Bacterial metabolism in the host and its association with virulence

The host restricted pathogens are competently dependent on their respective host for nutritional requirements. The bacterial metabolic pathways are surprisingly varied and remarkably flexible that in turn help them to successfully overcome competition and colonise their host. The metabolic adaptation plays pivotal role in bacterial pathogenesis. The understanding of host-pathogen metabolic crosstalk needs to be prioritized to decipher host-pathogen interactions. The review focuses on various aspects of host pathogen interactions that majorly involves adaptation of bacterial metabolism to counteract immune mechanisms by rectifying metabolic cues that provides pathogen the idea of different anatomical sites and the local physiology of the host. The key set of metabolites that are recognized as centre of competition between host and its pathogens are also briefly discussed. The factors that control the timely expression of virulence of bacterial pathogens is poorly understood. The perspective presented herein will facilitate us with a broader view of molecular mechanisms that modulates the expression of virulence factors in bacterial pathogens. The knowledge of crosslinked metabolic pathways of bacteria and their host will serve to develop novel potential therapeutics.

Global burden and trends of the Clostridioides difficile infection-associated diseases from 1990 to 2021: an observational trend study

BACKGROUND

This study was aimed to explore the global burden and trends of Clostridioides difficile infections (CDI) associated diseases.

METHODS

Data for this study were obtained from the Global Burden of Disease Study 2021. The burden of CDI was assessed using the age-standardized rates of disability-adjusted life years (ASR-DALYs) and deaths (ASDRs). Trends in the burden of CDI were presented using average annual percentage changes (AAPCs).

RESULTS

The ASR-DALYs for CDI increased from 1.83 (95% UI: 1.53-2.18) per 100,000 in 1990 to 3.46 (95% UI: 3.04-3.96) per 100,000 in 2021, with an AAPC of 2.03% (95% CI: 1.67-2.4%). The ASDRs for CDI rose from 0.10 (95% UI: 0.08-0.11) per 100,000 in 1990 to 0.19 (95% UI: 0.16-0.23) per 100,000 in 2021, with an AAPC of 2.26% (95% CI: 1.74-2.79%). In 2021, higher burdens of ASR-DALYs (10.7 per 100,000) and ASDRs (0.53 per 100,000) were observed in high socio-demographic index (SDI) areas, and among age group over 70 years (31.62/100,000 for ASR-DALYs and 2.45/100,000 for ASDRs). During the COVID-19 pandemic, the global ASR-DALYs and ASDRs slightly decreased. However, in regions with low SDI, low-middle and middle SDI, those rates slightly increased.

CONCLUSION

The global burden of CDI has significantly increased, particularly in regions with high SDI and among individuals aged 70 years and above. During the COVID-19 pandemic period from 2020 to 2021, the burden of CDI further increased in regions with low, low-middle, and middle SDI. These findings underscore the need for increased attention and intervention, especially in specific countries and populations.

Failure of colonization following gut microbiota transfer exacerbates DSS-induced colitis

To study the impact of differing specific pathogen-free gut microbiomes (GMs) on a murine model of inflammatory bowel disease, selected GMs were transferred using embryo transfer (ET), cross-fostering (CF), and co-housing (CH). Prior work showed that the GM transfer method and the microbial composition of donor and recipient GMs can influence microbial colonization and disease phenotypes in dextran sodium sulfate-induced colitis. When a low richness GM was transferred to a recipient with a high richness GM via CH, the donor GM failed to successfully colonize, and a more severe disease phenotype resulted when compared to ET or CF, where colonization was successful. By comparing CH and gastric gavage for fecal material transfer, we isolated the microbial component of this effect and determined that differences in disease severity and survival were associated with microbial factors rather than the transfer method itself. Mice receiving a low richness GM via CH and gastric gavage exhibited greater disease severity and higher expression of pro-inflammatory immune mediators compared to those receiving a high richness GM. This study provides valuable insights into the role of GM composition and colonization in disease modulation.

Isolation and characterization of a novel oxyphenisatin analogue, 4-Chloro-oxyphenisatin diisobutyrate, from a jelly candy purported to possess weight-loss properties

A novel oxyphenisatin analogue was identified in a type of jelly candy during routine inspections of food products marketed for weight-loss purposes. Through analysis utilizing ultra-high-performance quadrupole-Orbitrap high-resolution mass spectrometry (UHPLC-Q-Orbitrap-HRMS), the fragment ions at m/z 258 and 195 observed in the MS/MS experiments were found to be consistent with those of 4-Chloro-oxyphenisatin diacetate. It was inferred that the unknown compound is likely a derivative of 4-Chloro-oxyphenisatin diacetate. The candy was separated and purified by column chromatography, and the purified compound was determined to be 96.4 % by high-performance liquid chromatography (HPLC). Subsequently, the structure was confirmed through nuclear magnetic resonance (NMR) spectroscopy. Based on the data, it was concluded that the structure of the unknown compound involved the substitution of two symmetrical acetyl groups in the 4-chloro-oxyphenisatin diacetate molecule with two isobutyl groups. Ultimately, the novel oxyphenisatin analogue was identified as (5-chloro-2-oxoindolin-3,3-ylidene) bis (4,1-phenylbutan-2-yl) diisobutyrate and designated as 4-Chloro-oxyphenisatin diisobutyrate. Finally, a quantitative analysis of the novel unknown compound in the jelly candy revealed a concentration of 6 mg per pellet. Based on the recommended daily consumption of one pellet, as indicated on the product packaging, the level of illegal additives may lead to diarrhoea and consequently poses a risk to human health. To the best of our knowledge, this represents the first report on the identification of 4-Chloro-oxyphenisatin diisobutyrate.

A comprehensive review of small molecules, targets, and pathways in ulcerative colitis treatment

Ulcerative colitis (UC), a chronic inflammatory bowel disease (IBD), poses significant clinical challenges because of its complex pathophysiology, long-term nature, and the limited efficacy of existing treatments. Small-molecule compounds, particularly those that are able to modulate inflammation-related signaling pathways and, in many cases, occur in nature, offer a promising alternative or supplement to conventional therapies. Studies on molecules for UC therapeutics reported in 1394 publications over the past 30 years were collected from the Web of Science (WOS) database. Only studies that verified therapeutic efficacy through animal experiments were included. Through an analysis of the molecular classes, structures, common targets, and pathways using network pharmacology, we identified 14 classes of compounds, 5 direct-target modules, and 3 crucial downstream pathways. Alkaloids, phenylpropanoids, flavonoids, and terpenes (and their derivatives) appeared most frequently and mainly targeted lipid metabolism, oxidative stress, immune regulation, signaling transduction, and cancer-related pathways. Notably, there has been an increasing trend of applying naturally sourced compounds in both preclinical and clinical trials, especially flavonoids, over the last five years. Although progress in UC research has been made, the majority of studies have focused on the overall therapeutic effects and biomarker alterations, with limited emphasis on the direct targets and underlying mechanisms. These findings highlight the need to explore novel small-molecule therapeutic strategies for UC, focusing on clearly defined targets and precise modes of action.

Refractory Crohn's disease complicated with Guillain-Barré syndrome: A case report

BACKGROUND

Inflammatory bowel disease (IBD) comprises a group of chronic inflammatory gastrointestinal disorders, including Crohn's disease (CD) and ulcerative colitis, with uncertain etiologies. The natural course of IBD can be accompanied by extraintestinal manifestations involving the skin, mucous membranes, musculoskeletal structures, eyes, cardiovascular system and nervous system. Guillain-Barré syndrome (GBS) is a type of peripheral neuropathy. However, the etiology and pathogenesis of IBD combined with GBS are unclear, and only a few clinical cases have been reported. Here, we report a case of refractory CD complicated by GBS and review the previous literature to improve the understanding of these diseases.

CASE SUMMARY

A 34-year-old man had a 9-year history of refractory CD. He became unresponsive to multiple drugs and experienced recurrent intestinal fistulas. After several abdominal surgeries and treatment with ustekinumab, he achieved clinical remission. Unfortunately, he developed GBS during maintenance treatment with ustekinumab. According to previous reports, in some patients with IBD combined with GBS, GBS may be a comorbidity, an extraintestinal manifestation of IBD, or an adverse reaction to IBD therapeutic drugs. After a comprehensive evaluation, we suspected that GBS might have been a comorbidity in this patient. To avoid fatal disease relapse after medication discontinuation, we concluded that ustekinumab should not be withdrawn. On the basis of a joint decision between doctors and the patient, we decided to continue maintenance treatment with ustekinumab along with intravenous immunoglobulin, dexamethasone and traditional Chinese medicine acupuncture, which resulted in a steady improvement in his GBS symptoms and sustained remission of CD.

CONCLUSION

When IBD is complicated by a neurological disease, it is first necessary to analyze the patient's condition and then choose the corresponding treatment strategy. If the neurological disease is a specific comorbidity, treatment of both IBD and the comorbid disease should be considered. For IBD patients with extraintestinal manifestations involving the nervous system, neurological manifestations tend to resolve when the active IBD is controlled. When an adverse drug reaction is suspected, the medication should be discontinued, and symptomatic treatment should be administered.

Phenotypical Characterization of Gastroenterological and Metabolic Manifestations in Patients With Williams-Beuren Syndrome

Gastrointestinal (GI) symptoms are common in patients with Williams-Beuren syndrome (WBS), but their prevalence and possible causes are not yet fully known. This study assessed GI symptoms' prevalence and their possible origin by performing a predefined set of tests in adult WBS patients. Laboratory tests and a questionnaire were administered to assess GI symptoms and dietary habits. All the patients underwent the urea breath test, H2-lactose and H2-glucose breath tests, and intestinal ultrasound (IUS) and vibration-controlled transient elastography for liver stiffness measurement (LSM) and controlled attenuation parameter (CAP, dB/m). Thirty-one patients were enrolled (72% of the whole cohort, 17 males, median age 32 years). Gastroesophageal reflux disease (GERD) symptoms were reported in 29% of the patients, abdominal pain in 26%, and altered bowel habits in 48%. Pathologic signs at (IUS) were present in 60% of the cases. Prevalence was 0.26 (95% CI 0.12-0.44) for Helicobacter pylori infection and 0.61 (95% CI 0.42-0.78) for lactose intolerance. LSM was > 6 kPa (in the range of a fibrosis score > F1) in three patients, and CAP values were > 268 dB/m (corresponding to a steatosis score > S2, e.g., moderate steatosis) in nine. The presence of altered bowel habits was significantly related to chronic abdominal pain (OR 13.1, p = 0.03). Increased BMI (> 28 kg/m2) (OR 10.8, p = 0.04) was associated with the presence of moderate-severe hepatic steatosis. After specific treatment and dietary counseling, most patients reported resolution/improvement of symptoms, whereas a few retained/developed symptoms during follow-up. Chronic abdominal pain, GERD symptoms, and unbalanced metabolic parameters were common in our WBS patients, together with an increased prevalence of lactose intolerance/colonic diverticula. Specific counseling and treatment improved symptoms for most patients.

Effect of glycerin on colonic motility in children

OBJECTIVE

Colonic manometry (CM) involves measurement of colonic neuromuscular activity and administration of a stimulant laxative, most commonly bisacodyl, which is part of the study protocol. Glycerin is another laxative used in the treatment of constipation. Our objective was to evaluate the effect of glycerin on colonic motility and compare the response to glycerin with each patient's response to bisacodyl.

METHODS

We performed a retrospective review of all CM studies performed between May 2015 and May 2022. All studies with glycerin administration were included. Patient demographics, medical and surgical history, and results of each CM, including name, number, and dose of stimulant laxatives administered, colonic motor response after each stimulant, and final interpretation, were recorded.

RESULTS

We included 131 CM studies in 125 patients (53% female, median age at CM 10 years, interquartile range 7-14 years). Compared to bisacodyl, glycerin more commonly triggered fully propagated high-amplitude propagating contractions (HAPCs; 35% vs. 13%, p < 0.001) and led to a greater extent of propagation (propagation to sigmoid vs. to descending colon, p < 0.001). In 36% of studies, glycerin led to an improved response (stimulation of HAPCs when they were absent after bisacodyl, or HAPCs propagating through a greater extent of colon) compared to bisacodyl. In studies with an improved response, the median dose of glycerin in mL/kg was not significantly different compared to studies with the same/worse response.

CONCLUSION

Glycerin can trigger HAPCs in patients in whom bisacodyl was not able to do so. Incorporation of glycerin into standard CM protocols should be considered.

Gastrointestinal Symptoms and Psychological Conditions: A Literature Review with Emphasis on the Evidence in Military Personnel from China

Gastrointestinal symptoms are common in military personnel due to their special living and working environment. Notably, there is a close association between gastrointestinal symptoms and psychological conditions. Thus, it seems that psychological interventions are not only beneficial for alleviating mental stress and improving psychological health, but could also be potentially effective for preventing gastrointestinal symptoms, especially in military personnel, which could contribute to battle effectiveness. This paper aims to briefly review the prevalence and risk factors of gastrointestinal syndromes, and summarize the association of gastrointestinal syndromes with psychological conditions and possible effect of psychological interventions on the improvement of gastrointestinal syndromes, with emphasis on the evidence in military personnel from China.

Loss of α-smooth muscle actin immunostaining is not a useful marker for functional impairment: a comparison from patients with and without small bowel motility disorder

OBJECTIVE

Prior studies have reported the loss of α-smooth muscle actin (α-SMA) immunoreactivity in the inner circular layer of the muscularis propria in small bowel motility disorder cases, but this remains controversial with conflicting data. In this study, we aimed to characterize α-SMA immunoreactivity in the muscularis propria of the small intestine-specifically, jejunum-in patients with and without small bowel motility disorder.

METHODS

A total of 28 transmural proximal jejunum biopsy specimens from adult patients with clinical impression of upper gastrointestinal dysmotility disorder and 64 control tissues were evaluated. The controls were full-thickness, longitudinal tissue sections from segmental resections performed due to gunshot wounds, multivisceral transplant donation, and tumors. Immunostaining for α-SMA was performed with appropriate controls to confirm the presence of immunoreactivity in the circular and longitudinal muscle layers of the muscularis propria in each sample and recorded as retained or diminished.

RESULTS

In the small bowel motility disorder and control cases, 42.9% (12/28) and 70.3% (49/64) of the cases showed no or minimal α-SMA immunoreactivity in the inner circular layer with peripheral accentuation, respectively.

CONCLUSIONS

Loss or diminished α-SMA immunoreactivity in the inner circular layer of the muscularis propria occurs with a similar frequency in cases with and without small bowel motility disorder and does not correlate with impairment of function.

Prospective uncontrolled clinical study shows rapid and long lasting relief of heartburn and acid related gastric discomfort with Refluthin

Heartburn and acid regurgitation are main symptoms of gastro-esophageal reflux, a widespread complaint with a significant impact on quality of life (QoL). Refluthin® for Heartburn chewable tablets (Refluthin) are a symptomatic treatment option containing a combination of an antacid (CaCO3, MgCO3) and a polysaccharide-rich extract with mucoprotective substances from Opuntia ficus-indica cladodes. To investigate performance and safety of Refluthin in the rapid and long lasting relief of heartburn and acid related gastric discomfort under practical use conditions, a prospective, clinical, uncontrolled, open-label study was conducted. Adults with symptomatic heartburn, acid regurgitation, and/or recurrent acid related gastric discomfort took one tablet Refluthin up to four times/day as needed for up to 4 weeks. Endpoints were both time to onset and duration of symptom relief; reflux symptom intensity/frequency; global assessments (QoL, performance, satisfaction, usability, tolerability); and safety. 81/100 participants (81%) responded with a first symptom relief within ≤ 20 min in ≥ 50% of the individual applications. Long lasting effects of > 120 min were reported by 83/100 (83%) participants. Significant reductions in heartburn event frequency and intensity were seen within the 4 weeks of intermittent use (p < 0.0001, respectively). Global assessment results and safety-relevant findings were also favorable. Results thus demonstrated a distinct rapid and long lasting symptom relief after intake of Refluthin, with a safe and easy use. The significant reductions in frequency and intensity of heartburn events over time indicate sustained effects under treatment. These long-term effects might be explainable by soothing and protection of the irritated mucous membrane by Refluthin.

Effects of the combined use of linaclotide and oral sulfate solution in bowel preparation for patients with chronic constipation undergoing colonoscopy: protocol of a prospective, randomised, controlled, single-blind clinical trial from a single centre in China

INTRODUCTION

Chronic constipation is an independent risk factor for inadequate bowel preparation. The objective of this study is to evaluate the effectiveness and safety of the combined use of linaclotide and oral sulfate solution (OSS) in patients with chronic constipation undergoing colonoscopy.

METHODS AND ANALYSIS

This is a prospective, randomised, controlled, single-blind (endoscopist) clinical trial that compares three bowel cleansing regimens for patients with chronic constipation undergoing colonoscopy. Regimen A consists of 2d-linaclotide and OSS, regimen B consists of 3d-linaclotide and OSS, and regimen C consists of OSS. All patients are required to consume a low-fibre diet for 3 days and then a clear fluid diet for 1 day before the colonoscopy. The primary outcome is adequate bowel preparation (defined as a Boston Bowel Preparation Scale (BBPS) score ≥2 for each segment and a total BBPS score ≥6). The secondary outcomes include defecation frequency, caecal intubation rate, adenoma detection rate and colonoscope insertion time and withdrawal time. The tertiary outcomes include complications of colonoscopy, adverse events and degree of comfort, which is evaluated via a self-designed questionnaire of comfort.

ETHICS AND DISSEMINATION

The research will be conducted according to Good Clinical Practice principles. Ethical approval has been obtained from the Ethics Committee of Beijing Shijitan Hospital, Capital Medical University (IIT2024-146-003). Study findings will be published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ChiCTR2500096394.

Novel gut-restricted bivalent agonists targeting mucosal 5-HT4R: Design, synthesis, and biological evaluation

Chronic idiopathic constipation (CIC) is a prevalent gastrointestinal disorder with limited therapeutic options that balance efficacy and safety. Current therapies, such as the 5-HT4 receptor (5-HT4R) agonist prucalopride, demonstrate efficacy but are often associated with systemic side effects, highlighting the need for gut-restricted alternatives. Herein, we report for the first time the rational design and synthesis of gut-restricted bivalent agonists targeting mucosal 5-HT4R by integrating pharmacophores of prucalopride and tenapanor. Structural optimization, particularly of linker length and properties, led to the discovery of compound 4, which exhibited potent 5-HT4R agonistic activity, high selectivity, and favorable physicochemical properties. Preclinical studies demonstrated that compound 4 significantly enhanced whole-gut and colonic transit, increased fecal output and water content, while maintaining minimal systemic absorption, confirming its gut-restricted nature. These findings underscore the feasibility of gut-restricted 5-HT4R agonists as a novel therapeutic strategy for CIC and provide valuable insights into the development of safer, more effective treatments for gastrointestinal disorders.

Independent risk factors for diversion colitis: a retrospective case-control study

OBJECTIVE

The aim of this study was to investigate independent risk factors for diversion colitis induced by the surgical interruption of fecal flow in the non-functional colon.

METHODS

We performed a retrospective study with 163 patients who underwent low anterior resections and created prophylactic ileostomies for rectal cancer between January 2014 and June 2023 at the Department of General Surgery, Air Force Medical University Tangdu Hospital. Colonoscopy results of the non-functional region of the distal colon and clinical variables were collected, including age, sex, body mass index, pathological tumor node metastasis staging, ileostomy method, diversion time, receiving radiotherapy or chemotherapy or not, suffering from preoperative inflammatory bowel disease or postoperative anastomotic leakage or not. Diagnosis of diversion colitis based on the results of the patients' colonoscopy results. Univariate analysis and multivariate analysis of diversion colitis-related risk factors were performed subsequently.

RESULTS

The morbidity of diversion colitis is 53.4% (87/163) in our study. Multivariate analysis showed that risk factors for diversion colitis included single-lumen prophylactic ileostomy (63.2 vs. 30.3%, OR 4.481, 95%CI 1.897-10.584, p<0.001), diversion time ≥90 days (79.3 vs. 40.8%, OR 4.474, 95%CI 1.849-10.826, p<0.001), inflammatory bowel disease (17.2 vs. 3.9%, OR 7.491, 95%CI 1.839-30.507, p=0.005), radiotherapy (58.6 vs. 42.1%, OR 0.515, 95%CI 0.196-1.352, p=0.178).

CONCLUSION

These findings suggest that single-lumen prophylactic ileostomy, diversion time, and inflammatory bowel disease are independent risk factors for diversion colitis.

From Ulcerative Colitis to Metastatic Colorectal Cancer: The Neutrophil Contribution

Ulcerative colitis (UC) is an inflammatory colon and rectum disease affecting approximately 5 million people worldwide. There is no cure for UC, and approximately 8% of patients with UC develop colorectal cancer (CRC) by gradual acquisition of mutations driving the formation of adenomas and their progression to adenocarcinomas and metastatic disease. CRC constitutes 10% of total cancer cases worldwide and 9% of cancer deaths. Both UC and CRC have an increasing incidence worldwide. Although the epithelium has been well studied in UC and CRC, the contribution of neutrophils is less clear. Neutrophils are rapidly recruited in excessive amounts from peripheral blood to the colon during UC, and their overactivation in the proinflammatory UC tissue environment contributes to tissue damage. In CRC, the role of neutrophils is controversial, but emerging evidence suggests that their role depends on the evolution and context of the disease. The role of neutrophils in the transition from UC to CRC is even less clear. However, recent studies propose neutrophils as therapeutic targets for better clinical management of both diseases. This review summarizes the current knowledge on the roles of neutrophils in UC and CRC.

NIR-Propelled Thermosensitive Bowl-Shaped Nanomotors with High Penetration and Targeting for Photoacoustic Imaging Guided Thrombolysis Therapy

Traditional antithrombotic therapeutic strategies encounter challenges including heightened bleeding risks, short circulation times, low targeting ability, and inferior thrombus penetration. Therefore, a novel thrombolysis nanodrug (APBUL) is designed that incorporates urokinase (UK) loaded onto the surface of bowl-shaped nanomotors (APBs) encapsulated within fibrin peptide (CREKA)-modified thermosensitive liposomes, presenting an innovative therapeutic platform for thrombolysis. APBUL leverages CREKA's targeting ability for thrombus accumulation. Subsequently, under the irradiation of near-infrared light, the thermosensitive liposomal shell undergoes controlled disruption, releasing internal APBs and UK. Then, the APBs move directionally though thermophoresis effect, facilitating photothermal therapy and deep thrombus penetration, and synergistically enhancing UK release and diffusion to optimize thrombolysis. Moreover, the APBUL possesses a catalase-like activity, catalyzing hydrogen peroxide into oxygen to alleviate oxidative stress and inflammatory factors at the thrombus site, thereby lowering the recurrence risk. Combined with the ability of APBUL's photoacoustic imaging, this new strategy is expected to provide an inspiring idea for the integrated use of clinical thrombolytic therapy in diagnosis, imaging, and treatment.

Enteric neuronal Piezo1 maintains mechanical and immunological homeostasis by sensing force

The gastrointestinal (GI) tract experiences a myriad of mechanical forces while orchestrating digestion and barrier immunity. A central conductor of these processes, the enteric nervous system (ENS), detects luminal pressure to regulate peristalsis independently of extrinsic input from the central and peripheral nervous systems. However, how the ∼500 million enteric neurons that reside in the GI tract sense and respond to force remains unknown. Herein, we establish that the mechanosensor Piezo1 is functionally expressed in cholinergic enteric neurons. Optogenetic stimulation of Piezo1+ cholinergic enteric neurons drives colonic motility, while Piezo1 deficiency reduces cholinergic neuronal activity and slows peristalsis. Additionally, Piezo1 deficiency in cholinergic enteric neurons abolishes exercise-induced acceleration of GI motility. Finally, we uncover that enteric neuronal Piezo1 function is required for motility alterations in colitis and acts to prevent aberrant inflammation and tissue damage. This work uncovers how the ENS senses and responds to mechanical force.

Neural crosstalk and symptom overlap: The correlation between urinary and intestinal symptoms in patients undergoing colonoscopy

PURPOSE

Neural crosstalk in the pelvis involves intrinsic communication networks among pelvic structures that direct afferent inputs to converge on neurons, leading to viscerovisceral and somatovisceral reflexes. We aimed to explore the overlap between intestinal and urinary symptoms and their correlations in patients undergoing colonoscopy.

MATERIALS AND METHODS

Cross-sectional study with 167 participants who underwent colonoscopy and were assessed using three self-administered questionnaires: the International Prostate Symptom Score (IPSS) for lower urinary tract symptoms, the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) for overactive bladder symptoms, and the Gastrointestinal Symptom Rating Scale (GSRS) for gastrointestinal (GI) symptoms.

RESULTS

Among the participants, 55.1% were male, and the median age was 57 years. Most colonoscopies (80.8%) were performed for screening, and the most common finding was diverticular disease (DD) (35.9%). The IPSS and ICIQ-OAB were strongly correlated (rho=0.544, p<0.001), while the IPSS and GSRS scores showed a moderate correlation (rho=0.304, p<0.001). In the DD subgroup, both ICIQ-OAB and IPSS (rho=0.568, p<0.001), and IPSS and GSRS (rho=0.493, p<0.001) showed strong correlations. In contrast, the subgroup without DD showed a strong correlation between the ICIQ-OAB and IPSS (rho=0.510, p<0.001), but only a weak correlation between the IPSS and GSRS (rho=0.188, p=0.057), suggesting that the urinary-GI connection is influenced by the presence of DD.

CONCLUSIONS

The findings revealed intrinsic relationships between urinary and GI symptoms, with DD as a significant factor influencing these relationships, suggesting that a more integrated approach to evaluate and manage these patients can potentially improve diagnostic accuracy and treatment outcomes.

The Vibrating Capsule: Safety and Tolerability in Patients With Chronic Idiopathic Constipation

BACKGROUND

Chronic idiopathic constipation (CIC) remains a significant problem globally with increasing estimates for disease burden. In a Phase 3 placebo-controlled trial, a novel treatment using the Vibrating Capsule was recently shown to be effective in treating patients with CIC. However, its safety and tolerability has not been described in detail.

METHODS

We analyzed safety data from six trials encompassing the development of the Vibrating Capsule, including, dose-ranging and pivotal studies. The incidence of adverse events, treatment discontinuation, tolerability and satisfaction were assessed.

KEY RESULTS

A total of 800 patients who took either an active Vibrating Capsule or a sham/placebo (non-vibrating) but similar capsule from 6 studies were included in this post hoc analysis. The most common adverse gastrointestinal events were bloating (2.9%), abdominal pain (2.9%), nausea (2.3%) and diarrhea (1.9%). A sensation of vibration was reported by 11.7% of patients. The adverse events rates were low, and investigators categorized most of them as unrelated to treatment. There were no serious adverse events such as retention of therapeutic capsules and no patient stopped therapy or withdrew due to adverse effects. The majority of patients (83%) found the system convenient, with an overall treatment satisfaction rate of 71%.

CONCLUSIONS AND INFERENCES

The Vibrating Capsule, a first in class treatment for CIC was found to be safe and well tolerated by patients in clinical trials. No patient discontinued treatment due to adverse events.

High Throughput Pharmacovigilance Screening for Roflumilast Adverse Effects in Real-World Settings: A Sequence Symmetry Analysis

BACKGROUND

Roflumilast is an add-on therapy for COPD following exacerbations, but real-world safety data in the United States are limited.

OBJECTIVE

This study aimed to identify safety signals associated with roflumilast initiation through a high-throughput signal detection algorithm.

METHODS

Using sequence symmetry analysis (SSA), we analysed Marketscan databases for new roflumilast users (2011-2021). We screened for adverse effects across 211 therapeutic classes within 365 days of initiation. Sensitivity analyses were conducted by sex, age and observation period. Crude and adjusted sequence ratios (cSR and aSR) were reported with 95% confidence intervals (CIs).

RESULTS

Among 11 091 patients (53% aged 65+, 52% female), 32 safety signals were identified. Strong associations were observed with antithyroid agents (aSR, 4.18; 95% CI: 1.66-11.95), parathyroid hormones (aSR, 3.09; 95% CI: 1.56-6.44), haematopoietic agents (aSR, 2.55; 95% CI: 1.07-6.49) and meglitinides (aSR, 2.37; 95% CI: 1.15-5.35). While many signals aligned with prior clinical trial data, novel associations with antithyroid and parathyroid agents were discovered.

CONCLUSION

In our study, we detected 32 safety signals for roflumilast, including notable associations with antithyroid agents and parathyroid hormones. Future investigations using more robust study designs are warranted to evaluate those signals.

Repetitive Feeding-Challenge With Different Nutritional Densities on Markers of Gastrointestinal Function, Substrate Oxidation, and Endurance Exercise Performance

Gut-training has been shown to improve gastrointestinal tolerance, circulatory glucose availability, and exercise performance. The study aimed to investigate the effects of a repetitive feeding-challenge using fat versus carbohydrate (CHO) on markers of gastrointestinal function, glucose availability, and subsequent performance when challenged with a high-CHO load (87 g/hr) during exercise. Forty-four endurance athletes (mean ± SD [9 females and 35 males]: body mass: 71.2 ± 9.2 kg, height: 173.6 ± 7.0 cm, V˙O2max: 55.0 ± 6.1 ml·kg-1·min-1) completed a preintervention gut-challenge trial (T1), involving a 2 hr run (60% V˙O2max) while taking a CHO gel every 20 min (87 g/hr, 10% w/v), followed by a 1 hr self-paced distance test with ad libitum water. Participants were then randomized to a fat (fat feeding-challenge [FFC]; 20 g nut butter, 124 kcal, 11 g fat, 3 g protein, and 3 g CHO) or CHO supplement (CHO feeding-challenge [CFC]; 47 g CHO gel: 123 kcal, 29 g CHO) group to complete a 7-day repetitive feeding-challenge (1 hr exercise and supplement intake every 20 min with 290 ml water), followed by a gut-challenge retrial (T2). FFC did not differ from CFC in terms of resting orocecal transit time, feeding tolerance, or substrate oxidation during T1 and T2. Peak breath hydrogen was lower in FFC than CFC (p = .028) at T2. Total (FFC: 27%, p = .005 vs. CFC: 38%, p = .001) and upper gastrointestinal symptoms severity (FFC: 26%, p = .013 vs. CFC: 40%, p < .001) during exercise was reduced similarly between groups from T1 to T2. FFC covered more distance in T2 (11.51 ± 2.02 vs. 11.08 ± 2.02 km, p = .013), but not significantly different to CFC (p = .341). A repetitive feeding-challenge with fat does not enhance nor worsen gastrointestinal and fueling outcomes compared with a CHO repetitive feeding-challenge.

Consensus on Safe Initiation and Monitoring of Transanal Irrigation to Optimize Adherence With Therapy

BACKGROUND

Transanal irrigation is a well-established minimally invasive therapy that addresses symptoms of both constipation and incontinence. The therapy has been extended from just neurogenic bowel dysfunction patients to those with disorders of brain-gut interaction and postsurgical conditions.

AIM

To summarized the literature on transanal irrigation and update the contraindication profile.

MATERIALS AND METHODS

We undertook a literature review of transanal irrigation complications and outcomes.

RESULTS

Initiation of therapy as part of a bowel care regime is becoming more common outside specialist centers. In addition, the concept of both high- and low-volume irrigation schedules has entered the treatment paradigm, and it is clear that there is a differing safety profile. We present an update from the previous long list of contraindications.

DISCUSSION

We describe how optimizing long-term adherence depends on these factors in addition to a structured follow-up programme.

CONCLUSION

Transanal irrigation is an increasingly used therapy, with a good safety profile, further improved by the advent of low-volume irrigation options. Key to safe and effective usage of transanal irrigation is careful patient selection allied to tailored initial training of the patient.

Endoscopic healing in IBD: Still the target to achieve?

Mucosal healing is the mainstream goal of modern treat-to-target strategy as it is associated with a significantly more favorable disease course in IBD patients with either ulcerative colitis or Crohn's disease. Recent advances in endoscopic imaging technologies have overcome the traditional concept of mucosal healing assessed with conventional white light imaging, allowing for multiple levels of endoscopic healing up to the boundaries of molecular and functional evaluation. In this review, we focused on conventional and emerging strategies to assess endoscopic healing in ulcerative colitis and ileocolonic Crohn's disease, examining their pros and cons in real life practice.

Diabetic gastroenteropathy: a pan-alimentary complication

Autonomic neuropathy contributes to the pathophysiology of diabetic gastroenteropathy, which impacts the entire gastrointestinal tract alongside pancreatic and gallbladder functions. This is evident in the widespread morphological remodelling of the enteric nervous system, smooth muscle cells, interstitial cells of Cajal and vascular supply, causing pan-enteric motor, sensory and secretory disturbances. The gastrointestinal symptoms caused by these changes are often burdensome and non-specific and frequently coexist with poor glycaemic management and even malnutrition, impacting quality of life negatively. The Gastroparesis Cardinal Symptom Index and the Gastrointestinal Symptom Rating Scale are validated questionnaires for assessing gastrointestinal symptoms. However, clinical supplementary objective measures are essential. Transit time assessments are frequently used and typically evaluated using gastric emptying scintigraphy, breath tests or colonic radiopaque markers, but they cannot measure contractile activity or fluid transport. The primary treatment goals are to prevent further disease progression and to obtain symptomatic relief. Treatments include improved glycaemic management and dietary modifications, while pharmacological treatments target gastrointestinal symptoms, small intestinal bacterial overgrowth and exocrine pancreatic insufficiency. Invasive interventions may involve gastric peroral pyloromyotomy or the implantation of a gastric neurostimulator to manage pharmacologically refractory gastroparesis. This review describes the prevalence, pathophysiology, clinical presentation, assessment and treatment of diabetic gastrointestinal dysfunction within each segment of the gastrointestinal tract and directly connected exocrine organs.

Histological healing in IBD: Ready for prime time?

The main target of treatment in ulcerative colitis and Crohn's disease is to achieve a complete so-called mucosal healing. Various definitions of mucosal healing are available in literature, and the most recent ones include a combination of endoscopic and histological remission. However, the assessment of a complete histological remission is not always univocal. Absence of neutrophil infiltration in the lamina propria, together with neutrophil-mediated mucosal injuries in crypt and surface epithelium, is considered an important element to define histological remission. Although several histological scoring systems have been proposed to differentiate active vs quiescent disease and to evaluate the therapeutic efficacy, most of them are subjective and complex to employ in the daily diagnostic routine. For this reason, to simplify histologic scoring attempts have been made by introducing simplified scores, based on the evaluation of neutrophils and their mucosal localization. Artificial intelligence models are also being developed to standardize histological assessment of mucosal healing, and new biomarkers, such as claudin- 2, are emerging to simplify this latter aspect.

Smart Bioelectronics for Real-Time Diagnosis and Therapy of Body Organ Functions

Noncommunicable diseases (NCDs) associated with cardiovascular, neurological, and gastrointestinal disorders remain a leading cause of global mortality, sounding the alarm for the urgent need for better diagnostic and therapeutic solutions. Wearable and implantable biointegrated electronics offer a groundbreaking solution, combining real-time, high-resolution monitoring with innovative treatment capabilities tailored to specific organ functions. In this comprehensive review, we focus on the diseases affecting the brain, heart, gastrointestinal organs, bladder, and adrenal gland, along with their associated physiological parameters. Additionally, we provide an overview of the characteristics of these parameters and explore the potential of bioelectronic devices for in situ sensing and therapeutic applications and highlight the recent advancements in their deployment across specific organs. Finally, we analyze the current challenges and prospects of implementing closed-loop feedback control systems in integrated sensor-therapy applications. By emphasizing organ-specific applications and advocating for closed-loop systems, this review highlights the potential of future bioelectronics to address physiological needs and serves as a guide for researchers navigating the interdisciplinary fields of diagnostics, therapeutics, and personalized medicine.

Prevalence of gastroesophageal reflux disease in adult coeliac disease at diagnosis and during follow-up: a 20-year retrospective study

OBJECTIVE

Gastroesophageal reflux disease (GORD) is commonly reported in coeliac disease (CD). However, long-term data on GORD in coeliac patients on a gluten-free diet (GFD) are lacking. We aimed to evaluate the prevalence of GORD and endoscopic lesions in coeliac patients at diagnosis and throughout follow-up.

METHODS

Adult patients directly diagnosed with CD from January 2000 to October 2021 who underwent follow-up duodenal biopsy were enrolled. Clinical data were retrospectively collected and analysed.

RESULTS

A total of 197 patients (141 F, mean age at diagnosis 36 ± 13 years) were studied. At diagnosis, 33/197 (16.8%) had reflux symptoms and 12/197 (6.1%) had oesophagitis. Only 7/33 (21.9%) still had reflux symptoms at follow-up duodenal biopsy (median 16 months, interquartile range: 13-20). Conversely, 7/164 (4.3%) patients without GORD at diagnosis developed reflux symptoms after starting a GFD. Overall, GORD was significantly more common at diagnosis of CD than at follow-up duodenal biopsy ( P  < 0.01), where only five had oesophagitis. GFD adherence was good in 90.4% and duodenal biopsy showed recovery of villous atrophy in 83.8% of patients. Neither GFD adherence ( P  = 1.00) nor mucosal recovery ( P  = 0.13) were related to GORD at follow-up biopsy. During follow-up (median 111 months), 41/197 patients (20.8%) reported ongoing reflux symptoms, more commonly in those with GORD at CD diagnosis (42.4% vs. 16.5%, P  < 0.001).

CONCLUSION

GORD is common in coeliac patients at diagnosis and improves in the large majority of patients after starting a GFD. However, a minority of patients develop GORD after starting a GFD, and ongoing reflux symptoms are common during long-term follow-up in coeliac patients.

2025 Seoul Consensus on Clinical Practice Guidelines for Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a chronic, disabling, and functional bowel disorder that significantly affects social functioning and reduces quality of life and increases social costs. The Korean Society of Neurogastroenterology and Motility published clinical practice guidelines on the management of IBS based on a systematic review of the literature in 2017, and planned to revise these guidelines in light of new evidence on the pathophysiology, diagnosis, and management of IBS. The current revised version of the guidelines is consistent with the previous version and targets adults diagnosed with or suspected of having IBS. These guidelines were developed using a combination of de novo and adaptation methods, with analyses of existing guidelines and discussions within the committee, leading to the identification of key clinical questions. Finally, the guidelines consisted of 22 recommendations, including 3 concerning the definition and risk factors of IBS, 4 regarding diagnostic modalities and strategies, 2 regarding general management, and 13 regarding medical treatment. For each statement, the advantages, disadvantages, and precautions were thoroughly detailed. The modified Delphi method was used to achieve expert consensus to adopt the core recommendations of the guidelines. These guidelines serve as a reference for clinicians (including primary care physicians, general healthcare providers, medical students, residents, and other healthcare professionals) and patients, helping them to make informed decisions regarding IBS management.

A single-centre analysis of a biosimilar switching programme for adalimumab in inflammatory bowel disease

AIMS

Amgevita is a licensed biosimilar to adalimumab, having demonstrated high pharmacokinetic and clinical similarity to Humira. Switching to a lower-cost medicine may elicit a nocebo effect, whereby expectations of poorer efficacy impact outcomes despite pharmacological similarity. This prospective cohort study examined clinical and economic outcomes and associated psychosocial variables in a group of patients undergoing a nonmedical switch to biosimilar adalimumab.

METHODS

Patients with inflammatory bowel disease (IBD) were followed before and after switching from Humira to Amgevita. Objective disease activity was assessed pre- and post-switch using the Harvey-Bradshaw Index (Crohn's disease) or partial Mayo score (ulcerative colitis), faecal calprotectin and C-reactive protein. Subjective symptom burden was measured using the IBD Control Questionnaire (IBDCQ). Pre-switch, health anxiety was measured using the Health Anxiety Index (HAI).

RESULTS

In total, 64 patients aged 18-67 were enrolled. IBDCQ scores marginally improved post-switch (13.33 vs, 12.49, P = .043), with no significant changes in objective disease activity scores, faecal calprotectin or C-reactive protein. Sixteen patients reported 17 new adverse events within 4 weeks. Logistic regression revealed a significant relationship between HAI scores and adverse events (P = .0079); each unit increase in HAI score increased the odds of reporting an adverse event by 21%. Drug cost savings for the 64 patients over 8 weeks totalled €143 958.

CONCLUSION

Switching to biosimilar adalimumab did not affect disease control or quality of life. 25% of patients developed new side effects, particularly those with high levels of health anxiety. Significant cost savings were achieved.

Association of Clostridium difficile infection with clinical outcomes of patients with inflammatory bowel disease: A meta-analysis

BACKGROUND

Clostridium difficile infection (CDI) is common in patients with inflammatory bowel disease (IBD).

AIM

To assess the association of CDI with clinical outcomes of IBD.

METHODS

PubMed, EMBASE, Web of Science, and the Cochrane Library databases were searched from inception to March 2024. Eligible articles included observational studies that reported on outcomes such as mortality, colectomy, hospitalization, intensive care unit (ICU) admission, complication rates, and length of hospital stay in IBD patients with and without CDI. Data were extracted, and a random-effects model was used to calculate pooled odds ratios (ORs) and mean differences (MDs).

RESULTS

As shown in the data from 21 studies with 1249158 participants, CDI significantly increased the risk of mortality in IBD patients [pooled OR = 4.569, 95% confidence intervals (95%CI): 2.584 to 8.079]. Although the pooled OR for colectomy was 1.409 (95%CI: 0.922 to 2.155), it was not statistically significant. Similarly, CDI did not impact hospitalization (pooled OR = 1.056, 95%CI: 0.512 to 2.179) and ICU admission outcomes (pooled OR = 1.970, 95%CI: 0.420 to 9.246) of patients with IBD. The rate of complications was comparable in the two groups (pooled OR = 0.658, 95%CI: 0.378 to 1.147). However, CDI was associated with a significantly more extended hospital stay (pooled MD = 0.349 days, 95%CI: 0.002 to 0.696).

CONCLUSION

CDI is linked to increased mortality and prolonged hospitalization in IBD patients. These results emphasize the need for early detection and appropriate management. Implementing routine CDI screening during IBD flare-ups and stringent infection control measures could mitigate severe complications and reduce the healthcare burden.

Eosinophilic Myenteric Ganglionitis as a Cause of Digestive Tract Perforation

The etiology of eosinophilic myenteric ganglionitis (EMG) remains unclear. We present the case of a 62-year-old man who underwent right hemicolectomy with ileostomy and transverse colon mucous fistula due to ascending colon perforation. Pathological examination revealed severe eosinophilic infiltration in Auerbach's plexus and fibrosis extending from the external longitudinal muscle layer to the subserosal layer, suggesting that the perforation resulted from pseudo-obstruction and EMG-related increased intestinal pressure. Eosinophilic infiltration was observed not only near the perforation site but throughout the entire length of the resected intestine. Four months postoperatively, the patient underwent ileostomy closure, during which the ileal and colonic tracts left external to the wound were resected. Notably, no eosinophilic infiltration in Auerbach's plexus was found in the new specimen, unlike that in the previous surgical specimen, despite the patient receiving no postoperative medication. The patient has remained symptom-free for over 2 years. This is the first report to document histological time-course changes in eosinophil infiltration in Auerbach's plexus and demonstrate the efficacy of surgical treatment in a patient with EMG.

Study on the Effect and Mechanism of Weichang'an Pill and Its Extract on Slow Transit Constipation

BACKGROUND

Weichang'an pill (WCA) possesses potential advantages in promoting gastrointestinal motility and treating constipation. Ethanol extract (EE) and aqueous extract (AE) of WCA were used to investigate its efficacy in treating slow transit constipation (STC) and the material basis for exerting this effect.

METHODS

The STC model was established in vivo by gavage of loperamide (Lop) in Sprague-Dawley rats, followed by gavage of WCA, EE, and AE. In vitro, norepinephrine (NE) was used to stimulate isolated ileal smooth muscle of rats to imitate the state of insufficient gastrointestinal motility during STC, and a model of excessive relaxation of isolated ileal smooth muscle was established. This model was used to observe and record the changes in contraction tension, amplitude, and frequency of ileal smooth muscle after treatment with WCA, EE, AE, and the active ingredients of WCA.

KEY RESULTS

In vivo, WCA, EE, and AE treatment increased fecal parameters, improved gastrointestinal transit time, and alleviated pathological damage to the colon in STC rats. Its mechanism might be closely related to c-kit/SCF, RhoA/ROCK/MYPT1/MLC signaling pathways. In vitro, WCA, EE, AE, and the active ingredients of WCA, including costunolide (Cos), dehydrocostus lactone (Deh), agarotetrol (Aga), muscone (Mus), gallic acid (GA), oleic acid (Oleic), linoleic acid (Lin), umbelliferone (Umb), synephrine (Syn), ferulic acid (FA), chlorogenic acid (ChA), betaine (Bet), and riboflavin (Rib), significantly inhibited the NE-induced excessive relaxation of ileal smooth muscles.

CONCLUSIONS

WCA, EE, and AE significantly improved constipation in STC rats. Moreover, the active ingredients in WCA, including Cos, Deh, Aga, Mus, GA, Oleic, Lin, Umb, Syn, FA, ChA, Bet, and Rib, might be the material basis for promoting intestinal motility.

The role and intrinsic connection of cellular senescence and cell death in inflammatory bowel disease

Cellular senescence in the intestine can induce cell death, which extends beyond the mere clearance of senescent cells. This phenomenon is prevalent in inflammatory and immune-related diseases, particularly in inflammatory bowel disease (IBD). IBD is characterized by recurrent and chronic intestinal inflammation, with the occurrence and development of the disease being influenced by multiple factors, including genetics, environment, lifestyle, intestinal immunity, and gut microbiota. Chronic intestinal inflammation drives aging of the IBD immune system, reducing its efficiency and impairing the clearance of senescent cells. The disruption of cell death regulation and the interplay between cell death and cellular senescence contribute to disease progression in IBD, with inflammaging and immunosenescence playing the key role in this process. However, the mechanisms underlying the interplay between cell death and cellular senescence in the context of IBD remain unclear. Therefore, this paper comprehensively reviews the impact of cellular death and cellular senescence on intestinal aging in IBD, emphasizing the exploration of their potential interrelationships.

Switch acceptance and persistence of adalimumab biosimilars in IBD patients: a prospective observational study

Background

Prospective data about the acceptance and outcomes of switching from the adalimumab (ADA) reference product (RP) to multiple ADA biosimilars in inflammatory bowel disease (IBD) patients are lacking.

Objectives

To evaluate the acceptance rate of switching from the ADA RP to ADA biosimilars, identify factors associated with non-acceptance, assess persistence at 6 and 12 months, determine reasons for discontinuation, analyze changes in disease activity, and explore patient perceptions at 12 months.

Design

A prospective study was conducted at a French tertiary center between July 2020 and September 2021, including consecutive IBD outpatients treated with ADA RP for over 6 weeks.

Methods

Patients were offered a switch to five different ADA biosimilars, with the presence of a trained nurse. Data were collected on acceptance rates, persistence at 6 and 12 months, discontinuation reasons, disease activity, and patient perceptions using a 5-item questionnaire at 12 months.

Results

Of the 97 patients included, 91.8% accepted the switch. The only factor linked to non-acceptance was a poor opinion of generic drugs. Persistence with the initial ADA biosimilar was 68.6% at 6 months and 60.4% at 12 months. The overall survival rate without biosimilar discontinuation was 76.7% at 6 months and 71% at 12 months. Injection site pain (24.7%) was the leading cause of discontinuation, and 22 patients switched back to the ADA originator. Clinical remission was maintained in 90.4% of patients at 12 months. Among respondents, 65.8% reported a positive experience with the switch.

Conclusion

The study demonstrates high acceptance and favorable outcomes for switching to ADA biosimilars in IBD patients, including sustained efficacy and good treatment persistence. These findings suggest that switching to ADA biosimilars is a viable option for IBD patients, with positive results in terms of both clinical effectiveness and patient adherence.

Effect of propinox and pinaverium bromide on ex vivo colonic motor patterns and their synergistic effect with hyoscine butyl bromide

Background

Antispasmodic agents are used to treat abdominal pain. The mode of action of pinaverium bromide and propinox in the colonic tissue has never been characterized. This study aimed to explore whether HBB can complement the antispasmodic effects of these drugs.

Methods

Colon samples were procured from the macroscopically normal regions of 33 patients undergoing colon cancer surgery and subjected to muscle bath experiments. Pinaverium bromide and propinox alone and in combination with HBB were assessed under the following conditions: (1) spontaneous phasic contractions (SPCs) induced by isometric stretch (with 1 µM tetrodotoxin); (2) contractility induced by 10-5 M carbachol; (3) the electrical field stimulation (EFS) of the excitatory pathway (in the presence of 1 mM Nω-nitro-L-arginine and 10 µM MRS2179); and (4) an EFS-induced selective excitation of the inhibitory pathway (under nonadrenergic, noncholinergic pharmacological conditions). An isobolographic study was performed to evaluate the possible interaction between pinaverium bromide, or propinox and HBB.

Results

Pinaverium bromide and propinox concentration-dependently reduced SPC (10-5 M: 29%-47% reduction) in both muscle layers. Carbachol-induced contractions were partially reduced by pinaverium bromide (10-5 M: 37%-46% reduction) and propinox (10-5 M: 32%-44% reduction) and almost totally inhibited by the combination with HBB. EFS-induced contractions were slightly decreased by pinaverium bromide (10-5 M; circular muscle: 39% reduction, but no effect on longitudinal muscle) and propinox (10-5 M: circular 48% and longitudinal 37%), and to a greater extent, by the combination with HBB. Both pinaverium bromide (10-5 M: 11%) and propinox (10-5 M: 42%) reduced the EFS-induced off-response but not the on-relaxation. The interaction index measured for the combined activity of HBB with pinaverium bromide or propinox was less than 1 in SPC, carbachol-induced contractions, and EFS-induced contractions.

Conclusion

The pharmacological profile obtained in this study was consistent with an L-type calcium channel blocker for both pinaverium bromide and propinox, with an unlikely or a weak antimuscarinic effect for the latter. When combined with the antimuscarinic agent HBB, both pinaverium bromide and propinox showed a synergistic inhibition of contractile responses. This finding could have clinical implications, suggesting a combination treatment approach for greater therapeutic benefits.

Switching from Adalimumab Reference Product to and Among Adalimumab Biosimilars Outside the USA: Insights for US Clinicians

Ten adalimumab biosimilars have been introduced in the United States (USA) since 2023, while adalimumab biosimilars have been available for several years in other countries. These experiences of biosimilar uptake outside the USA can inform US-based healthcare professionals on switching in real-life practice settings. Considerations include how healthcare professionals might meaningfully address patient concerns about outcomes to improve patient satisfaction. A search of the MEDLINE database was used to identify publications on switching to and among adalimumab biosimilars in an ex-US setting, with no restriction on publication language and using a time frame of 1 January 2017 through 12 December 2023, coinciding with the European Union approval of the first adalimumab biosimilar, adalimumab-atto, in March 2017. This narrative review aims to provide insights into the efficacy and safety of transitioning to and among adalimumab biosimilars in adult patients from clinical studies but also, more importantly, using real-world evidence (RWE) from outside the USA. Overall, RWE suggested that efficacy and outcomes were consistent in patients who underwent switching from the reference product (RP) across various immune-mediated inflammatory diseases when compared to patients who did not switch from the RP. The ex-US RWE of RP and biosimilar adalimumab switches generally reflected the experiences observed in clinical trials; however, RWE findings elucidated several challenges to biosimilar uptake, including patient education, provider training, and supportive policies.

A Not-So-Sweet Crohn's Disease: A Case Report of Ileocecal Crohn's Disease Unmasked by Sweet Syndrome

Sweet syndrome (SS) is an acute febrile neutrophilic dermatosis characterized by a constellation of clinical symptoms and histologic findings: pyrexia, neutrophilia, and tender and erythematous cutaneous lesions (plaques, nodules, and papules) with neutrophilic infiltration of the upper reticular dermis. SS can be either an inflammatory disease or a hypersensitivity disorder. SS has been associated with autoimmune disease, such as inflammatory bowel disease (IBD), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and sarcoidosis. We herein present a case of a 70-year-old white male presenting for persistent fevers, rash, intermittent diarrhea, and hematochezia. The patient had marked improvement of his clinical symptoms following systemic corticosteroid treatment. He was diagnosed with SS and ileocecal Crohn's disease (CD). This article highlights the need to rule out CD in the setting of SS and gastrointestinal (GI) manifestations.

Chemical strategies for targeting lipid pathways in bacterial pathogens

Microbial pathogens continue to plague human health and develop resistance to our current frontline treatments. Over the last few decades, there has been limited development of antibiotics with new mechanisms of action, highlighting our need to identify processes that can be targeted by next generation therapeutics. Recent advancements in our understanding of the roles that lipids play in key bacterial processes suggest that these biomolecules are a potentially valuable site for disruption by therapeutic agents. Specifically, the success of a pathogen depends on its ability to make fatty acids de novo or scavenge lipids from its host. This review focuses on recent advances using chemical biology tools for defining and disrupting lipid pathways in bacteria.

Selection, Comparative Genomics, and Potential Probiotic Features of Escherichia coli 5C, a pks-Negative Strain Isolated from Healthy Infant Donor Feces

Among the emerging issues in probiotic safety, the possible presence of pks, a gene cluster synthetizing a genotoxin known as colibactin, is one of the most alarming. Indeed, indigenous E. coli strain pks-positive are found in 60% of patients with colorectal cancer, and the most widely used E. coli-based probiotic, known as E. coli Nissle 1917 (DSM 6601), is pks-positive. Starting from 25 potential candidates selected by screening 25 infant stool samples, we have selected an E. coli strain (named 5C, deposited as LMG S-33222) belonging to the phylotype A and having the serovar O173:H1. Having been previously completely sequenced by our group, we have further characterized this strain, demonstrating that it is (i) devoid of the most known potential pathogenic-related genes, (ii) devoid of possible plasmids, (iii) antibiotic-sensitive according to the EFSA panel, (iv) resistant in gastric and enteric juice, (v) significantly producing acetate, (vi) poorly producing histamine, (vii) endowed with a significant in vitro antipathogenic profile, (viii) promoting a significant in vitro immunological response based on IL-10 and IL-12, and (ix) devoid of the pks genes. A comparative genomics versus E. coli Nissle 1917 is also provided. Considering that the other two most commonly used E. coli-based probiotics (E. coli DSM 17252 and E. coli A0 34/86) are respectively pks-positive and alpha-hemolysin-(hly) and cytotoxic necrotizing factor-1-(cnf1) positive, this novel strain (E. coli 5C) is likely the probiotic E. coli strain with the best safety profile available to date for human use.

Advancements in the application of botulinum toxin type a in the treatment of anorectal disorders

Botulinum toxin type A (BoNT/A) has garnered significant attention in recent years due to its unique biological properties and neuromuscular blocking effects, particularly in the field of anorectal disorders. This review discusses the application of BoNT/A in treating various conditions such as anal sphincter spasms, hemorrhoids, anal fissures, and other related ailments. We analyze the latest research findings regarding its efficacy, safety, and clinical applications, highlighting both the current state of research and the challenges that persist in this area. This synthesis aims to provide valuable insights and guidance for future studies and clinical practices involving BoNT/A in the management of anorectal diseases.

Comparison of the Swallowing Function After Reconstruction of Cervical Esophagus with Jejunum, Ileocolon or Skin Flap: Method of Physiotherapy for Deglution and Long Term Follow-Up

The swallowing function is a major goal of reconstruction for the patients who had hypopharyngeal cancer and received total pharyngolaryngectomy with or without voice reconstruction. We would like to share our experience in reconstruction of swallowing function using jejunum, ileocolon, or anterolateral thigh flap for cervical esophagus. In this study, we proposed that the jejunum flap is the most suitable option for restoring swallowing function, owing to its physiological characteristics. A retrospective study was conducted in 36 patients undergoing reconstruction of cervical esophagus with free jejunum flap (7 cases), ileocolon flap (21 cases), or anterolateral flap (8 cases). Esophagography, time required to achieve swallowing of semisolid diet without tube feeding, changes in body weight before and after the surgery, and 99mTc for transit scan to evaluate pharyngeal clearance were used to evaluate the swallowing function of the patients. Patients with jejunum flap had the best swallowing function, followed by ileocolon and then ALT flap. Besides, no conduits needed to be modified in jejunum and ileocolon flap. Regarding swallowing function, for patients with longer life expectancy and no contraindication of laparotomy, jejunum flap should be the first choice to obtain optimal swallowing function for cervical esophagus. Anterolateral flap is the easiest and most commonly used flap and provides fair swallowing function if there is no leakage. However, the anterolateral thigh flap tends to develop narrowing on long-term following-up. Based on completeness of pharyngeal transit of bolus and lack of complications, patients with jejunal flap reconstruction showed best swallowing function, followed by ileocolon and then ALT flaps.

Gut microbiota protect against colorectal tumorigenesis through lncRNA Snhg9

The intestinal microbiota is a key environmental factor in the development of colorectal cancer (CRC). Here, we report that, in the context of mild colonic inflammation, the microbiota protects against colorectal tumorigenesis in mice. This protection is achieved by microbial suppression of the long non-coding RNA (lncRNA) Snhg9. Snhg9 promotes tumor growth through inhibition of the tumor suppressor p53. Snhg9 suppresses p53 activity by dissociating the p53 deacetylase sirtuin 1 (SIRT1) from the cell cycle and apoptosis regulator 2 (CCAR2). Consequently, the depletion of the microbiota by antibiotics causes upregulation of Snhg9 and accelerates CRC progression. Moreover, Snhg9 is functionally conserved. Human SNHG9 promotes tumor growth via the same mechanism as mouse Snhg9, despite their low sequence similarity.

Neurogastroenterology: The Cinderella among the ecological niches of gastroenterology?

Neurogastroenterology (NGE) refers to a specific sub-specialty of gastroenterology that investigates the pathophysiology, diagnostics and therapeutic approaches to the "disorders of gut-brain interaction" (DGBIs), frequently encountered in clinical practice and often associated with poor quality of life and high healthcare costs. Two recent national surveys, focused on common DGBIs, highlighted two main issues. Despite the high incidence of DGBIs there is a lack of awareness and appropriate training to effectively treat these conditions and a lack of specific referral centers in each region. Indeed, specific training and a multidisciplinary approach are required to properly manage these patients, but these are not always available. As a result, NGE lacks attractiveness for many young gastroenterologists. We believe that NGE has great potential to emerge among the various sub-branches of gastroenterology. However, its growth is limited by lack of specific training, knowledge, accessibility, diagnostic capabilities, multidisciplinary integration, and financial investments in research. To bridge this gap, it would be helpful to overcome these limits through an increase in specific training concerning DGBIs among students, residents, physicians and general practitioners. This, coupled with improved access to advanced diagnostic tests, innovative therapies, and a better multidisciplinary approach, could help expand the knowledge in this still niche area and achieve better treatment outcomes for patients.

Biosimilars versus biological therapy in inflammatory bowel disease: challenges and targeting strategies using drug delivery systems

Inflammatory bowel disease (IBD) is a multifactorial illness with a climbing prevalence worldwide. While biologics are commonly prescribed especially for severe cases, they may worsen patients' outcomes due to financial burden. Consequently, there has been an increased focus on biosimilars to improve overall disease outcomes by maintaining similar efficacy and safety while minimizing the cost of therapy. Infliximab-dyyb was the first biosimilar approved by US-FDA for IBD. Since that, the US-FDA approved 14 biosimilars with different mechanisms of action and different routes of administration for IBD patients (four infliximab biosimilars, nine adalimumab biosimilars, and most recently one ustekinumab biosimilar). It should be noted that more biologics are in the pipeline as golimumab and natalizumab patents are set to expire in the near future, and biosimilars are now in pre-clinical to phase 3 trials. Different studies have evaluated biologics' effectiveness and safety and concluded that the majority of available biosimilars are efficacious and have similar adverse effect profiles compared to their reference biologics. It is worth mentioningthat post-marketing surveillance reports revealed some risks associated with biosimilars which should be taken into consideration in future research and clinical trials to avoid health hazards. Most biologics and biosimilars are administered parenterally which results in several drawbacks such as raised risk of infections, hypersensitivity, autoimmunity, development of malignancies, liver toxicity as well as worsening of heart failure. Several drug delivery systems based on passive and active targeting mechanisms are under active investigation to overcome these limitations. This review sheds light on the emergence of biologics and biosimilars as alternatives in IBD management, the differences between them, challenges and risks, and future perspectives in IBD therapy and new trends in drug delivery systems.

Fecal miRNA Profiling of Yorkshire Terrier Enteropathy

MicroRNAs (miRNAs) are small non-coding RNAs involved in gene regulation and are potential biomarkers for several diseases, including canine enteropathies. While metabolite profiling and microbiome in canine enteropathies have been previously explored, data on miRNA expression remain limited. This study aimed to profile miRNA expression in Yorkshire Terrier canine enteropathy using Illumina sequencing and quantitative PCR (qPCR) to compare miRNA levels between sick and healthy dogs from fecal samples. Despite the hypothesis that disease-related alterations in miRNA levels would differentiate sick dogs from controls, no significant differences were observed between the groups in either sequencing or qPCR analyses. These findings suggest that miRNA profiles may not vary significantly in the context of Yorkshire Terrier enteropathy and indicate that other molecular or metabolomic markers may be more indicative of disease state. This study also indicates that fecal samples may not be an ideal sample type for miRNA profiling. This study contributes to the understanding of molecular signatures in canine enteropathies and provides a basis for further research into alternative biomarkers for diagnosis and monitoring.

Impact of Histological Remission for Predicting Clinical Relapse in Crohn's Disease: A Post Hoc Analysis of the Prospective STORI Cohort

BACKGROUND AND AIMS

Achieving deep remission, encompassing clinical, endoscopic, and biological remission, is the goal in managing Crohn's disease (CD). The role of histological remission (HR) remains unclear. This study aimed to examine the impact of histological inflammation on clinical relapse risk in CD and explore the relationship between histology, endoscopic scores, and biomarkers.

METHODS

Patients from the prospective STORI (Stable Remission on Combined Therapy with Immunosuppressors) cohort underwent ileocolonoscopy with Crohn's Disease Endoscopic Index of Severity calculation and 2 biopsies from the most inflamed or previously inflamed areas. Histological scores (Robarts, Geboes, modified Geboes, Nancy, and IBD-DCA) were determined by 2 independent pathologists in a central reading process. Histological remission was defined by specific score thresholds. Clinical relapse, defined by Crohn's Disease Activity Index (CDAI) > 250 or a CDAI increase of 70 points over 2 weeks, was monitored for at least 1 year.

RESULTS

Out of 115 patients included in STORI, 160 biopsies (44 ileal and 116 colonic) from 76 patients were analyzed. Histological remission rates were 46% (Nancy), 55% (Robarts), 61% (Geboes), and 41% (IBD-DCA). During follow-up, 35 patients (46%) experienced a clinical relapse: 37% with HR and 56% without, based on the Nancy score. Among the mucosal healing subgroup (45 patients), 34% with HR, and 44% without relapsed (p = 0.18). Histological scores did not predict clinical relapse. Only fecal calprotectin was a significant predictor in multivariate analysis (p = 0.029).

CONCLUSIONS

Despite correlations with endoscopy and biomarkers, histological scores did not predict clinical relapse in CD patients in remission. Thus, these scores are not recommended for clinical practice to assess relapse risk in CD.

Assessment of the association between constipation and atherosclerosis in cardiovascular and cerebrovascular diseases: a systematic review and meta-analysis

INTRODUCTION

Cardiovascular and cerebrovascular diseases remain leading causes of morbidity and mortality worldwide, with atherosclerosis as a key underlying mechanism.

METHODS

A systematic review was conducted of studies published between 2000 and August 2024, sourced from PubMed, Web of Science, Cochrane, and EMBASE databases. Twelve studies, involving 5,772,682 adults across six countries, met predefined inclusion criteria. Study quality was assessed using the Newcastle-Ottawa Scale (NOS) and the Agency for Healthcare Research and Quality (AHRQ) scale. A meta-analysis was performed to quantify the association.

RESULTS

The meta-analysis revealed a statistically significant association between constipation and atherosclerosis-related cardiovascular and cerebrovascular diseases, with a pooled odds ratio of 1.18 (95 % CI: 1.08-1.30). This finding indicates that individuals with constipation may face an elevated risk of these conditions.

CONCLUSIONS

These findings suggest that constipation could serve as a potential risk factor or marker warranting further investigation in clinical and mechanistic studies.

Will Rogers Paradox in Gastroenterology

The use of various classifications to grade and differentiate appearances of digestive diseases has enhanced precision and provided better means for their clinical evaluation and comparison. Staging systems abound to classify erosive esophagitis, gastro-esophageal varices, upper gastrointestinal hemorrhage, histopathology of celiac disease, various types of gastrointestinal neoplasia, and colitis associated with Crohn's disease or ulcerative colitis. The present review serves to highlight how potential bias may become introduced when comparing clinical outcomes based on varying and continuously evolving staging systems of digestive diseases.

Unique properties of proximal and distal colon reflect distinct motor functions

The gastrointestinal tract is made up of specialized organs that work in tandem to facilitate digestion. The colon regulates the final steps in this process where complex motor patterns in proximal regions facilitate the formation of fecal pellets that are propelled along the distal colon via self-sustaining neural peristalsis and temporarily stored before defecation. Historically, our understanding of colonic motility has focused primarily on distal regions, and the intrinsic reflex circuits of the enteric nervous system involved in neural peristalsis have been defined, but we do not yet have a clear grasp on the mechanisms orchestrating motor function in proximal regions. New approaches have brought to the forefront the unique structural, neurochemical, and functional characteristics that exist in distinct regions of the mouse and human colon. In this mini-review, we highlight key differences along the proximal-distal colonic axis and discuss how these differences relate to region-specific motor function.