Gastrointestinal Quality Research Articles

High-dose probiotic mix of Lactobacillus spp., Bifidobacterium spp., Bacillus coagulans, and Saccharomyces boulardii to prevent antibiotic-associated diarrhea in adults: a multi-center, randomized, double-blind, placebo-controlled trial (SPAADA)

Abstract Background Probiotics have been used to prevent antibiotic-associated diarrhea (AAD), but practical guidelines are sparse. This trial evaluated the efficacy and safety of a high-dose, multi-strain probiotic mix (Sinquanon®), specially designed for prevention of AAD in adults. Methods A Phase IV, multi-center, randomized, double-blind, placebo-controlled, parallel-group clinical trial was conducted over 5 months. Participants receiving broad-spectrum antibiotics were administered the specialized probiotic mix or placebo from the first dose of antibiotics until 14 days after the last antibiotic dose. The primary outcome measure was the incidence of AAD. Results In total, 564 participants were randomized (probiotic mix: 285; placebo: 279), of which 9 participants discontinued the trial early (probiotic mix: 3; placebo:6), had no efficacy data, and were excluded from the efficacy analysis. The 555 remaining participants completed the trial and were included in the efficacy analysis (probiotic mix: 282; placebo: 273). AAD occurred less frequently in the studied probiotic mix versus placebo group (9.2% versus 25.3%, p<0.001), resulting in an absolute risk reduction of 16% and a number needed to treat of 6 (95% CI: 4.55-10.49). A significant improvement in the average gastrointestinal quality of life in the studied probiotic mix versus placebo group was also observed. There were no clinically relevant differences in the incidence of adverse events between the studied probiotic mix and the placebo group. Conclusions The specially designed high-dose, multi-strain probiotic mix (Sinquanon®) demonstrated to be beneficial compared with placebo in the prevention of AAD in adults who received broad-spectrum antibiotics. ClinicalTrials.gov Identifier NCT05607056.

Intestinal inflammation and permeability in patients recovered from SARS-CoV-2 infection.

Different works suggest a close link between Long COVID Gastrointestinal (GI) manifestations and the post-infection disorders of gut-brain interaction (PI-DGBIs). However, the actual mechanisms underlying long-term GI sequelae are still not clear. Our study was aimed to assess both intestinal inflammation and permeability among subjects recovered from SARS-CoV-2 infection and their eventual correlation with long-term GI sequelae. Eighty-six subjects attending the Post-COVID Service and recovered from SARS-CoV-2 infection for six months, were investigated for Long COVID manifestations. Those subjects complaining of long-term GI symptoms were further evaluated by Rome IV questionnaire to assess PI-DGBIs. Intestinal inflammation (by fecal calprotectin, FC), and permeability (by serum and fecal levels of zonulin) were evaluated in all subjects. The Hospital Anxiety and Depression Scale (HADS) and The Gastrointestinal Quality of Life Index (GIQLI) questionnaires were further provided to all participants. Thirty-seven subjects (43%) complained of long-term GI symptoms, while 49 subjects (57%) did not. Thirty-three subjects fulfilled Rome IV criteria for PI-DGBIs. FC values resulted higher in those subjects who did not complain GI symptoms (p=0.03), although remaining quite close to the normal range. No significant differences were shown regarding the assessment of intestinal permeability. By GIQLI, long-term gastrointestinal sequelae were inversely correlated with quality of life (p=0.009). Long COVID GI complaints unlikely recognize underlying local inflammatory mechanisms. Since the healthcare, economic, and social burden of post-COVID DGBIs, a deeper understanding of this emerging condition should be encouraged to improve management of the affected subjects.

Evaluating T1-weighted MRI techniques for fetal gastrointestinal diagnostics: A comparative study

PurposeIn clinical practice, fetal gastrointestinal magnetic resonance imaging (MRI) encounters significant challenges. T1-weighted images are particularly susceptible to the effects of fetal and maternal movements compared to other weighted images, complicating the acquisition of satisfactory results. This study aimed to compare three fast 3D-T1 weighted gradient echo (GRE) sequences—free-breathing stack-of-stars VIBE (STAR-VIBE), breath-hold VIBE (BH-VIBE), and free-breathing multi-average VIBE (MA-VIBE)—for fetal gastrointestinal MRI in fetuses with both normal and abnormal gastrointestinal tracts between 21 and 36 weeks of gestation. MethodsThis study enrolled 67 pregnant women who underwent fetal abdominal MRI at our hospital between October 2022 and October 2023, during their gestational period of 21–36 weeks. Among these participants, 22 were suspected of having fetal gastrointestinal anomalies based on ultrasound findings, while the remaining 45 were considered to have normal fetal gastrointestinal development. All subjects underwent True fast imaging with steady-state precession sequence scanning along with three T1-weighted imaging techniques on a Siemens 1.5-T Aera scanner: STAR-VIBE, BH-VIBE, and MA-VIBE. Two radiologists evaluated image quality, intestinal clarity, and lesion conspicuity using a five-point scale where higher scores indicated superior performance for each technique; they were blinded to the acquisition schemes used. Interobserver variability assessments were also conducted. ResultsThe free-breathing MA-VIBE sequence demonstrated significantly better performance than both STAR-VIBE and BH-VIBE in terms of fetal gastrointestinal MRI quality (3.81 ± 0.40 vs. 3.35 ± 0.70 vs. 2.90 ± 0.64; p < .05). The STAR-VIBE and BH-VIBE sequences exhibited moderate consistency (kappa = 0.586 and kappa = 0.527 respectively; P < .05), whereas the MA-VIBE sequence showed higher consistency (kappa = 0.712; P < .05). ConclusionThe free-breathing MA-VIBE sequence provided superior visualization for assessing fetal intestinal conditions compared to other methods employed in this study. On a 1.5 T MRI device, T1-weighted images based on the free-breathing MA-VIBE sequence can effectively overcome motion artifacts and compensate for the reduced signal-to-noise ratio caused by the application of acceleration techniques, thus significantly improving the quality of T1-weighted images.

Gastrointestinal function and pain outcomes following segmental resection or discoid resection for low rectal endometriosis.

This study aims to examine the effect of full thickness discoid resection (FTDR) and modified, limited nerve-vessel sparing segmental bowel resection (NVSSR) in symptomatic patients with low rectal deep endometriosis (DE) within 7 cm from the anal verge. Presurgical and postsurgical evaluation of gastrointestinal (GI) function reflected by low anterior resection syndrome (LARS) and gastrointestinal function-related quality of life index (GIQLI) scores, complication rates, pain scores/visual analog scale (VAS) and endometriosis health profile (EHP-30) was performed. In this prospective multicenter cohort study, 63premenopausal patients with symptomatic low (within 7 cm from the anal verge) colorectal endometriosis, undergoing low modified limited nerve vessel sparing rectal segmental bowel resection (NVSSR) and full thickness discoid resection (FTDR) were evaluated. Presurgery and postsurgery lower anterior resection syndrome (LARS) scores, gastrointestinal function-related quality of life index (GIQLI), pain symptoms, endometriosis health profile (EHP-30) parameters compared between two groups. Out of 63women, 49(77.8%) underwent NVSSR while 14(22.2%) underwent FTDR. LARS-like symptoms were observed presurgically in 24/63 (38.1%) patients. Postsurgical LARS was observed in 14/63 (22.2%) of the patients (10/49, 20.4% in NVSSR vs.4/14, 28.5% in the FTDR group). The LARS-like symptoms significantly decreased following surgery in the FTDR group (p = 0.049) and showed atrend for decrease in the NVSSR group (p = 0.077). Postsurgical de novo LARS was only observed in 5/63 (8%) of the patients (NVSSR 4/49, 8.1%, FTDR 1/14, 7.1%). Postsurgical GIQLI scores improved in both groups (p < 0.001) with comparable changes in the NVSSR and FTDR cohorts (p = 0.490). Postoperative gradeIII complication rates between NVSSR and FTDR did not vary significantly (6/49, 12.2% vs.3/14, 21.4% p = 0.26). Pain/VAS scores and EHP-30 scores significantly decreased after amean follow-up of 29.6 ± 11 months and 30.6 ± 11months in the NVSSR and FTDR groups, respectively (EHP-30; p < 0.001; dysmenorrhea, dyspareunia, dyschezia all p < 0.05 for both cohorts). When comparing low colorectal surgery by either NVSSR or FTDR in ahigh-risk group for surgical complications, both techniques confer improvement of GI function reflected by LARS and GIQLI with non-significant differences in major complication rates, reduced pain and EHP-30 scores.

410. THE RELATIONSHIP BETWEEN GASTRIC CONDUIT EMPTYING, FUNCTIONAL ANATOMY AND PERISTALSIS: A DETAILED ANALYSIS USING DYNAMIC MAGNETIC RESONANCE IMAGING

Abstract Background Gastric conduit peristalsis post oesophagectomy is an important mediator of conduit emptying and consequently gastrointestinal symptoms and quality of life. The relationship between anatomical variations of the conduit, peristaltic function and transpyloric flow are incompletely defined. We aimed to analyse gastric conduit function using dynamic MRI to evaluate functional anatomy, quantify peristaltic function and measure emptying. Methods Eighteen patients with gastric conduit reconstruction post oesophagectomy and 12 controls with normal gastric anatomy were recruited. Dynamic and static sequences of MRI following ingestion of a semi solid meal were obtained. Peristalsis variables including Gastric Motor Index (GMI - Velocity x Amplitude) were measured at 4 time points throughout the MRI, and volume scans were taken at the beginning and end of the 20-minute scanning period. Nuclear Scintigraphy conduit emptying studies were obtained from 17/18 (94%) of patients. Quality of Life questionnaire data was collected. Results Nine (50%) conduits demonstrated coordinated peristalsis, 3(16.7%) had no measurable peristalsis and 6 (33.3%) had incoordinate peristalsis. Regarding conduits vs controls, there was no difference in peristaltic wave frequency (5 vs 5/90 seconds) or GMI (35.45 vs 36.5, p=0.61), but emptying was decreased (0.10% vs 15% p=0.01). Acute angulation of the conduit was associated with a slower emptying half time (444 vs 127 min, p=0.025). Conduit width and location of the pylorus relative to the hiatus made no significant difference to peristalsis or emptying. Quality of life scores were significantly better in controls compared with conduits. Conclusion Although coordinate peristalsis was present in many conduits, it did not appear to be a key mediator of conduit emptying. Conduit shape and location within the mediastinum significantly affected emptying. These data demonstrate that construction of the conduit at the index operation may be a key factor in long term function and reducing gastrointestinal symptoms. Dynamic MRI is a promising research and diagnostic tool to assess conduit function due to its capacity to accurately delineate the key elements of conduit function.

“Gastrointestinal Quality of Life After Congenital Duodenal Obstruction Repair: A Nationwide Long-term Follow-up Study”

BackgroundCongenital duodenal obstruction (CDO) is one of the most common gastrointestinal congenital anomalies. Still, patient-reported long-term results are limited. The aims of this study were to evaluate the long-term gastrointestinal quality of life (QoL), generic QoL, patient-reported scar appearance, and reinterventions after CDO repair. MethodsPatients who underwent surgery for CDO in Norway from 1995 to 2020 were invited to answer the validated questionnaires PedsQL and PedsQL gastrointestinal symptom scale and a study-specific questionnaire on general health and scar assessment. Parent-proxy reports were used for patients <12 years and patients with cognitive impairment. Scores were compared with an American and Norwegian control group for gastrointestinal and generic QoL, respectively. ResultsOf 186 eligible patients, eight were deceased, 25 had unretrievable contact information, and 79 did not respond. There were no significant differences between included (n = 74) and not included (n = 112) patients regarding baseline data. The mean follow-up time was 13.3 (SD = 6.6) years. Patients with CDO had significantly lower overall gastrointestinal QoL than controls (85.9 versus 90.0, p = 0.010). The most common symptoms were gas/bloating, constipation, food/drink limits, and reflux. Generic QoL was similar between the CDO population and controls (84.4 versus 85.3, p = 0.530). Twenty-one (28 %) patients had some degree of pain and/or concern related to the surgical scar. Nine (12 %) patients had reoperations related to the CDO repair; four due to adhesive small bowel obstruction. ConclusionA notable portion of patients report troublesome gastrointestinal symptoms and cosmetic concerns regarding their surgical scar after CDO repair. Even so, generic QoL was good. Level of evidenceIV.

586. VALUE OF PEPSIN IN SALIVA TO ASSESS THE POSTOPERATIVE OUTCOME OF PATIENTS WITH GERD

Abstract Background The aim of this study was to evaluate the value of salivary pepsin to assess the outcome of surgical treatment of patients with gastroesophageal reflux (GERD). Methods Forty-five consecutive patients with GERD despite proton pump inhibitor treatment received laparoscopic anti-reflux surgery (LARS). 24-hour esophageal pH-monitoring (MII-pH) and esophageal manometry (HRM) data were documented preoperatively and at 3-month follow-up. Clinical symptoms were rated with the Gastrointestinal Quality of Life Index (GIQLI) and gastrointestinal symptoms were evaluated by a standardized symptom checklist (SCL), assessing the severity and intensitiy of 14 different symptoms. Simultaneous to MII-pH the collection of 3 saliva samples per patient was performed. Treatment failure was defined as improvement of GIQLI and SCL of &amp;lt; 10 points, despite showing a normal DeMeester score. Results At baseline, all patients showed a pathological MII-pH measurement. Furthermore, all patients showed postoperatively a normal DeMeester score (mean 7.10 ± 4.56). Ten patients were defined as treatment failures with a change of pepsin concentration from a mean value of 198.73 ng/mL to 186.00 ng/mL (p&amp;gt;0.05). In patients defined as treatment success, mean pepsin value decreased from 205.83 ng/mL to 85.24 ng/mL (p&amp;lt;0.001). Conclusion Salivary pepsin could be a marker for treatment success after LARS. However, larger studies are required to reach firm conclusions.

Quality of life with diverticular disease: translation and validation of the German version of the diverticulitis quality of life questionnaire (DV-QOL).

The DV-QoL is a 17-item questionnaire measuring health-related quality of life in patients affected by symptomatic diverticular disease, covering four domains: physical symptoms, concerns, feelings, and behavioral changes. Given the lack of a diverticulitis-specific questionnaire to be used for German-speaking patients, we prospectively validated the German version of the DV-QoL. German-speaking patients with CT-confirmed history of recurrent diverticular disease admitted to a Swiss surgical department completed the German version of the DV-QoL, along with short form-36 (SF-36) and the Gastrointestinal Quality of Life Index (GIQLI). Reliability was examined using exploratory and confirmatory factor analysis, a Martin-Loef test, and Cronbach's alpha. For convergent validity testing, correlations were calculated with the GIQLI and SF-36. Discriminant validity tests included age and gender. We included 121 patients, of whom 77 were admissions for elective surgery and 44 presented with acute diverticulitis treated conservatively. The DV-QoL's total score showed good correlations with the GIQLI (r = -0.77) and its subscales (r = -0.76 to -0.45), as well as with the SF-36's subscales (r = -0.30 to -0.57). No relationships were found with age or gender (p < 0.05). The Cronbach's alpha coefficient was 0.89 over all items and 0.69, 0.90, 0.78, and 0.77 for the four separated domains (physical symptoms, cognitions/concerns, feelings, and behavioral changes, respectively). A nonsignificant Martin-Loef test indicated unidimensionality (p = 1), further supported by the exploratory factor analysis, which showed an item information sharing of 65%. The German DV-QoL questionnaire can be used as a valid and reliable disease-specific measure for quality of life in patients with recurrent diverticular disease.

Exploring the Effect of Qi Cross-Shaped Moxibustion on the Recovery of Gastrointestinal Function after Hip Fracture in the Elderly

Objective: To explore the effect of Qi cross-shaped moxibustion on the recovery of gastrointestinal function in elderly hip fracture patients after surgery. Methods: 62 elderly hip fracture surgery patients were selected as the base analysis sample, enrolled in January 2023–May 2024, and divided into an observation group (n = 31) and a control group (n = 31) using the digital table random draw scheme. The patients in the control group underwent conventional dietary intervention, and the patients in the observation group underwent Qi cross-shaped moxibustion intervention, comparing the gastrointestinal function recovery time and quality of life scores (PAC-QOL) of patients with constipation between the two groups. Results: The gastrointestinal function recovery time of the observation group was lower than that of the control group (P &lt; 0.05); the PAC-QOL score of the observation group was lower than that of the control group after the intervention (P &lt; 0.05). Conclusion: Qi cross-shaped moxibustion can shorten the recovery time of gastrointestinal function and improve the quality of life of elderly hip fracture patients after surgery, and it has the value of promotion and application.

The Swedish PedsQL gastrointestinal symptoms scale and symptoms module showed good psychometric performance.

There is no validated symptom scale for Swedish children with gastrointestinal disorders. Our aim was to validate the Swedish version of the Paediatric Quality of Life Inventory (PedsQL) gastrointestinal symptoms scale and symptoms module. Families were recruited from two hospitals in Gothenburg, Sweden, from 1 March 2021 to 31 October 2022. The instruments were completed by 115 children with functional, congenital or organic acquired gastrointestinal disorders and 149 of their parents. These were the gastrointestinal symptoms scales, symptoms module and the 4.0 Generic core scale. Data were analysed for feasibility, construct validity and reliability, including internal consistency, re-test reliability and child-parent agreement. Feasibility was good, with a failure to respond of ≤5%. Construct validity showed strong correlation in the PedsQL gastrointestinal symptoms module. The known-group validity agreed with the expectations associated with the disease characteristics (p < 0.05). Cronbach's alpha was 0.96, which indicated excellent internal reliability. The intraclass correlation coefficient for the child self-report and parent-proxy report was 0.74, which indicated good agreement. The Swedish PedsQL Gastrointestinal Symptoms Scales, the symptoms module provided acceptable measurement properties and can be used to evaluate symptoms of gastrointestinal disorders and quality of life during clinical work or research projects.

Using Social Media to Understand Primary Discussions in Gastrointestinal Cancers: Machine Learning Approach.

The incidence and mortality rates of gastrointestinal (GI) cancers are high in the United States as well as worldwide. The widespread use of social media provides unique opportunities to facilitate the dissemination of information, especially in the context of health. We aim to characterize the public's primary discussions, including perceptions, concerns, and interests toward GI cancers, from prevention, diagnosis, and treatment to survivorship care through the social media platform Twitter, using tweets posted by Twitter users. We analyzed 87 860 Twitter posts related to GI cancers. We used machine learning with natural language processing to identify salient topics and themes in the collected tweets. The most common themes across all GI cancer types included cancer risk prevention and awareness outreach programs, risk factors including lifestyles (primarily diet), and cancer survivorship-related discussions (primarily GI symptoms and quality of life). GI symptom-related tweets were prevalent in patients with colorectal and stomach cancers, whereas themes of newer clinical trials, end-of-life trials, palliative care trials, and disease prognosis were common in tweets related to liver/biliary and pancreatic cancers. Our research emphasizes the importance of individualized approaches in managing GI cancers, considering lifestyle and diet, the need for comprehensive survivorship care, raising awareness, delivering information, and improving targeted interventions related to GI cancers. Our study suggests utilizing Twitter data to better understand the real-world interest and concerns about GI cancers among the public, which can guide future patient-centered research in this field.

Ablative Radiation Therapy for Unfavorable Prostate Tumors (ABRUPT): Preliminary Analysis of Toxicity and Quality of Life from a Prospective Study

To assess late gastrointestinal (GI) and genitourinary (GU) side effects in patients with organ-confined unfavorable prostate cancer (PCa) treated with single-dose ablative radiation therapy (SDRT). Thirty patients enrolled in a single-arm prospective trial received 24 Gy SDRT to the whole prostate with urethra-sparing and organ motion control delivered on a Linac platform with a 10 MV flattening filter-free single partial arc. Androgen deprivation therapy was prescribed as per standard of care. Treatment-related acute and late GU and GI toxicities (Common Terminology Criteria for Adverse Events_v5 scale) and quality of life (QoL) outcomes (European Organisation for Research and Treatment of Cancer [EORTC] QLQ-PR25/C30, International Prostate Symptom Score [IPSS]) were assessed at different time points. Minimal important difference (MID) was established as a change of >0.5 pooled standard deviations from baseline. Statistical analysis included analysis of variance and logistic regression. Median follow-up was 18 months (range, 6-31 months), with no ≥G3 late side effects observed. G2 late GI and G2 late GU toxicities occurred in 1 and 2 patients, respectively. GI toxicity of any grade correlated with maximum rectal dose (P = .021). Lower baseline QoL score (P = .025), higher baseline IPSS score (P = .049), acute GU toxicity (P = .029), and acute urinary domain MID (P = .045) predicted GU toxicity of any grade. In multivariate analysis (MVA), only baseline QoL score (odds ratio [OR], 0.95, P = .031) and acute GU toxicity (OR, 8.4, P = .041) remained significant. Significant QoL change was observed only in the urinary domain (P = .005), with a median increase from 8 to 17. Late urinary MID correlated with acute urinary MID (P = .003), acute QoL MID (P = .029), acute GU toxicity (P = .030), and lower baseline urinary score (P = .033). In MVA, only acute urinary MID predicted late urinary MID (OR, 9.7, P = .035). Our findings provide promising data on the feasibility and safety of 24 Gy whole-gland SDRT with urethra-sparing and organ motion control, in association with androgen deprivation therapy and an adequate prophylactic medication, in organ-confined unfavorable PCa. Long-term follow-up is needed to confirm these results.

Psychosocial outcomes following emergency laparotomy (POLO) study: a study protocol for a multicentre mixed-methods prospective cohort study assessing the psycho-social outcomes following emergency laparotomy in adults

IntroductionMorbidity from an emergency laparotomy (EmLap) is difficult to define and poorly understood. Morbidity is a holistic concept, reliant upon an interplay of bio-psychosocial outcomes that evolve long after discharge....

Comparison of Digitally Delivered Gut-Directed Hypnotherapy Program With an Active Control for Irritable Bowel Syndrome.

Gut-directed hypnotherapy (GDH) treats irritable bowel syndrome (IBS), but its accessibility is limited. This problem may be overcome by digital delivery. The aim of this study was to perform a randomized control trial comparing the efficacy of a digitally delivered program with and without GDH in IBS. Adults with IBS were randomized to a 42-session daily digital program with the GDH Program (Nerva) or without (Active Control). Questionnaires were completed to assess gastrointestinal symptoms through IBS Symptom Severity Scale (IBS-SSS), quality of life, and psychological symptoms (Depression Anxiety and Stress Scale-21) at regular intervals during the program and 6 months following the conclusion on the intervention. The primary end point was the proportion of participants with ≥50-point decrease in IBS-SSS between the interventions at the end of the program. Of 240/244 randomized participants, 121 received GDH Program-the median age 38 (range 20-65) years, 90% female, IBS-SSS 321 (interquartile range 273-367)-and 119 Active Control-36 (21-65), 91% female, IBS-SSS 303 (255-360). At program completion, 81% met the primary end point with GDH Program vs 63% Active Control ( P = 0.002). IBS-SSS was median 208 (interquartile range 154-265) with GDH and 244 (190-308) with control ( P = 0.004), 30% reduction in pain was reported by 71% compared with 35% ( P < 0.001), and IBS quality of life improved by 14 (6-25) compared with 7 (1-15), respectively ( P < 0.001). Psychological status improved similarly in both groups. A digitally delivered GDH Program provided to patients with IBS was superior to the active control, with greater improvement in both gastrointestinal symptoms and quality of life and provides an equitable alternative to face-to-face behavioral strategies.

Honey Added to Yogurt with Bifidobacterium animalis subsp. lactis DN-173 010/CNCM I-2494 Supports Probiotic Enrichment but Does Not Reduce Intestinal Transit Time in Healthy Adults: A Randomized, Controlled, Crossover Trial

BackgroundHoney improves probiotic survival in vitro. However, if this effect translates to humans has not been investigated. ObjectivesWe aimed to determine effects of honey plus yogurt containing the probiotic Bifidobacterium animalis subsp. lactis DN-173 010/CNCM I-2494 (B. animalis) on intestinal transit time, probiotic enrichment, digestive health, mood, and cognition in adults. MethodsSixty-six healthy adults (34 female; 33.6 ± 9.8 y; 24.6 ± 3.0 kg/m2) in a crossover trial were randomly assigned to 2-wk yogurt conditions in a counterbalanced order with ≥4-wk washout: 1) Honey (HON): yogurt plus honey and 2) Negative Control (NC): heat-treated yogurt plus sugar. Of the participants, n = 62 completed the trial, and n = 37 (17 female; 32.0 ± 8.3 y; 25.0 ± 2.9 kg/m2) elected to enroll in a third condition (a nonrandomized study extension) after ≥4-wk washout with a reference Positive Control (PC): yogurt plus sugar. At baseline and end of each of the 3 conditions, intestinal transit time was measured with dye capsules; probiotic abundance with fecal DNA 16S sequencing; digestive health with symptom/function records, Bristol stool consistency, Gastrointestinal Tolerability, and Gastrointestinal Quality of Life Index; mood with Positive and Negative Affect Schedule-Short Form, Depression Anxiety Stress Scales-42, Patient-Reported Outcomes Measurement Information System questionnaires, and an emotional image task; and cognition with a spatial reconstruction task. Data were analyzed using linear mixed-effects models (LMMs) with significance at P ≤ 0.05. Baseline and end data were included in the LMM, with fixed effects being treatment, time, treatment by time interaction, and baseline covariate, and the random effect being the participant. ResultsB. animalis was enriched in HON (d = 3.54; P = 0.0002) compared to controls with linear discriminant analysis effect size. Intestinal transit time, gastrointestinal health, mood, and cognition did not differ between conditions (LMM: Ps > 0.05). ConclusionsYogurt + honey enriched B. animalis but did not reduce intestinal transit time or have other functional gastrointestinal, mood, or cognitive effects in adults.This trial was registered at www.clinicaltrials.gov as NCT04187950 and NCT04901390.

Follow-Up Colonoscopy for Detection of Missed Colorectal Cancer After Diverticulitis

Background and aimsColonoscopy is often recommended following an episode of diverticulitis to exclude missed colorectal cancer (CRC). This is a controversial recommendation based on limited evidence. We estimated the prevalence and odds of CRC and advanced colorectal neoplasia on colonoscopy in patients with diverticulitis compared to CRC screening. MethodsUsing data from the Gastrointestinal Quality Improvement Consortium registry, we performed a cross-sectional study with patients ≥40 years old undergoing outpatient colonoscopy for an indication of diverticulitis follow-up or CRC screening. The primary outcome was CRC. The secondary outcome was advanced colorectal neoplasia. Odds ratios and 95% confidence intervals were calculated. ResultsWe identified 4,591,921 outpatient colonoscopies performed for screening and 91,993 colonoscopies for diverticulitis follow-up. CRC prevalence was 0.33% in colonoscopies for screening and 0.31% in colonoscopies for diverticulitis. Compared to screening, patients with diverticulitis were less likely to have CRC (adjusted OR 0.84, 95% CI 0.74-0.94). CRC prevalence decreased to 0.17% in colonoscopies performed for diverticulitis only. Compared to screening, patients with diverticulitis as the only indication were less likely to have CRC (adjusted OR 0.49, 95% CI 0.36-0.68). CRC prevalence increased to 1.43% in patients with complicated diverticulitis. Compared to screening, patients with complicated diverticulitis were more likely to have CRC (adjusted OR 3.57, 95% CI 1.59-8.01). ConclusionThe risk of CRC cancer is low in most patients with diverticulitis. Patients with complicated diverticulitis are the exception. Our results suggest that colonoscopy to detect missed CRC should include diverticulitis patients with a complication and those not current with CRC screening.

Totally intracorporeal colorectal anastomosis (TICA) versus classical mini-laparotomy for specimen extraction, after segmental bowel resection for deep endometriosis: a single-center experience

PurposeThe surgical approach to bowel endometriosis is still unclear. The aim of the study is to compare TICA to conventional specimen extractions and extra-abdominal insertion of the anvil in terms of both complications and functional outcomes.MethodsThis is a single-center, observational, retrospective study conducted enrolling symptomatic women underwent laparoscopic excision of deep endometriosis with segmental bowel resection between September 2019 and June 2022. Women who underwent TICA were compared to classical technique (CT) in terms of intra- and postoperative complications, moreover, functional outcomes relating to the pelvic organs were assessed using validated questionnaires [Knowles-Eccersley-Scott-Symptom (KESS) questionnaire and Gastro-Intestinal Quality of Life Index (GIQLI)] for bowel function. Pain symptoms were assessed using Visual Analogue Scale (VAS) scores.ResultsThe sample included 64 women. TICA was performed on 31.2% (n = 20) of the women, whereas CT was used on 68.8% (n = 44). None of the patients experienced rectovaginal, vesicovaginal, ureteral or vesical fistula, or ureteral stenosis and uroperitoneum, and in no cases was it necessary to reoperate. Regarding the two surgical approaches, no significant difference was observed in terms of complications. As concerns pain symptoms at 6-month follow-up evaluations on stratified data, except for dysuria, all VAS scales reported showed significant reductions between median values, for both surgery interventions. As well, significant improvements were further observed in KESS scores and overall GIQLI. Only the GIQLI evaluation was significantly smaller in the TICA group compared to CT after the 6-month follow-up.ConclusionsWe did not find any significant differences in terms of intra- or post-operative complications compared TICA and CT, but only a slight improvement in the Gastro-Intestinal Quality of Life Index in patients who underwent the CT compared to the TICA technique.

Ileorectal intussusception compared to end-to-end ileorectal anastomosis after laparoscopic total colectomy in slow-transit constipation

BackgroundAlthough end-to-end ileorectal anastomosis (EEIRA) following total colectomy is the most effective surgical treatment for slow-transit constipation (STC), frequent diarrhea and urgent defecation is often not resolved for over 6 months after surgery. ObjectiveThis study aimed to compare defecating frequency, surgical complications, and quality of life after ileorectal intussusception anastomosis (IRIA) or EEIRA following laparoscopic total colectomy for treatment of STC. MethodsThis is a retrospectively collected and analyzed data set of 100 patients with consecutive STC treated by the same medical team at Tianjin Union Medical Center from August 2016 to July 2021. Out of 100, 70 cases underwent IRIA, and 30 cases underwent EEIRA. The incidence and mortality of postoperative complications, gastrointestinal quality of life score (GIQLI), and fecal incontinence quality of life score (FIQL) were assessed at a median 3-year postoperative follow-up. The frequency of defecation, use of antidiarrheal drugs, and Wexner constipation score were assessed at the 12-month follow-up. ResultsA total of 100 patients (83 women and 17 men) were enrolled; no patients died during the study. At the 12-month follow-up, 19 patients (19/30, 63,33%) in the EEIRA group defecated >10 times after surgery. At 7 days, 1 month, 2 months, 3 months, 6 months, and 12 months after operation, there were statistically significant reductions in defecation times in the IRIA compared to the EEIRA group (all P < 0.05). ANOVA showed that the number of defecations decreased significantly in the IRIA compared to the EEIRA group (P < 0.00). Follow-up at the a median of three years showed a significant difference in the prevalence of short-term (P = 0.03) and long-term complications (P = 0.01) between the IRIA and EEIRA groups. The IRIA group had significantly improved FIQL (P = 0.03) and GIQLI scores (P = 0.01) compared to the EEIRA group at the median 3-year postoperative follow-up. ConclusionsAfter a median of three years, IRIA results in a lower prevalence of surgical complications than EEIRA and significantly improves the quality of life for STC patients by reducing defecation frequency within 12 months postoperatively.

Bowel health, defecation patterns and nutrient intake following adoption of a vegan diet: a randomized-controlled trial

Background The beneficial effects of a plant-based diet on gut microbiota diversity are well documented, however, its impact on clinical bowel health and defecation patterns are less well understood. Vegetarian diets have been associated with a higher bowel movement (BM) frequency as well as softer stools in cross-sectional studies. The effects of the de-novo adoption of a vegan diet on bowel health, however, have never been investigated in a randomized-controlled trial. Materials and Methods The present study examined bowel health and defecation patterns in relation to diet and nutrient intake in a young and healthy sample of n = 65 physically-active German university students who were randomly assigned to either a vegan or a meat-rich diet for eight weeks. Bowel health assessment included the Bristol Stool Form Scale (BSFS), the Gastrointestinal Quality of Life Index (GIQLI) and the Cleveland Clinic Fecal Incontinence Score (CCFIS). Nutrient intake was assessed using weighed food diaries. The study was prospectively registered at the German Clinical Trial Register (DRKS00031541). Results Weekly BM frequency slightly increased in vegans, whereas it remained unaltered in participants assigned to a meat-rich diet. Fiber intake increased significantly in vegans (34.89 (18.46) g/d) whereas it decreased in those assigned to the meat-rich group (22.79 (12.5) g/d). No significant intergroup differences in BSFS and CCFIS patterns were observed. Adoption of a vegan diet neither resulted in a transient increase in abdominal discomfort nor in a decreased gastrointestinal quality of life, which was comparable across the diet groups. Conclusions The short-term de-novo adoption of a vegan diet did not negatively affect markers of bowel health in this study.

Dietary habits and nutrition status in esophageal cancer patients after esophageal reconstruction.

Surgery is the cornerstone of the treatment of esophageal cancer (EC). This study is to evaluate the dietary habits and nutrition status in EC patients who underwent esophagectomy followed by esophageal reconstruction. This retrospective study included patients with EC who underwent esophagectomy followed by esophageal reconstruction in the Department of Thoracic Surgery I of Peking University Cancer Hospital between February 2014 and December 2018. The primary outcomes were dietary habits and nutrition status. The secondary outcomes were gastrointestinal symptoms and quality of life (QoL). A total of 346 patients were included. At 30 months after the operation, 90.2% of the patients had recovered to regular dietary habits, 72.8% of patients had a restored frequency of preoperative regular food intake, 2.3% of the patients ate more than six times a day, and 0.6% had semi-liquid food because of bad teeth. The nutrition status remained stable after 6 months postoperatively and recovered slightly 1 year after the surgery. At 30 months after the operation, the most common gastrointestinal symptoms were reflux (38.4%), dysphagia (15.3%), hoarseness (11.8%), abdominal distension (6.6%), diarrhea (2.9%), and nausea and vomiting (2.3%). According to the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire-OG 25 (EORTC QLQ-OG 25), the factors that affected the life quality of patients during follow-up were anxiety, reflux, and dietary limitations. Most patients with EC who underwent esophageal reconstruction recovered to regular dietary habits and stable nutrition status, while some may still suffer from gastrointestinal symptoms, anxiety, and dietary limitations.