Recurrent Gastrointestinal Symptoms Research Articles

The Role of Gut Microbiome in Irritable Bowel Syndrome: Implications for Clinical Therapeutics.

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder (FGID) characterized by chronic or recurrent gastrointestinal symptoms without organic changes, and it is also a common disorder of gut-brain interaction (DGBIs).. The symptoms of IBS not only affect the quality of life for individual patients but also place a significant burden on global healthcare systems. The lack of established and universally applicable biomarkers for IBS, along with the substantial variability in symptoms and progression, presents challenges in developing effective clinical treatments. In recent years, preclinical and clinical studies have linked the pathogenesis of IBS to alterations in the composition and function of the intestinal microbiota. Within the complex microbial community of the gut, intricate metabolic and spatial interactions occur among its members and between microbes and their hosts. Amid the multifaceted pathophysiology of IBS, the role of intestinal microenvironment factors in symptom development has become more apparent. This review aims to delve into the changes in the composition and structure of the gut microbiome in individuals with IBS. It explores how diet-mediated alterations in intestinal microbes and their byproducts play a role in regulating the pathogenesis of IBS by influencing the "brain-gut" axis, intestinal barrier function, immune responses, and more. By doing so, this review seeks to lay a theoretical foundation for advancing the development of clinical therapeutics for IBS.

Two cases of deficiency in ELF4 gene X-linked and literature review

Objective: To summarize the clinical phenotype and genetic characteristics of deficiency in ELF4 gene X-linked (DEX). Methods: A case series study was conducted to retrospectively analyze the clinical data and genetic testing results of 2 cases of DEX treated at Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and the First Hospital of Jilin University from January 2023 to April 2024. And literature up to April 2024 was searched from the PubMed database, as well as CNKI and Wanfang databases, using keywords such as "ELF4 deficiency" "deficiency in ELF4, X-linked""ELF4 gene". The main clinical manifestations and genotypes of DEX were summarized. Results: Both patients were male, with onset ages of 3 months and 3 years, respectively. Both patients presented with recurrent oral ulcers and abdominal pain. And the laboratory examination showed a significant increase in inflammatory markers. Intestinal examinations showed multiple intestinal ulcers, and both patients developed intestinal fistulas. Whole exome sequencing found ELF4 c.799C>T, p Arg267Trp and ELF4 c. 248-7G>A, both maternal variants. Based on clinical and genetic results, DEX were diagnosed. In terms of treatment, both patients underwent surgical treatment during the acute phase of the disease and received anti-tumor necrosis factor α therapy, but recurrent gastrointestinal symptoms were still observed in Patient 1, while the clinical effect in Patient 2 was still acceptable. However, the inflammatory markers in both patients were not normal even after treatment. Literature review found 18 patients including 2 patients in this study, reported in 5 English articles and no Chinese reports. Thirteen patients had disease onset age before 5. The main clinical manifestations were fever (12/17), oral ulcers (14/18), abdominal pain (8/18), diarrhea (6/18), perianal ulcers (5/17), ileum ulcers (6/16), colon ulcers (7/16), skin involvement (7/17) and recurrent infections (7/18); laboratory examinations found increased erythrocyte sedimentation rate (13/15) as well as C-reactive protein (9/9), and anemia (13/15); in terms of immunological function, there is a decrease in natural killer cells (9/15) as well as a decrease in class switching memory B cells (8/9). The main types of gene variantions were missense variantions (6/18), nonsense variantions (4/18) or frameshift variantions (3/18). Conclusions: DEX should be considered when an early-onset male patient manifested with recurrent fever, oral ulcers or mucosal ulcers, with elevated inflammatory markers, with or without recurrent infection. It is recommended to perform lymphocyte subsets analysis, gastrointestinal endoscopy and genetic testing to support the diagnosis.

A Review on Functional Gastrointestinal Disorders: Irritable Bowel Syndrome and its Association with Obesity

Worldwide, Functional Gastrointestinal Disorders (FGIDs) are common, although their prevalence varies among cultures, ethnic groups, and geographic regions. FGIDs, now referred to as Disorders of Gut-Brain Interactions (DGBIs), encompass a variety of chronic or recurrent gastrointestinal symptoms that are not related to structural or morphological abnormalities. Irritable Bowel Syndrome (IBS) and Functional Dyspepsia are two of the most common examples of FGIDs. According to the Rome IV criteria established in 2016, these disorders are classified based on specific diagnostic guidelines. The Rome Foundation is expected to launch the updated Rome V criteria in 2026. IBS is one of the most common types of FGID. The causes of IBS include a range of factors such as dietary habits, psychological influences, and genetic predispositions. The role of neurotransmitters such as serotonin, norepinephrine, histamine, dopamine, and gamma-aminobutyric acid (GABA) has been identified in the development of IBS. Due to gender differences, it is anticipated that the symptoms and treatment approaches for men and women with IBS may vary. Studies have shown that IBS is more frequent in women than in men. Various treatment strategies are used for the management of IBS, including medications (such as laxatives, antidepressants, and analgesics), lifestyle modifications, and herbal approaches. Increasing emphasis is being placed on plant-based products and probiotics. Management often differs from one individual to another; a treatment that works for one person may not be effective for another. Different studies have suggested an association between obesity and FGIDs, particularly IBS. Some research indicates that obesity could exacerbate the inflammatory processes associated with IBS, while other studies suggest a bidirectional link between IBS and obesity. Common pathophysiological features found in both obesity and IBS include alterations in the gut microbiome, changes in intestinal permeability, visceral hypersensitivity, and low-grade inflammation.

Expanding clinical characteristics and genotypic profiling of Yao syndrome in Chinese patients.

Yao syndrome (YAOS, OMIM# 617321) is a kind of systemic autoinflammatory diseases (SAIDs) linked to the nucleotide-binding oligomerization domain containing 2 (NOD2). Clinical reports of YAOS in China are sparse. Herein, we reported the largest YAOS cohort of Chinese patients to expand the understanding of its phenotype, genotype, and therapeutic responses. This study enrolled 15 adult patients diagnosed with YAOS at Peking Union Medical College Hospital from April 2015 to May 2024. Whole-exome sequencing was performed on all patients. Clinical data, genetic variations, and treatment responses were documented and compared with a Caucasian cohort. The mean age of disease onset was 35 ± 17 years old. The most common clinical manifestations included recurrent high-grade fever (100%), gastrointestinal symptoms (73.3%), arthralgia/arthritis, fatigue, myalgia, and lower extremity swelling (46.7%). All patients exhibited elevated acute-phase reactants during episodes. 12 heterozygous NOD2 variants were identified, with Q902K in 4 patients, R471C in 3, and variants c.-14C>T, A110T, S127L, R311W, A432V, Y514H, R541P, A661P, K818Q, A886V each found in individual patients. 90% of the patients responded well to glucocorticoids, and 55.6% to sulfasalazine. 66.7% of patients who received TNF inhibitors achieved complete resolution of symptoms. Additionally, one patient each responded favorably to canakinumab and tocilizumab. Compared to the Caucasian cohort, our cohort exhibited a more balanced gender ratio and a higher proportion of recurrent fever, proteinuria/hematuria as well as more frequent leukocytosis, elevated acute phase reactants, and anemia. Lower proportions of arthralgia/arthritis, skin rashes, headaches, and sicca-like symptoms were noted in our cohort. Moreover, a higher proportion of patients in our cohort showed a good response to TNF inhibitors. Chinese patients with YAOS had more pronounced inflammatory manifestations compared to the Caucasian cohort. Variants c.-14C>T, A110T, S127L, A661P, K818Q, A886V, R471C, and A432V were identified as novel NOD2 variants in YAOS. TNF, IL-6, and IL-1 inhibitors are the promising treatment options. These findings expand the clinical spectrum, genetic profile, and treatment efficacy of YAOS, underscoring the need for heightened awareness of this disease in diverse populations.

The most frequent febrile syndromes and autoinflammatory diseases in adulthood

Autoinflammatory diseases are characterized by inflammatory manifestations in various organ systems, whereby recurrent febrile episodes, musculoskeletal complaints, gastrointestinal and cutaneous symptoms frequently occur accompanied by serological signs of inflammation. Autoinflammatory diseases include rare monogenic entities and multifactorial or polygenic diseases, which can manifest as a variety of symptoms in the course of time. Examples of monogenic autoinflammatory diseases are familial Mediterranean fever (FMF), cryopyrin-associated periodic syndrome (CAPS), tumor necrosis factor (TNF) receptor-associated periodic syndrome (TRAPS) and the recently described VEXAS (vacuoles, E1 enzyme, X‑linked, autoinflammatory and somatic) syndrome. For non-monogenically determined autoinflammatory diseases, the most important representatives in adulthood are adult-onset Still's disease (AOSD) and the Schnitzler syndrome, in which a polygenic susceptibility and epigenetic factors are more likely to play a role.

Multiple sarcomatoid carcinomas in the small intestine with perforation: A case report and literature review.

Sarcomatoid carcinoma of the small intestine is an exceedingly rare and aggressive malignancy, often diagnosed at advanced stages with a poor prognosis. This study documents a detailed case of sarcomatoid carcinoma of the small intestine, highlighting the diagnostic challenges and treatment approaches, underscored by a comprehensive review of related literature. Given the rarity of this condition, our report aims to enrich the existing diagnostic and treatment frameworks for this malignancy, emphasizing the necessity for early detection and intervention strategies. By presenting this case in conjunction with a literature review, we seek to shed light on the elusive nature of sarcomatoid carcinoma in the small intestine and propose avenues for improving patient outcomes. Case presentation A 61-year-old male patient initially presented with recurrent abdominal pain and gastrointestinal symptoms. Initial abdominal computed tomography (CT) scans and gastrointestinal endoscopy revealed only inflammatory and hyperplastic changes in the duodenum and jejunum, with a diagnosis of intestinal obstruction. Two years later, due to gastrointestinal perforation, the patient was hospitalized again. CT scans and other examinations revealed small intestinal lesions. Four small intestinal lesions were surgically removed, and pathology and immunohistochemistry confirmed sarcomatoid carcinoma of the small intestine. A short time later, enhanced CT scans revealed metastatic lesions in the hepatic portal and adrenal glands. After surgery, the gastrointestinal function gradually recovered, and the patient was discharged from the hospital on a semiliquid diet. No further treatment such as radiotherapy or chemotherapy was administered postoperatively. Five months after the surgery, the patient died due to brain metastasis. The study outcomes reveal the aggressive nature of sarcomatoid carcinoma of the small intestine, characterized by rapid progression and poor prognosis despite surgical interventions. The patient condition rapidly deteriorated, leading to metastasis and death within 5 months postsurgery. These findings underscore the critical need for early detection and possibly innovative treatment approaches to improve survival rates. This case also highlights the potential for gastrointestinal sarcomatoid carcinoma to metastasize to distant organs, including the brain, suggesting a propensity for hematogenous spread.

The Presence of Ganglionic Acetylcholine Receptor Antibodies in Sera from Patients with Functional Gastrointestinal Disorders: A Preliminary Study.

Functional gastrointestinal disorders (FGIDs), including functional dyspepsia (FD) and irritable bowel syndrome (IBS), are characterized by chronic and recurrent gastrointestinal symptoms. Clinically, FD and IBS often resemble gastrointestinal dysmotility caused by autoimmune autonomic neuropathy. We examined the seropositive frequency of autoantibodies against ganglionic nicotinic acetylcholine receptors (gnAChRs) in patients presenting with FGIDs. To elucidate the seropositivity of gnAChR antibodies and the clinical features of seropositive FD and IBS. We measured autoantibodies against the gnAChR α3 and β4subunits using luciferase immunoprecipitation systems. Serum samples from patients with any autonomic symptoms were obtained from hospitals in Japan between January 2012 and August 2018 (1787 serum samples of 1381 patients). We selected FD and IBS patients and compared the clinical characteristics and prevalence of autonomic symptoms between those with seropositive and seronegative IBS and FD. Nine IBS and two FD cases (one comorbid case with IBS) were found. We found four patients (36.4%) in whom gnAChR antibodies were positive in these eleven patients. Sicca symptoms were observed in three of four cases (75%) of seropositive FGID compared with zero of seven cases (0%) of seronegative FGID. We found patients with gnAChR antibodies in FD and IBS patients. These data will be valuable for elucidating the pathophysiology of these FGIDs and developing new treatment strategies.

Development and validation of the Gastrointestinal Symptom Severity Scale in Spanish children and adolescents.

Functional gastrointestinal disorders (FGIDs) are characterized by chronic or recurrent gastrointestinal symptoms (GS) that are not explained by structural or biochemical abnormalities. FGIDs are related to lower quality of life, increased demands on medical resources, and greater somatization and emotional instability. Furthermore, GS appears to be an indicator of dysbiosis in gut-microbiota, affecting the gut-microbiota-brain relationship. To develop and evaluate the psychometric properties of a new instrument called the Gastrointestinal Symptom Severity Scale (GSSS) using a web-based survey in a sample of neurotypical children and adolescents from Spain. Instrument development and validation processes were applied to the GSSS following its administration as part of an online survey. The sample included 1242 neurotypical children and adolescents. The mean age of participants was 13.95years, with a standard deviation of 1.37years. Overall, 13.8% suffered infectious diarrhea, 12.6% suffered abdominal pain, 5% suffered dyspepsia and 2.6% suffered gastro-esophageal reflux. A single-factor model produced good fit indices. Furthermore, internal consistency and test-retest reliability outcomes were acceptable. The GSSS was found to have acceptable metric measurement invariance. Significant correlations with other instruments were produced and were of expected direction and magnitude, confirming scale validity for hypothesis testing. Conclusions: The GSSS shows promising psychometric properties for assessing GS in neurotypical Spanish adolescents and children. What is Known: • To the best of our knowledge, instruments assessing the severity of gastrointestinal symptoms in children and adolescents are still too few. What is New: • The GSSS shows promising psychometric properties for assessing GS in neurotypical adolescents and children. The GSSS may help improve understanding of GS involvement in the gut-brain microbiota axis in children and adolescents.

Psychometric Properties of the Gastrointestinal Symptom Severity Scale in a Sample of Adolescents and Young Adults.

Background: Functional gastrointestinal disorders (FGIDs) are a set of chronic or recurrent gastrointestinal symptoms (GS) with great psychobiological complexity. The appearance of FGIDs harms quality of life and drains medical resources. Methods: Psychometric properties of the Gastrointestinal Symptom Severity Scale (GSSS) based on Rome IV criteria were examined in a sample of 1247 individuals with typical development. Observations were randomly divided into two subsets, namely, subsample 1 (n = 624) and subsample 2 (n = 623). Exploratory factor analysis (EFA) was performed with data from subsample 1, whilst confirmatory factor analysis (CFA) was performed with data from subsample 2. Internal consistency of the scale was assessed for the whole dataset according to ordinal alpha, whilst four-week reliability was measured according to the intraclass correlation coefficient (ICC). Measurement invariance as a function of sex was also examined, and discriminant-convergent validity of the GSSS was examined through hypothesis testing. Results: EFA revealed a two-factor structure with a moderate percentage of explained variance (51.3%), whilst CFA exhibited an excellent fit of the data to the model. A one-factor CFA model demonstrated an acceptable but slightly lower fit. Internal consistency was moderate and test-retest reliability was deemed adequate. Metric invariance was demonstrated as a function of sex. Hypothesis testing demonstrated strong convergent-discriminant validity with measures of sensory sensitivity, obsessive-compulsive symptoms, and pain. Conclusions: The GSSS is a tool with acceptable and promising psychometric properties when administered to neurotypical adolescents and young adults. The self-report GSSS may promote better understanding of GS involvement in the gut microbiota-brain axis in the general population.

When the Stomach Pain Is Literally “In Your Head”

Abdominal epilepsy (AE) is an extremely rare condition, classified as temporal lobe epilepsy, and is usually a diagnosis of exclusion. Temporal lobe epilepsy often has no clear cause, although it may be associated with diseases such as temporal lobe sclerosis, dysembryoplastic neuroepithelial tumours, and other benign tumours, as well as arterio-venous malformations, gliomas, defects in neuronal migration, or lesions of the cortex caused by encephalitis. AE is more common in children but has been reported in adults. AEs are characterised by recurrent and unexplained gastrointestinal symptoms such as seizure pain, nausea, bloating and diarrhoea, which improve with antiepileptic treatment. Given the vague nature of these symptoms, patients are at high risk of misdiagnosis. An electroencephalogram and neuroimaging of the brain are needed to confirm the diagnosis. We present the clinical case of a 67-year-old female patient who was investigated at the Gastroenterology Department for a sharp pain in the left side of the abdomen, frequent abdominal distension and gurgles, diarrhoeal episodes, weight loss, paroxysmal hallucinations, and headaches. After a thorough gastroenterological examination, consultations with a psychiatrist and a neurologist, an MRI and an EEG were performed and the patient was diagnosed with focal temporal lobe epilepsy.

Difficulty in the differential diagnosis of peritoneal carcinomatosis and tuberculosis in a young female patient with ascites: a case report

The differential diagnosis between peritoneal tuberculosis and peritoneal carcinomatosis is quite challenging because of the similarity of the clinical picture and laboratory and instrumental examination data. Peritoneal tuberculosis and peritoneal carcinomatosis may present with the development of ascites, lymph nodes, and intestinal loop conglomerates. This article presents the clinical case of a young patient who, after her second childbirth, noted the appearance of intense pain in the neck and between the scapulae. Two months later, she experienced pneumonia with a positive reaction to antibiotic therapy. After another 2 months, she experienced recurrent ascites and gastrointestinal symptoms for the first time. The examination revealed ovarian masses and signs of peritoneal carcinomatosis and lung nodules. However, the clinical presentation was atypical for peritoneal carcinomatosis, and lung lesions were suspicious for tuberculosis, which allowed us to hypothesize the presence of tuberculosis of multiple localizations. The diagnosis was confirmed by laparoscopy with a biopsy of the involved tissues and subsequent histological and laboratory confirmation of the etiological role of Mycobacterium tuberculosis. The described case demonstrates the importance of using all available diagnostic methods to establish the causes of ascites in young female patients for differential diagnosis between specific and neoplastic etiologies.

Clinical applications of current biomarkers in canine chronic enteropathies

Chronic enteropathies (CEs) are a group of multifactorial gastrointestinal diseases in dogs, which are defined by chronic persistent or recurrent gastrointestinal symptoms, along with histopathological indications of mucosal inflammation. These disorders have gained significant interest in recent years due to their unclear etiopathogenesis, the severity of symptoms and lack of response to conventional treatments. The diagnosis of canine CEs is challenging because of their non-specific clinical symptoms, which require an extensive diagnostic investigations to exclude alternative causes of chronic gastrointestinal signs. Currently, the gold standard for diagnosing CEs relies on histopathologic evaluation and assessing responses to therapeutic trials. However, these methods have limitations in terms of invasiveness, cost and time consumption. Therefore, biological markers that objectively reflect the severity of gastrointestinal disease, assist in diagnosing clinical practice, predicting treatment response, determining prognosis and monitoring disease progression may offer valuable clinical benefits for dogs with CEs. This article provides an overview of the current biomarkers for canine CEs and discusses their potential clinical applications, as well as their advantages and limitations. Furthermore, this review expects to contribute to the identification of future directions for advancing biomarkers in canine CEs research.

A rare cause of abdominal pain: Abdominal epilepsy a diagnosis often missed

Abdominal epilepsy (AE) is a very rare and easily missed; which is thought to be temporal lobe epilepsy and is usually a diagnosis of exclusion. AE usually affects the pediatric age group. However, there have been recorded occurrences even in adults. AE presents as unexplained, variable severity, relentless, recurrent gastrointestinal symptoms such as paroxysmal pain episodes, nausea, bloating, and diarrhea. These symptoms show significant improvement with antiepileptic therapy. Diagnosis is aided by electroencephalography changes in the temporal lobes associated with symptoms suggestive of central nervous system involvements such as altered consciousness, confusion, or lethargy. Vague nature of the symptoms causes misdiagnosis in most cases, leading to persistent suffering for the patient. We present a case of 35-year-old female who presented with abdominal pain and after extensive workup was diagnosed as a case of AE. She responded well to the treatment and doing well on follow-up.

Susceptibility of nucleotide-binding oligomerization domain 2 mutations to Whipple's disease.

Whipple's disease (WD) results from infection of the bacteria Tropheryma whipplei (TW). This disease is characterized by macrophage infiltration of intestinal mucosa and primarily affects Caucasian males. Genetic studies of host susceptibility are scarce. Nucleotide-binding oligomerization domain containing protein 2 (NOD2) is an innate immune sensor, resides mainly in monocytes/macrophages and contributes to defence against infection and inflammatory regulation. NOD2 mutations are associated with autoinflammatory diseases. We report the association of NOD2 mutations with TW and WD for the first time. A multicentre, retrospective study of three patients with WD was conducted. Patients received extensive multidisciplinary evaluations and were cared for by the authors. NOD2 and its association with infection and inflammation were schematically represented. All patients were Caucasian men and presented with years of autoinflammatory phenotypes, including recurrent fever, rash, inflammatory arthritis, gastrointestinal symptoms and elevated inflammatory markers. All patients underwent molecular testing using a gene panel for periodic fever syndromes and were identified to carry NOD2 mutations associated with NOD2-associated autoinflammatory disease. Despite initially negative gastrointestinal evaluations, repeat endoscopy with duodenal tissue biopsy ultimately confirmed WD. After initial ceftriaxone and maintenance with doxycycline and/or HCQ, symptoms were largely controlled, though mild relapses occurred in follow-up. Both NOD2 and TW/WD are intensively involved in monocytes/macrophages. WD is regarded as a macrophage disease. NOD2 leucin-rich repeat-associated mutations in monocytes/macrophages cause functional impairment of these cells and consequently may make the host susceptible for TW infection and WD, especially in the setting of immunosuppression.

#4383 WHEN SHOULD WE TRY TREATMENT FOR PERITONEAL SCLEROSIS?

Abstract Background and Aims Although it is very important to detect patients at increased risk of developing encapsulating peritonitis (EPS), there are not established predictors which would promote early diagnosis and treatment of EPS ensuring sustainability of peritoneal dialysis (PD). D-Dimers are considered a significant test in evaluation of peritoneal fibrinolysis activity and Ca 125 is used as an alternative marker for the integrity of peritoneal membrane.[1] We examined prospectively a combination of these surrogate markers both in serum and effluent to discern early peritoneal sclerosis. Method In a cohort of 39 PD patients D-Dimers, Ca 125, CRP along with a complete biochemical profile were tested both in serum and overnight effluent dialysate at the beginning of the study. In 9 patients, who presented with recurrent gastrointestinal symptoms, such as mild nausea, incidence of gastric discomfort or sense of bloating, CT imaging was performed for evaluation of potent EPS and thickening of the bowel wall was measured. The latter group of nine patients received tamoxifene for a period of approximately one year and both serum/effluent biomarkers and CT imaging were repeated at the end of this period. Results In Table 1 characteristics of patients are shown. At the beginning of the study CRP was the only biomarker that was different between the group with or without gastrointestinal symptoms (4±6mg/dl vs 0.8±1.1mg/dl, p = 0.04). In patients, who received tamoxifene gastrointestinal symptoms improved. In these patients follow up with CT imaging demonstrated amelioration of bowel wall thickening compared to the beginning (3±1.2mm vs 2.1±0.4mm), which was not statistically significant. Moreover, Ca 125 in dialysate decreased (60.4±74 U/ml vs 27±27 U/ml, p = 0.04). No side effects were recorded. Five patients are still on PD, 3 patients died from unrelated causes and 1 was transferred to hemodialysis. Conclusion In this study neither D-Dimers, a test for the assessment of the peritoneal fibrinolysis activity, nor Ca 125 an alternative marker for assessing the integrity of peritoneal membrane helped us to distinguish patients at risk for EPS. In fact Ca 125 levels in the effluent were higher in the treated group just before initiation of treatment, although in some references it is proposed that it is minimized.[1,2] Clinical evaluation along with radiologic findings led us to the decision to treat patients with tamoxifene, which exerts a protective effect on the peritoneal membrane during both early and late stages of fibrotic disorders.[3] Despite the small number of patients in this study, bowel wall thickening showed a tendency to decrease and symptoms improved.

NON-PHARMACOLOGICAL MANAGEMENT OF FUNCTIONAL GASTROINTESTINAL DISORDERS THROUGH AYURVEDA: A REVIEW

Non-pharmacological management refers to the management without the use of medications. Gastrointestinal disorders, especially Functional Gastrointestinal Disorders (FGIDs), are common disorders characterized by persistent and recurrent gastrointestinal symptoms due to abnormal functioning of the enteric nervous system where no structural or organic pathology is identified. FGIDs are associated with motility disturbances, visceral hypersensitivity, altered mucosal and immune function, gut microbiota, etc. To fully understand the pathophysiology of FGIDs, it is important to comprehend the biopsychosocial behaviour, which focuses on understanding and treatment of the illness and the subjective sense of the patient's suffering. Globally, the most common FGIDs (irritable bowel syndrome and functional dyspepsia) alone affect 16–26% of the population. The non-pharmacological management includes reassurance, lifestyle modifications including observance of dinacharya (daily regimen), gut hygiene, ritucharya (seasonal regimen), psychotherapy, dietary interventions like intake of pathyaahara, implementing sadvritta, the ideal code of conduct, performing yoga, etc. Since gastrointestinal disorders are highly prevalent and pharmacological modalities are limited in contemporary medicine. Thus, a non-pharmacological approach can be preferred in today’s era for sustainable results. Ayurveda follows a holistic approach and has never considered an individual's physical, physiological, and psychological aspects as separate entities. Hence, the management of different diseases has been given under three modalities: daivavyapashraya, yuktivyapashraya, and satvavajaya chikitsa. Thus, in the non-pharmacological management of FGIDs, Ayurveda played a magnificent role.

Post-infectious irritable bowel syndrome following a diagnosis of traveller's diarrhoea: a comprehensive characterization of clinical and laboratory parameters.

Prolonged or recurrent gastrointestinal symptoms may persist after acute traveller's diarrhoea (TD), even after adequate treatment of the primary cause. This study aims to describe the epidemiological, clinical and microbiological characteristics of patients with post-infectious irritable bowel syndrome (PI-IBS) after returning from tropical or subtropical areas. We conducted a retrospective study of patients presenting between 2009 and 2018 at the International Health referral centre in Barcelona with persistent gastrointestinal symptoms following a diagnosis of TD. PI-IBS was defined as the presence of persistent or recurrent gastrointestinal manifestations for at least 6 months after the diagnosis of TD, a negative stool culture for bacterial pathogens and a negative ova and parasite exam after targeted treatment. Epidemiological, clinical and microbiological variables were collected. We identified 669 travellers with a diagnosis of TD. Sixty-eight (10.2%) of these travellers, mean age 33years and 36 (52.9%) women, developed PI-IBS. The most frequently visited geographical areas were Latin America (29.4%) and the Middle East (17.6%), with a median trip duration of 30days (IQR 14-96). A microbiological diagnosis of TD was made in 32 of these 68 (47%) patients, 24 (75%) of whom had a parasitic infection, Giardia duodenalis being the most commonly detected parasite (n = 20, 83.3%). The symptoms persisted for a mean of 15months after diagnosis and treatment of TD. The multivariate analysis revealed that parasitic infections were independent risk factors for PI-IBS (OR 3.0, 95%CI 1.2-7.8). Pre-travel counselling reduced the risk of PI-IBS (OR 0.4, 95%CI 0.2-0.9). In our cohort, almost 10% of patients with travellers' diarrhoea developed persistent symptoms compatible with PI-IBS. Parasitic infections, mainly giardiasis, seem to be associated with PI-IBS.

Bochdalek hernia presenting gastrointestinal symptoms in late childhood: a case report

Most cases of congenital diaphragmatic hernia (CDH) can be diagnosed based on symptoms of severe respiratory failure during the neonatal period or fetal ultrasonography. However, some rare cases are diagnosed in late childhood or adolescence. In this case report, I describe an 11-year-old male patient diagnosed with late-onset CDH presenting with acute abdominal pain. The patient had recently experienced anorexia, nausea, and vomiting after eating. However, he reported no abdominal pain or past history of trauma. The abdomen was generally convex. All laboratory data were within normal limits. A chest X-ray revealed elevation of the left diaphragm. Chest computed tomography showed a defect in the left diaphragm. Based on the above radiologic findings, emergency surgery was performed after the diagnosis of diaphragmatic hernia. A surgical incision was performed in the left subcostal area. Finally, late-presenting Bochdalek hernia was diagnosed. The operation was completed and no specific findings on chest X-ray were found after surgery. The patient was discharged on the fourth day after surgery. In conclusion, CDH in late childhood or adolescence is rare and has various clinical manifestations. To avoid complications such as strangulation and bowel perforation, emergency surgery may be required. Thus, it is necessary to suspect CDH in children with recurrent gastrointestinal or respiratory symptoms, based on which an accurate diagnosis can be made and successful surgical treatment can be performed.

Testing the Arabic-Saudi Arabia version of the Rome IV Diagnostic Questionnaire for functional gastrointestinal disorders for Children living in Saudi Arabia.

Functional gastrointestinal disorders (FGID) are a worldwide phenomenon described by painful, recurrent or chronic gastrointestinal (GI) symptoms. Variable types of FGID exist in a significant portion of children in Saudi Arabia (SA). While the studies and reports on child FGID are limited, the available ones show a notable significance of FGID in children in SA. The self-report Rome IV Diagnostic Questionnaire (DQ) globally recognizes the selection of symptom criteria and incidence thresholds. Using such a questionnaire would help clinicians provide a provisional diagnosis, serve as a case definition for epidemiological surveys, and identify inclusion criteria for clinical trials. This research aimed to pilot test the collective FGIDs prevalence among preschool children in Jeddah city and its countryside of Saudi Arabia, using Rome IV DQ in Arabic-SA. Of the 59 responses, 11.8% (n = 7), 5% (n = 3), 1 (1.6%), and 1 (1.6%) participants have functional dyspepsia, functional constipation, functional irritable bowel syndrome, and functional aerophagia, respectively according to the Rome IV criteria. The tested translated DQ in this study was the first translated version available in Arabic- SA, which could provide researchers and clinicians in SA with a diagnostic tool for FGIDs. However, because this study is a pilot study in a new field, the conclusions cannot be extrapolated to the demographic of the targeted population of children. The same researchers plan a larger study to use the current results and a larger calculated sample to assess FGIDs prevalence in children 4+ years old in Jeddah and its countryside, Saudi Arabia.

Update on eosinophilic gastrointestinal disease beyond eosinophilic esophagitis in children.

Eosinophilic gastrointestinal disease (EGID) is an emerging condition worldwide in both children and adults, although it is considered rare. EGID has been underestimated owing to its underdiagnosis in the past, and its prevalence has recently increased. The diagnosis of EGID is based on histopathologic findings of endoscopic mucosal biopsy in which the total number of infiltrating eosinophils in each segment of the gastrointestinal tract is determined in patients with chronic or recurrent gastrointestinal symptoms despite a lack of consensus or guidelines on the definition of tissue eosinophilia except for eosinophilic esophagitis. Laboratory findings, including peripheral eosinophilia and increased fecal calprotectin levels, may be additional clues for detection of EGID in practice. Individualized treatment strategies, including adequate dietary modification and pharmacological therapy, may improve clinical outcomes of pediatric patients with EGID.