.

(1) Serotonin primarily regulates our emotions. A complex process, which includes dysfunctions in gastrointestinal motility and deregulation of the gene responsible for serotonin reuptake (SERT), is implicated in the pathophysiology of irritable bowel syndrome (IBS). This also encompasses changes in intestinal microbiota, the response to stress, the intricate interplay between the brain and the digestive tract, heightened sensitivity to visceral stimuli, and low-grade inflammation. This paper aims to investigate the effectiveness of probiotic therapy in managing gastrointestinal and neuropsychiatric symptoms related to serotonin levels, with a focus on individuals with serotonin deficiency and those with normal serotonin levels experiencing gastrointestinal disorders. (2) The study involved 135 pediatric patients aged 5-18 years with gastrointestinal disturbances, including constipation, diarrhea, and other symptoms, such as nausea, flatulence, feeling full, or gastrointestinal pain. (3) Serotonin testing was performed, and administering probiotics appeared to be effective in addressing serotonin deficiency and other gastrointestinal disorders. (4) Serotonin's pivotal role in regulating neurotransmitter secretion and its impact on neuropsychiatric health, coupled with gender differences and age-related declines, underscore the complexity of their influence on gastrointestinal and neuropsychiatric conditions.

An atypical presentation of Covid 19 infection with isolated acute abdominal pain: A case report and review of the literature

Coronavirus illness (Covid-19) is an associate degree infectious disease caused by a newly discovered coronavirus. Patients often present with respiratory symptoms (cough, breathing difficulty) and fever. However, patients with Covid-19 have also been presented with gastrointestinal symptoms like abdominal pain, nausea, and vomiting, but are very unusual and often correlated with other symptoms. In our emergency department, we have a patient with atypical presentation of severe pain in the abdomen as the primary complaint without having any other gastrointestinal complaints but coronavirus infection.

Standard-of-care systemic therapy with or without stereotactic body radiotherapy in patients with oligoprogressive breast cancer or non-small-cell lung cancer (Consolidative Use of Radiotherapy to Block [CURB] oligoprogression): an open-label, randomised, controlled, phase 2 study

Most patients with metastatic cancer eventually develop resistance to systemic therapy, with some having limited disease progression (ie, oligoprogression). We aimed to assess whether stereotactic body radiotherapy (SBRT) targeting oligoprogressive sites could improve patient outcomes. We did a phase 2, open-label, randomised controlled trial of SBRT in patients with oligoprogressive metastatic breast cancer or non-small-cell lung cancer (NSCLC) after having received at least first-line systemic therapy, with oligoprogression defined as five or less progressive lesions on PET-CT or CT. Patients aged 18 years or older were enrolled from a tertiary cancer centre in New York, NY, USA, and six affiliated regional centres in the states of New York and New Jersey, with a 1:1 randomisation between standard of care (standard-of-care group) and SBRT plus standard of care (SBRT group). Randomisation was done with a computer-based algorithm with stratification by number of progressive sites of metastasis, receptor or driver genetic alteration status, primary site, and type of systemic therapy previously received. Patients and investigators were not masked to treatment allocation. The primary endpoint was progression-free survival, measured up to 12 months. We did a prespecified subgroup analysis of the primary endpoint by disease site. All analyses were done in the intention-to-treat population. The study is registered with ClinicalTrials.gov, NCT03808662, and is complete. From Jan 1, 2019, to July 31, 2021, 106 patients were randomly assigned to standard of care (n=51; 23 patients with breast cancer and 28 patients with NSCLC) or SBRT plus standard of care (n=55; 24 patients with breast cancer and 31 patients with NSCLC). 16 (34%) of 47 patients with breast cancer had triple-negative disease, and 51 (86%) of 59 patients with NSCLC had no actionable driver mutation. The study was closed to accrual before reaching the targeted sample size, after the primary efficacy endpoint was met during a preplanned interim analysis. The median follow-up was 11·6 months for patients in the standard-of-care group and 12·1 months for patients in the SBRT group. The median progression-free survival was 3·2 months (95% CI 2·0-4·5) for patients in the standard-of-care group versus 7·2 months (4·5-10·0) for patients in the SBRT group (hazard ratio [HR] 0·53, 95% CI 0·35-0·81; p=0·0035). The median progression-free survival was higher for patients with NSCLC in the SBRT group than for those with NSCLC in the standard-of-care group (10·0 months [7·2-not reached] vs 2·2 months [95% CI 2·0-4·5]; HR 0·41, 95% CI 0·22-0·75; p=0·0039), but no difference was found for patients with breast cancer (4·4 months [2·5-8·7] vs 4·2 months [1·8-5·5]; 0·78, 0·43-1·43; p=0·43). Grade 2 or worse adverse events occurred in 21 (41%) patients in the standard-of-care group and 34 (62%) patients in the SBRT group. Nine (16%) patients in the SBRT group had grade 2 or worse toxicities related to SBRT, including gastrointestinal reflux disease, pain exacerbation, radiation pneumonitis, brachial plexopathy, and low blood counts. The trial showed that progression-free survival was increased in the SBRT plus standard-of-care group compared with standard of care only. Oligoprogression in patients with metastatic NSCLC could be effectively treated with SBRT plus standard of care, leading to more than a four-times increase in progression-free survival compared with standard of care only. By contrast, no benefit was observed in patients with oligoprogressive breast cancer. Further studies to validate these findings and understand the differential benefits are warranted. National Cancer Institute.

The clinico-epidemiological, diagnostic and therapeutic aspects of methanol poisoning: A five-year retrospective study, northern Iran

IntroductionMethanol poisoning (MP) is a serious health issue that has become more prevalent in recent years and has resulted in numerous deaths. Early detection and timely treatment are critical for preventing fatalities and reducing the incidence of neurological complications. Patients and methodsThis study was designed as a retrospective investigation with the purpose of analyzing the clinico-epidemiological, diagnostic, and therapeutic aspects of patients who were admitted to two training hospitals in northern Iran due to MP. The selection of samples for this study was based on a pre-defined checklist. Following the completion of the treatment period in the hospital, the patients were categorized into three groups based on their clinical outcome. All relevant variables for each group were recorded and reported separately, using the SciPy library in the Python programming language. ResultsThe majority of the patients (88.12%) were male (P=0.012), the average age was 41.46, and mostly (82.18%) lived in urban regions (P=0.025). The primary clinical complaint reported was visual disorders, accounting for 75.25% of the cases, followed by nervous, gastrointestinal, respiratory, and chest pain accordingly. The average hospitalization length for the patients was 5.065 days. Out of the 101 patients, 65 (64.36%) were discharged without any complications, 17 (16.83%) were discharged with complications, and unfortunately, 19 (18.81%) were died. ConclusionA decreased level of consciousness and severe metabolic acidosis are commonly associated with unfavorable outcomes in MP. The use of systemic corticosteroids as a treatment method has a significant association with reducing mortality rates.

Ginger Update

The spice ginger is prepared from the rhizome of Zingiber officinale (Rosc.) belonging to the family Zingiberaceae. The unique aromas and flavors of the many cultivars make them suited for multiple food-related purposes. Besides being used in the preparation of pickles, candies, gingerbread, biscuits, soups, puddings, alcoholic beverages, and soft drinks, ginger and its extracts are also packaged in dietary supplements. Ginger has been a part of traditional medicine for thousands of years treating such ailments as gastrointestinal disorders, nausea, pain, cold, and asthma. In the past 10 to 15 years, a considerable number of preclinical and clinical studies have explored in more detail the potential of ginger to ameliorate diverse conditions such as nausea and vomiting, glycemic dysfunction, pain, and the metabolic syndrome. This narrative review provides an update on the clinical evidence related to potential benefits of ginger and discusses future research opportunities.

Investigating Antibody Reactivity to the Intestinal Microbiome in Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): A Feasibility Study.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a multisystemic disease of unknown aetiology that is characterised by disabling chronic fatigue and involves both the immune and gastrointestinal (GI) systems. Patients display alterations in GI microbiome with a significant proportion experiencing GI discomfort and pain and elevated blood biomarkers for altered intestinal permeability compared with healthy individuals. To investigate a possible GI origin of ME/CFS we designed a feasibility study to test the hypothesis that ME/CFS pathogenesis is a consequence of increased intestinal permeability that results in microbial translocation and a breakdown in immune tolerance leading to generation of antibodies reactive to indigenous intestinal microbes. Secretory immunoglobulin (Ig) A and serum IgG levels and reactivity to intestinal microbes were assessed in five pairs of severe ME/CFS patients and matched same-household healthy controls. For profiling serum IgG, we developed IgG-Seq which combines flow-cytometry based bacterial cell sorting and metagenomics to detect mucosal IgG reactivity to the microbiome. We uncovered evidence for immune dysfunction in severe ME/CFS patients that was characterised by reduced capacity and reactivity of serum IgG to stool microbes, irrespective of their source. This study provides the rationale for additional studies in larger cohorts of ME/CFS patients to further explore immune-microbiome interactions.

THU294 Glucagon Like Peptide-1 Analogue Therapy In Obese Patients With Cystic Fibrosis Related Diabetes

Abstract Disclosure: A.R. Ankireddypalli: None. A. Moheet: None. Introduction: Cystic fibrosis (CF) has classically been associated with malnutrition and being underweight. Intense emphasis on nutritional augmentation and advancement in medical therapies including recent introduction of CFTR modulators have significantly reduced the prevalence of malnutrition in CF. However, this success has been accompanied by a significant rise in overweight/obesity in CF. Recent studies have reported that one-third of all adult CF patients are overweight or obese. Glucagon like peptide receptor-1 agonists (GLP-1RA) therapy is an effective treatment for type 2 diabetes mellitus (T2DM) and obesity. Current guidelines for CF related diabetes (CFRD), recommend insulin as the mainstay of treatment. However, with increase in prevalence of obesity, there is increased interest in examining the role of incretin-based therapies in CFRD. Gastrointestinal (GI) symptoms like abdominal pain, steatorrhea, gastroparesis are common in CF. Concerns about the potential GI side effects had previously dampened the enthusiasm for these drugs in CF.The objective of this case series is to demonstrate impact on glycemic control and weight, and tolerability of GLP1-RA treatment in obese patients with CFRD and pancreatic insufficiency (PI) after 1 year of therapy. Case 1: A 21-year-old female with CF (delta F508 homozygote) and PI, was diagnosed with CRFD at 15 years. She was initially on lantus 14 units daily with HbA1c of 6.7%. She was started on CFTR modulator therapy and with increase in BMI from 37 to 45 in 1 year with HbA1c of 8.9%. She was started on semaglutide and tolerated the medication well with no GI side effects. 1 year later her BMI reduced to 42 and HbA1c was 8.2%. Case 2: A 62-year-old male with CF (delta F508 heterozygote) and PI, diagnosed with CFRD at age 44 years. He was on lantus 66 units and aspart 1 unit per 5 grams carbohydrate coverage. He was started on CFTR modulator and in 1 year BMI increased from 53 to 57. He was started on semalglutide, which he tolerated well with no GI symptoms. 1 year later his Hba1c improved to 7% with a BMI of 54. Discussion: In this era of CFTR modulator therapy, CF patients are faced with changing metabolic parameters, including weight gain and developing T2DM phenotype with insulin resistance. There is one previous case report of short duration of GLP-1RA use in CFRD. We report &amp;gt; 1 year of clinical experience of GLP-1RA use in 2 patients. GLP-1RA was well tolerated in these patients with improvement in glycemic control and weight loss. GLP-1 RA should be considered in obese, PI patients with CFRD as an add-on therapy to insulin. However, larger studies with long-term follow up are required to study the full impact of GLP-1RA to establish it as a treatment option in CFRD. Presentation: Thursday, June 15, 2023

Plateau pika fecal microbiota transplantation ameliorates inflammatory bowel disease manifestations in a mouse model of colitis.

Inflammatory bowel disease (IBD) is a serious global public health concern. Although the pathogenesis of the disease is currently unknown, it has been reported to be associated with both intestinal microbiota and inflammatory mediators. There is evidence suggesting that the feces of the Plateau pika is useful for treating gastrointestinal injuries and pain. Although fecal microbiota transplantation is highly efficacious intervention for IBD prevention, however, potential the transfer of pathogenic microbes or toxic substances is potentially hazardous. Fortunately, micropore filtering of the donor feces can minimize the risk of bacterial infection allowing retention of the therapeutic effects of the residual bacteriophages. Here, we demonstrated that Plateau pika feces not only alleviated the IBD symptoms but also promoted optimal structure and composition of the intestinal microbiota. Additionally, Plateau pika feces transfer also enhanced phenotypic features, such as, body-weight, disease activity index, and histological scores. In conclusion, Plateau pika feces was found to protect mice against colitis induced by dextran sodium sulfate by reducing inflammation and regulating microbial dysbiosis. These findings suggest the potential of Plateau pika feces as an alternative therapy for IBD.

Applications of Beehive Products for Wound Repair and Skin Care

There is a long and interesting history between honeybees and humans. From the beginning, honey has been utilized not only as a sweetener, but also as an ointment and a drug to treat several diseases. Until the discovery of antibiotics, honey was a very popular product used to protect and preserve skin and promote wound healing, to counteract gastrointestinal pains and disorders of the oral cavity, and for other diseases. After the development of antibiotic resistance, honey again gained interest for its use in wound management. Subsequently, more recently, in vitro and in vivo studies have displayed antimicrobial, antioxidant, and other effects of honey and honeybee products, as well as protection of cardiovascular, respiratory, nervous, and gastrointestinal systems. Moreover, recent studies have demonstrated that beehive products are also able to influence the phenotype of skin cells, such as keratinocytes, fibroblasts, and endothelial cells, involved in correct wound healing. This review will characterize the great potential of honeybee products in the field of health and skin care, considering that honey is a virtually inexhaustible natural resource which people, as bees have been domesticated over the centuries, can freely access.