Gastrointestinal Symptoms Research Articles

Protein-losing enteropathy as the first presentation of systemic lupus erythematosus as the first case reported in Palestine, case report with systematic review

Introduction: Systemic lupus erythematosus is a chronic inflammatory disease affecting women, causing gastrointestinal issues like acute pancreatitis, esophagitis, and protein-losing enteropathy. Protein loss is uncommon, but a case study shows protein losing enteropathy as a first sign. Importance: Protein-losing enteropathy (PLE) is a rare gastrointestinal manifestation of SLE, often seen years before diagnosis. Suspecting hypoalbuminemia without protein loss is crucial, but diagnosis is challenging due to imaging and histological findings. Case presentation: A 22-year-old woman with epigastric pain experienced sudden abdominal pain, vomiting, and arthralgia. An abdominal CT scan revealed moderate bilateral hydronephrosis, pelvic free fluid, a kidney stone, and a cyst. Laboratory tests showed normal hemoglobin levels, platelets, white blood cells, C-reactive protein, and ESR. Diagnosis of SLE was confirmed, and pulse steroid therapy and hydroxychloroquine were initiated. Severe ascites required pigtail insertion, and Ceftazidime was added. The patient’s condition improved, and she was discharged with regular follow-ups. Clinical discussion: A 22-year-old female was diagnosed with protein-losing enteropathy, a rare gastrointestinal manifestation of Systemic Lupus erythematosus (SLE). The disease is divided into mesenteric vasculitis, pseudo obstruction, and protein loss enteropathy. The patient also had severe enteritis, abdominal pain, nausea, and diarrhea. The study found that the main complaint was abdominal pain with dysphagia, mainly due to active SLE inflammation. The patient responded well to treatment, with a 62.5% rapid improvement in pulse steroids and a cure for underlying causes through DMARDS or immunosuppressant drugs. Conclusions: The case presents a rare SLE diagnosis with gastrointestinal involvement, pleural effusion, and progressive swelling. Despite correct diagnosis and aggressive treatment, clinical improvement occurred, requiring high clinical suspicion.

BS SO10 - Predictive Factors in the Development of Dumping Syndrome After Bariatric Surgery

Abstract Background Dumping syndrome (DS) is a recognised complication of Roux En-Y Gastric Bypass (RYGB) and rarely Sleeve Gastrectomy (SG). The prevalence of DS is unclear, with current literature ranging from 10-50%. The condition is characterised by gastrointestinal and vasomotor symptoms resulting in a significant impact on quality of life. This study aimed to prospectively utilise Sigstad scoring to evaluate post-operative patients, investigating the timing of symptom onset and its correlation with pre-existing diabetes, revision surgery, and percentage of Total Body Weight Loss (TBWL). Method We used the Sigstad scoring questionnaire, administered by our bariatric Clinical Nurse Specialists (CNS) at outpatient clinics to assess patients for DS between January to May 2024. Data collected included patient demographics, surgery type and date, TBWL, Body Mass Index (BMI), and whether the patient had a diagnosis of Diabetes Mellitus type II (DMII). A diagnosis of DS was confirmed if a patients score ³7 points on the Sigstad questionnaire. We explored factors influencing the development of DS. Results In total, 64 patients were evaluated for DS of whom 86% were female and the median age was 44 years (IQR: 35-45). Most patients (67%) had undergone primary RYGB, 19% SG, 11% conversion from SG to RYGB and 70% were assessed within one year of surgery. DS symptoms emerged in 25% of patients, predominantly within the first-year post-operation (60%). The median TBWL was 12% (IQR: 9-22%), showing no correlation to DS onset. Patients with DMII exhibited a higher propensity for DS (66% vs 20%, p=0.029). Patients undergoing revisional surgery also had a higher incidence of DS (33% vs 6%, p=0.117). Conclusion A quarter of patients undergoing bariatric surgery will develop DS, most of whom within the first-year post-surgery. Revisional surgery and pre-existing DMII are the primary predictors in developing DS. There was no observed association between TBWL and DS onset. Further extensive studies are needed to confirm these observations.

OGC SO05 - Prevalence of Malabsorption and Impact on Quality of Life After Oesophago-Gastric Cancer Surgery

Abstract Background Recent Cancer Research UK data highlights a concerning rise in oesophago-gastric cancers, with 9,200 new cases of oesophageal cancer cases and 7,000 new cases of gastric cancer annually, ranking them the 13th and 17th most prevalent cancers, respectively. Surgery offers potential cure, but survival rates remain modest. Procedures include oesophagectomy and gastrectomy with Roux-en-Y reconstruction. Patients frequently experience nutrition-impact symptoms (NIS) associated with malabsorption post-surgery, however limited data exits on how this malabsorption affects their quality of life (QoL). This study aimed to investigate the prevalence of malabsorption and its correlation with QoL following oesophago-gastric cancer surgery. Method A cross-sectional cohort observational study was conducted on 98 cancer-free patients aged 18 or older following oesophagectomy (57%, including 1% with colonic interposition), subtotal gastrectomy (21.4%), or total gastrectomy (20.4%) with curative intent at the Northern Oesophago-Gastric Unit in Newcastle Upon Tyne from January 2013 to December 2023. Data collection utilised a modified Gastrointestinal Symptom Rating Scale (mGSRS) and QoL questionnaire distributed via post or email. Participants assessed their QoL on a self-reported Likert-scale (0-10) for their own subjective QoL perception. SPSS statistical software was employed to explore correlations between post-surgery malabsorption and QoL outcomes within this patient cohort. Results Post-surgery, 44.3% of patients encountered weight management challenges, notably within the first year. Malabsorption was prevalent in 69.9% of patients, with common symptoms such as flatulence and reduced appetite. Steatorrhoea, experienced by 47.3% of patients, also commonly caused flatulence and urgent bowel movements. NIS prevalence varied among surgical procedures, with 64.1% post-oesophagectomy and 78% post-gastrectomy, particularly after total gastrectomy. Pancreatic enzyme replacement therapy remained underused at 9.4%. Malabsorption strongly correlated with reduced QoL scores (r=-0.583, p<0.001), regardless of the time elapsed since surgery. Patients with steatorrhoea reported significantly lower QoL scores compared to those without (MD:-1.874, 95% CI, p<0.001). Conclusion The study highlights a significant prevalence of malabsorption and impaired QoL among patients following oesophago-gastric surgery, particularly notable in those experiencing steatorrhoea. Despite medical advancements, these issues often go unrecognized. The multifaceted nature of NIS and their impact on QoL necessitate a multidisciplinary approach involving gastroenterologists, dietitians, and other healthcare professionals. This collaborative effort aims to identify underlying factors contributing to malabsorption, provide consistent dietetics support, and manage symptoms effectively throughout the patient's recovery. Standardised guidelines are essential for ensuring comprehensive care and addressing both physical and psychosocial aspects, thereby enhancing overall postoperative QoL and long-term health outcomes.

Abstract 4120680: Language AI Chat BOTs as Pioneers in Cardiovascular Diagnosis? A Retrospective Analysis on Real-Time Patients in a Tertiary Care Centre

GPT-3 and GPT-4, show promise in assisting healthcare professionals with clinical questions. Their performance in real-time clinical scenarios, particularly with cardiovascular symptoms, remains underexplored. This study aims to evaluate their precision and reliability compared to physicians. Hypothesis: We hypothesize that board-certified emergency department attendings at Maimonides Medical Center exhibit higher accuracy and reliability than GPT-3.5 and GPT-4 in generating differential diagnoses based on history and physical examination for patients presenting to the emergency department. Methods: Patient data from Maimonides Medical Center's emergency department, collected from January 1, 2023, to April 30, 2023, was analyzed. Demographics, symptoms, medical history, and discharge diagnoses recorded by emergency room attendings were examined. ChatGPT-3.5 and GPT-4 generated differential diagnoses, which were compared with those by attending physicians. Accuracy was determined by comparing each rater's diagnoses with discharge diagnosis, calculating the proportion of correctly identified cases. Precision was assessed using Cohen's kappa coefficient and Intraclass Correlation Coefficient to measure agreement between raters. Results: Patient demographics showed mean age of 49.12 years, with 57.3% males and 42.7% females. Chief complaints included fever/sepsis (24.7%), gastrointestinal issues (17.7%), and cardiovascular problems (16.4%). Diagnostic accuracy against discharge diagnoses was highest for Chat GPT-4 (85.5%), followed by Chat GPT-3.5 (84.6%) and ED attendings (83%). Cohen’s kappa demonstrated moderate agreement (0.7) between AI models, with lower agreement observed for ED attendings. Stratified analysis revealed higher accuracy for gastrointestinal complaints with Chat GPT-4 (87.5%) and cardiovascular complaints with Chat GPT-3.5 (81.34%). Conclusion: Our study demonstrates that Chat GPT-4 and GPT-3.5 exhibit comparable diagnostic accuracy to attendings, highlighting their potential to aid decision-making in dynamic clinical settings. The stratified analysis revealed comparable reliability and precision of the AI chat bots for cardiovascular complaints which represents a significant proportion of the high risk patients presenting to the emergency department. This study contributes to integrating AI models into medical practice, enhancing efficiency and effectiveness in clinical decision-making

Unlocking the potential of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in revolutionizing type 2 diabetes management: A comprehensive review

Diabetes mellitus (DM) is a long-term metabolic disorder caused by inadequate production and resistance to insulin. The prevalence of DM is rapidly increasing, with type 2 diabetes (T2D) accounting for more than 90% of cases. Despite new treatments, many patients with T2D do not meet their glycemic targets due to clinical inertia. This review provides an overview of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) in the management of T2D. The review synthesizes data from clinical trials and meta-analyses on the efficacy, safety, and cost-effectiveness of GLP-1 RAs. It also discusses the mechanisms of action, classification, and barriers to adherence and persistence in therapy. GLP-1 RAs improve glycemic control by lowering A1C levels and promoting weight loss. They have cardioprotective effects and may reduce endothelial inflammation, oxidative stress, and blood pressure. Adherence to GLP-1 RAs is better with once-weekly injections, though gastrointestinal side effects and cost can affect persistence. Semaglutide and liraglutide have shown significant weight reduction, with semaglutide being particularly effective. GLP-1 RAs are cost-effective due to reduced healthcare costs associated with fewer hospitalizations and lower mortality rates. Safety concerns include gastrointestinal issues, pancreatitis, and rare cases of diabetic retinopathy and thyroid C-cell tumors. For clinical practice, GLP-1 RAs represent a valuable option not only for glycemic control but also for weight management and cardiovascular protection. Incorporating GLP-1 RAs into treatment plans can improve patient outcomes, and optimizing dosing regimens and addressing barriers such as cost and side effects are crucial to enhancing patient adherence and long-term treatment success.

Bibliometric analysis of research hotspots and trends on the relationship between the gut microbiota and depression from 2020 to 2024

IntroductionIn recent years, an increasing body of research has illustrated a strong correlation between gut microbiota and depression. However, there has yet to be a comprehensive discussion or summary of the latest advancements and trends in this field.MethodsWe retrieved research articles focused on gut microbiota and depression through the WOS database from 2020 to 2024, using visual text analysis tools such as CiteSpace and VOSviewer.ResultsThe literature on the relationship between gut microbiota and depression surged from 396 papers in 2020 to 711 by 2024. During this period, the journal with the highest publication rate was Nutrients. China led the countries in contributions, while University College Cork topped the institutions. Kenji Hashimoto emerged as the most prolific author. The most cited paper was authored by Cryan JF et al., published in 2019 in Physiol Rev. The keywords “gut microbiota,” “depression,” and “anxiety” appeared most frequently, while recent years saw explosive increases in terms such as “growth performance,” “receptors,” “depression-like phenotypes,” “stress response,” “gastrointestinal symptoms,” “reliability,” and “neurogenesis.”DiscussionOur article displayed the overview of the relationship between the gut microbiome and depression from 2020 to 2024 using bibliometric methods, providing perspectives and research hotspots for studies exploring the correlation between the gut microbiome and depression.

Dumping syndrome: Update on pathophysiology, diagnosis, and management

AbstractBackgroundDumping syndrome is a complex of gastrointestinal symptoms originally studied in peptic ulcer surgery patients. At present, it is most prevalent in patients who underwent bariatric, upper gastrointestinal cancer or anti‐reflux surgery. The symptom pattern comprises early and late dumping symptoms. Several management options have been reported including nutritional, pharmacological and surgical approaches.Aims and MethodsIn this study, we aimed to review the current evidence on dumping syndrome definition, diagnosis and treatment, including preliminary data from newer pharmacological studies.ResultsCurrent pathophysiological concepts and analyses of provocative tests has led to a clear definition of dumping syndrome, including both early and late dumping symptoms. The term postbariatric hypoglycemia represents a limited focus on late dumping only. The diagnosis relies on recognition of symptoms and signs in a patient with appropriate surgical history; and can be confirmed by provocative testing or registration of spontaneous hypoglycemia. The initial treatment focuses on dietary intervention, to which meal viscosity enhancers and/or the glycosidase inhibitor acarbose can be added. The most effective therapy is the use of short‐ or long‐acting somatostatin analogues, which is however expensive and entails side effect issues. In case of refractory hypoglycemia, diazoxide or SGLT2 inhibitors can be considered, based on limited evidence. In refractory patients, continuous enteral feeding or (rarely) surgical reinterventions have been advocated, although not supported by solid evidence. Therapies under current evaluation include the broad‐spectrum somatostatin analogue pasireotide, GLP‐1 receptor antagonists, GLP‐1 receptor agonists and administration of stable forms of glucagon are currently under study.ConclusionsDumping syndrome is a well‐defined but probably under‐diagnosed complication of upper gastrointestinal, especially bariatric, and surgeries. Diagnosis is confirmed by a provocative test and incremental therapies starting with diet, adding meal viscosity enhancers or glycosidase inhibitors and adding somatostatin analogues in refractory cases. A number of emerging therapies targeting intestinal propulsion, peptide hormone effects and hypoglycemic events are under evaluation.

Prevalence of Helicobacter Pylori Infection Among Dyspepsia Patients in a Tertiary Care Hospital of Puducherry

Background: Dyspepsia is a relatively common clinical condition characterized by chronic / recurrent upper abdominal pain or discomfort. Dyspeptic individuals were found to be infected with H-pylori than asymptomatic individuals. Though most individuals are asymptomatic, H. pylori plays a key role in the etiology of many upper gastrointestinal disorder. Materials and Methods: This cross-sectional prospective analytical study was done in Department of General surgery, IGMCRI Pondicherry from February 2022 to June 2022. Both male and female patients attending surgery OPD of age 20 to 60 years with upper gastrointestinal symptoms like dyspepsia and epigastric pain were subjected to upper gastrointestinal endoscopy and scopy findings noted and a Rapid urease test done for them. Results: The prevalence of H-Pylori was found to be 53%. Gender wise distribution shows more prevalence among females (61%) compared to males (44%). Of the total patients, 72% presented with abdominal pain, 34% presented with associated nausea, vomiting and 50% presented with regurgitation, 47% presented with bloating sensation. 11% present with other associated symptoms like malena and dysphagia. 9 patients with dyspepsia had ulcers in the antral wall and duodenum with 33% RUT positivity. 11 of them presented with pangastritis with 72% RUT positivity, 47 of them had antral gastritis with 66% RUT positivity, and 15 of them were found to have normal endoscopic findings with 33% RUT positivity.47% of the patients with esophageal varices and 20% of the patients with ulceroproliferative growth showed RUT positivity. Conclusion: This study validates that more than half the patients with dyspepsia in our population are H-pylori positive. Early referral for Upper GI endoscopy can help diagnose the same and associated clinical condition and initiate an early anti-H. Pylori regimen to achieve quicker symptom relief in these patients.

Effects of famotidine use during pregnancy: an observational cohort study

BackgroundFamotidine, a histamine2-receptor antagonist (H2Ras), is widely used to treat and prevent gastrointestinal symptoms during pregnancy. Although several studies have reported the use of H2Ras during pregnancy, limited data on famotidine were included in these reports. Therefore, we analyzed pregnancy outcome data to evaluate the effects of famotidine use during pregnancy on the fetus.MethodsPregnancy outcome data were used for females enrolled in two Japanese facilities that provided counseling on drug use during pregnancy between April 1988 and December 2017. For the primary endpoint, the incidence of congenital malformations was calculated from the data of live birth to pregnant women who took famotidine (n = 330) or drugs considered to exert no teratogenic risk (control, n = 1,407) during the first trimester of pregnancy. Considering secondary endpoints, the incidence of obstetric outcomes, including preterm delivery, was calculated from data on the use of famotidine (n = 347) and controls (n = 1,476) during the entire pregnancy. The crude odds ratios (cORs) for the incidence of congenital malformations were calculated using univariate logistic regression analysis, with the control group used as the reference. Adjusted ORs (aORs) were calculated using multivariate logistic regression analysis adjusted for various other factors.ResultsThe incidences of congenital malformations in the famotidine and control groups were 3.9% and 2.8%, respectively. There was no significant difference between the famotidine and control groups (cOR: 1.40 [95% CI:0.68–2.71], aOR: 1.06 [95% CI:0.51–2.16]). Conversely, the preterm delivery rates were 8.1% and 3.8% in the famotidine and control groups, respectively, indicating a significant difference (cOR: 2.00 [95% CI:1.20–3.27]). However, the multivariate analysis eliminated famotidine use as a confounding factor.ConclusionsThis observational cohort study revealed that exposure to famotidine during the first trimester of pregnancy was not associated with an increased risk of congenital malformations in infants. Although a higher rate of preterm delivery was detected in famotidine users when compared with controls, this could be attributed to confounding factors, such as complications.

Perceived Negative Menstrual Cycle Symptoms, but not Changes in Estrogen or Progesterone, are Associated with Impaired Cycling Race Performance.

Purpose: To examine the relationship between menstrual cycle (MC) phase-dependent fluctuations of estrogen and progesterone and virtual cycling race performance, with a secondary aim of correlating perceived MC-related symptoms with performance.Methods: In a novel observational study design, thirty-seven female cyclists/triathletes not using any hormonal contraception completed one virtual cycling race [19.5 km time trial (TT)] per week across a one-month period (totaling four races). Participants completed MC characterization and tracking, including urinary ovulation kits, across two complete MCs. Venous blood samples were collected within 21 h of racing to determine serum 17-β-estradiol and progesterone concentrations, as well as an assessment of self-reported, perceived race-day MC and gastrointestinal (GI) symptoms, which were all then correlated to race performance.Results: There was no relationship between race completion time and individual estradiol (r = -0.001, p = 0.992) or progesterone (r = -0.023, p = 0.833) concentrations. There was no difference between race time between MC phases (follicular/luteal, p = 0.238), whether MC bleeding or not bleeding (p = 0.619) and ovulating or not ovulating (p = 0.423). The total number of perceived MC symptoms recorded on race day was positively correlated to increased race time [r = 0.268 (95% CI 0.056 to 0.457), p = 0.014], as was the number of GI symptoms of at least "moderate" severity before the race (r = 0.233 [95% CI 0.021 to 0.425], p = 0.031), but not post-race (r = 0.022, p = 0.841).Conclusions: When implementing a novel, virtual cycling race, fluctuations in ovarian hormone concentrations across the MC do not appear to affect real-world cycling performance among trained cyclists, while perceived negative MC and GI symptoms may relate to impaired performance. Therefore, the management of negative MC and GI symptoms appears important for athletic performance enhancement or to mitigate performance decline.

Gastrointestinal health and serum proteins are associated with BMD in postmenopausal women: a cross-sectional study

BackgroundWith increasing age, the social and economic burdens of postmenopausal osteoporosis are steadily increasing. This study aimed to investigate the factors that influence the development of postmenopausal osteoporosis.MethodsPostmenopausal women at the Affiliated Hospital of Jiangnan University from January 2023 to December 2023 were recruited for BMD examination. The patients were divided into a normal group, an osteopenia group and an osteoporosis group according to their T value. Questionnaires, including the Gastrointestinal Symptom Rating Scale and Short Form 12, were administered through face-to-face interviews. Bone turnover markers and serum protein levels of Fasting venous blood were detected.ResultsA total of 222 postmenopausal women met the inclusion criteria were recruited. Univariate analysis revealed statistically significant differences in age, education, BMI, supplementation with soy products, supplementation with dairy products, supplementation with other nutritional supplements, exercise frequency, gastrointestinal symptom score, quality of life, 25(OH)D, total protein, albumin and prealbumin among the three groups (P < 0.05). Pearson correlation analysis revealed that gastrointestinal symptoms (r = -0.518, P < 0.01) was negatively correlated with BMD in postmenopausal women, while PCS (r = 0.194, P = 0.004), MCS (r = 0.305, P < 0.01), 25(OH)D (r = 0.531, P < 0.01), total protein (r = 0.324, P < 0.01), albumin (r = 0.341, P < 0.01) and prealbumin (r = 0.259, P < 0.01) were positively correlated with BMD. Logistic regression analysis revealed that both the gastrointestinal symptom score and serum 25(OH)D level were found to have a significant association with BMD (both P < 0.01). This association remained significant even after adjusting for age, BMI, education level, dietary habits, and exercise frequency.ConclusionGastrointestinal symptoms and serum 25(OH)D elevel are associated with increased risk of osteoporosis in postmenopausal women and may be useful in predicting osteoporosis in postmenopausal women.

Probiotic Formulation for Patients With Bipolar or Schizophrenia Spectrum Disorder: A Double-Blind, Randomized Placebo-Controlled Trial.

Probiotic augmentation offers a promising treatment for bipolar disorder (BD) and schizophrenia spectrum disorder (SSD). By targeting microbiome deviations, they may improve both gut and brain health. In this double-blind, randomized, placebo-controlled trial with the multi-strain probiotic formulation Ecologic BARRIER, we aimed to improve psychiatric and cognitive symptoms, intestinal permeability, and gastrointestinal symptoms in patients with BD or SSD. A total of 131 patients were randomized 1:1 to receive either the probiotic supplement (n = 67) or a placebo (n = 64) for 3 months, in addition to treatment-as-usual. The primary outcomes were symptom severity assessed by the Brief Psychiatric Rating Scale and cognitive functioning by the Brief Assessment of Cognition in Schizophrenia. No significant effect of probiotics was observed on psychiatric symptoms, but borderline significant improvement was observed in the cognition category of verbal memory (Linear Mixed Model (LMM)0.33; adjusted P = .059). Probiotics beneficially affected markers of intestinal permeability and inflammation, including zonulin (LMMserum = -18.40; adjusted P = .002; LMMfecal = -10.47; adjusted P = .014) and alpha-1 antitrypsin (LMM 9.26; adjusted P = .025). Indigestion complaints significantly decreased in male participants in the probiotics group (LMM = -0.70; adjusted P = .010). Adverse events were similar between groups. Our study observed significant advantages of probiotics for gut health in BD and SSD, with excellent safety and tolerability. A borderline effect on verbal memory was also indicated. These results underscore the need for further research into microbiome-targeted interventions for patients with complex brain disorders.

Larval cyathostominosis in horses

Small strongyles are the most common parasites of horses, capable of surviving different climate conditions. Though the infection is usually asymptomatic, young horses are considered more prone to developing a parasitic syndrome called larval cyathostominosis. In most cases, gastrointestinal symptoms are most prevalent. Treatment is based on the use of fenbendazole and moxidectin. Diagnosis is difficult and serological methods are still under development. The main prevention methods include regular coprological testing, pasture rotation, co-grazing with ruminants, and regular removal of faeces from the pasture.

Characteristics of Multisystem Inflammatory Syndrome in Children Across COVID-19 Variants in Vojvodina

Background/Objectives: To investigate if the severity and presentation of multisystem inflammatory syndrome in children (MIS-C) vary between different severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants. Methods: This retrospective study included 59 patients aged 0–18 years, diagnosed with COVID-19 and MIS-C, treated and monitored over a one-year period after discharge from hospital. The patients were grouped according to the predominant SARS-CoV-2 variant. The predominant variant of SARS-CoV-2 was assumed by the date of hospitalization. The following patient data were collected: demographic data (age, sex), information on comorbidities, body mass index, clinical data (fever and duration of febrile periods, symptoms of Kawasaki-like phenotypes, and presence of respiratory, cardiovascular, gastrointestinal, neurological and other symptoms), and laboratory and imaging findings. Results: In total, 24 (41%), 19 (32%), and 15 (25%) patients were diagnosed with MIS-C during the Alpha, Delta, and Omicron periods, respectively (63.8% were males; 36.2% were females). Comorbidities were present in 49% of patients. Respiratory symptoms were the most common during the Delta period (73%, p = 0.028). There was no statistically significant difference in the occurrence of other symptoms, laboratory findings, treatment, complications, and long-term outcomes between groups. Conclusions: No significant correlation was found between hospitalization date (used to estimate COVID-19 variant) and presentation/severity of MIS-C.

Novel hypothesis and therapeutic interventions for irritable bowel syndrome: interplay between metal dyshomeostasis, gastrointestinal dysfunction, and neuropsychiatric symptoms.

Irritable bowel syndrome is a gastrointestinal disorder due to multiple pathologies. While patients with this condition experience anxiety and depressed mood more frequently than healthy individuals, it is unclear how gastrointestinal dysfunction interacts with such neuropsychiatric symptoms. Data suggest that irritable bowel syndrome patients predominantly display a lower zinc intake, which presumably impairs enterochromaffin cells producing 5-hydroxytryptamine, gut bacteria fermenting short-chain fatty acids, and barrier system in the intestine, with the accompanying constipation, diarrhea, low-grade mucosal inflammation, and visceral pain. Dyshomeostasis of copper and zinc concentrations as well as elevated pro-inflammatory cytokine levels in the blood can disrupt blood-cerebrospinal fluid barrier function, leading to locus coeruleus neuroinflammation and hyperactivation with resultant amygdalar overactivation and dorsolateral prefrontal cortex hypoactivation as found in neuropsychiatric disorders. The dysregulation between the dorsolateral prefrontal cortex and amygdala is likely responsible for visceral pain-related anxiety, depressed mood caused by anticipatory anxiety, and visceral pain catastrophizing due to catastrophic thinking or cognitive distortion. Collectively, these events can result in a spiral of gastrointestinal symptoms and neuropsychiatric signs, prompting the progression of irritable bowel syndrome. Given that the negative feedback mechanism in regulation of the hypothalamic-pituitary-adrenal axis is preserved in a subset of neuropsychiatric cases, dorsolateral prefrontal cortex abnormality accompanied by neuropsychiatric symptoms may be a more significant contributing factor in brain-gut axis malfunction than activation of the hypothalamic corticotropin-releasing hormone system. The proposed mechanistic model could predict novel therapeutic interventions for comorbid irritable bowel syndrome and neuropsychiatric disorders.

Predictive analysis of osteoarthritis and chronic pancreatitis comorbidity: complications and risk factors

BackgroundThe comorbidity of chronic pancreatitis (CP) in patients with osteoarthritis (OA) is insufficiently studied, and the reciprocal impact of these conditions remains poorly understood. This study aimed to investigate potential predictors for the development of CP in OA patients, as well as associated complications.MethodsA cohort of 181 patients was categorized into four groups: a control group (n=30), patients with OA (n=68), patients with CP (n=31), and patients with OA and comorbid CP (n=52). All four groups had no statistical differences in age and gender. The study utilized the WOMAC index, Visual Analog Scale (VAS), Lequesne index, biochemical assays, and advanced statistical methods to assess joint status in OA patients with comorbid CP. It explored potential predictors of comorbidity development and associated complications.ResultsThe study revealed that concurrent CP in OA exacerbates progression and contributes to malnutrition. Body Mass Index (BMI) emerged as a potential predictor for CP comorbidity development in OA patients. Factors such as the WOMAC total score, fecal elastase-1, C-reactive protein (CRP), ferritin, retinol, tocopherol, 25-hydroxyvitamin D3, and BMI were found to influence the development of comorbidity of CP in OA. Additionally, Gastrointestinal Symptom Rating Scale-Diarrhea Syndrome (GSRS-DS), Gastrointestinal Symptom Rating Scale-Constipation Syndrome (GSRS-CS), Qualitative Assessment of the Symptoms and Impact of Pancreatic Exocrine Insufficiency Domain A (PEI-Q-A), retinol, tocopherol, and iron were identified as potential predictors comorbidity CP with exocrine pancreatic insufficiency in OA patients.ConclusionThe presence of CP in OA patients exacerbates disease progression and complications, necessitating further investigation.

A Study on Prevalence and Incidence of Lower Gastrointestinal Symptoms

The incidence and prevalence of Lower gastrointestinal symptoms is estimated. A study of 600 patient were studied using cross sectional study . The rationality of drug were assessed using core indicators and the medication error were assessed. It was found a larger burden of lower gastrointestinal symptoms .

Mycobacterium avium complex (MAC) infection in severely immunocompromised people living with HIV: Findings from a five-year cohort.

We sought to clarify the current incidence, risk factors and symptoms of disseminated Mycobacterium avium complex (dMAC) infection in admitted people living with HIV in a hospital in the Southeast of Spain. 5-years observational, retrospective and single-centre study. Demographic, clinical and analytical variables, along with microbiological, treatment and follow-up were collected. Five cases of dMAC infection in severely immunocompromised people living with HIV people living were found. dMAC was diagnosed in 22.7% of patients under 100 CD4. All patients presented with fever and clinical manifestations of pneumonia, lymphadenopathy, or gastrointestinal symptoms. Despite low CD4 levels and high viral loads in some cases, primary prophylaxis had not been previously administered. Until 2018, U.S. American guidelines recommended antimycobacterial prophylaxis for patients with low CD4 cell counts, a practice not adopted in Europe. Untreated dMAC infection is associated with high morbidity and mortality rates. dMAC infection represents a prevalent disease in severely immunosuppressed people living with HIV. dMAC requires a high index of suspicion in this population, in order to perform mycobacterial cultures from different samples.

Distinct age-related characteristics in patients with irritable bowel syndrome: patient reported outcomes and measures of gut physiology

Irritable bowel syndrome (IBS) is common among all ages, but the associations between symptoms, gut physiology, and ageing are poorly understood. We aimed to characterize patients of different age by comparing symptom reports and gut physiology measures. This retrospective cohort study included IBS patients that completed questionnaires (severity of (non-) gastrointestinal and psychological symptoms, quality of life) and gut physiology testing (transit time, rectal sensitivity, anorectal manometry, small bowel permeability). We included 1677 IBS patients (females 74%, mean age 39 ± 14 years). Younger age was associated with more severe symptoms and worse quality of life. Ageing affects the physiologic state of the gut; older patients have slower gut transit and have an altered anorectal function. Exploratory analyses suggest that age-related changes in gut sensorimotor function could partially explain the severity of specific gastrointestinal symptoms. Our results underline that age should be taken into consideration in the management of IBS.

Exploring the impact of probiotics on adult ADHD management through a double-blind RCT.

Attention deficit hyperactivity disorder (ADHD) is a common neuropsychiatric condition often persisting into adulthood, characterized by inattention, impulsivity, and hyperactivity. Emerging research suggests a connection between ADHD and gut microbiota, highlighting probiotics as potential therapeutic agents. This study involved a double-blind, randomized controlled trial where college students with ADHD received either a multi-strain probiotic supplement or a placebo daily for three months. ADHD symptoms were evaluated using a computerized performance test (MOXO) and the MATAL questionnaire. Academic records provided performance data. Additionally, eating and sleeping habits, gastrointestinal symptoms, and anthropometrics were assessed through questionnaires before and after the intervention. Fingernail cortisol concentrations (FCC) measured the long-term activity of the hypothalamic-pituitary-adrenal axis. The findings indicated that the probiotic significantly decreased hyperactivity, improved gastrointestinal symptoms, and enhanced academic performance. A multivariate analysis identified age as a significant predictor, with younger participants experiencing greater overall benefits from the intervention. There was also a negative correlation between FCC and symptoms of attention and impulsivity. Furthermore, higher academic grades were associated with lower levels of hyperactivity and impulsivity. These results suggest a beneficial impact of probiotics on ADHD symptoms and lay the groundwork for further studies to evaluate the effects of various probiotic strains on clinical outcomes in ADHD.