Gastrointestinal Tract Research Articles

Methodological advances in gastrointestinal tract physiology measurements: relevance to nutritional studies

Abstract The gastrointestinal (GI) tract plays a critical role in nutrition and the pathophysiology of disease, and there is an increasing variety of methodologies available for the assessment of various aspects of GI physiology. Advancements in assessment methods, including techniques to study gut motility, fermentation, permeability, and microbiota composition, have provided researchers with powerful tools to investigate the impact of diet on GI tract physiology and the microbiota-gut-brain axis. Mechanistic evidence from reverse translational studies, which apply findings from human studies to preclinical models in a “bedside-to-bench” approach, have also enhanced our understanding of the bidirectional interactions and candidate signalling molecules among the diet-gut-brain relationship. Interpreting data from these advanced techniques and study designs requires a thorough understanding of their principles, applications, and limitations. This review aims to summarise the methodological advances in GI tract physiology measurements and their application in nutritional studies, focusing on gut motility, fermentation, and permeability. We will present examples of how these techniques have been utilised in recent research, discuss their advantages and limitations, and provide insights on their use and interpretation in research. Understanding the capabilities and limitations of these tools is crucial for designing robust studies and elucidating the complex interplay between diet and the GI tract. The scope of this review encompasses recent advancements in GI tract assessment methodologies and their implications for nutritional research, providing a comprehensive overview for researchers in the field.

Case report: a rare clinical presentation of a difficult diagnosis of dedifferentiated liposarcoma showing leiomyosarcoma phenotype in the ileocecal region

Dedifferentiated liposarcoma is a malignant lipomatous tumor that rarely occurs in the gastrointestinal tract, including the ileocecal region. In this case, computed tomography and magnetic resonance imaging showed no fatty mass located in the mesenteric or submucosal lesion, and positron emission tomography–computed tomography showed a high maximum standardized uptake value, collectively indicating the gastrointestinal stroma tumor and lymphoma. The pathological findings resemble leiomyosarcoma; the immunohistochemistry findings including mouse double minute 2 homolog and cyclin D-dependent kinase-4 and amplification of mouse double minute 2 homolog in fluorescence in situ hybridization just favored the diagnosis of dedifferentiated liposarcoma with leiomyosarcoma phenotype and not leiomyosarcoma. Recently, a new inhibitor for mouse double minute 2 homolog and cyclin D-dependent kinase-4 has been developed, and clinical trials for dedifferentiated liposarcoma are currently ongoing. This could change the treatment strategy drastically compared with other soft tissue sarcomas. Hence, a correct diagnosis of dedifferentiated liposarcoma is required.

Coexistence of complete intestinal tract, prostatic tissue, prostatic urethra and bladder structure in ovarian mature cystic teratoma: a case report

AbstractMature cystic teratomas (MCTs) of the ovary comprise tissues from all three germ layers. The coexistence of the complete intestinal tract, prostatic tissue, and bladder component within the same ovarian MCT is unprecedented. Here, we report the diagnosis and management of such a rare case. A 26-year-old woman presented with a right ovarian mass, which was later confirmed as an MCT by histopathological examination. The patient underwent a successful laparoscopic cystectomy with no evidence of malignancy or postoperative complications. Histological examination revealed that this MCT contained the complete organ structures including a lower intestinal tract and male genital tract with prostate, urethra, and bladder components, which is unusual. This case underscores the importance of understanding the pathogenesis of extensive organogenesis in MCTs and raises questions about the differentiation processes leading to such unique presentations.

Plants, plant‐derived compounds, probiotics, and postbiotics as green agents to fight against poultry coccidiosis: A review

AbstractThe intestinal tract is the main place for animals to digest food and absorb nutrients, which also serves as the first line of defense against pathogens that invade the internal environment. Therefore, normal intestinal structure and function are essential for animal health. Poultry coccidiosis is an intestinal disease primarily caused by the parasitization of intestinal epithelial cells by protozoa of the genus Eimeria. The occurrence of coccidiosis not only compromises the intestinal integrity of poultry but also increases their disease susceptibility, thus posing a serious threat to the overall health and productivity of poultry. Nowadays, the primary methods for controlling and preventing coccidiosis in poultry are anticoccidial drugs or live oocyst vaccines. However, the use of the former may be associated with problems of resistance and drug residues, while the use of the latter may cause intestinal damage and significantly increase farming costs. For these reasons, it is critical to investigate green, safe, and cost‐effective natural alternative strategies such as phytochemicals and probiotics for controlling coccidiosis as well as mitigating the deleterious effects of coccidial infections in production. In this review, we aim to summarize the role, mechanisms, and therapeutic potential of natural products in the treatment of coccidiosis to lay a theoretical foundation for effective coccidiosis control.

Venous intestinal ischemia of fungal origin as a cause of intestinal obstruction in immunocompromised patients: case report and literature review

BackgroundMucormycosis is a highly lethal opportunistic fungal disease caused by ubiquitous molds of the order Mucorales, with Rhizopus, Lichtheimia and Mucor being the most common genera. This rare disease primarily affects immunocompromised patients, with presentations ranging from rhino-orbito-cerebral infections to disseminated mucormycosis with angioinvasion, leading to thrombosis and tissue infarction. Gastrointestinal mucormycosis is the least common clinical presentation and is believed to be secondary to spore ingestion. It can involve multiple components of the gastrointestinal tract, such as the stomach, liver, ileum, and colon, with nonspecific manifestations, including pain, nausea, vomiting, and abdominal distension. The initial clinical presentation may even manifest as gastrointestinal bleeding due to gastric ulceration or intestinal perforation.Case presentationHere we present the case of a 48-year-old male patient with a 9-year history of human immunodeficiency virus (HIV) infection who was hospitalized in the context of febrile neutropenia and whose acute respiratory infection was documented; therefore, antibiotic treatment was initiated. However, due to persistent febrile peaks and peripheral blood showing documentation of multilineage cytopenias, a bone marrow biopsy was performed, compatible with presenting features of marrow myelodysplasia. During hospitalization, the patient presented left flank abdominal pain, and an abdominal computed tomography (CT) scan revealed signs of intussusception of a small bowel loop at the distal jejunum level, leading to intestinal obstruction with ischemic progression, requiring ileectomy (60 cm). Histopathological analysis of the resected intestine revealed severe transmural ischemic changes associated with venous thrombosis due to fungal structures, with histochemical studies demonstrating the presence of zygomycete (Mucor) fungal structures, leading to the initiation of treatment with amphotericin B. However, despite treatment, the patient experienced progressive clinical deterioration with persistent fever and ventilatory failure, with follow-up tests showing absolute neutropenia and blood cultures positive for yeast, leading to death 52 days after admission.ConclusionsThe diagnosis of intestinal mucormycosis may be delayed due to the lack of specificity of the signs and symptoms. Pathologists as well as histopathological studies are essential for timely treatment.

Fitness of SARS-CoV-2 Omicron subvariants in respiratory and gastrointestinal cell lines as determined by RT-ddPCR and whole genome sequencing

Abstract The fitness of SARS-CoV-2 Omicron subvariants was determined in human epithelial and continuous cells of the respiratory and gastrointestinal tracts. Competition experiments over 4 days were performed followed by quantification of variant ratios by reverse transcription-droplet digital PCR. These quantitative data were correlated with whole genome sequencing. In competition experiments of two subvariants, the more recent XBB.1 subvariant outcompeted the BA.1.15 subvariant at early time points in the upper respiratory tract epithelium. No difference in replication was observed between the two subvariants in the lower respiratory tract. Furthermore, XBB.1 predominated over BA.1.15 and JN.1.1 subvariants in the gastrointestinal tract.

Actinomycosis of the gallbladder: A rare case report and literature review

Actinomycosis of the gallbladder is rare, with only a few documented cases in the medical literature. Actinomyces is typically part of the normal flora of the cervicofacial region, gastrointestinal tract, and urogenital tract. Here, we report a case of a 31-year-old female who presented with pain abdomen. Radiological investigation revealed a contracted gallbladder with multiple calculi and a thickened wall. A provisional diagnosis of acute cholecystitis was considered preoperatively and hence planned for laparoscopic cholecystectomy. Histopathological examination showed moderate lymphocytic infiltrate within the muscular layer of the gallbladder along with colonies of filamentous bacteria suggestive of actinomycosis. The relevant stains, including Gram and Giemsa, highlighted the Gram-positive bacteria and confirmed the diagnosis. Post-cholecystectomy, the patient received prolonged antibiotic therapy to prevent recurrence.

Understanding of Polydopamine Formulation for Oral Therapeutic Delivery in Ulcerative Colitis Treatment

AbstractOral therapeutic delivery remains challenged by gastrointestinal tract (GI) barriers, which hinders the successful transition of therapeutic candidates into clinical treatments. Polydopamine (PDA), with its versatile ability to overcome GI barriers, offers a promising drug formulation technology to address the challenge. Nevertheless, many critical questions remain unanswered regarding the practicality of PDA‐based formulations. Building on the previous research, which tackled multiple physicochemical aspects, the current study aims to address another three outstanding issues, including the quantification of residual dopamine (DA) in PDA‐based formulations, the examination of these formulations stimulatory effects on colon tissue, and the potential anti‐inflammatory properties. To facilitate this investigation, a curcumin‐containing nanomedicine (CP@CCS) is prepared as a representative PDA‐based formulation. The results reveal a marked decrease of residual DA within the formulation. In the treatment of ulcerative colitis (UC), the formulation do not provoke the substantial contractions in colon tissue typically induced by DA. Furthermore, in vivo evaluation verified the supplementary anti‐UC benefits of PDA. These outcomes add evidence for the practicality of PDA‐based formulations in terms of safety and therapeutic efficacy. Finally, a conceptual framework is proposed for understanding the role of PDA in oral therapeutic delivery, thereby providing insightful directions for subsequent research.

Annual Prize Lecture 2024: Endogenous physiological mechanisms as basis for the treatment of obesity and type 2 diabetes

AbstractIn 1964, it was proven that postprandial insulin secretion is largely regulated by gut hormones and, in 1973, it was proposed that a gut hormone would also regulate appetite and food intake. Several gut hormones were tested for metabolic actions with disappointing results until the discovery of the proglucagon derivative, glucagon‐like peptide‐1 (GLP‐1). This peptide from the distal intestine has preserved activity on insulin secretion in people with type 2 diabetes and turned out to regulate both secretion and motility in the gastrointestinal tract and importantly, appetite and food intake, thus functioning as an efficient ‘ileal brake’ hormone. However, the natural hormone acts predominantly via sensory afferent systems and is extremely rapidly removed from the circulation by enzymatic degradation and renal elimination, and increasing the doses merely results in nausea and vomiting. Lipidation of analogs turned out to provide both stability and limit renal elimination, and very slow up‐titration of dosing improves tolerance. Indeed, the most recent agonists may near‐normalize glycaemic control in type 2 diabetes, may cause weight losses of up to 25% of body weight, and significantly reduce cardiovascular risk, effects that resemble those of bariatric surgery. Thus, a solution to one of the most serious health problems of modern civilization, the increased morbidity and mortality of the metabolic syndrome, may be addressed by mobilization of one of the body's own regulatory mechanisms. image

Impact of an intranasal L-DBF vaccine on the gut microbiota in young and elderly mice

ABSTRACT Shigella spp. cause bacillary dysentery (shigellosis) with high morbidity and mortality in low- and middle-income countries. Infection occurs through the fecal-oral route and can be devastating for vulnerable populations, including infants and the elderly. These bacteria invade host cells using a type III secretion system (T3SS). No licensed vaccine yet exists for shigellosis, but we have generated a recombinant fusion protein, L-DBF, combining the T3SS needle tip protein (IpaD), translocator protein (IpaB), and the LTA1 subunit of enterotoxigenic E. coli labile toxin, which offers broad protection in a mouse model of lethal pulmonary infection. The L-DBF vaccine protects high-risk groups, including young and elderly mice. Here, we investigated how the gut microbiota of young and elderly mice responds to intranasal L-DBF vaccination formulated in an oil-in-water emulsion (ME). Samples from lungs, small intestines, and feces were collected on day 14 after 2 or 3 doses of L-DBF in ME. 16S rRNA gene sequencing revealed age-dependent changes in gut microbiota post-vaccination. The vaccine-induced changes were more prominent in the elderly mice and were most significant in the intestinal tract, indicating that vaccination by the intranasal route can have a tremendous impact on the gut environment. These findings provide insight into the communication between the intranasal mucosal surface following subunit vaccination and the microbiota at a distant mucosal site, thereby highlighting the impact of vaccination and the host’s microbiome.

Determination of Ki-67 indices in neuroendocrine tumours of the gastrointestinal tract: the past, the present, and the future

Determination of Ki-67 indices in neuroendocrine tumours of the gastrointestinal tract: the past, the present, and the future

Grape seed oil attenuates sodium arsenite-induced gastric, hepatic and colonic damage in Wistar rats

ABSTRACT Arsenic exposure is associated with numerous morbidities due to dysfunction of various organ systems including the gastrointestinal tract. We investigated the protective effect of grape seed oil (GSO) against sodium arsenite (NaAsO2)-induced gastric, hepatic and colonic injuries in rats. Twenty-four male Wistar rats were divided into four groups of six as follows: Group A (control) received saline; group B received NaAsO2 (2.5 mg/kg) orally for 7 days; group C were treated concurrently with NaAsO2 and GSO (2 ml/kg), while group D received only GSO. Administration of NaAsO2 induced significant (p < 0.05) increases in alanine aminotransferase (ALT) and aspartate aminotransferase (AST); increased periodic acid Schiff (PAS) staining for mucus and increased goblet cell numbers in the stomach and colon; inflammatory cell infiltration and vascular congestion and alterations in the fecal bacterial flora. GSO supplementation generally promoted a reversal of changes induced by NaAsO2 towards control levels. Additionally, there was increased immunohistochemically detected expression of colonic B-cell lymphoma-1 (Bcl-2) and cytokeratins AE1/AE3, but reduced expression of mucin 1 (MUC1) and carcinoembryonic antigen (CEA) in NaAsO2 + GSO and GSO treated rats when compared with the NaAsO2 group. These results suggest that GSO promoted anti-inflammatory processes in the liver, stomach and colon, as well as opposing apoptosis in the colon, resulting in significant attenuation of damage to these tissues.

Clinical aspects of pathology of the upper gastrointestinal tract in military personnel of the North Caucasian District of the Russian Guard, participating in combat operations

BACKGROUND: The use of modern technology and weapons forces us to reconsider classical approaches to the prevalence and understanding of the specifics of the existing pathology of participants in hostilities and providing them with medical care. AIM: To study the prevalence of pathology of the upper gastrointestinal tract in servicemen of the North Caucasian District of the Russian Guard, participating in hostilities, and their clinical features. DESIGN OF THE STUDY: 118 participants in combat operations were examined, all men aged 21 to 65 years, 48 officers and 70 military personnel of the contract service with a background mild surgical and therapeutic pathology and a burdened gastroenterological history. Statistical processing of the results was carried out using the variable frequency method in the MedCalc Statistical Software version 22.009 (MedCalc Software Ltd, Ostend, Belgium; https://www.medcalc.org; 2023). RESULTS: In patients participating in combat operations (at р 0.0001), acute and chronic erosive and ulcerative destructive damage to the mucous membrane in the gastrointestinal tract prevails (61%), chronic superficial gastritis occurs in 19%, GERD in 15% and functional dyspepsia in 5%. Among officers, acute gastric erosions, combined erosive-ulcerative pathology and chronic gastritis were more common; among contract military personnel, chronic duodenal ulcers, the erosive form of GERD, chronic gastritis and combined pathologies predominated. CONCLUSION: Participants in combat operations are susceptible to erosive and ulcerative lesions in the gastrointestinal tract and require close attention with an emphasis on a group of officers, as well as the creation of modern clinical and diagnostic programs for the early detection of diseases of the upper parts of the digestive organs to prevent delayed complications.

Micro/nanorobots for gastrointestinal tract

The application of micro/nanomotors (MNMs) in the gastrointestinal tract has become a Frontier in the treatment of gastrointestinal diseases. These miniature robots can enter the gastrointestinal tract through oral administration, achieving precise drug delivery and therapy. They can traverse mucosal layers and tissue barriers, directly targeting tumors or other lesion sites, thereby enhancing the bioavailability and therapeutic effects of drugs. Through the application of nanotechnology, these MNMs are able to accomplish targeted medication release, regulating drug release in response to either external stimuli or the local biological milieu. This results in reduced side effects and increased therapeutic efficacy. This review summarizes the primary classifications and power sources of current MNMs, as well as their applications in the gastrointestinal tract, providing inspiration and direction for the treatment of gastrointestinal diseases with MNMs.

Improvement of Adsorption Capacity by Refined Encapsulating Method of Activated Carbon into the Hollow-Type Spherical Bacterial Cellulose Gels for Oral Absorbent

To reduce the risk of adsorption of granular activated carbon (AC) in the gastrointestinal tract, we successfully prepared a hollow-type spherical bacterial cellulose gel encapsulated with AC (ACEG) and evaluated its pH tolerance and adsorption capacity. The bacterial cellulose gel membrane of ACEG features a three-dimensional mesh structure of cellulose fibers, allowing the selective permeation of substances based on their size. In this study, the preparation method of ACEGs was investigated, and the indole saturation adsorption capacity of the obtained gel was measured. We modified the gel culture nucleus gel from calcium alginate gel to agar gel, facilitating the encapsulation of previously challenging particles. The new preparation method used sodium hydroxide solution for sterilization and dissolution to remove the debris of Komagataeibacter xylinus, which was feared to remain in the bacterial cellulose membrane. This treatment was also confirmed to have no effect on the adsorption capacity of the AC powder. Therefore, this new preparation method is expected not only to improve the performance of ACEGs but also to be applied to a wide range of adsorbent-encapsulated hollow-type bacterial cellulose gels.

Awareness of Peptic Ulcer Disease among the General Population in Al-Ahsa

Abstract Introduction: Peptic ulcer disease (PUD) is a condition characterized by discontinuity in the gastrointestinal (GI) tract’s inner lining, often caused by factors such as Helicobacter pylori infection and NSAID consumption. PUD can lead to various symptoms, but up to 70% of patients may not experience any symptoms. Diagnosing PUD can be challenging due to the unreliability of individual symptoms and signs. PUD can have serious complications if left untreated. Despite its significance, there is a lack of studies measuring the awareness of PUD among the population in Al-Ahsa, Saudi Arabia. Therefore, this study aimed to assess the level of awareness of PUD among the general population in Al-Ahsa. Methodology: A cross-sectional study was conducted in Al-Ahsa, Saudi Arabia, from September to December 2023. The study included 399 adult residents of Saudi Arabia who agreed to participate. A convenient nonprobability sampling technique was used to collect data. An online self-administered questionnaire, distributed through social media platforms, was used to gather information on participants’ awareness of PUD. The questionnaire included sociodemographic characteristics and questions related to PUD awareness. Data were analyzed using SPSS, and qualitative data were presented as numbers and percentages. The Chi-square test was used to examine qualitative data between the two groups. Results: Of the 399 participants, 71.4% demonstrated a good level of knowledge regarding PUD, whereas 28.6% had a low level of knowledge. The sample consisted of nearly equal numbers of males and females, with participants aged 18–55+ years. The majority of participants had attained a bachelor’s degree and were employed. The findings suggest a relatively high level of education among the study population. Conclusion: The study highlights the need for increased public awareness of PUD in Al-Ahsa, Saudi Arabia. While some participants showed good knowledge of PUD, a significant number had low awareness. Educational initiatives are essential to improve understanding and knowledge of PUD among the community. By enhancing awareness, early detection and appropriate management of PUD can be promoted, resulting in improved health outcomes for individuals in Al-Ahsa.

Preserved vegetable consumption and gastrointestinal tract cancers: A prospective study

Preserved vegetable consumption and gastrointestinal tract cancers: A prospective study

Morning Salivary Cortisol Has a Positive Correlation with GAD-7 Scores in Patients with Ulcerative Colitis

Objectives: Inflammatory bowel diseases (IBDs) are chronic inflammatory conditions of the gastrointestinal tract, comprising ulcerative colitis (UC) and Crohn’s disease (CD). Earlier onset of IBD symptoms has been linked to a higher prevalence of depression and anxiety. Evidence supports that cortisol abnormalities correlate with the development and severity of autoimmune diseases. The primary aim of this study was to investigate the correlation of morning salivary cortisol levels with self-reported mood (depression and anxiety) and quality of life in patients with IBD. Methods: This was a prospective, single-center study including outpatients with IBD. Enrolled patients provided a one-time morning salivary cortisol sample and electronically completed a one-time survey encompassing self-reported quality of life (Short Inflammatory Bowel Disease Questionnaire (SIBDQ)) and mood (Patient Health Questionnaire 8 (PHQ-8), General Anxiety Disorder-7 (GAD-7)). Results: A total of 36 patients (UC, n = 21) were included in the study. There was no correlation between morning salivary cortisol and depressive symptoms (PHQ-8: r = 0.007, p = 0.968) or quality of life (SIBDQ: r = −0.095, p = 0.606). However, there was a trend towards a positive correlation between self-reported anxiety symptoms by GAD-7 and salivary cortisol (r = 0.347, p = 0.052). A subgroup analysis showed a positive correlation between morning salivary cortisol and GAD-7 scores in patients with UC (r = 0.535, p = 0.015), but not in patients with CD (r = 0.064, p = 0.843). Conclusions: This pilot study is the first to associate cortisol with anxiety symptom severity in UC. Further research is needed to investigate the link between salivary cortisol, neuropsychiatric disease, and IBD outcomes.

Annexin A2 in Tumors of the Gastrointestinal Tract, Liver, and Pancreas

Annexin A2 (ANXA2) is a protein that is involved in many physiological and pathological cellular processes. There is compelling evidence that its dysregulated expression, be it up- or downregulation, contributes to the oncogenesis of various neoplasms, including those of the digestive system. The present review summarizes the current knowledge on the role of ANXA2 in the main tumors of the digestive system. The clinical significance of ANXA2 is primordial, due to its potential use as a diagnostic and prognostic biomarker, and as a part of therapeutic protocols. Certain preclinical studies have shown that inhibiting ANXA2 or disrupting its interactions with key molecules can suppress tumor growth, invasion, and metastasis, as well as increase the cancer cells’ sensitivity to treatment in various cancers. Further research is needed to fully elucidate the complex role of ANXA2 in the carcinogenesis of tumors of the digestive system, and to translate these findings into clinical applications for improved diagnosis, prognosis, and treatment.

DUPILUMAB: A NEW ALLY FOR THE TREATMENT OF EOSINOPHILIC ESOPHAGITIS?

INTRODUCTION: Eosinophilic esophagitis is a chronic, immune-mediated disease of the gastrointestinal tract, resulting from the interaction between genetic, environmental and immunological factors of the affected patient. The clinical picture is characterized by esophageal dysfunction, which may present as dysphagia, precordial pain, upper abdominal pain or food impaction. Treatment aims to improve clinical symptoms and prevent disease progression and subsequent complications. In this context, immunobiologicals are emerging and promising therapies, with Dupilumab being the first specific treatment approved by the FDA. It is an IgG4 monoclonal antibody that targets IL-4R alpha and, from there, reduces protein transphorylation, transcription and the T helper 2-regulated response. The objective of this systematic review is to evaluate the efficacy of this drug in the treatment of eosinophilic esophagitis, in comparison with the options already available on the market. METHOD: PubMed searches were performed using the keywords “eosinophilic esophagitis dupilumab” and “dupilumab treatment esophagitis eosinophilic”. Initially, 60 results were obtained, but after exclusion by title, abstract and full text, 14 articles were included. RESULT: all articles analyzed demonstrated improvement in patients using Dupilumab, with 13 of them indicating a reduction in eosinophil counts, 8 showing clinical improvement in symptoms, 8 indicating histological improvement, 7 indicating improvement in the endoscopic pattern, according to the Endoscopic Reference for Eosinophilic Esophagitis, and 4 indicating a reduction in the Dysphagia Symptom Questionnaire (DQQ) score. DISCUSSION: eosinophilic esophagitis is a rare disease, but with potential for progression, negatively interfering with the patient's quality of life. Therefore, since current drug therapy is nonspecific, the use of Dupilumab presents itself as an innovative and optimistic solution for the future, because it changes the understanding of disease management, expands therapeutic options and improves prognosis. CONCLUSION: the use of Dupilumab in the treatment of eosinophilic esophagitis has proven to be effective. However, for the treatment to be well established with regard to the doses used, frequency of administration and longitudinal monitoring, further studies are still required.