Branchio-oto-renal syndrome is a rare autosomal dominant disorder characterized by hearing impairment, branchial arch anomalies, preauricular pits, and renal malformations. Although recurrent abdominal pain is not a classic feature, it can arise owing to renal complications such as hydronephrosis. An 8-year-old Arab boy with a history of congenital sensorineural hearing loss presented to the emergency department with recurrent right flank pain radiating to the anterior abdomen occurring approximately every 2weeks over 4months. Previous treatments for suspected irritable bowel syndrome and enteritis were ineffective. Physical examination revealed a significant left preauricular pit and right costovertebral angle tenderness; no branchial fistula or external ear deformities were noted. Urinalysis showed moderate proteinuria, marked pyuria, and microscopic hematuria. Renal ultrasound revealed mild-to-moderate bilateral hydronephrosis, hypoechoic areas, mild pelvicalyceal dilatation, and early cystic changes, supporting the diagnosis of branchio-oto-renal syndrome. The patient was started on empirical intravenous antibiotics, and a urine culture was obtained; laboratory tests 48-72hours after antibiotic initiation showed partial improvement in inflammatory markers and urinary sediment findings. However, serum creatinine remained mildly elevated (1.10mg/dL), flank pain persisted, and renal ultrasound findings supported a congenital or obstructive renal anomaly. Further ear, nose, and throat and urologic evaluation were recommended; the patient was subsequently lost to follow-up. In children with congenital hearing loss, recurrent abdominal/flank pain should prompt renal evaluation and consideration of syndromic diagnoses such as branchio-oto-renal syndrome. Early systemic screening and genetic counseling are advised.

Cold snare polypectomy (CSP) is widely considered a safe treatment for colorectal polyps. We report a rare case of intraperitoneal hemorrhage followed by delayed perforation after CSP in a 78-year-old man undergoing hemodialysis. CSP was performed for an 8-mm slightly elevated lesion in the ascending colon, requiring forced CSP to complete resection. Four hours after the procedure, the patient developed abdominal pain, and contrast-enhanced computed tomography revealed an intramural hematoma with active bleeding. Transcatheter arterial embolization achieved hemostasis. Two days after colonoscopy, recurrent abdominal pain occurred during hemodialysis, and repeat imaging demonstrated free air. Emergent right hemicolectomy revealed bloody ascites and a perforation at the CSP site. The patient recovered uneventfully and was discharged on postoperative day 22. This case suggests that impaired hemostasis related to hemodialysis and concomitant antithrombotic therapy may predispose patients to intramural hematoma formation and delayed perforation. Mechanical compression from the expanding intramural hematoma may have caused structural failure at the forced CSP site, ultimately leading to perforation. In our exploratory in vivo porcine colon experiment, forced CSP generated traction that appeared to pull the muscularis propria and serosa into the endoscopic working channel, indicating the need for careful use of the technique and perioperative management. (200 words).

Our manuscript presents a rare case of idiopathic mesenteric phlebosclerosis (IMP) in a 73-year-old woman who experienced recurrent abdominal pain and diarrhea. Through a detailed clinical investigation, including laboratory tests, colonoscopy, biopsy, and enhanced abdominal CTA, we diagnosed the patient with IMP. Notably, we identified a potential link between the patient's long-term intake of a traditional Chinese herb containing Gardenia Fructus and the development of IMP. This finding is supported by existing literature, which suggests that genipin, a component of Gardenia Fructus, may cause intimal hyperplasia and fibrosis of the venous wall, leading to chronic intestinal ischemia. Our case highlights the importance of considering herbal intake as a potential risk factor for IMP and underscores the need for clinicians to be aware of the potential adverse effects of traditional herbal remedies.

Gallbladder carcinoma (GBC) rarely presents as hemobilia or hemocholecyst. Intraluminal hemorrhage as the initial manifestation of gallbladder cancer is extremely uncommon, reported in nearly 1% of cases, with only a handful of cases described in the literature over the last three decades. A 54-year-old female presented with recurrent abdominal pain, melena, jaundice, and severe anemia requiring multiple blood transfusions. Repeated upper gastrointestinal endoscopies, colonoscopies, and contrast-enhanced computed tomography scans failed to identify the bleeding source initially. A subsequent upper gastrointestinal endoscopy demonstrated active blood ooze in the second part of the duodenum, raising suspicion of hemobilia. Further imaging revealed a gallbladder mass with common bile duct involvement. Exploratory surgery identified a gallbladder tumor with intraluminal blood clots extending into the common bile duct. The patient underwent radical cholecystectomy with liver wedge resection and en bloc excision of the common bile duct followed by Roux-en-Y hepaticojejunostomy. Histopathology confirmed grade 1 mucinous adenocarcinoma of the gallbladder (pT2a pN0). Postoperative recovery was uneventful, with no further episodes of gastrointestinal bleeding. This case highlights the diagnostic challenges of hemobilia in the absence of prior biliary intervention or trauma and emphasizes the importance of persistent evaluation and high clinical suspicion for early diagnosis of gallbladder malignancy presenting with obscure gastrointestinal bleeding.

To compare the measurement properties of paediatric patient-reported outcome measures (P-PROMs) used in clinical trials and practice for common conditions. Data from the Australian Paediatric Multi-Instrument Comparison study were used, including children aged 5-18 years with autism spectrum disorder (ASD) (n=510), asthma (n=487), eating disorder(s) (n=216), epilepsy (n=298), recurrent abdominal pain (n=392), sleep problems (n=346), dental problems (n=490), type 1 diabetes (T1D) (n=67), enuresis (n=182) and no health conditions (reference group) (n=1259). The acceptability, response distribution (floor/ceiling effects), known-groups validity, test-retest reliability, responsiveness and convergent validity of the Paediatric Quality of Life Inventory (PedsQL), EuroQol Group's Youth instruments with three and five response options (EQ-5D-Y-3L and EQ-5D-Y-5L), Child Health Utility 9D (CHU9D), Assessment of Quality of Life 6D (AQoL-6D), Health Utilities Index Mark 3 and Patient-Reported Outcomes Measurement Information System Paediatric Profile 25 (PROMIS-25) were assessed. PedsQL, EQ-5D-Y-3L, EQ-5D-Y-5L, CHU9D and PROMIS-25 were easy and quick to complete, indicating acceptability. Only the EQ-5D-Y-3L and EQ-5D-Y-5L demonstrated ceiling effect issues. All measures were able to differentiate between children with no health conditions and children with each condition (p<0.001, effect sizes between 0.47 and 3.5), indicating known-groups validity. Test-retest reliability varied by condition; however, the PedsQL and EQ-5D-Y-5L were the most reliable. Certain P-PROMs may be preferred in different conditions, that is, ASD (PedsQL and EQ-5D-Y-5L), asthma (PedsQL), eating disorder(s) (PedsQL and CHU9D), epilepsy (PedsQL and CHU9D), recurrent abdominal pain (PedsQL, EQ-5D-Y-5L and CHU9D), sleep problems (PedsQL), dental problems (PedsQL), T1D (PedsQL and CHU9D) and enuresis (PedsQL). Notably, the PedsQL performed favourably in all conditions assessed. More evidence is required on the responsiveness of P-PROMs to changes in child health. ACTRN12621000657820.

BACKGROUNDFunctional abdominal pain syndrome (FAPS) is a subset of functional gastrointestinal disorder characterized by chronic recurrent abdominal pain condition that is not attributable to structural, organic, or metabolic diseases. The etiology and pathophysiology of FAPS remain poorly understood; however, brain-gut interactions and food intolerance, particularly to fermentable oligo-, di-, and monosaccharides and polyols, have been implicated.AIMTo determine the frequency of fructose malabsorption (FM) in patients with FAPS and to evaluate the occurrence of resultant symptoms.METHODSThis was a prospective, case-control study conducted over 22 months, from December 2016 to September 2018, at the Department of Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India. In this study, 61 patients with FAPS and 31 healthy controls underwent fructose hydrogen breath testing (FHBT) after excluding small intestinal bacterial overgrowth.RESULTSFM was detected in 26% of patients with FAPS vs 3% of controls (P = 0.009). Symptoms during the FHBT were significantly more prevalent in patients with FAPS (39.3%) than in the controls (12.9%) (P = 0.009). Among patients with FAPS, those with positive FHBT results had a higher prevalence of symptoms (62.5%) than those with negative results (31%) (P = 0.03). Multivariate analysis identified younger age (P = 0.012) and male sex (P = 0.049) as predictive of a positive FHBT result. Methane producers were present in 37% of patients with FAPS, with no difference between those with and without FM.CONCLUSIONThis study demonstrated a high prevalence of FM and intolerance in patients with FAPS, with younger age and male sex as predictors.

Small intestinal bacterial overgrowth (SIBO) and irritable bowel syndrome (IBS) are common gastrointestinal disorders that significantly impact patients' quality of life and pose a financial burden on healthcare systems. SIBO is characterized by an abnormal increase in small intestinal bacteria, leading to symptoms such as malabsorption, diarrhea, bloating, and abdominal pain. IBS is a functional gastrointestinal disorder marked by recurrent abdominal pain with changes in bowel habits, and is subclassified into diarrhea-predominant IBS (IBS-D), constipation-predominant IBS (IBS-C), and mixed-type IBS. Notably, SIBO and IBS-particularly IBS-D-often present with overlapping symptoms. Antibiotics such as Metronidazole, Bismuth, and Rifaximin are commonly used to treat both conditions; however, their comparative efficacy and safety remain unclear. To analyze and compare the role of Metronidazole, Bismuth, Rifaximin for improvement of SIBO and IBS. A systematic review was performed on the databases PubMed and Cochrane Library, spanning from 2000 to 2023. Studies eligible for inclusion were observational studies or randomized controlled trials (RCTs) performed on human subjects that examined the use of Metronidazole, Bismuth, or Rifaximin in the management of SIBO and IBS. Two independent reviewers performed data extraction, and resolved discrepancies by consensus. The data extracted consisted study characteristics, patient demographics, intervention details, and outcome measured. Key references were verified and prioritized using Reference Citation Analysis to ensure contemporary relevance and citation impact. A total of 55 studies, including RCTs and observational studies, met inclusion criteria and were analyzed. These studies assessed the efficacy and safety of Metronidazole, Bismuth, and Rifaximin in patients with SIBO and IBS. Rifaximin demonstrated the most consistent efficacy across both conditions, particularly in IBS-D and mild to moderate SIBO, with a low incidence of adverse events (16.7%). Metronidazole showed moderate efficacy, with some benefit in IBS-C and mild SIBO, but was associated with a higher rate of gastrointestinal side effects (16.6%). Bismuth offered symptom relief in IBS, especially for bloating and diarrhea, though its effectiveness was generally lower than the other agents. Subgroup analyses suggested differential efficacy by IBS subtype and SIBO severity, supporting the potential role of clinical phenotype in guiding antibiotic selection. Significant clinical efficacy was shown by the drug Rifaximin among IBS-D patients at reducing symptoms, with minimal undesirable adverse effects and a favorable safety profile. Metronidazole was effective in treating SIBO but was generally associated with a higher prevalence of gastrointestinal side effects than the other drugs. However, Bismuth generally proved to be effective on isolated levels, especially in combination regimes where it showed its efficacy levels to be less pronounced relative to Rifaximin as well as Metronidazole. Further studies are needed to optimize treatment strategies and clarify the comparative long-term benefits and risks of these therapies.

Acute hepatic porphyria (AHP) is a heme metabolism disorder characterized by acute abdominal pain episodes, with diagnostic delays and misdiagnosis due to heterogeneous presentations and symptom overlap with other diseases. Timely diagnosis is crucial as untreated attacks can lead to life-threatening complications such as hepatocellular carcinoma, chronic kidney disease, neuropathy and chronic pain. AHP often mimics various conditions such as lead poisoning, Guillain-Barré syndrome, vasculitis and surgical abdominal conditions, leading to diagnostic challenges and inappropriate treatment. Familial Mediterranean fever (FMF), another disease with recurrent abdominal pain as its main feature, has a similar symptomatology to AHP. The aim of this study was to investigate the prevalence of AHP in patients with clinically suspected FMF without a confirmatory genotype using cross-sectional urinary porphobilinogen (PBG) screening during abdominal pain episodes. This cross-sectional study included a total of 104 patients under rheumatology follow-up for suspected FMF and two control groups (genetically confirmed FMF patients and healthy controls). Patients presenting with severe abdominal pain and had a spot urinary PBG/creatinine ratio of ≥ 10 µmol/mmol were diagnosed with AHP together with at least one clinical manifestation defined by the European Porphyria Network. Among 104 suspected-FMF patients, 5 (4.8%) were diagnosed with AHP, with a diagnostic delay of 16.4 ± 10.38 years. AHP patients frequently exhibited neurological (muscle weakness, paresthesia), psychiatric, and gastrointestinal (nausea, vomiting) symptoms. In likelihood ratio analyses, urinary incontinence, hypertension and neuropathic symptoms were strong discriminative indicators of AHP, whereas fever, arthritis, rash and chest pain were more indicative of FMF, aiding differential diagnosis. Due to diagnostic challenges and overlapping symptoms, AHP should be considered in the differential diagnosis of FMF, particularly in patients with neurological or systemic features. Urinary PBG screening and identifying predictive markers may improve diagnostic accuracy and early management of AHP.

Neuronal intranuclear inclusion disease (NIID) is a rare and progressive neurodegenerative disorder, distinguished by extreme clinical heterogeneity that frequently results in diagnostic delays. While gastrointestinal symptoms are common in NIID, the prolonged gastrointestinal-dominant prodrome—lasting years before neurological signs emerge—remains under-recognized in adult-onset cases. We report a 59-year-old female evaluated in the gastroenterology department for a four-year history of recurrent vomiting and abdominal pain. Comprehensive investigations, including endoscopy, abdominal CT scans, and laboratory studies, excluded significant structural or inflammatory pathology. She was admitted on March 30, 2024, for another episode of abdominal pain and vomiting. Over the disease course, her symptoms extended beyond the gastrointestinal tract to include cognitive decline, urinary retention, and two episodes of impaired consciousness. On April 2, 2024, she acutely developed stroke-like manifestations—somnolence, loss of speech, and left-sided hemiparesis—requiring urgent transfer to neurology. Brain MRI demonstrated cerebral atrophy, extensive confluent white matter hyperintensities with frontoparietal predominance, and characteristic linear DWI hyperintensities along the corticomedullary junction. Genetic testing ultimately confirmed neuronal intranuclear inclusion disease (NIID). This case underscores the fact that NIID may present with prominent gastrointestinal symptoms in its early stages. Therefore, NIID should be considered in the differential diagnosis for patients with chronic unexplained gastrointestinal complaints, particularly those with concurrent autonomic or subtle neurological dysfunction. A timely diagnosis requires comprehensive neurological assessments, characteristic MRI findings, and definitive genetic testing.

A 24-year-old female patient with a 4-year history of recurrent abdominal pain, diarrhea, periodic fever and elevated C-reactive protein was referred to our institution. Colonoscopy, esophago-gastro-duodenoscopy, capsule endoscopy and contrast-enhanced CT showed no significant findings. Because she and her mother had sensorineural hearing loss, a diagnosis of cryopyrin-associated periodic syndrome was suspected. Genetic testing of the patient and her mother revealed a candidate germline variant of NLRP3. The patient was commenced on subcutaneous 150 mg canakinumab, a fully human monoclonal antibody targeting IL-1β, at a dose of 150 mg every 8 weeks, which resulted in the persistence of sensorineural hearing loss but led to the complete disappearance of her abdominal symptoms and periodic fever.

A 12-year-old boy presented with recurrent abdominal pain for more than 5 months and a perianal mass for 10 days. Gastrointestinal endoscopy revealed multiple ulcers in the terminal ileum and colon, and Crohn's disease was diagnosed based on histopathology. The patient had atopic dermatitis and had previously received upadacitinib; after the diagnosis of Crohn's disease, upadacitinib was continued. During a total follow-up of 100 weeks, the patient maintained clinical remission without serious adverse reactions. This is the first report from China on upadacitinib treatment for pediatric Crohn's disease and provides guidance for its use in this population.

Diarrhea-predominant irritable bowel syndrome (IBS-D) is a functional bowel disorder with chronic recurrent diarrhea, abdominal pain and abdominal distension as the core symptoms, accompanied by intestinal motility disorder, visceral hypersensitivity and abnormal intestinal mucosal barrier function. Its pathogenesis involves multiple levels including intestinal mucosal barrier injury, neuro-endocrine-immune (NEI) network imbalance, intestinal flora disorder and abnormal regulation of signaling pathways. In traditional Chinese medicine (TCM), the core pathogenesis of IBS-D is “spleen deficiency and liver hyperactivity, internal retention of dampness and turbidity”. Huanji Zhixie Decoction, a self-designed TCM compound prescription by Director Yu Tao for the clinical treatment of IBS-D, has the effects of soothing the liver and invigorating the spleen, relieving depression and eliminating dampness, stopping diarrhea and resolving stagnation. Its clinical efficacy has been initially verified, but the mechanism of action has not been fully clarified. The TP53-PI3K-AKT signaling pathway, as a key pathway regulating cell survival, proliferation, apoptosis and metabolism, plays an important role in the repair of intestinal mucosal barrier, regulation of intestinal motility and maintenance of inflammatory microenvironment homeostasis, and is closely related to the core pathological features of IBS-D. This paper systematically sorts out the modern medical research progress of IBS-D, TCM theoretical understanding and application basis of Huanji Zhixie Decoction, focuses on the mechanism of the TP53-PI3K-AKT signaling pathway in IBS-D and the regulatory effect of TCM compound prescriptions on this pathway, and finally points out the current research gaps and the research ideas of this subject, so as to provide theoretical basis and literature support for the mechanism research of Huanji Zhixie Decoction in the treatment of IBS-D.

Abstract We present the case of a male patient with a history of compensated advanced chronic liver disease secondary to hepatitis C virus infection and clinical signs of portal hypertension, who required three hospital admissions due to gastric outlet obstruction caused by duodenal stenosis secondary to acute pancreatitis in the setting of an annular pancreas. The patient had remained asymptomatic until the first episode of acute pancreatitis. Initial management was conservative, including symptomatic treatment and total parenteral nutrition until resolution of the inflammatory process. He later presented with recurrent vomiting and abdominal pain. Imaging studies revealed multiple intra-abdominal fluid collections and duodenal perforation as complications of the previous episode. Given the severity and unfavorable clinical course, surgical management was indicated once the acute episode subsided. Portal hypertension significantly influenced therapeutic decision-making, and the surgical approach was adapted to select the safest technique for this high-risk patient.

BACKGROUND Eosinophilic pancreatitis (EP), representing <1% of pancreatitis cases, poses significant diagnostic challenges due to its heterogeneous manifestations ranging from mild to life-threatening. The overlapping clinical symptoms and imaging features with other types of pancreatitis often make EP particularly difficult to differentiate. Although tissue demonstration of eosinophilic infiltration (>10/high-power field) after excluding secondary causes is diagnostic, the invasiveness of pancreatic biopsy and disease rarity lead to high misdiagnosis rates in clinical practice. The present case report includes detailed imaging (CT, MRCP, EUS) and histopathology findings, providing a visual guide for clinicians encountering similar cases. CASE REPORT We present the case of a 68-year-old Chinese man diagnosed with EP manifesting as recurrent pancreatitis episodes. His chief concern was recurrent severe abdominal pain of unknown etiology. During his first admission, an upper endoscopy was performed despite the absence of gastrointestinal symptoms and revealed eosinophilic gastroenteritis (EGE). One year later, upon recurrence of pancreatitis, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of the pancreas was performed, confirming EP with approximately 15 eosinophils/high-power field. The patient's symptoms and pancreatic duct dilation resolved rapidly following corticosteroid therapy. The diagnosis was definitively established based on a composite framework comprising recurrent pancreatitis, persistent peripheral eosinophilia, the rigorous exclusion of secondary causes, and histological confirmation of eosinophilic infiltration via EUS-FNA. CONCLUSIONS Eosinophilic pancreatitis (EP) is a rare yet potentially severe acute pancreatitis subtype requiring early diagnosis. It can also be associated with subclinical eosinophilic gastroenteritis (EGE). Immunomodulatory therapy, especially glucocorticoids, is highly effective. Our findings support using endoscopy in cases of unexplained pancreatitis for a definitive histological diagnosis. Prompt diagnosis is crucial for initiating effective corticosteroid therapy, which can resolve symptoms and prevent disease progression.

Behçet's disease (BD) is a multisystem inflammatory disorder in which innate immune dysregulation has been increasingly recognised as a key pathogenic feature, and MEFV variants have also been implicated in its pathogenesis. We describe the case of a 51-year-old Japanese woman with incomplete BD who developed large-vessel vasculitis during treatment with low-dose glucocorticoids and colchicine. She had a history of recurrent abdominal pain associated with menstruation and two episodes of aseptic meningitis since childhood, but she had never experienced periodic fever. Genetic analysis revealed compound heterozygous MEFV variants (E148Q in exon 2 and M694I in exon 10). An 18F-fluorodeoxyglucose positron emission tomography/computed tomography demonstrated aneurysms of the brachiocephalic and bilateral subclavian arteries with patchy fluorodeoxyglucose uptake, indicating active vasculitis consistent with BD rather than familial Mediterranean fever. Infliximab therapy was initiated for BD-associated vasculitis, resulting in the rapid normalisation of C-reactive protein and successful tapering of prednisolone. This case suggests that MEFV variants may contribute to an autoinflammatory background that predisposing to vascular involvement in BD, even in the absence of clinical familial Mediterranean fever. The association between MEFV variants and vascular involvement in BD remains controversial, and it has not been consistently demonstrated in Japanese populations, where both the clinical features and genetic background of familial Mediterranean fever differ from those of Eastern Mediterranean patients. This case may, therefore, provide further insight into the role of MEFV variants in the pathogenesis of vascular involvement in BD, particularly in Japanese patients.

Background:Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder worldwide, characterized by recurrent abdominal pain and altered bowel habits, which significantly impair quality of life and impose a socioeconomic burden. Traditional pharmacological treatments have limited efficacy and are often associated with side effects, highlighting the need for effective non-pharmacological interventions. Non-invasive transcutaneous nerve stimulation (NITNS) has shown potential in improving IBS symptoms and autonomic function, but systematic evidence is lacking.Objectives:To systematically evaluate the efficacy and safety of NITNS in IBS and explore its potential mechanisms.Design:Systematic review and meta-analysis.Data sources and methods:Randomized controlled trials (RCTs) were identified through PubMed, Embase, Cochrane Library, and Web of Science from database inception to September 28, 2025. Studies included patients aged 18–75 years who met IBS diagnostic criteria. Interventions involved NITNS, with sham-NITNS as the control. Primary outcomes were IBS symptom severity scale (IBS-SSS) and IBS quality of life (IBS-QOL). Secondary outcomes included visual analogue scale (VAS), Bristol stool form scale (BSFS), heart rate variability (HRV), and adverse events (AEs). Data extraction and risk-of-bias assessment were independently performed by two reviewers.Results:Four RCTs, including 170 patients, were analyzed. NITNS significantly reduced IBS-SSS scores (p = 0.0001) and increased IBS-QOL scores (p < 0.0001). VAS (p = 0.0003) and BSFS (p < 0.00001) scores also improved significantly. HRV results suggested NITNS might influence the autonomic nervous system function. The incidence of AEs did not differ significantly between NITNS and sham-NITNS groups (p = 0.64). Exploratory subgroup analysis indicated that differences in NITNS stimulation modalities and IBS subtypes might influence the therapeutic efficacy of NITNS. Overall evidence quality ranged from low to very low.Conclusion:NITNS is a safe and effective non-pharmacological intervention with potential value in the management of IBS. However, further large-scale, high-quality RCTs are needed to confirm their long-term efficacy and safety.Trial registration:PROSPERO CRD420251157617.

Inflammatory bowel disease (IBD) is characterized by an aberrant immune response that results in intestinal inflammation and tissue damage, which manifest clinically as recurrent abdominal pain and diarrhea. As a chronic condition with limited curative options, the incidence of IBD has markedly increasing globally, imposing a considerable socioeconomic burden and leading to significant losses in workforce productivity. Recent research has indicated that the intestinal metabolite profile of patients with IBD is substantially altered compared to that of healthy individuals. Notably, a significant reduction was observed in the levels of microbiota-derived bile acid metabolites that are essential for gut immunity, indicating a potential association between bile acid metabolism and IBD progression. In this review, we aim to synthesize the role and recent research advancements regarding bile acid metabolites in mediating immune balance in IBD, thereby providing theoretical support for future investigations.

Recurrent bowel obstruction secondary to angioedema is uncommon, particularly when due to C1 esterase inhibitor (C1-INH) deficiency. We present a case of a 56 year old, male patient with recurrent abdominal pain, nausea and vomiting secondary to bowel angioedema resulting in multiple hospitalisations and surgical interventions. This case underscores the importance of considering hereditary and acquired C1-INH deficiency in the differential diagnosis of recurrent abdominal pain and bowel oedema despite late onset and lack of concomitant facial or peripheral angioedema. We review the clinical presentation, laboratory evaluation and management of C1-INH deficiency, including the hereditary and acquired forms.

Helminth and protozoan infections remain a significant public health problem among preschool children, particularly in developing regions. Conventional stool microscopy, widely used in routine practice, is known to have limited sensitivity, potentially leading to underdiagnosis and delayed treatment. Objective: To evaluate the diagnostic performance of conventional stool microscopy in detecting helminth–protozoan infections in preschool children and to identify clinical predictors associated with missed diagnoses. Methods: A cross-sectional study was conducted involving 186 preschool children aged 3–6 years. Each child underwent three consecutive stool examinations using direct microscopy and concentration methods. A subset of 72 samples was additionally analyzed using enzyme-linked immunosorbent assay (ELISA) as a reference method. Diagnostic accuracy indicators including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Logistic regression analysis was performed to assess clinical predictors of infection. Results: Overall prevalence of helminth–protozoan infection was 41.9% based on combined diagnostic methods. Single stool microscopy detected infection in only 27.4% of cases. The sensitivity of single-sample microscopy was 62.8%, while three consecutive examinations increased sensitivity to 84.3%. ELISA-based detection revealed an additional 13.5% of cases missed by microscopy. Recurrent abdominal pain (OR = 2.6; 95% CI: 1.4–4.8; p = 0.003) and persistent eosinophilia (OR = 3.1; 95% CI: 1.6–6.0; p = 0.001) were independent predictors of infection. Conclusion: Conventional single-sample stool microscopy significantly underestimates helminth–protozoan infection prevalence in preschool children. Repeated sampling and adjunct immunodiagnostic methods substantially improve detection rates. Incorporating enhanced diagnostic strategies may reduce underdiagnosis and improve clinical outcomes.

Irritable bowel syndrome (IBS) is a common functional bowel disorder marked by recurrent abdominal pain, altered stool frequency or form, and significant symptomatic relief and may not provide sustained benefit for many patients. Ayurveda correlates IBS with Grahani Roga, a condition primarily rooted in Agnimandya (impaired digested fire), Ama (toxic metabolic by products) and imbalance of vata dosha affecting the gut -brain axis. This review article aims to present an integrative perspective on IBS by correlating contemporary understanding of its pathophysiology with Ayurvedic concepts, and by summarizing available evidence on Ayurvedic interventions. Classical Ayurvedic texts and modern scientific literature were critically reviewed to identify descriptions of Grahani roga, its etiological factors (Nidan), Samprapti and therapeutic principles, along with clinical studies on Ayurvedic formulations and Pancha karma procedures in IBS. Various herbal and Herbo-mineral preparations like Nrupatiballabha rasa, Panchamrit Parpati, Bilvadileha, Jeerakadyarista, Gangadhar churna, Chitrakadi vati Deepana- pachana therapies, Basti karma, dietary regulations and mind body practices such as yoga and meditation have shown promising results in reducing symptoms burden and improving overall well-being. An integrative approach that combines individualized Ayurvedic management with appropriate modern diagnostic evaluation may offer a more holistic and sustainable strategy for IBS care.